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JAFFY Clin Skills > MSK Upper Limb > Flashcards

MSK Upper Limb Flashcards

1
Q

general process of physical exam

A
  • introduction (HAND HYGIENE)
  • look (mass deformity)
  • feel (best temperature)
  • move and measure
  • special tests
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2
Q

Introduction phase (of any examination)

A
  • HAND HYGIENE
  • introduce myself
  • name, age, DOB, preferred address, indigenous status, occupation
  • confidentiality
  • explain that you will be examining them, discuss exposure - gain informed consent (any questions before we begin?)
  • ask if they currently have any pain inc neck, upper abdomen, chest and tell them to let you know if it hurts at any time
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3
Q

‘look’ part of shoulder exam

A
  • Muscle bulk/wasting
  • Asymmetry/abnormal posture or gait
  • Skin: lumps, redness, scars, rashes
  • Swelling
  • Deformity: subluxation or dislocation e.g. winging of scapula - ask them to place their hands on their hips when you look from behind
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4
Q

‘feel’ for shoulder exam

A
  • bony landmarks
  • effusions
  • swelling over joints
  • temperature
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5
Q

bony landmarks for shoulder

A
  • Sternal notch
  • Sternoclavicular joints (and see if they’re level)
  • Clavicles
  • Acromioclavicular joints
  • Deltoid, infraspinatus, supraspinatus muscle bulk
  • Greater and lesser tubercule (in extension)
  • Bicipital groove and long head of biceps tendon (flex and supinate)
  • Coracoid process: find the ‘bump’ on the anterior part of the clavicle, 2/3 of the way in (from medial to lateral) then go 2.5cm below this (externally rotate and supinate)
  • Spine of the scapula (check if both at T3 level)
  • Medial border of scapula (tell them to put hands on hips)
  • Inferior angle of scapula (check if both at T7 level)
  • Some of the lateral border
  • Subacromial space (feel laterally)
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6
Q

movements for shoulder exam

A
  • ACTIVE > PASSIVE, UNAFFECTED SIDE 1st, CHECK FOR CREPITUS
  • flexion - 180˚
  • Extension – 65˚
  • Abduction – 180˚ active and 90˚ passive (STABILISE SCAPULA)
  • Adduction – 50˚
  • External rotation – 65˚
  • Internal rotation – 90˚
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7
Q

special tests for shoulder exam (just list them)

A
  • impingement: hawkins, neer, painful arc
  • resisted movements: empty can, infraspinatus + teres minor, lift off, biceps
  • other: apprehension, apley scratch
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8
Q

‘look’ for elbow exam

A
  • General appearance: pain, body build noted, abnormal positioning
  • Muscle bulk/wasting
  • Abnormal carrying angle/valgus position (normal = 5-10˚ when standing in anatomical position)
  • Skin: lumps, redness, scars, rashes
  • Swelling: rheumatoid nodules are hard, gouty tophi usually firm and yellow - cheesy looking, fluid collections in the olecranon bursa
  • Deformity
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9
Q

‘feel’ for elbow exam

A
  • Bony landmarks: medial epicondyle, lateral epicondyle, olecranon, ulnar nerve
  • Effusions: fluid that can be moved
  • Swelling: rheumatoid nodules are hard, gouty tophi usually firm and yellow, fluid collections in the olecranon bursa - cheesy looking
  • Temperature (feel w/ back of hand)
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10
Q

move + measure for elbow exam

A
  • ACTIVE > PASSIVE, UNAFFECTED SIDE 1st, CHECK FOR CREPITUS
  • Flexion - 150˚
  • Extension - 0˚
  • Supination and pronation - 90˚
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11
Q

special tests for elbow exam

A
  • medial epicondylitis: check if pain, palm facing Pt in supination, get them to bring palm towards them against resistance
  • lateral epicondylitis: check if pain, dorsum facing Pt in pronation, get them to bring dorsum towards them against resistance
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12
Q

‘look’ for wrist

A
  • General appearance: pain, body build noted, abnormal positioning
  • Muscle bulk/wasting
  • Asymmetry/abnormal contour and posture - fixed ulnar deviation?
  • Skin: lumps, redness, scars, rashes - possible due to carpal tunnel surgery
  • Swelling: (effusion - can fluid move around?)
  • Deformity
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13
Q

‘feel’ for wrist

A
  • Bony landmarks: radial styloid, ulnar head, ulnar styloid, lister’s tubercle - kinda @ bottom of snuffbox, carpals
  • Effusions: fluid that can be moved
  • Swelling
  • Temperature (feel w/ back of hand
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14
Q

how to palpate carpals

A

DORSAL
- trapezium - @ base of thumb
- scaphoid - @ border of snuffbox
- Trapezoid - under index finger
- Capitate - find the dip in the middle of the hand and go towards the metaCarpals, between 2nd and 3rd digits
- Lunate - find the dip in the middle of the hand and go towards the shoulder

PALMAR
- Hamate - on palmar side, in between pinky and ring finger, should feel the hook (deep)
- pisiform - bottom corner, under pinky (very prominent)
- Triquetrium - under pisiform

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15
Q

move and measure for wrist

A
  • ACTIVE > PASSIVE, UNAFFECTED SIDE 1st, CHECK FOR CREPITUS
  • flexion - 75˚
  • Extension - 75˚
  • radial deviation: flat on the pillow in pronation - 20˚
  • Ulnar deviation: flat on the pillow in pronation - 20˚
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16
Q

‘look’ for hand

A
  • General appearance: pain, body build noted, abnormal positioning
  • Muscle bulk/wasting (thenar and hypothenar eminences - ulnar nerve)
  • Asymmetry/abnormal contour
  • Skin: lumps, redness, scars, rashes
  • Swelling: (effusion - can fluid move around?)
  • deformity (separate list lol)
17
Q

hand deformities

A
  • Pitting nails (psoriatic arthritis)
  • Mallet finger: DIP is naturally flexed and returns to flexed position if you try to straighten it
  • Trigger finger: DIP is naturally flexed but can be straightened if you passively do it
  • Sausage shaped fingers: red and swollen fingers (psoriatic arthritis)
  • Boutonniere (fixed extension of DIP and flexion of PIP - like press a button), swan neck (flexion of DIP and extension of PIP), Z deformity (thumb) - RA
  • Hard nodes @ sides of IP joints (usually due to OA) - Bouchard’s if PIP joint and Heberden’s if DIP joint (B comes before H)
  • Rheumatoid nodules + gouty tophi
  • Flexion deformity on 3-5th digits: Dupuytren’s contraction (caused by thickening of palmar fascia)
18
Q

‘feel’ for hand exam

A
  • Bony landmarks: metacarpal and interphalangeal joints w/ thumbs
  • Effusions: fluid that can be moved
  • Swelling
  • Temperature (feel w/ back of hands)
19
Q

move and measure tests for hand

A
  • ACTIVE > PASSIVE, UNAFFECTED SIDE 1st, CHECK FOR CREPITUS
  • IP joints: flexion and extension inc thumb
  • CMC joints: flexion (90), extension (30), abduction and adduction
  • thumb (supination): flexion (bring thumb in to palm), extension, abduction (like the thumbs up motion), adduction, opposition
20
Q

special tests for hand

A
  • hand function tests (GP OK): grip strength, practical, opposition strength, key grip
  • carpal tunnel tests: Whalen’s (flex wrists against each other and hold for 30 seconds) and Tinel (percuss carpal tunnel)
  • Finkelstein test: flex thumb and make a fist, perform ulnar deviation
21
Q

conclusion stage (for all examinations)

A
  • thank the Pt for their time
  • tell them to dress
  • summarise relevant findings
  • HAND HYGIENE
22
Q

red flag

A
  • piece of info from medical history that could indicate a serious underlying condition that needs medical intervention
23
Q

yellow flag

A
  • psychosocial barriers which may prevent recovery
24
Q

OA vs RA

A
  • RA (autoimmune - chronic inflammation of synovium): morning stiffness for 1 hr or more, pain improves w/ activity but returns @ rest
  • OA (repeated movements degrade articular cartilage): morning stiffness for 30 mins or less, pain after activity but better @ rest, crepitus
25
Q

what do pitting nails indicate?

A
  • psoriatic arthritis
26
Q

mallet finger vs trigger finger

A
  • mallet: DIP joint is naturally flexed and returns to flexed position if you try to straighten it
  • trigger: DIP is naturally flexed but can be straightened if you do it passively
27
Q

what are sausage fingers and what condition do they indicate?

A
  • red and swollen fingers
  • psoriatic arthritis
28
Q

3 hand deformities which indicate rheumatoid arthritis

A
  • boutonniere: extension of DIP and flexion of PIP (like pressing a button)
  • swan neck: flexion of DIP and extension of PIP
  • Z deformity: flexion of thumb IP joint
29
Q

what hand deformities indicate osteoarthritis?

A
  • Bouchard’s nodes: hard nodes @ side of PIP joint
  • Heberden’s nodes: hard nodes @ side of DIP joint
  • B comes before H so B is proximal
30
Q

what is dupuytren’s contraction?

A
  • flexion on digits 3-5
  • caused by thickening of palmar fascia
31
Q

spasticity vs rigidity

A
  • spasticity: continuous muscle contraction, velocity dependent e.g. stroke (pyramidal - voluntary)
  • rigidity: resistance to movement, velocity INDEPENDENT, e.g. parkinson’s (extrapyramidal - involuntary)

JAFFY Clin Skills (5 decks)

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