Lecture Midterm 2 Flashcards
The cervical plexus makes up what spinal nerves?
C1-C4
The brachial plexus makes up what spinal nerves?
C5-T1
What are the important details when performing motor tests?
Clear explanation to the patient
-Test across one joint
-Steady pressure for a count of 3 with no ballistic stresses
When a person is giving a motor testing grade of 5, what does that mean?
Complete range of motion against gravity with full resistance
When a person is given a motor testing grade of 4, what does that mean?
Complete range of motion against gravity with some resistance
When a person is given a motor testing grade of 3, what does that mean?
Complete range of motion against gravity only
When a person is given a motor testing grade of 2, what does that mean?
Complete range of motion with gravity eliminated
Your patient is able to raise their arm into abduction, but cannot resist any over pressure. What is the correct grading for this finding?
3/5
Your patient is able to raise their arm into abduction with full resistance. What is the correct grading for this finding?
5/5
When a herniated disc is present between C5 and C6, what nerve root is affected?
C6
What muscle would you test to examine the C5 nerve root?
Deltoid
What muscle would you test to examine the C6 nerve root?
Wrist extensors
What muscle would you test to examine the C7 nerve root?
Wrist flexors
What muscle would you test to examine the C8 nerve root?
Finger flexors
What muscle would you test to examine the T1 nerve root?
Interossei
What deep tendon reflex would you use to examine the C5 nerve root?
Biceps tendon
What deep tendon reflex would you use to examine the C6 nerve root?
Brachioradialis tendon
What deep tendon reflex would you use to examine the C7 nerve root?
Triceps tendon
What deep tendon reflex would you use to examine the C8 nerve root?
There is no reflex
What deep tendon reflex would you use to examine the T1 nerve root?
There is no reflex
What is the sensory dermatome for C5 nerve root?
Lateral arm
What is the sensory dermatome for C6 nerve root?
Lateral forearm, thumb, and lateral side of 2nd digit
What is the sensory dermatome of C7 nerve root?
Medial side of 2nd digit, 3rd digit, and lateral side of 4th digit
What is the sensory dermatome of C8 nerve root?
Medial forearm, 5th digit, and medial side of 4th digit
What is the sensory dermatome of T1 nerve root?
Medial arm from axilla to elbow
Interosseous wasting is a symptom of what conditions?
Apical lung tumor or space occupying lesion on the inferior aspect of the brachial plexus
What deep tendon reflex would you use to examine the Musculocutaneous nerve?
Biceps tendon
What deep tendon reflex would you use to examine the Radial nerve?
Brachioradialis or Triceps tendon
What is the order of muscle testing needed to assess the axillary nerve motor function?
- Deltoid
- Teres minor
What is the order of muscle testing needed to assess the musculocutaneous nerve motor function?
- Biceps
- Coracobrachialis
What is the order of muscle testing needed to assess the radial nerve motor function?
- Extensor digitorum
- Wrist extensors (extensor carpi radialis longus and brevus)
- Brachioradialis
- Triceps + Anconeus
What is the order of muscle testing needed to assess the median nerve motor function?
- Flexor pollicus brevis
- Flexor digitorum profundus (2nd and 3rd digit)
- Flexor carpi radialis
What is the order of muscle testing needed to assess the ulnar nerve motor function?
- Adductor pollicus
- Flexor digitorum profundus (4th and 5th digit)
- Flexor carpi ulnaris
- Interossei
What is the largest nerve in the upper extremity?
Radial nerve
What is the most commonly entrapped nerve in the body?
Median nerve
A patient comes in and complains of weak abduction of their arm. What nerve root or peripheral nerve would you suspect could be an issue?
C5 or Axillary nerve
A patient comes in and complains of weak external rotation of their arm. What nerve root or peripheral nerve would you suspect to be an issue?
C5 or Axillary nerve
A patient comes in and complains of weak elbow flexion in a supinated position. What nerve root or peripheral nerve would you suspect to be an issue?
C5 or Musculocutaneous nerve
A patient comes in and complains of weak wrist extensions. What nerve root or peripheral nerve would you suspect to be an issue?
C6 or Radial nerve
A patient comes in and complains of weak elbow extension. What nerve root or peripheral nerve would you suspect to be an issue?
C7 or Radial nerve
A patient comes in and complains of weak wrist flexion. What nerve root or peripheral nerve would you suspect to be an issue?
C7 or Ulnar and Median nerve
A patient comes in and complains of weak finger flexion. What nerve root or peripheral nerve would you suspect to be an issue?
C8 or Median nerve
When performing an orthopedic test, what side of the body should you test first?
Asymptomatic side
When charting an orthopedic test, how would you describe the results?
Positive or negative
What type of pain follows along nerves and can be described as a sharp, radiating, pins and needles, or numbness?
Neurological pain
What type of pain follows the dermatome pattern?
Dermatogenous pain
What type of pain is considered a referred pain from sensory irritation to a structure that shared embryological mesodermal innervation and is usually described as burning?
Sclerotogenous pain
What type of pain originates within a muscle due to a trigger point referral and is often described as cramping, spasm, or aching?
Myotogenous pain
What type of pain is considered a throbbing, pulsating pain?
Vascular pain
What test is used to evaluate the patient’s pain threshold by applying firm pressure to the mastoid process?
Libman’s sign
How do you perform O’Donaghue’s Maneuver?
Have the patient move the affected joint/s actively, against isometric contraction, and passively looking for exacerbation of pain
If a doctor performs O’Donaghue’s Maneuver on a patient and they report pain upon resisted motion, what do you suspect the injury is?
Muscle or musculotendinous injury
If a doctor performs O’Donaghue’s Maneuver on a patient and they report pain upon passive motion, what do you suspect the injury is?
Ligamentous, capsular, or articular injury
What test is performed by striking the top of the patient’s head through the doctor’s hand and should not be done?
Spurling’s test
What is the least invasive test for nerve root encroachment?
Neutral Compression Test
What is the positive finding for the Cervical Compression Test?
Sharp shooting pain and/or parenthesis down the upper extremity
What is the order from least invasive to most invasive cervical compression tests?
- Neutral Compression
- Lateral Compression (Jackson’s Compression)
- Rotary Compression
- Hyperextension Compression
- Maximal Foraminal Compression
What three motions are used during the Maximal Foraminal Compression test?
Lateral flexion, extension, and rotation
When performing Jackson’s Compression or Hyperextension Compression tests, where should your line of drive be?
Down the spine (towards the chin)
What are the three positive findings associated with Cervical Distraction Test?
-Decrease in symptoms
-Increase in symptoms down the arm
-Well localized cervical pain
If you perform the Cervical Distraction Test and the patient says the symptoms decrease, what do you suspect is going on?
Nerve root encroachment
If you perform the Cervical Distraction test and the patient says the symptoms down the arm have increased, what do you suspect is going on?
-Nerve root adhesions
If you perform the Cervical Distraction test and the patient says they have an increased pain in the cervical area, what do you suspect is going on?
Capsular inflammation
What is the positive finding for Bakody Maneuver?
Relief of the upper extremity pain or paresthesia
A positive finding to the Shoulder Depression Test indicated what?
Radicular/Nerve root adhesions
What is the position called when a patient walks into your office holding their neck with both of their hands, and what does it mean?
Rust Sign; Instability of neck
What tests can be performed if you suspect a Space Occupying Lesion?
Triad of Dejerine, Valsalva, and Milgrams
What test is performed by asking the patient if coughing, sneezing, or straining of the bowel causes the pain to get worse?
Triad of Dejerine
What test is performed by having the patient blow on their own thumb to increase intrathecal and intra-abdominal pressure?
Valsalva Maneuver
What is a positive finding for the Valsalva Maneuver?
Pain is worsened
What test is performed by having the patient hold their feet 3-6 inches off the table for 15 seconds?
Milgram’s Test
What space occupying lesion test is considered the least invasive?
Triad of Dejerine
What space occupying lesion test is considered the most aggressive?
Milgram’s Test
What test is used to test the arterial filling of the upper extremity?
Allen’s test
Before tests for thoracic outlet syndrome, what test must be performed first?
Allen’s test
What is a positive finding when you perform Allen’s Test?
Flushing that takes more than 10 seconds
A patient complains of pain and numbness down their left arm when they turn to the left. What is one of the possible explanations for this finding?
Anterior scalene TOS
A patient complains of pain and numbness down their left arm when they turn their head to the right. What is one of the possible explanations for this finding?
Middle scalene TOS
A patient complains of pain and numbness down their left arm when they are asked to hold their breath. What is one of the possible explanations for this finding?
Costoclavicular space or scalenes TOS
A patient complains of pain and numbness down their left arm when they try and grab something above their head. What is one of the possible explanations for this finding?
Pectoralis minor TOS
A patient complains of pain and numbness down their left arm when their neck is tractioned. What is one of the possible explanations for this finding?
Cervical rib or elongated TP
If you suspect a patient is suffering from anterior scalene TOS, what test would you have them perform?
Adson Test
What is the positive finding for Adson’s Test?
Decrease in pulse volume and/or exacerbation of upper extremity symptoms
If you suspect a patient is suffering from middle scalene TOS, what test would you have them perform?
Reverse Adson Test
If you suspect a patient is suffering from costoclavicular TOS, what test would you have them perform?
Eden’s Test or Soldier’s Position
What costoclavicular TOS test is performed passively?
Soldier’s Position
What costoclavicular TOS test is performed actively?
Eden’s Test
What tests are able to be performed if you suspect hyperabduction syndrome?
- Roos test
- Hostage position
- Wright’s test
- Reverse Bakody Maneuver
What is a positive finding for the Hostage position?
Decrease in pulse patency and/or exacerbation of upper extremity symptoms
When performing the Wright’s Test, how far do you raise the arm?
120 degrees
What is a positive finding for the Traction test?
Decrease in pulse patency and/or exacerbation of upper extremity symptoms
What tests can be performed to test for the integrity of the transverse humeral ligament?
- Yergason’s Test
- Speed’s Test
- Abbott-Saunders
What are the other possible names for Supraspinatus press test?
Jobe Test or Supraspinatus Stress Test
What tests can be performed if you suspect a patient has a Supraspinatus strain/tear?
- Supraspinatus press test
- Codman’s Test (Drop arm test)
What test can be performed if you suspect a patient has an acute glenohumeral dislocation?
Dugas Test
What test should not be performed on a patient that has recurrent glenohumeral dislocations?
Apprehension Test
What test can be performed if you suspect a patient has subacromial bursitis?
“Dawbarn’s “Pushbutton” Test”
What is the most likely cause of popping, clicking, and pain in the anterior shoulder with motion?
Transverse humeral ligament tear
What two tests can be performed to test for lateral epicondylitis?
Cozen’s Test and Mill’s Test
Which of the following is a positive indication for Cozen’s Test?
Pain at the lateral epicondyle
Which of the following is a positive indication for Mill’s Test?
Pain at the lateral epicondyle
What test can be performed to test for medial epicondylitis?
Golfer’s Elbow Test
When performing a Varus Stress test on the elbow, what are we testing for instability?
Lateral (radial) collateral ligament
When performing a Valgus Stress test on the elbow, what are we testing for instability?
Medial (ulnar) collateral ligament
When performing any stress test at the elbow, which side of the body should you do first?
Well-side first
What is a positive finding when you perform Valgus Stress test?
Pain or excessive motion at the medial elbow
What test can be performed to test for ulnar neuropathy at the elbow joint?
Tineal tap at the Elbow
What is a positive finding for the Tineal Tap test at the Elbow?
Sustained paresthesia along the distribution of the ulnar nerve
If a patient complains of numbness and tingling on the 2nd and 3rd digits, what test could be done to examine this?
Tineal Tap test at the Wrist
What is a positive finding for the Tineal Tap test at the Wrist?
Sustained paresthesia into the distal median nerve distribution
What is a positive finding for the Tineal Tap at the Tunnel of Guyon?
Sustained paresthesia along the distribution of the ulnar nerve
What is the positive finding for Carpal tunnel orthopedic tests always?
Increased or sustained paresthesia along the (distal) Median N. distribution
True or False: Wrist pain is a positive finding for Carpal Tunnel Syndrome?
FALSE
What forms the borders of the Carpal Tunnel?
-Tubercle of Scaphoid
-Pisiform
-Hamulus of Hamate
-Tubercle of Trapezium
What structures can be found inside the Carpal Tunnel?
-Tendons of Flexor digitorum superficialis & profundus
-Flexor pollicus longus tendon
-Median nerve
What tests can be performed to test for Carpal Tunnel Syndrome?
-Phalen’s test
-Prayer Sign
-English test
-Tineal tap at the Wrist
What is a positive finding when performing the English test?
Increased or sustained pain or paresthesia into the median nerve distribution of the hand
What are some of the other names for English Test?
Sphygmomanometer Test or Tourniquet Test
What test can be performed to see if a patient has De Quervain’s syndrome?
Finkelstein’s Test
What is a positive finding when performing Finkelstein’s Test?
Pain at the lateral wrist (radial styloid distally)
What is another name for De Quervain’s syndrome?
Stenosing tenosynovitis
What test can be performed if you suspect a ulnar neuropathy with paresis of the adductor pollicus?
Froment’s/Paper Test
Nerve entrapment in the cubical fossa will cause symptoms into what part of the upper extremity?
Volar surface of the lateral hand and fingers
What diagnosis does a 4+J bicep reflex suggest?
Corticospinal tract lesion
What is the likely diagnosis for a patient that has pain into the right arm when turning the head to the left?
Middle scalene TOS
A positive finding for cervical capsulitis during the Cervical Distraction test is what?
Increased localized posterior-lateral cervical pain
A patient sticks their tongue out and it deviates to the left. Where could the lesion be located?
CN XII on the left
Interosseous wasting may be a sign of what condition?
Apical lung tumor
Your patient has right medial forearm pain when turning their head to the right. What muscle test is most appropriate?
Finger flexors (C8)
Your patient has right arm pain extending into the index finger when turning their head to the left. What two tests are most useful to evaluate this patient?
Reverse Adson’s and rotary compression test
When testing for pallesthesia, what should be used?
Using a 128 Hz tuning fork
What are some of the positive findings you would see in a patient with a basal ganglia lesion?
Resting tremors, Cogwheel or lead pipe rigidity, Pill rolling, Festinating gait
A 68-year old woman with pain in her forearm and hand on the left side when she raises her arm to the side. She admits her hand tends to get cold and sometimes her finger turns white. What test you would you want to do first on this patient?
Allen’s Test
what is the ROM for cervical flexion?
60-90*
what is the ROM for cervical extension?
75-90*
what is the ROM for cervical lateral flexion?
45-55*
what is the ROM for cervical rotation?
80-90*
what is the ROM for thoracic flexion?
25-45*
what is the ROM for thoracic extension?
25-45*
what is the ROM for thoracic lateral flexion?
20-40*
what is the ROM for thoracic rotation?
30-45*
what is the ROM for shoulder flexion?
180*
what is the ROM for shoulder external rotation?
90* (w/ ADduction)
what is the ROM for shoulder extension?
50* (w/ elbow straight)
what is the shoulder open-packed position?
55* abduction; 30* horizontal adduction
what is the ROM for shoulder internal rotation?
90* (w/ ABduction)
what is the ROM for shoulder ABduction?
180*
what is the ROM for shoulder ADduction?
50*
what is the shoulder closed-packed position?
abduction + external rotation
The median n runs thru ____
Cubital Fossa
The median n runs thru ____
Cubital Fossa
The Ulnar n runs thru ____
Cubital Tunnel
