MSK Flashcards
Special test for TOS
These 5 involve palpating radiual pulse and if pulse decreases then positive for arrterial TOS
Adson maneuver Costoclavicular syndrome (Militarry brace) test Halstead maneuver Wright test Allen test
Roos test (Elevated arm stress test): Arterial TOS, open close hands 3 mins and fatigue
Shoulder girdle passive elevation (Cyriax release test): Cross arms on shoulders, physio lifts arms up, looking for reduction of symptoms
Possible complications of a shoulder dislocation
Axillary nerve damage
Axillary artery
brachial plexus (most common the posterior cord)
bankart lesion (damage to the anteroinferior glenoid labrum)
Hill sachs lesion (fracture to the posterolateral humeral head secondary to forceful impact on the anteroinferior labrum)
Spectrum of instability
AMBRI (born loose)
Atraumatic etiology, multidirectional with bilateral shoulder findings, rehab for treatment, and rarely inferior capsule shift surgery if required
TUBS Torn loose
Traumatic etiology, unilateral aterior with a bankart lesion responding to surgery (surgery will lead to reductions in ER)
Special tests for shoulder dislocation
Anterior instability
- Apprehension test and relocation test
- Apprehension release (surprise test)
- Load and shift test
Posterior instability
- Jerk test
- load and shift test\
- posterior apprehension test
Inferior instability
-Sulcus sign
-feagin test (Examiner position: The clinician holds the patient’s upper extremity at 90
degrees of abduction, with the patient’s forearm over the clinician’s shoulder
and elbow extended.
Technique: The clinician uses one hand to apply an inferiorly and slightly
anteriorly directed force while the other hand palpates the edge of the
acromion and the humeral head to feel for displacement anteriorly and
inferiorly.
Special tests for SLAP lesions
Compression test of obrian (best test to use) ( positive with resistance to arm in 90 degree flex and internally rotated, and symptoms resolved when repeated with ER)
Biceps load test (Kim test II)
Clunk test
Bankaert lesion
Injury of labrum at 3 to 7 o clock
common in overhead athletes and with anterior GH dislocations
presents with clicking or popping
worse with HBB
Adhesive capulitis
Idiopathic condition characterized by shoulder pain followed by progressive loss of GH ROM following the capsular pattern (ER>ABD>IR) d/t dense adhesions and capsular thickening
Primrary adhesive capsulitis is idiopathic
Secondary is due to other conditions ex trauma, immobilization, surgery, post stroke, etc.
Has a high correlation with psychosocial issues
Stages of adhesive capsulitis
Stage 1
- Gradual onset of pain
- Increase with movement and at night
- Loss of ER ROM with intact RC strength
- Duration: <3 months
Stage 2: “freezing”
- Persistent and more intense pain, even at rest (dull and achy)
- Restricted ROM in all directions
- Duration: 3-6 months
Stage 3 “frozen”
- Pain only with movement, less night pain
- Signiicant adhesions. Hard capsular end-feel in most directions
- Restricted ROM in all directionswith increased scapular compensations
- May present with atropy of deltoid, RC, biceps and triceps d/t disuse
- Duration 9-15 months
Stage 4: " thawing" -Minimal pain -Significant capsular restrictions initially, bit get a gradual return of ROM -Some patients may never regain full ROM _Duration 15-24 months or longer
Special tests for subacromial impingement syndrome
Hawkins kennedy test
Neers impingement test
scapular assistance test
Hallmark sign of Subacromial impingement syndrome
Painful arc (60-120 degrees)
Special tests for tendinopathy of Biceps and RC muscles
Biceps
- Yergasons
- Speeds
Subscapularis
- Lift off test
- belly press test
- internal rotation lag sign
Infranspinatus
-External rotation lag sign
Teres minor
-Hornblowers sign
supraspinatus
- Empty can
- drop arm test
Causes of dynamic scapular winging
Sprcial tests for scapular winging
Serratus anterior weakness, long thoracic nerve damage affecting serratus anterior, spinal accessory nerve (trapezius), C3,C4 trapezius, C5 rhomboids, C7 serratus anterior and rhomboids
Wall push off test
punch out test
scapular load test (manual resistance at 45 degrees abduction and observe scapula for winging)
Lateral epicondylosis
Special tests for lateral epicondylosis
Management
Commonly involves the extensor carpii radialis brevis tendon
Commonly known as tennis elbow
Cozens test (Resisted wrist extension) Mills test ( Passive wrist extension) Maudsleys test (resisted extension of 3rd MCP)
- Counterforce brace
- Eccentric exercise
- activity modification
- Stretching
Medial epicondylosis
Management
Degeneration due to overuse of flexor trndon at the medial epicondykle
Commonly involves the pronator teres, and the flexor carpi redialis tendon
Known as golfers eelbow
Pain with resisted wrist flexion, resisted forarm pronation and passive wrist extension
Eccenteric exercise
Bracing
Stretching
activity mofication
Median nerve (C6, C7, C8, and T1) Peripheral nerve injuries
humerus supracondylar process syndrome
-median nerve entrapped under the ligament of struthers ( on the distal humerus)
pronator syndrome
-Median nerve entrapped between the two heads of the pronator teres muscle
Anterior interosous nerve syndrome
-the anterior interousous nerve, which is a branch of the median nerve is entrapped between the two heads of the pronator teres muscle and characterized as a pinch deformity
Ulnar nerve (C7, C8 and T1)
cubbital tunnel syndrome
-Ulnar nerve entrapped between the cubittal tunnel or the two heads of the flexor carpi ulnaris muscle
Special tests
- Tinnels test at the elbow
- cubital tunnel compression test
- Elbow flexion test
Radial nerve (C5, C6, C7, C8, and T1)
radial tunnel syndrome
- Entrspment of the posterior interousous nerve (branch of rsadial nerve) in:
1) Between the 2 heads of the supinator in the arcade of froshe
2) At the entrance of the radial tunnel anterior to the radial head
3) Nerve the brachioradialis and the ECRL
4) Between ulnar half of ECRB tendon and fascia
5) Distal border of the supinator
Complex regional pain syndrome (CRPS)
S & S
Clinical course
Type I: Occurs after injury to tissue, previously known as regional sympathetic dystrophy
Type II: Occurs after injury to a nerve, previously known as causalgia
S & S:
- Severe pain (burning)
- Allodynia/hyperalgesia
- Abnormal blood flow (vasomotor changes)
- Abnormal sweating ( sudomotor changes)
- Abnormal motor function
- Trophic changes (Colour changes, temperature changes, edema, shiny taut skin, abnormal hair and nail growth)
Stage 1: Acute/reversible stage
- typically begins several days after the injury or insidious over several weeks
- characteristics: pain, hyperhidrosis, warmth, erythema, rapid nail growth, edema in distal extremities
Stage 2: dystrophic. or vasoconstriction (Ischemic) stage
- Typically begins 3 months after the injury and lasts 3-6 months
- characteristics: Burning pain, sympathetic hyperactivity, hyperesthesia exacerbated by cold weather, mottling and coldness, brittle nails, osteoporosis
Stage 3: Atrophic stage
- Typically begins 6 months to 1 year after the injury and can last months or years
- characteristics: Pain either decreasing or becoming worse, severe osteoporosis, muscle wasting, and contracturees.
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