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Upper Extremity Adjusting > Lab/Lecture/Ameripress and Powerpoint Notes for Midterm > Flashcards

Lab/Lecture/Ameripress and Powerpoint Notes for Midterm Flashcards

1
Q

Muscle Test for SC joint

A

Pec Major, Clavicular branch

-Dr. pulls out and away at 20-30 degree angle from pt.

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2
Q

MC mislalignment of SC joint

A

Anterior/ Inferior/ Medial

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3
Q

What is LOC for SC joint challenge?

A

Posterior/ Lateral/ Superior

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4
Q

SC Supine- Same and Opposite side

  • SCP
  • CP
  • SH
  • LOC
A

SCP- Medial aspect of SC joint
CP- Soft pisiform (of inside or outside hand)
SH- Lateral side of head of humerus, gently tractioning P-I
LOC- M-L (95%), A-P along line of clavicle (usually I-S)

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5
Q

SC modified side laying

  • SCP
  • CP
  • SH
  • LOC
A

SCP- Medial side of SC joint
CP- Soft Pisiform of inferior hand
SH- Support pt. head (C-spine) AND inferior knee behind scapula
LOC- M-L (95%), A-P along line of clavicle (usually I-S)

  • On female- use hand opposite side of joint (side) being adjusted to cover ( o )( o ). Dr. can place the forearm of the CP hand over pt’s. hand to achieve LOC
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6
Q

Muscle test for AC joint

A

Corcobrachialis

-Dr. at head of table facing down. Pt. supine with humeral flexion to 30 degrees. Push arm towards ipsilateral ASIS.

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7
Q

M/C misalignment of A/C joint

A

Superior

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8
Q

A/C joint Supine Adjustment

  • SCP
  • CP
  • SH
  • LOC
A

SCP- 12-1” medical to AC joint (distal 1/3 of clavicle)
CP- End of thumb and 2nd digit middle phalanx
SH- supporting elbow
LOC- S-I

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9
Q

A/C joint Seated web contact

  • SCP
  • CP
  • SH
  • LOC
A

SCP- 1/2-1” medial to AC joint
CP- Web of hand or 2nd MCP joint
SH- Outside hand grasping the flexed elbow jt. keeping the shoulder in same position as others. Varies from pt. to pt.
LOC- S-I

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10
Q

AC seated Chiro-Chiro

  • SCP
  • CP
  • SH
  • LOC
A

SCP- 1/2-1” medial to AC joint
CP- dominant chiro index finger overlaps the other chiro index finger
SH- Supine with arm abducted, motion joint to find where it closes and bring the arm down 5-10 degrees this is the position for stabilization. Place pt’s elbow on doc’s shoulder
LOC- S-I

*Arms flared out!

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11
Q

A/I Humerus relative muscle test

A

Anterior Deltoid and Teres Major

*Test both before considering adjusting either one

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12
Q

A/I humerus Same Side/ opposite side

  • SCP
  • CP
  • SH
  • LOC
A

SCP- Olecranon of involved side and lateral GH joint
CP- Palms of the hands
SH- Bring GH joint back into nutral position
LOC- I-S, A-P, M-L

*Pt. elbow pressed against the chest to bring GH joint to tension. Take to the midline over Xiphoid process to clear labrum

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13
Q

A/I Humerus seated adjustment

  • SCP
  • CP
  • SH
  • LOC
A

SCP- Olecranon of involved side
CP- Palms of hands with fingers interlocked (same side)
SH- Doc’s strenum against spine of scapula
LOC- M-l, A-P, I-S

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14
Q

Posterior Humerus Web Contact (and knife edge)

  • SCP
  • CP
  • SH
  • LOC
A

SCP- Posterior Proximal aspect of humerus (distal to Gh joint)
CP- Web of inside hand
SH- Outside hand grasping the humerus above flexed elbow joint with humerus slightly abducted (no more than 30 degrees) and extended- DO NOT WING- Outside hand also applies slight long axis traction
LOC- P-A, I-S, M-L (Slightly- bend elbow to demonstrate slight M-L)

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15
Q

Elbow Rules

Medial elbow listings where is the Doctor’s position?

A

Dr. stands medial to the patient’s arm

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16
Q

Elbow Rules

Lateral elbow listings where is the Doctor’s position?

A

Dr. stands lateral to the patient’s arm

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17
Q

Elbow Rules

For all ULNA listings what is the position of the patient’s forearm

For all RADIAL listings what is the position of the patient’s forearm

A

ULNA–> supinated

RADIAL –> pronated

Note for a PL or PM elbow listing, ALWAYS test ULNA first, therefore, wrist flexion is your set up. Also, before adjusting PL, try adjusting PM 2x with appropriate re-muscle testing.

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18
Q

MC subluxation of the elbow

A

Posterior medial ulna

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19
Q

Posterior Medial Ulna
(web contact or End of Thumb and 2nd Digit)

  • SCP
  • CP
  • SH
  • LOC
A

Proximal medial ulna approximately 1 inch distal to the medial epicondyle

Web of medial hand or end of thumb and 2nd digit DIP joint

Outside hand on lateral humerus

M-L, P-A, I-S

*** Must state, I would do this adjustment twice

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20
Q

Posterior Lateral Ulna - 4 Finger contact

  • SCP
  • CP
  • SH
  • LOC
A

Proximal lateral ulna, approximately 1 inch distal to olecranon

Four finger tips of the lateral hand or end of thumb

Medial hand grabbing the medial arm, ensuring patient elbow is firmly stabilized against doctor forearm

L to M, P to A, I to S

*** Must state, I would do the PM adjustment twice before adjusting the PL Ulna

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21
Q

Elbow -Radius-RMT

______ muscle test with wrist in ______

A

Triceps

Extension

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22
Q

To differentiate between a posterior lateral (PL) and anterior medial (AM) radius, what RMT would your perform?

A

Brachioradialis

“Coffee drinking muscle”

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23
Q

If Brachioradialis muscle test is strong, the listing will be ____

A

PL

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24
Q

If Brachioradialis muscle test is weak, the listing is

A

AM

“Too early in the am, not enough coffee)

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25
Q

PL- Radius

  • SCP
  • CP
  • SH
  • LOC
A

Proximal lateral radius , approx. 1/4 inch distal to radial head

End of thumb against the proximal lateral radial head

Medial hand grabbing the medial arm, assuring the patient’s medial elbow is firmly stabilized against doctor’s forearm.

L to M, P to A, I to S

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26
Q

MC radius subluxation is _____

A

PL-Radius

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27
Q

For an AM-Radius listing the doctor will stand ________ to the patient arm and place CP in to the ____ ______ and _____ the patient hand during the set up.

A

Medial
cubital fossa
pronate

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28
Q

AM-Radius

  • SCP
  • CP
  • SH
  • LOC
A

Proximal anterior medial radial head

End of thumb against the anterior medial radial head in the cubital fossa

Outside hand grasping the lateral arm, ensuring the lateral elbow is firmly stabilized against the doctor’s forearm

M to L, A to P (elbow high, no tea pot) , I to S

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29
Q

What is the theory states that a muscle functioning across a misaligned joint will be inhibited by a reflex signal originating from mechanoreceptors surrounding that joint.

A

Mechanoreceptor Theory

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30
Q

Normally the G/H capsule contains .5-1.5 cc of fluid. How much fluid can the G/H capsule contain before seeing it?

A

30 cc

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31
Q

Trauma, if acute check for patient ______, joint ________, then _________.

A

patient safety
joint stability
subluxation/misalignment

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32
Q

_________ is probably responsible for most of the proprioception information for the upper extremity

A

Sternoclavicular joint

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33
Q

The elbow in closed packed position is in full ________

A

extension

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34
Q

Medial epicondylitis = golfers elbow typically from _____ ulna

A

PM

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35
Q

Tennis elbow typically from a _____ Ulna

A

PL Ulna

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36
Q

List the dynamic stabilizers

A

Levator Scap (medial superior border)
Pectoralis Minor (anterior border)
Rhomboids (Major and Minor- medial border)
Serratus Anterior (Lateral border)
Trapezius (middle and lower mainly- superior medial border)

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37
Q

The compensatory stabilizers are

A

BICEPS and SUPRASPINATUS

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38
Q

Describe the shoulder sulcus sign?

A

inferior and anterior instability of GH joint.

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39
Q

Lack of joint play will cause dysfunction and _____

A

PAIN

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40
Q

After clearing the SC joint, AC joint, G/H joint, and biceps, next check ____________?

A

Scapulothoracic Articulation

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41
Q

The most common reason for re-injury is a

A

Failure to properly condition the healed tissues

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42
Q

The concept of extraspinal management within the Chiropractic paradigm must include integration of extraspinal areas to the spine.

First one must consider the ___________ connection, then the _____________.

A

Neurological, muscles

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43
Q

If multiple extremities are subluxated, how do you determine which one to adjust?

A

Use the pain scale (adjust the extremity w/highest pain level)

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44
Q

What are benefits of bracing vs. using tape?

A

Brace can be washed

No dermatitis from the brace (tape can cause
contact dermatitis)

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45
Q

Forces of injury, position of joint, and time of episode fall under which category?

A

Safety

Note that during the safety mgmt criteria, we must consider closely the MOI

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46
Q

A sprain with no separation is considered grade ____

A

1

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47
Q

The end of travel in a joint whereby the surfaces are at maximal congruency, the ligaments are taut, and no further movement in that direction of travel may result
in

A

Dislocation/fracture

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48
Q

The most common subluxation for the SC joint is and what is the LOC

A

Inferior, anterior and medial

LOC is Superior, Posterior and Lateral

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49
Q

Ligamentous disruption of _________ mm is a SC separation and the direction it most commonly separates is ______________ and
_________________.

A

5, Anterior and Superior

50
Q

AC Joint separation between Coracoid and Clavicle >1.3cm =

A

coracoclavicular ligament disruption

51
Q

What can mimic carpal tunnel syndrome. Patient is tested by pronation against resistance; symptoms follow a median nerve
distribution

A

Pronator teres syndrome

52
Q

TMJ intra-articular involvement = synovitis and capsulitis with the focus on the disc which is considered displaced or degenerated. Studies show that ___to____% of all individuals will show some TMJ related symptom in their
lifetime

53
Q

Based off Ameripress (BOAP) what is the innervation to musculature that suspends the scapulae?

A

Lower cervicals

54
Q

BOAP: Trigger point pain between the scapula and upper trap/levator scap is evidence of ____ and symptomatic referred pain

A

dysfunction

55
Q

BOAP

TRUE or FALSE

Scapular efficiency determines GHJ efficiency

56
Q

BOAP

The dynamic stabilizers of the shoulder are mostly _____ in contrast to the compensatory stabilizers, which are mostly _______

A

underused

overused

57
Q

BOAP

Of the following two, which is a biomechanical responder and which serves as an intersection of forces with little force dissipation options

Wrist
Elbow

A

Wrist –> biomechanical responder

Elbow –> intersection of forces with little force dissipation options

58
Q

BOAP

In the managment of an upper extremity (UE) DIRECT injury, for instance a contusion, what is the preferred modality?

59
Q

BOAP

Orthopedic tests provide ______ information for teh examining doctor

60
Q

BOAP

Sulcus sign displays inferior and _____ instability of GH joint

61
Q

BOAP

The ______ tests of the shoulder are

A

Neer or Hawkins-Kennedy test

62
Q

BOAP

Crank test or empty can test are great indicators for ______ ______ tears

A

Rotator cuff

63
Q

BOAP

O’Brien sign or anterior slide test indicate _____ or ______ joint instability

A

Labrum or AC joint

64
Q

BOAP

Frozen shoulder—-> Adhesive _______

A

Capsulitis

65
Q

BOAP
Postural Signs/Upper Cross Syndrome (UCS)

Rounded Shoulders =’s

A

Shortened Pectoralis

Critical thought: What would you do to lengthen the muscle?

66
Q

BOAP
Postural Signs/Upper Cross Syndrome (UCS)

Forward head weight–> anterior head carriage =’s

A

A kyphotic upper thoracic spine

67
Q

BOAP
Postural Signs/Upper Cross Syndrome (UCS)

Elevated Shoulders =’s
(Shortened and Weak)

A

Shortened upper trap/levator scap

Weak lower and middle trap

68
Q

BOAP
Postural Signs/Upper Cross Syndrome (UCS)

Winging of the scapulae indicates a ________ and what could you do to help correct this ?

A

Weak Serratus Anterior

Use wall pushup, squeezing shoulder blades together, thus opening up the chest and diaphragm

69
Q

BOAP

When managing the UE, the soft tissue involvement should be categorized into _____ or ______

A

Acute or Chronic

70
Q

BOAP

What are the 3 S’s for Chiropractic Extremity Management

A

Safety
Stability
Subluxation

71
Q

BOAP

As it pertains to Safety what must we consider in management criteria

“FD-PUP”

A 
fracture
dislocation
pathology
underlying condition 
pain tolerance
72
Q

BOAP

Safety mechanism of injury (MOI) 3 considerations

_______ involved, _______ of joint, and time of episode

A

Forces involved
Position of joint
Time of episode ( was it quick/slow/insidious/or gradual, or occurred over a long period of time)

73
Q

BOAP

Mgmt criteria for Stability
Perform____ evaluation of injured area or area of pain

Do we adjust sprains and strains?
Do we adjsut grade III injuries? Why?

A

Orthopedic

Yes

No, bc tissue no longer is attached

74
Q

BOAP

Sensations transmitted from joints include ___ and _____

A

Pain and position

75
Q

T or F

Joints and muscles acting on joints have same nerve supply ? And this is based off what law?

A

True

Hilton’s Law
The principle that the nerve supplying a joint also supplies both the muscles that move the joint and the skin covering the articular insertion of those muscles.

76
Q

LAB Rules of Thumb

_____ spine first

Establish criteria for adjustment utilizing the _______

A

Clear

3 S’s (safety, stabilization, subluxation/misalignment)

77
Q

BOAP

Regarding the safety criteria for UE adjusting, neurological involvement means there is _______ dysfunction

78
Q

BOAP

Regarding the stability criteria for UE adjusting, what two methods of evaluation can be used ?

A

ROM

Orthopedic tests

79
Q

BOAP

Regarding the subkuxation criteria for UE adjusting, we always start ______ and go _______

A

Proximal

Distal

80
Q

SC joint most common subluxation

81
Q

During SC RMT, the arm is ______ rotated with the palm facing ____.

A

Internally rotated

82
Q

During RMT in general you want to always ask the patient?

A

Do they have any problems in the respective area you are evaluating?

83
Q

During the SC muscle test, the arm is extended forward and how many degrees with the table

How many degrees is the arm brought down during the aforementioned RMT?

84
Q

During RMT we are looking for joint lock, ________ or ________

A

compensation or recruitment

85
Q

After completing a challenge what is the next step?

86
Q

When adjusting a SC joint what direction is the traction of the humerus during stabilization

A

Posterior and inferior

87
Q

BOAP

RMT for AC joint?

How many degrees does this muscle flex the shoulder

A

Coracobrachialis

15-30 degrees

88
Q

MC subluxation for Ac joint

89
Q

As with the SC jint, the AC joint RMT has the arm extended forward with the _____ bent and the forearm is kept parallel to the chest. SH point is the _______

A

elbow

Olecranon fossa

90
Q

The challenge set up for an AC joint is similar to what Orthopedic test set up?

A

Dugas

involved side hand is rested on opposite shoulder, with elbow firmly against the chest

91
Q

LOC for Ac joint and SCP

A

S to I

1/2 inch or 1 medial to the AC joint (aka distal 1/3 of clavicle)

92
Q

BOAP

What are the various methods to evaluate for joint play? (5)

A 
Motion (tests fo joint proper motion)
Muscle testing (based on mechanoreceptor theory)
MOI 
Symptoms
X-rays
93
Q

3 ways to adjust extraspinal area(s)

A

hands
instrument (i.e. activator)
mechanically assisted “drop”

94
Q

What three ways does a SC compensate (Lab tidbit)

What way does AC joint compensate?

A

SC: protraction, shoulder shrug, body roll

AC: humeral abduction

95
Q

When setting up for AC joint adjustment, how many degrees is attained for stabilization before impulse/thrust is delivered?

A

5-10 degrees

96
Q

hydrodynamics are essential for

Proper ______
Transport of _________
Removal of waste material form ______ surfaces

A

Lubrication
Nutrients
articular surfaces

97
Q

BOAP

AI Humerus
Arm is extended 40-__ degrees to the table, per lab it is and is MC 95% of the time

RMT is and if weak what RMT do we do next?

A

40-60 degrees, per lab its 45 degrees

Anterior deltoid

Teres MAJOR

98
Q

What type of subluxation is the biceps tendon? and what direction is the sub-x in?

A

Soft tissue sub-x

Lateral

  • Ask patient if they have any problems with shoulder or elbow*
99
Q

BOAP

ST Articulation Criteria
__ of ___ must be met

1.
2.
3.

A

2 of 3

Apleys Inferior
1inch to 1.5 inch lower is +
the lower side is the fixated side

Scaption
Less movement +, and the less moveable scapulae is the fixated one

Internal rotation
70 degrees is normal the higher side of the two is the fixated side!

100
Q

What does compensation look like while RMT Elbow baseline

A

Clenching of fist

Wrist rotates

101
Q

If during examination, you are thinking the trauma is chronic yo must

  1. Check for ____ joint______
  2. Then ______
A
  1. Residual joint instability

2. Then subluxation

102
Q

A forgotten acute injury to extraspinal areas by patients lead to altered joint mechanics
1.
2.

A
  1. Fixations

2. Hypermobility

103
Q

3 Reasons the body compoensates for injury

A

Abnormal stress upon normal structure
i.e. pregnancy

Normal stress upon abnormal structure
i.e. spondylolisthesis, hemivertebra, scoliosis

Normal stress upon normal structure that is NOT prepared t receive stress
i.e. stepping off curb and twisting ankle

104
Q

FYI: Five questions must be answered prior to extrasinal adjusting

A
  1. is this chronic or acute
  2. What tissues are damaged
  3. What is severity of damage
  4. Is there instability or restiction of motion
  5. Is this pre or post surgical area
105
Q

Ligaments _______

Muscles ______

A

Sprain

Strain

106
Q

Grade 1

7- __ days
NO _____ laxity
NO residual ______

A

7 to 10 days
No residual laxity
No residual weakness

107
Q

Grade 2

______ deformation
residual laxity
______ muscle tear

A

Plastic
residual laxity present
Partial muscle tear

108
Q

Grade 3

Complete ______ of structure –> complete tear

109
Q

MC grade injuries seen in DCs office

A

grade 1 or MILD grade 2

Remember serious grade 2 and grade 3 legally require a referral OUT

110
Q

Grade 3 injuries will heal without ____ and almost will never return to normal Stability and/or function

A

reconstruction

111
Q 
In CPP (closed pack position)
End of travel in a joint 
Surface is at maximum\_\_\_\_\_\_ 
Ligaments are \_\_\_\_\_\_ 
and

Further direction of travel in CPP leads to

A

congruency
taut
Fracture or dislocation

112
Q

Loose or Open packed position (OPP)

Position of travel of joint away from CPP
Capsule and ligaments are _____ _______

Extreme movement in that direction of OPP leads to

A

NOT TAUT

strain/sprain

113
Q

Degenerative changes in joint (loss of normal joint mechanics)

Produces _______, leading to fibrotic response aka _____ tissue

Ultimately degenerative changes promote altered ______ ______

A

inflammation
scar tissue
joint mechanics

114
Q

Initial healing 3 - __ days

Regeneration 6 - __ weeks

Remodeling __ months to ____ Years

A

3 to 10

6 to 8 weeks

6 months to 2+ years

115
Q

Proper hydrodynamics occur during

  2. Intermittent ______ activity
  3. Full ROM of ______ and capsule
A

Weight bearing
Intermittent muscle activity
Full ROM of joint and capsule

“running is a good example”

116
Q

How many degrees is the elbow bent for elbow baseline muscle test?

A

70 degrees

117
Q

The GH joint capsule may contain up to 3o cc of lfuid, which is equivalent o about ____ oz

A

1

Note, you can not always see edema on average you the space contains 0.5 to 1.5 cc ( 0.02 to 0.05 ounces)

118
Q

What is the osseous link to the GH joint?

119
Q

SC joint elevation 4 to ____ degrees
depression 5 ____ degrees
Protraction and Retraction _____ degrees
Rotation ____ to ___ degrees

Adjusting SC-joint helps what 4 lung pathologies

A

60
15
15
30-50

Asthmatics, COPD, Emphysema, Bronchitis

120
Q

Sc joint seperation in 3 directions
1.
2.
3.

It does not move posterior due to _____, if it does you nede to call 911 as this could occlude ___ or ______ arteries, veins, or lung tissue

MC seperation

A

superior, inferior, and anterior

1st and 2nd ribs are behind it

carotid or jugular arteries

Anterior and Superior

Note, upon care if x-rayed, the post should be less than 5mm in height difference. If not better by 6 weeks REFER OUT

121
Q

FILL OUT BLANK OUTLINES from BB

A

FILL OUT BLANK OUTLINES from BB

Upper Extremity Adjusting (2 decks)

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