Musculo-sho, elbow, wrist/hand

Question 1

Anterior apprehension with relocation test

Answer 1

The purpose is to assess for anterior dislocation.

Patient lying supine on the table closest to PTA with elbow flexed to 90°, PTA passively abducts patient shoulder to 90° while supporting arm on their leg. PTA Palpates anterior part of shoulder while taking the shoulder into external rotation.

Positive test is apprehension or fear as the therapist moves the patient’s arm.

If apprehension or fear is noted, release slightly into internal rotation and add a posterior glide to relocate the glenohumeral joint and then proceed into external rotation again. Once end range is felt, gently release posterior glide. Positive test is apprehension in this position.

Question 2

Neer test

Answer 2

Purpose is to test for shoulder impingement.

(Pt. and PTA standing) PTA passively takes patients shoulder into full flexion while maintaining internal rotation looking for pain. If there are no reproduction of symptoms do this motion again and add over pressure by placing one hand on the scapula and the other hand in the axilla near the glenohumeral joint applying overpressure into flexion and adduction.

Positive test is reproduction of symptoms.

Question 3

Hawkins Kennedy test

Answer 3

Purpose is to assess for subacromial pain syndrome.

Patient is seated, PTA passively takes patient’s arm into flexion and horizontal adduction, then stabilizes the top of the shoulder and internally rotates the humerus looking for available range and reproduction of symptoms. Compare to opposite side.
Positive test is limited range or pain in the shoulder.

Question 4

Adson’s Test

Answer 4

Purpose is to assess for thoracic outlet syndrome with entrapment in the scalene triangle.

First, find the patients radial pulse. Then, Passively abduct, extend, and externally rotate the patient’s arm. Have patient take a deep breath in and rotate their head to the same side.
A positive test is an abolishment or decreased radial pulse.

Question 5

Roos test

Answer 5

Purpose is to assess for thoracic outlet syndrome. Patient actively abducts their arms to 90°, flexes elbows to 90°, and fully externally rotate their shoulders (like a goal post). Patient opens and closes their fists through full range as quickly as possible for one minute.
Positive test is patients increase in symptoms, increased sensation of heaviness or tingling.

Question 6

Clunk test

Answer 6

Purpose is to assess for a glenoid labral tear.

Patient supine and PTA abducts arm to 90 and externally rotates arm. PTA grabs posterior aspect of humeral head and pushes it anteriorly to feel/listen for a “clunk”

Question 7

Crank test

Answer 7

Also called labral crank test or compression rotation test. Purpose is to identify glenoid labrum tears and assess unstable superior labral anterior posterior (SLAP) lesions.

Patient can be supine or sitting flex arm to 90 and hold patients elbow and forearm with one hand and use other hand to perform humeral rotation while the shoulder is elevated in the scapular plane.

Positive test is indicated during the maneuver (usually during external rotation) if there is reproduction of symptoms (pain) with or without a click.

Question 8

O’brien test

Answer 8

Purpose is to indicate potential labral (SLAP lesion) or acromioclavicular lesions as cause for shoulder pain.

Patient is placed at 90° shoulder flexion and about 10° of horizontal adduction then fully internally rotates shoulder (elbow pronates). PTA provides resistance while pt pushes upward.
Then do test again with pt. ER.

A positive for the test would be pain during resistance while internally rotated whereas when they are externally rotated they do not have pain.

Question 9

Bennett fracture

Answer 9

Fracture of the palmar base of the proximal first metacarpal

Question 10

Boxer’s fracture

Answer 10

Fracture of the neck of the fourth or fifth metacarpal caused by a strike to a hard object with a clenched fist

Question 11

Colles fracture

Answer 11

A radius fracture within 2.5 cm of the wrist in which the distal fragment is displaced in a dorsal direction

*also known as dinner fork deformity
Looks like a fork upside down.

Usually the result of a fall on the palm of an outstretched hand

Question 12

Smith fracture

Answer 12

Also referred to as a reverse Colles fracture. Usually occurs from a fall on the dorsum of the hand, with the resultant distal radial fragment displaced in a palmar direction.

Question 13

Complex regional pain syndrome (CRPS)

Answer 13

A condition in which pain after an injury or surgery is disproportionate or prolonged beyond that of a typical response

Question 14

Carpal tunnel syndrome

Answer 14

A group of symptoms that occur when the median nerve is compressed or entrapped at the wrist

Question 15

Compression neuropathy

Answer 15

Disorder that occurs when adjacent structures constrict a peripheral nerve, limiting it’s blood supply and resulting in impaired nerve conduction

Question 16

De Quervain’s disease

Answer 16

Tenosynovitis or tendinosis of the abductor pollicis longus and extensor pollicis brevis tendons and sheaths near the radial styloid characterized by pain in the radial side of the wrist and thumb, especially with use.

Question 17

Dinner fork deformity

Answer 17

A deformity seen after a Colles fracture with the position of the wrist and forearm resembling a dinner fork

Question 18

Depuytren’s disease

Answer 18

A disease process in which the balance of collagen formation and breakdown is disrupted leading to excess collagen that is seen in the palm as thickening, pits, and nodules. This can lead to Depuytren’s contracture, a flexion contracture of one or more digits that is due to the collagen deposited and the action of myofibroblasts.

Question 19

Extrinsic muscle system (of hand)

Answer 19

Muscles acting on the joints of the wrist and hand that originate in the arm an insert in the hand

Question 20

Mallet finger

Answer 20

Interruption of the extensor tendon mechanism over the distal interphalangeal joint.

Results in distal interphalangeal joint flexion contracture

Question 21

Nerve entrapment

Answer 21

Disorder that occurs when adjacent tissue restricts gliding of the nerve. The nerve is subjected to stretch that can result in paresthesias and pain.

Question 22

Tendinitis

Answer 22

Inflammation of a tendon

Question 23

Tendinosis

Answer 23

A degeneration Of tendon cells without inflammation . This is usually a chronic process that leads to decreased tendon strength

Question 24

Tendovaginitis

Answer 24

Inflammation of the tendon sheath

Question 25

Trigger finger

Answer 25

Resistance to motion in a finger as a result of narrowing of the pulley system and enlargement of the tendon. The finger can become stuck in a bent position and requires additional force to extend it.

Question 26

Triangular fibrocartilage complex (TFCC)

Answer 26

A structure between the ulna and the ulnar carpal bones composed of an articular disc in the ligaments that helps stabilize the distal radial ulnar joint and protects the ulnar carpal bones, especially during compressive loading.

Question 27

Epicondylitis

Answer 27

Inflammatory condition of the epicondyle of the medial or lateral elbow

Question 28

Lateral epicondylitis

Answer 28

A form of tendinitis commonly referred to as tennis elbow.

Occurs from repetitive overuse and affects the common wrist extensors origin of the extensor carpi radialis longus, extensor carpi radialis brevis, extensor digitorum, and extensor digiti minimi

Question 29

Ligament stability

Answer 29

Anterior band of the medial ulnar collateral ligament is the main ligamentous stabilizer

Question 30

Medial epicondylitis

Answer 30

And the overuse condition also known as golfers elbow.

Affects the origin of the pronator teres, flexor carpi radialis, flexor digitorum sublimis , and flexor carpi ulnaris at the medial epicondyle of the elbow

Question 31

Medial Valgus stress overload

Answer 31

A condition that occurs commonly among patients who participate in repetitive throwing and racquet sports, it is also known as valgus extension overload

Question 32

Ulnar collateral ligament

Answer 32

A thick triangular band at the medial aspect of the elbow uniting the distal aspect of the humerus to the proximal aspect of the ulna

Question 33

Acromioplasty

Answer 33

Beveling or reshaping of the acromion with detachment of the Coricoacromial ligament

Question 34

Bankart lesion

Answer 34

An avulsion of the capsule and glenoid labrum off of the anterior rim of the glenoid resulting from traumatic anterior dislocation of the shoulder

Question 35

Hill-Sachs lesion

Answer 35

Compression or “impaction fracture” of the posterolateral aspect of humeral head as a result of anterior shoulder instability. Results from instability.

Question 36

Primary shoulder impingement

Answer 36

Mechanical compression of the rotator cuff tendons, primarily the supraspinatus tendon, as they pass under the coracoacromial ligament

Question 37

Secondary shoulder impingement

Answer 37

Relates to glenohumeral instability that creates a reduced subacromial space because the humeral head elevated minimizes the area under the coracoacromial ligament

Question 38

What range is normal functional elbow range of motion?

Answer 38

30-130 degrees