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SMUPAFall-PD Lecture > MSK-UE > Flashcards

MSK-UE Flashcards

1
Q
  1. Synovial Joint membrane
  2. Synovial cavity
  3. Joint capsule
A
  1. lines synovial cavity, secretes fluid
  2. separates the bones and cushions the joint
  3. is fibrous structure that surrounds membrane-syndesmois (little healing)
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2
Q

3 Type of jOints

A
  1. Synovial- extra movement
  2. Cartilaginous- bony surface separate by disc
  3. Fibrous- bone direct contact
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3
Q
  1. Inspection:
    Palpation:
    ROM:
    Active ROM
A
  1. joint symmetry, alignment and bony deformities
    Surrounding tissues for skin changes (erythema), nodules, muscle atrophy, swelling
    EX- squaring of shoulder= Anterior shoulder dislocation
  2. joint for crepitus, tenderness, deformity
    Surrounding tissues for skin changes (warmth), nodules, muscle atrophy

3.test joint function and stability, integrity of ligaments

4.FIRST then passive ROM if appropriate.
Isolate GH place at 90deg ABD

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4
Q

Strength testing:

A

test against resistance to grade strength of the muscle

evaluates muscular strength and nerve function which controls that muscle

Part of neurological exam

documented as part of musculoskeletal exam

scale from 0-5
5/5 is normal strength

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5
Q

SHOULDER

A 
Glenohumeral Joint
Ball and socket joint 
Large ROM
Sternoclavicular Joint 
Acriomoclavicular Joint
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6
Q

Muscles of the Shoulder

Scapulohumeral Group

A

Rotator Cuff: SITS

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7
Q

Axioscapular Group

A

Help rotate the scapula

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8
Q

Axiohumeral Group

A

Internal rotation of the shoulder

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9
Q

Biceps tendon

A

Long head of biceps enclosed in synovial sheath

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10
Q

Subacromial bursa

A

Lies on top of supraspinatus tendon between head of the humerus and the acromion

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11
Q

SHOULDER ROM

A 
Flexion
Extension
Abduction
Adduction
Rotation
Internal
External
Circumduction
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12
Q

Palpation of shoulder

A

Find
Acromion process
Acromioclavicular joint: find the anterior tip of the acromion, distal end of the clavical
Coracoid process

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13
Q

Crossover Test

A

Adduct patient’s arm across chest as you palpate the AC joint
Pain= positive test
AC or SC joint disease

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14
Q

Shoulder ROM and MMT

A

Flexion/extension
Adduction/abduction
Internal/external rotation
MMT-Shrug (CN XI)

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15
Q

Sulcus Sign: Glenohumeral Instability

A

Sulcus sign: arm straight and relaxed to side of pt, elbow is grasped and downward traction is applied; a depression at the acromion indicates glenohumeral instability

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16
Q

Drop Arm Test

A

: patient fully abducts arm to shoulder level, ask them to lower the arm slowly.
POSITIVE= If the patient cannot control the movement on the way down that is a “positive drop arm test,” which indicates a potential tear in a rotator cuff muscle
Stick to 90ABD bc above will be scapothoracic muscles helping

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17
Q

Crepitus

A

grinding sensation. Articular cartilage irregular or loss

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18
Q

Swelling

A

Synovitis- synoival membrane soft and buggy
Effusion- inc. synovial fluid firm, look swollen
Hemearthrosis
Soft tissue- tendon swelling

19
Q

Jobe’s(empty can) Test:

A

supraspinatus impingement

20
Q

Neer Test:

A

POS= posterior rotator cuff impingement or bicipital tendonitis

forces greater tuberosity against anterior acromion;

rotates posterior rotator cuff tendons under acromion (infraspinatus, teres minor);

“near to the ear”; start arm at side, elbow fully extended, thumb toward body, practitioner passively forward flexes shoulder 180 degrees overhead;

21
Q

Hawkins-

A

rotator cuff injury
Hawkins Test: shoulder flexed to 90 degrees, elbow flexed to 90 degrees, examiner grasps wrist with one hand and elbow with the other and passively internally rotates the shoulder (supraspinatus, teres minor, infraspinatus); pain suggests impingement of affected rotator cuff muscles

22
Q

Lift-off Test:

A

subscapularis tear or impingement

23
Q

Apprehension Test:

A

anterior shoulder instability or AC impingement
elbow flexed 90 degrees, shoulder abducted 90 degrees; examiner holds pt’s wrist, applies forward pressure from back of shoulder and externally rotate shoulder; pain or a look of apprehension is positive test. If positive, perform relocation maneuver: continue external rotation, apply posterior pressure from front of shoulder; if pain is reduced, anterior shoulder instability; if pain is not reduced, AC impingement

24
Q

Speeds Test: biceps tendonitis

A

arm forward flexed 50 degrees at shoulder, palm up, elbow flexed 15 degrees, pt forward flexes shoulder against resistance at forearm; pain sensitive for tendonitis of long head of biceps

25
Q

Elbow

A

Inspection: swelling, deformity

Palpation: olecranon process, epicondyles, ulnar nerve
ROM: flexion, extension, supination and pronation (with arm @ 90 deg, elbow into body)
EX- note supercondylar condyle and radial head FX

Strength: flexion and extension

26
Q

Elbow Structure and Pathology

A

Olecranon Bursitis
Biceps Tendon Rupture
Ulnar Nerve-Ulnar nerve runs posterior between medial epicondyle and olecranon process

Olecranon Bursa

27
Q

Tennis Elbow:

A

Lateral Epicondylitis

grip tennis racket. Extensor mass inflamed

28
Q

Golfer

A

Medial Epicondylitis

Flexor mass inflamed

29
Q

Wrist and Hand Anatomy

A 
Distal radius
Distal ulna
Carpal bones (8): scaphoid, lunate, triquetrium, pisiform, trapezium, trapezoid, capitate, hammate
Metacarpals
Phalanges
30
Q

Wrist and Hand Joint

A 
Radiocarpal joint
Distal radioulnar joint
Midcarpal joint
Carpometacarpal joint
Metacarpophalangeal  joint (MCP Joint)
Proximal interphalangeal joint (PIP Joint)
Distal interphalangeal joint (DIP Joint)
31
Q

Wrist Muscles

A 
Flexor carpi ulnaris and radialis
Extensor carpi radialis brevis and longus
Extensor carpi ulnaris
Supinator 
Pronator teres
32
Q

ROM

A 
Flexion
Extension
Supination
Pronation
Deviation 
Radial
Ulnar
33
Q

Carpal Tunnel

A

FPS, FPD and median nerve
Channel beneath palmar aspect of wrist and proximal hand
Median nerve provides sensation to digits 1-3 (and part of 4)
Median nerve innervates thumb muscles

34
Q

Muscles of fingers

A 
Extensor digitorum - fingers
Thumb
Snuff-Abductor pollicis longus
Extensor pollicis longus
Extensor pollicis brevis

Flexor pollicis longus

35
Q

Intrinsic muscles of hand

A

Intrinsic hand muscles
Lumbricals (flexion)
Dorsal interossei (abduction)
Palmar interossei (adduction)

36
Q

ROM and MMT fingers

A

Forearm: pronation, supination
Wrist: flexion, extension, ulnar and radial deviation
Fingers:
Flexion and extension: make fist, release
Abduction and adduction: spread fingers apart
THUMB: flexion and extension, abduction and adduction, opposition

37
Q

Wrist hand Exam

A

Inspection: swelling, deformity, thenar atrophy, flexion contractures of fingers
Palpation: distal radius and ulna, carpal bones, fingers (phalanges), snuffbox (scaphoid)
PIP, DIP stability

38
Q

Findings to note with Inspection

A

Thenar Atrophy

Dupuytren’s contracture

39
Q

Hand Motor Nerve

A

Radial nerve: Thumb extension (extensors)
Median nerve: Thumb opposition (flexors)
Ulnar nerve: Abduction fingers (dorsal interossei)

40
Q

Finkelstein

A

Tests for inflammation of muscles around base of thumb (DeQuervain’s tenosynovitis)

Pt makes a fist with the fingers closed over the thumb and the wrist is bent toward the little finger

Pain is positive result

41
Q

Tinel’s Sign

A

Lightly percuss over the course of the median nerve on the volar aspect of the wrist along the carpal tunnel

Tingling or electric sensations in the median nerve distribution caused by percussion is considered positive

42
Q

Phalen’s Test

A

Compress the median nerve by holding patient’s wrist in an acutely flexed position for 60 seconds

Numbness or tingling that develop as a result of compressing the median nerve is considered positive

43
Q

BATES MMT

A

0—No muscular contraction detected
1 barely detectable flicker or trace of contraction
2—Active movement of the body part with gravity eliminated
3—Active movement against gravity
4—Active movement against gravity and some resistance
5—Active movement against full resistance without evident fatigue. This is
normal muscle strength.

SMUPAFall-PD Lecture (7 decks)

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