Musculoskeletal: UE Flashcards
1
Q
joint
A
the point of connection between two bones or elements of a skeleton (especially if it allows motion)
2
Q
synovial joint
A
- Bones don’t touch each other, freely moveable
- Bones are covered with articular cartilage
- Synovial cavity separates the bones and cushions the joint
- Synovial membrane lines synovial cavity, secretes synovial fluid
- Joint capsule is fibrous structure that surrounds membrane
- Joint capsule is strengthened by ligaments extending from bone to bone
- Examples: Knee, Shoulder
3
Q
cartilaginous joint
A
- Bones are separated by fibrocartilaginous discs, slightly movable
- Bony surfaces separated by cartilaginous discs
- Center of each disc nucleus pulposus (shock absorber)
- Example: vertebral bodies of spine
4
Q
fibrous joint
A
- Bones are almost in direct contact, no movement
- Intervening layers of fibrous tissue or cartilage hold bones together
- Bones are more or less in direct contact
- Examples: forearm, suture of the skull
5
Q
ball and socket joint
A
- Synovial
- convex surface in concave cavity
- flexion, extension, abduction, adduction, rotation, and circumduction
- Ex. shoulder and hip
6
Q
hinge joint
A
synovial joint
- flat, planar
- allow motion in one plane only: flexion and extension
- Ex. IP joints of hand and foot, elbow
7
Q
Condylar joint
A
- convex or concave: condyles
- movement of two articulating surfaces
- example: knee or temporomandibular joint
8
Q
inspection of UE
A
- joint symmetry, alignment and bony deformities
- Surrounding tissues for skin changes (erythema), nodules, muscle atrophy, swelling
9
Q
palpation of UE
A
- joint for crepitus, tenderness, deformity
- Surrounding tissues for skin changes (warmth), nodules, muscle atrophy
10
Q
ROM of UE
A
- test joint function and stability, integrity of ligaments
- Active ROM first, then passive ROM if appropriate
11
Q
Strength testing of UE
A
- test against resistance to grade strength of the muscle
- Strength testing evaluates muscular strength and nerve function which controls that muscle
- Part of neurological exam section in Bates
- Often documented as part of musculoskeletal exam
- Graded on a scale from 0-5 (see Bates table)
- 5/5 is normal strength
12
Q
bones of the shoulder joint
A
humerus, clavicle, scapula
13
Q
joints of the shoulder
A
- Glenohumeral Joint
- -Ball and socket joint at scapula and humerus
- -Large ROM
- Sternoclavicular Joint (SC joint)
- Acriomoclavicular Joint (AC joint)
14
Q
muscles of the shoulder
A
- Scapulohumeral Group
- -Rotator Cuff: SITS
- Axioscapular Group
- -Help rotate the scapula
- Axiohumeral Group
- -Internal rotation of the shoulder
15
Q
rotator cuff
A
- Supraspinatus
- -Initiates Deltoid Abduction
- Infraspinatus
- -External Rotation
- Teres Minor
- -External Rotation
- Subscapularis
- -Internal Rotation, Adduction
16
Q
biceps tendon
A
Long head of biceps enclosed in synovial sheath
17
Q
subacromial bursa
A
Lies on top of supraspinatus tendon between head of the humerus and the acromion
18
Q
Shoulder ROM
A
Flexion Extension Abduction Adduction Rotation -Internal -External Circumduction
19
Q
inspection of shoulder
A
Look for swelling, muscle atrophy, deformity or abnormal positioning
20
Q
palpation of shoulder
A
- Find 3 bony landmarks
- -Acromion process; move laterally and superior to greater tubercle of humerus
- -Acromioclavicular joint: find the anterior tip of the acromion, distal end of the clavical
- -Coracoid process (medial bony prominence)
21
Q
crossover test
A
- Adduct patient’s arm across chest as you palpate the AC joint
- Pain indicates positive test
- -AC or SC joint disease
22
Q
strength testing of shoulder
A
- Strength testing: movement against resistance
- -Flexion/Extension
- -Abduction/Adduction
- -Internal/External Rotation
- -Shrug (CN XI)
- Isolate shoulder joint with proper hand position and bracing
- Gives you a sense of rotator cuff strength
23
Q
sulcus sign
A
- glenohumeral instability
- arm straight and relaxed to side of pt, elbow is grasped and downward traction is applied; a depression at the acromion indicates glenohumeral instability
24
Q
drop arm test
A
patient fully abducts arm to shoulder level, ask them to lower the arm slowly. 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
25
neer test
- 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; shoulder pain indicates shoulder impingement of posterior cuff or bicipital tendonitis
26
hawkins test
- rotator cuff injury
- shoulder flexed to 90 degrees, elbow flexed to 90 degrees, examiner grasps wrist with one hand and elbow with the other and passively externally rotates the shoulder (subscapularis) and internally rotates the shoulder (supraspinatus, teres minor, infraspinatus); pain suggests impingement of affected rotator cuff muscles
27
jobe's test
- supraspinatus impingement
- “empty can” test
- extend arms in front at 90 degrees with thumbs pointed downward (“empty can”); pt lifts arms against resistance; positive test indicates supraspinatus impingement
28
lift-off test
- subscapularis tear or impingement
- patient internally rotates shoulder, places back of their hand on lower back, internally rotates against resistance; weakness suggests subscapularis tear or impingement
29
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 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
30
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
31
bones of elbow joint
Distal humerus, proximal radius, proximal ulna
32
muscles of the elbow/forearm
```
Biceps
-Flexion
Brachioradialis
-Flexion
Triceps
-Extension
Pronator teres
-Pronation
Supinator
-Supination
```
33
ROM of elbow/forearm
Flexion
Extension
Supination
Pronation
34
ulnar nerve location
Ulnar nerve runs posterior between medial epicondyle and olecranon process
35
Inspection of elbow
swelling, deformity
36
palpation of elbow
olecranon process, epicondyles, ulnar nerve
37
ROM of elbow
flexion, extension, supination and pronation (with arm @ 90 deg, elbow into body)
38
Strength of elbow
flexion and extension
39
elbow abnormalities
- olecranon bursitis
| - biceps tendon rupture
40
tennis elbow
lateral epicondylitis
41
bones of wrist
Distal radius
Distal ulna
Carpal bones (8): scaphoid, lunate, triquetrium, pisiform, trapezium, trapezoid, capitate, hammate
42
bones of hands
```
Metacarpals
Phalanges
Proximal phalange
Middle phalange
Distal phalange
```
43
joints of the wrist and hand
- Radiocarpal joint
- Distal radioulnar joint
- Midcarpal joint
- Carpometacarpal joint
- Metacarpophalangeal joint (MCP Joint)
- Proximal interphalangeal joint (PIP Joint)
- Distal interphalangeal joint (DIP Joint)
44
muscles of the wrist
- Flexor carpi ulnaris and radialis
- Extensor carpi radialis brevis and longus
- Extensor carpi ulnaris
- Supinator
- Pronator teres
45
ROM of the wrist
```
Flexion
Extension
Supination
Pronation
Deviation
-Radial
-Ulnar
```
46
Carpal tunnel
- Contains flexor tendons of forearm 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
47
muscles of the hand
- Fingers
- -Extensor digitorum
- Thumb
- -Abductor pollicis longus
- -Extensor pollicis longus
- -Extensor pollicis brevis
- -Flexor pollicis longus
- Intrinsic hand muscles
- -Lumbricals (flexion)
- -Dorsal interossei (abduction)
- -Palmar interossei (adduction)
48
ROM of the fingers
- Flexion
- Extension
- Abduction
- Adduction
- Thumb: flexion, abduction and opposition
49
inspecting wrist and hand
swelling, deformity, thenar atrophy, flexion contractures of fingers
50
palpation of wrist and hand
- distal radius and ulna, carpal bones, fingers (phalanges), snuffbox (scaphoid),
- -PIPJ, DIPJ stability
51
ROM of wrist and hand
- 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
52
Hand exam: motor nerves
- Radial nerve: Thumb extension (extensors)
- Median nerve: Thumb opposition (flexors)
- Ulnar nerve: Criss-Cross fingers (hand intrinsics)
53
strength of wrist and hand
- Wrist: flexion, extension
- Fingers: adduction, abduction
- Thumb: opposition
- Grip strength
54
examining sensation of wrist and hand
```
Median nerve
-Index finger (volar)
Ulnar nerve
-Small finger (volar/dorsal)
Radial nerve
-Web space of thumb and index finger (dorsal)
```
55
Finkelstein's
- 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
56
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
57
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
