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Physical Dx > L5: UE Assessment > Flashcards

L5: UE Assessment Flashcards

1
Q

What are the three types of joints in the UE?

Examples?

A
  • Synovial
    • Hinge joint: elbow joint, interphalangeal joints
    • Condylar joint: metacarpoplangeal (knuckle) joints, wrist joints
    • Ball-and-socket joint: shoulder joints
  • Cartilaginous
  • Fibrous
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2
Q

Anatomy

What are the superficial veins of the UE?

What are the lymph nodes of the UE?

A
  • Superficial veins
    • Cephalic
    • Bascilic
  • Lymph nodes
    • Axillar
    • Epitrochlear (~inner elbow)
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3
Q

ROS: What would you be looking for in each of the following systems?

Skin

Musculoskeletal

Cardiovascular

Neurovascular

A
  • Skin
    • Changes in color
    • Temperature
    • Hair distribution
    • Ecchymosis
    • Atrophy
    • Swelling
    • Asymmetry
  • Musculoskeletal
    • Joint stiffness
    • Pain
    • Restriction of motion
    • Joint swelling/edema
    • Deformity
    • Myalgia
  • Cardiovascular
    • Claudication
  • Neurovascular
    • Numbness
    • Tingling
    • Burning sensation
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4
Q

Principles of examination:

Proximal to distal or distal to proximal?

What are the components of the exam?

What are ou assessing for in each

What do you always examine last?

A
  • Evaluate: Proximal to Distal
  • Evaluate painful area last
  • Components of examination:
    • Inspection
    • Palpation
    • Range of Motion
    • Neurologic
    • Vascular
    • Special Tests
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5
Q

Tenderness to Palpation (TTP)

How to assess?

A
  • Localize as specifically as possible
    • “ONE finger”
  • Anatomical location usually provides diagnosis
    • Bone, muscle, bursa, tendon, ligament, or combination
  • Correlate with positive findings on inspection
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6
Q

Muscle Strength

What are the 6 grades of muscle function?

A

Grade 0: No muscle contraction

Grade 1: Visible contraction, no joint movement

Grade 2: Joint motion, but not against gravity

Grade 3: Movement against gravity only

Grade 4: Movement with some resistance

Grade 5: Full strength with full resistance

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7
Q

Winged Scapula

What is it?

what is injured?

A
  • Paralysis of the serratus anterior from injury to the long thoracic nerve
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8
Q

Glenohumeral Dislocation

What type of dislocation is the most common?

Clinical presentation?

A
  • Dislocation
    • 95% Anterior
    • 5% posterior
  • Inspection
    • Arm held in position of protection
      • Sulcus Sign
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9
Q

Shoulder: Palpation

What are you palpating for?

A
  • Palpate and verbalize muscles and bony landmarks of the shoulder:
    • Clavicle
    • Acromioclavicular (AC) joint
      • Acromion process
      • Coracoid process
    • Humerus
    • Bicipital groove
  • Tenderness
    • Unilateral or bilateral
    • Localized or radiating
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10
Q

Shoulder: ROM testing

What actions are you testing?

A

ROM testing should be done both passive and active:

  • Flexion/Extension
  • Abduction/Adduction
  • Internal/External rotation
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11
Q

ROM: Rotator Cuff Function

What are the actions of the rotator cuff?

Which muscle does which action?

A
  • Abduction
    • Supraspinatus
  • External Rotation
    • 80% Infraspinatus
    • 20% Teres Minor
  • Internal Rotation
    • Subscapularis
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12
Q

Impingement syndrome

What is it?

What causes it?

A
  • Mechanical phenomenon
  • Not enough space
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13
Q

Arc Test

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A

Pain Provocation Test: Painful Arc Test

  • How to test
    1. Passively adduct arm 0– 180
    2. Determine degrees of pain
  • Positive test:
    • Pain between 60° and 120°
  • DDx:
    • Subacromial impingement
    • Rotator cuff tendinitis
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14
Q

Neer’s Sign

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    • Stabilize scapula with one hand
    • Rotate hand away
    • Raise patient’s arm into full forward flexion
  • Positive test:
    • Pain with internal rotation
  • DDx:
    • Subacromial impingement
    • Rotator cuff tendinitis
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15
Q

Hawkins

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Stabilize shoulder with one hand
    2. Flex elbow to 90
    3. Internally rotate shoulder (“rock” the arm)
  • Positive test:
    • Pain
  • DDx:
    • Supraspinatus impingement
    • Rotator cuff tendonitis
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16
Q

External Lag Sign

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    • Flex elbow to 90 degrees
    • Passively externally rotate shoulder
  • Positive test:
    • Inability to maintain external rotation
  • DDx:
    • Supraspinatus pathology
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17
Q

External Rotation Resistance Test

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    • Ask patient to flex elbows to 90° in supination
    • Stabilize one arm
    • Apply internal pressure at wrist
    • Ask patient to externally rotate against resistance
  • Positive test:
    • Pain or weakness
  • DDx:
    • Infraspinatus pathology
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18
Q

Gerber Lift Off

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    • Patient seated or seated
    • Ask patient to rest dorsum of hand on low back/sacrum
    • Ask patient to lift off to increase amount of internal rotation
    • Apply gentle resistance to hand
  • Positive test:
    • Inability to lift off or maintain resistance
  • DDx:
    • Subscapularis pathology
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19
Q

Empty Can (Jobe’s Test)

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Elevate arms 90slightly away from midline
    2. Internally rotate arm, thumbs down (pour out can of soda)
    3. Resist downward pressure
  • Positive test:
    • Weakness or pain (inability to maintain resistance and may indicate supraspinatus injury/tear)
  • DDx:
    • Rotator cuff tear
    • Tendinopathy
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20
Q

Drop Arm

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Passively abduct shoulder to 120
    2. Patient to slowly lower arm back to side
  • Positive test:
    • Weakness, difficulty with smooth ROM
  • DDx:
    • Rotator cuff tear
    • Tendinopathy
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21
Q

Adhesive Capsulitis

Symptoms

What is it?

A
  • Adhesive Capsulitis (Frozen Shoulder)
  • Diffuse, dull, aching pain
    • Usually no localized tenderness
  • Progressive restriction of ROM in multiple planes: Mechanical restriction
  • Usually unilateral
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22
Q

Apley Scratch Test

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Ask patient to reach for opposite scapula
      • Abduction/External Rotation
      • Adduction/Internal Rotation
    2. Compare ROM to both sides
  • Positive test:
    • Asymmetry in comparison ROM
  • DDx:
    • Rotator cuff pathology
    • Labral pathology
    • Arthritis
    • Adhesive capsulitis
23
Q

Sulcus Sign

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Arm in neutral position by side
    2. One hand to stabilize shoulder
    3. Apply downward pressure at elbow
  • Positive test:
    • ≥ 2cm depression of humeral head
  • DDx:
    • Inferior shoulder instability
    • Subluxation
24
Q

Apprehension, Relocation, and Release Test

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Patient supine
    2. Elbow flexed 90
    3. Externally rotate shoulder (towards head)
    4. Apply posterior pressure to humerus (relocation)
    5. Abruptly remove pressure from humerus (release)
  • Positive test:
    • Pain with external rotation & relieved with internal rotation
  • DDx:
    • Shoulder laxity/ instability (i.e. previous shoulder dislocation or chronic laxity)
25
Q

Speeds

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Extend elbow with full supination
    2. 60-90° shoulder flexion
    3. Ask patient to resist downward pressure
  • Positive test:
    • Pain
  • DDx:
    • Biceps tendonitis
26
Q

Yergason Test

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Arm positioned like shaking hands, but with elbow at torso
    2. One hand to stabilize upper arm, hold patient’s hand with other
    3. Patient to supinate & externally rotate against resistance
  • Positive test:
    • Pain or popping/clicking along biceps tendon
  • DDx:
    • Biceps subluxation
    • Biceps tendonitis
27
Q

Cross-Body Adduction

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A

Acromioclavicular (AC) Joint: Cross-body Adduction Test

  • How to test:
    • Examiners adducts pts arm across body toward other arm
  • Positive test:
    • Pain (pain elicited and localized to the AC joint)
  • DDx:
    • AC pathology
28
Q

O’Brien’s Test

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Place one hand on shoulder
    2. Arm flexed to 90
    3. Adduct arm 10-15
    4. Patient to resist downward pressure on wrist
  • Positive test:
    • Pain or weakness in: labral, AC, biceps
  • DDx:
    • Biceps tendonitis
29
Q

Deformity of Upper Arm

Causes?

A
  • Acute trauma: fracture
  • Previous trauma: malunion, nonunion
  • Biceps rupture
  • Tumor
30
Q

Elbow: ROM

What do you test for ROM?

For strenght testing?

A
  • ROM:
    • Flexion and extension
    • Pronation and supination
  • Strength Testing:
    • Flexion/extension
    • Supination/pronation
31
Q

Epicondylitis

What is it?

What is it called when you injure the medial side? Test?

What is it called when you injure the lateral side? Test?

A
  • Overuse syndromes
  • Inspection/Palpation: localized pain and swelling
    • Reproducible pain with wrist flexion (medial) or extension (lateral) against resistance
  • Medial: Golfers Elbow
    • Flexor pronator muscle group
    • Pain with resisted wrist flexion
  • Lateral: Tennis Elbow
    • Extensor supinator muscle group
    • Pain with with resisted wrist extension
32
Q

Olecranon Bursitis

What is it?

Cause?

A
  • Inflammation of the bursa with fluid accumulation
  • May be due to local irritation, trauma, or infection
  • Pain suggests trauma or infectiona
33
Q

Tinels Sign at Elbow

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    • Tap median nerve at wrist or ulnar nerve at elbow.
  • Positive test:
    • Shooting electric sensation or paresthesia over ulnar nerve distribution
  • DDx:
    • Cubital Tunnel Syndrome
34
Q

Subcutaneous Nodules

A
35
Q

Colles’ Fracture (distal radius)

A
  • Colles’ Fracture (distal radius)
  • Often happens when falling on outstretched arms
  • Displaced dorsally
36
Q

Hand Inspection

Swan neck

Boutonnière

Palmar thickening

Ulnar deviation

Nodes

A
  • Swan neck: hyperextension of PIP joints with fixed flexion of DIP
  • Boutonnière: flexion of PIP joint with hyperextension of DIP joint
  • Palmar thickening (cords): Dupuytren’s contracture
  • Ulnar deviation: RA
  • Nodes: Heberden & Bouchard
37
Q

Ulnar deviation

A

MCP and PIP

Rheumatoid Arthritis

38
Q

Hand Nodes

Heberden nodes

Bouchard nodes

Rheumatoid nodules

A
  • Heberden nodes: osteoarthritis (OA)
    • NOT characteristic of rheumatoid arthritis u dorsolateral aspects of DIP joints
    • usually hard and painless
  • Bouchard nodes: OA>> RA
    • less common than Heberden nodes in OA u nodes at PIP joints
    • Swelling at PIPs (and MCPs) more common in RA
  • Rheumatoid nodules: common on dorsum of hand
39
Q

Boutonniere & Swan Neck Deformity

Action at PIP joints?

Action at DIP joints?

A
40
Q

Carpal Tunnel Syndrome

Cause?

Nerve involved?

Result?

A
  • Median nerve and flexor tendons pass through tunnel
  • Median nerve becomes compressed by inflammation of the synovium
  • Results in compression neuropathy with pain, paresthesias, and thenar atrophy
41
Q

Tinels Sign at the Wrist

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    • Slightly extend at the wrist
    • Percuss over the median nerve
  • Positive test:
    • Shoot electric sensation or paresthesia in the distribution of the median nerve
  • DDx:
    • Carpal tunnel
42
Q

Phalens Test

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    • Patient to maintain flexion OR extension of the wrists for 60+ s.
  • Positive test:
    • paresthesia in the distribution of the median nerve
  • DDx:
    • Carpal tunnel syndrome
43
Q

de Quervain’s Tenosynovitis

What is it?

Cause?

A
  • Inflammation of the 1st dorsal compartment involving the sheath of the abductor pollicis longus and extensor pollicis brevis
  • Causes: overuse/repetitive gripping
44
Q

Finkelstein Test

How to perform the test?

What is a positive test?

What is the differential diagnosis?

A
  • How to test:
    1. Arms out in front of body, make a fist with thumb inside
    2. Ulnar deviate wrist (downward)
    3. Provider may then attempt to ↑ degree of ulnar deviation
  • Positive test:
    • Pain along radial dorsal wrist (1st dorsal compartment)
  • DDx:
    • de Quervain’s tenosynovitis
45
Q

Ganglion Cysts

What are they?

Inspection?

Palpation?

ROM?

A
  • Collection of synovial fluid within a joint or tendon sheath
  • Herniation of synovial tissue from capsule or tendon sheath
  • Inspection: dorsal radial & volar aspects of wrist
  • Palpation: Soft mobile mass
  • ROM: May restrict motion or become painful with repetitive activity
46
Q

Anatomic Snuffbox Palpation

How to perform the test?

What is a positive test?

What is the differential diagnosis?

What are the borders of the anatomical snuffbox?

A
  • How to test:
    1. Palpate anatomical snuff box
  • Positive test:
    • Tenderness
  • DDx:
    • Scaphoid/navicular fx.
  • Borders
    • Lateral border:
      • Extensor pollicis brevis and abductor pollicis longus
    • Medial border:
      • Extensor pollicis longus
47
Q

Dupuytren’s Contracture

What is it?

A

A condition in which one or more fingers bend in towards the palm due to the development of fibrous connective tissue between the tendons of the finger.

48
Q

Capillary Refill

How to test?

What is normal?

A
  • Place pressure over nail beds to cause blanching then quickly remove
  • Observe the time elapsed for full return of color
  • Normal: < 2 seconds
49
Q

Wrist and Hand ROM

What are you evaluating?

A
  • Wrist flexion and extension
  • Radial and ulnar deviation
  • MCP, PIP, DIP flexion
    • Make a fist
  • Digit extension with abduction/adduction
50
Q

ROM of the Digits

How to test?

A
51
Q

Wrist & Hand Strength Testing

What are you testing?

A
  • Wrist flexion/extension
  • Test grip strength:
    • Ask patient to grip your two fingers and squeeze
52
Q

Neurologic Check: Sensory

What nerves?

How to test?

A

Sensory check:

Axillary

Radial

Median

Ulnar

53
Q

Neurologic check: Motor

How to test?

A
  • Motor examination of the hand:
    • Rock: Median nerve
    • Paper: Radial nerve
    • Scissors: Ulnar nerve
  • OK: Anterior Interosseus n. (AIN)
    • Branch of the Median n.
  • Mnemonic: “OK, Stop, Spread “em”
    • OK = Rock
    • Stop = Paper
    • Spread ‘em = Scissors
54
Q

Neurovascular

A
  • Median
    • Sensory
      • Palmar tip of index finger
    • Motor
      • Pronated full fist
      • Recurrent branch: palmar thumb abduction
      • AIN: “OK” sign
  • Radial
    • Sensory
      • Dorsum 1st webspace
    • Motor
      • Wrist, finger, thumb extension
  • Ulnar
    • Sensory
      • Palmar tip of small finger
    • Motor
      • Cross fingers or spread against resistance
      • Adduction of thumb

Physical Dx (11 decks)

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