L5: UE Assessment Flashcards

Question

**Speeds** How to perform the test? What is a positive test? What is the differential diagnosis?

Answer 1

* _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

Answer 2

* _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

Answer 3

**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

Answer 4

* _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

Answer 5

* Acute trauma: fracture * Previous trauma: malunion, nonunion * Biceps rupture * Tumor

Answer 6

* **ROM:** * Flexion and extension * Pronation and supination * **Strength Testing:** * Flexion/extension * Supination/pronation

Answer 7

* 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

Answer 8

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

Answer 9

* _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

Answer 10

* Colles’ Fracture (distal radius) * Often happens when falling on outstretched arms * Displaced dorsally

Answer 11

* S**wan 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

Answer 12

MCP and PIP Rheumatoid Arthritis

Answer 13

* **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

Answer 14

* 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

Answer 15

* _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

Answer 16

* _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

Answer 17

* Inflammation of the 1st dorsal compartment involving the sheath of the abductor pollicis longus and extensor pollicis brevis * _Causes:_ overuse/repetitive gripping

Answer 18

* _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

Answer 19

* 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

Answer 20

* _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

Answer 21

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.

Answer 22

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

Answer 23

* Wrist flexion and extension * Radial and ulnar deviation * MCP, PIP, DIP flexion * Make a fist * Digit extension with abduction/adduction

Answer 24

* Wrist flexion/extension * Test grip strength: * Ask patient to grip your two fingers and squeeze

Answer 25

Sensory check: Axillary Radial Median Ulnar

Answer 26

* 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

Answer 27

* **_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