Musculoskeletal Disorders of the Upper Limb Flashcards
tests for anterior glenohumeral joint instability.
Anterior Apprehension and Relocation Tests
patient is placed in the supine position. The examiner abducts the patient’s shoulder 90 degrees and flexes the elbow 90 degrees.
Anterior Apprehension and Relocation Tests
patient is placed in the supine position. The examiner abducts the patient’s shoulder 90 degrees and flexes the elbow 90 degrees. The examiner uses one hand to slowly externally rotate the patient’s humerus using the patient’s forearm as the lever. At the same time, the examiner’s other hand is placed posterior to the patient’s proximal humerus and exerts an anteriorly directed force on the humeral head
Anterior Apprehension and Relocation Tests
Anterior Apprehension and Relocation Tests
considered positive if
feeling of impending anterior dislocation
from anterior apprehension test
the examiner removes the hand from behind the proximal humerus and places it over the anterior proximal humerus and then exerts a posteriorly directed force, and the patient subsequently reports a reduction in apprehension, this has occurred
positive relocation test has occurred
test evaluates posterior glenohumeral joint stability.
Posterior Apprehension Test
patient’s affected shoulder is forward flexed to 90 degrees and then maximally internally rotated. A posteriorly directed force is then placed on the patient’s elbow by the examine
Posterior Apprehension Test
Posterior Apprehension Test
positive test
50% or greater posterior translation of the humeral head or a feeling of apprehension in the patien
used to evaluate inferior glenohumeral joint instability
Sulcus Sign
patient is seated or standing with the arm relaxed in shoulder adduction. The patient’s forearm is grasped by the examiner, and a distal traction force is placed through the patient’s arm.
Sulcus Sign
In the presence of i rior instability
in sulcus sign
+ test is
sulcus will develop between the humeral head and the acromion
evaluates for acromioclavicular (AC) joint and labral abnormalities
O’Brien Test
The shoulder is flexed to 90 degrees with the elbow fully extended. The arm is then adducted 15 degrees, and the shoulder is internally rotated so that the patient’s thumb is pointing down. The examiner applies a downward force against the arm, which the patient is instructed to resist. The shoulder is then externally rotated so that the patient’s palm is facing up, and the examiner applies a downward force on the patient’s arm, which the patient is instructed to resist
O’Brien Test
A positive test result is indi cated by pain during the first part of the maneuver with the patient’s thumb pointing down, which is then lessened or eliminated when the patient resists a downward force with the palm facing up
O’Brien Test1
+ result obrient test
A positive test result is indi cated by pain during the first part of the maneuver with the patient’s thumb pointing down, which is then lessened or eliminated when the patient resists a downward force with the palm facing up
Obrien test
Pain in the region of the AC joint indicates
AC pathology
pain or painful clicking deep inside the shoulder suggests
labral pathology
The shoulder is passively flexed to 90 degrees and then horizontally adducted across the chest.
Horizontal Adduction Test
+ test
Horizontal Adduction Test
Pain located in the region of the AC joint- suggests AC joint pathology
posterior shoulder pain suggests posterior capsular tightness.
test is for biceps tendonitis
Speed’s Test
patient’s shoulder is forward flexed to 90 degrees with the elbow fully extended and the palm facing up. The examiner applies a downward force against the patient’s active resistance.
Speed’s Test
+ pain
speed’s test means
Pain in the region of the bicipital groove suggests bicipital tendonitis
With the patient’s arm at the side, the elbow is flexed to 90 degrees and the forearm is pronated. The patient then tries to simultaneously supinate the forearm and externally rotate the shoulder against the examiner’s resistance.
Yergason’s Test
This test can provoke bicipital region pain in patients with bicipital tendonitis, and a painful “pop” in patients with bicipital tendon instability.
Yergason’s Test
patient’s shoulder is internally rotated while at the side. The examiner passively forward flexes the patient’s shoulder to 180 degrees while maintaining internal rotation. Pain in the subacromial area suggests rotator cuff tendonitis.
Neer-Walsh Impingement Test
The patient’s shoulder and elbow are each passively flexed to 90 degrees, respectively. The examiner then grasps the patient’s forearm, stabilizes the patient’s scapulothoracic joint, and uses the forearm as a lever arm to internally rotate the glenohumeral joint.
Hawkins-Kennedy Impingement Test
A positive test result is i cated by pain in the subacromial region occurring with the internal rotation.
Hawkins-Kennedy Impingement Test
The examiner passively abducts the patient’s shoulder 90 degrees. The patient is then asked to slowly lower the arm back to the side. A positive test result is indicated by pain and an inability to slowly lower the arm to the side, suggesting a rotator cuff tear.
Drop Arm Test
Shoulder special tests
Anterior Apprehension and Relocation Tests Posterior Apprehension Test Sulcus Sign O’Brien Test Horizontal Adduction Test Speed’s Test Yergason’s Test Neer-Walsh Impingement Test Hawkins-Kennedy Impingement Test Drop Arm Test
patient is asked to fully extend the elbow, pronate the forearm, and make a fist. The examiner then resists the patient’s attempt to extend and radially deviate the wrist. Pain over the lateral epicondyle represents a positive test result and suggests the presence of lateral epicondylitis.
Cozen’s Test
examiner flexes the patient’s elbow 20 to 30 degrees and stabilizes the patient’s arm by placing a hand at the elbow and a hand on the distal forearm. Varus and valgus forces are placed across the elbow by the examiner to test the stability of the radial and ulnar collateral ligaments (UCL), respectively.
Ligamentous Instability Test
Wrist and Hand Special Tests
Finkelstein Test
Watson Test
This test is used to detect tenosynovitis of the extensor pollicis brevis and abductor pollicis longus tendons (de Quervain’s tenosynovitis).
Finkelstein Test
The patient makes a fist with the thumb inside the fingers, and the examiner passively deviates the wrist in an ulnar direction
Finkelstein Test
test assesses scapholunate stability.
Watson Test
The patient’s wrist begins in an ulnarly deviated position. The examiner places a dorsally directed force against the proximal volar pole of the scaphoid. The examiner then radially deviates the wrist while continuing to place the same force against the scaphoid. A “pop” or subluxation of the scaphoid indicates a positive test result.
Watson Test
stage of rehabilitation focuses on reducing the patient’s symptoms and facilitating tissue healing. In specific circumstances, immobilization through splinting or casting might be used
acute stage of rehabilitation
core strengthening and aerobic conditioning should be emphasized during this phase of rehabilitation
acute stage of rehabilitation
Kinetic chain deficits should be identified and treated during the
acute r bilitation stage.
can be used for acute injuries to decrease pain, inflammation, muscle guarding, edema, and local blood flow
cryotherapy
increases blood flow, reduces muscle “spasm,” reduces pain, and can be used in the acute phase of rehabilitation for chronic injuries.
Heat
often used during the acute phase of rehabilitation to reduce muscle guarding and increase local circulation.
High-frequency electrical stimulation
might be required for pain control during the acute phase of rehabilitation.
Opioid and nonopioid analgesics
Randomized, placebo-controlled trials have demonstrated reduced pain, edema, and tenderness, and a faster return to activity in
NSAID-treated athletes
can cause significant gastrointestinal, renal, c vascular, hematologic, dermatologic, and neurologic side effects
Nonsteroidal antiinflammatory drugs (NSAIDs)
NSAIDs should be used only if
if local physical modalities and less toxic medications such as acetaminophen are not effective.
for pain control and reduction of inflammation during the acute phase of rehabilitation
Oral and injected corticosteroids
side effects include suppression of the hypothalamic–pituitary–adrenal axis, osteoporosis, avascular necrosis, infection, and tendon or ligament rupture.
Oral and injected corticosteroids h
when the pain has been adequately controlled and tissue healing has occurred
patient can advance to the recovery phase of r bilitation
recovery phase of rehabilitation indicated by
full pain-free ROM and the ability to participate in strengthening exercises for the injured limb
emphasis of the recovery phase of rehabilitation involves the
restoration of flexibility, strength, and proprioception in the injured limb.
should be corrected in recovery phase of rehabilitation
Strength and flexibility imbalances and m tive movement patterns and muscle substitutions
can be beneficial when correcting strength imbalances
Open kinetic chain exercises
are frequently used to provide joint stabilization through muscle co-contraction
closed chain exercise
Sternoclavicular joint dislocations account for less than % of all joint dislocations
1%
Two thirds of s lar joint dislocations occur
anteriorly
Two thirds of s lar joint dislocations occur anteriorly, whereas one third of dislocations occur
posteriorly
can cause the medial end of the clavicle to become more prominent
Anterior sternoclavicular joint injuries
typically have more pain with a less prominent medial clavicular end.
posterior joint injuries
can also be associated with vascular compromise to the ipsilateral upper limb, neck and upper limb venous congestion, difficulty breathing, or difficulty swallowing. Sternoclavicular joint dislocations
Posterior dislocations
Ligament injuries are commonly graded on a scale of
1 to 3
The presence of tenderness at the sternoclavicular joint without subluxation or dislocation indicates a
grade 1 injury
tenderness with subluxation
at the sternoclavicular joint
grade 2 injury
tenderness with associated dislocation
at the sternoclavicular joint
indicates
grade 3 injury
radiologic evaluation of sternoclavicular joint i ries includes an
anteroposterior radiograph of the chest or sternoclavicular joint and a serendipity view, which involves a 40-degree cephalic tilt view of the sternoclavicular joints
