MSK-UE Flashcards
- Synovial Joint membrane
- Synovial cavity
- Joint capsule
- lines synovial cavity, secretes fluid
- separates the bones and cushions the joint
- is fibrous structure that surrounds membrane-syndesmois (little healing)
3 Type of jOints
- Synovial- extra movement
- Cartilaginous- bony surface separate by disc
- Fibrous- bone direct contact
- Inspection:
Palpation:
ROM:
Active ROM
- joint symmetry, alignment and bony deformities
Surrounding tissues for skin changes (erythema), nodules, muscle atrophy, swelling
EX- squaring of shoulder= Anterior shoulder dislocation - 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
Strength testing:
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
SHOULDER
Glenohumeral Joint Ball and socket joint Large ROM Sternoclavicular Joint Acriomoclavicular Joint
Muscles of the Shoulder
Scapulohumeral Group
Rotator Cuff: SITS
Axioscapular Group
Help rotate the scapula
Axiohumeral Group
Internal rotation of the shoulder
Biceps tendon
Long head of biceps enclosed in synovial sheath
Subacromial bursa
Lies on top of supraspinatus tendon between head of the humerus and the acromion
SHOULDER ROM
Flexion Extension Abduction Adduction Rotation Internal External Circumduction
Palpation of shoulder
Find
Acromion process
Acromioclavicular joint: find the anterior tip of the acromion, distal end of the clavical
Coracoid process
Crossover Test
Adduct patient’s arm across chest as you palpate the AC joint
Pain= positive test
AC or SC joint disease
Shoulder ROM and MMT
Flexion/extension
Adduction/abduction
Internal/external rotation
MMT-Shrug (CN XI)
Sulcus Sign: Glenohumeral Instability
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
Drop Arm Test
: 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
Crepitus
grinding sensation. Articular cartilage irregular or loss
Swelling
Synovitis- synoival membrane soft and buggy
Effusion- inc. synovial fluid firm, look swollen
Hemearthrosis
Soft tissue- tendon swelling
Jobe’s(empty can) Test:
supraspinatus impingement
Neer Test:
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;
Hawkins-
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
Lift-off Test:
subscapularis tear or impingement
Apprehension Test:
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
Speeds Test: biceps tendonitis
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
Elbow
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
Elbow Structure and Pathology
Olecranon Bursitis
Biceps Tendon Rupture
Ulnar Nerve-Ulnar nerve runs posterior between medial epicondyle and olecranon process
Olecranon Bursa
Tennis Elbow:
Lateral Epicondylitis
grip tennis racket. Extensor mass inflamed
Golfer
Medial Epicondylitis
Flexor mass inflamed
Wrist and Hand Anatomy
Distal radius Distal ulna Carpal bones (8): scaphoid, lunate, triquetrium, pisiform, trapezium, trapezoid, capitate, hammate Metacarpals Phalanges
Wrist and Hand Joint
Radiocarpal joint Distal radioulnar joint Midcarpal joint Carpometacarpal joint Metacarpophalangeal joint (MCP Joint) Proximal interphalangeal joint (PIP Joint) Distal interphalangeal joint (DIP Joint)
Wrist Muscles
Flexor carpi ulnaris and radialis Extensor carpi radialis brevis and longus Extensor carpi ulnaris Supinator Pronator teres
ROM
Flexion Extension Supination Pronation Deviation Radial Ulnar
Carpal Tunnel
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
Muscles of fingers
Extensor digitorum - fingers Thumb Snuff-Abductor pollicis longus Extensor pollicis longus Extensor pollicis brevis
Flexor pollicis longus
Intrinsic muscles of hand
Intrinsic hand muscles
Lumbricals (flexion)
Dorsal interossei (abduction)
Palmar interossei (adduction)
ROM and MMT fingers
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
Wrist hand Exam
Inspection: swelling, deformity, thenar atrophy, flexion contractures of fingers
Palpation: distal radius and ulna, carpal bones, fingers (phalanges), snuffbox (scaphoid)
PIP, DIP stability
Findings to note with Inspection
Thenar Atrophy
Dupuytren’s contracture
Hand Motor Nerve
Radial nerve: Thumb extension (extensors)
Median nerve: Thumb opposition (flexors)
Ulnar nerve: Abduction fingers (dorsal interossei)
Finkelstein
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
Tinel’s Sign
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
Phalen’s Test
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
BATES MMT
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.
