Neck and Upper Extremity Exam Flashcards
Torticollis
Sternocleidomastoid spasm causes ipsilateral sidebending and contralateral rotation
Spondylolisthesis
forward displacement of one of the vertebra may compress the spinal cord
Ankylosing spondylitis
spinal inflammatory degenerative arthritis that causes vertebral fusion
Spurling’s maneuver evaluates what?
Cervical nerve impingement
Spurling’s maneuver procedure?
Side bending to the affected side with compression down along the spinal axis- produces radicular symptoms
Maximum cervical compression test -procedure
Add extension and rotation to the same side as the head is side bent
Distraction Test
Used to alleviate radicular symptoms and support a diagnosis of radiculopathy
Thoracic Outlet Syndrome
compression of vessels and nerves in the area of the clavicle.
Thoracic Outlet Syndrome- s/s?
pain in the neck and shoulders
numbness in the last 3 fingers and forearm.
Roo’s Test evaluates for what?
Thoracic outlet syndrome
Roo’s Test
Arms abducted to 90°, externally rotated
Elbows flexed at 90°
Patient slowly opens and closes his hands for 3 minutes.
If there is weakness, numbness or tingling of the hand or arm the test is positive.
Adson’s Test evaluates for what?
Thoracic outlet syndrome
Adson’t test procedure
Palpate the radial pulse with the elbow and shoulder in extension
Continue to palpate pulse and move the arm the arm into abduction and external rotation and flex elbow.
Have the patient turn their head away from the side being tested.
If the pulse diminishes then the test is positive for thoracic outlet syndrome.
Empty Can Test evaluates what?
supraspinatus test
empty can test procedure
Abduct arms to 90° and forward flex to 45°. Internally rotate to point thumb downward (like emptying a can of soda). Then put gentle pressure downward on both arms. Pain or weakness indicates injury to the supraspinatus muscle.
shoulder strength - supraspintus test
elbow at 90- pt abducts against resistance
shoulder strength - subscapularis test
elbow at 90- pt rotates forearm medially against resistance
shoulder strength - infraspinatus, teres minor test
elbow at 90- pt rotates forearm laterally against resistance
shoulder strength - thoracohumeral group
elbow at 90- pt adducts forearm against resistance
lift off test evaluates what?
subscapularis injury
lift off test procedure
With arm internally rotated so dorsum of hand rests on low back, have patient lift the hand off their low back posteriorly against your resistance.
Bear hug test evaluates what
subscapularis injury
bear hug test procedure
The patient crosses a hand to the opposite shoulder and attempts to oppose an examiner effort to lift the hand off the shoulder. Inability to resist the examiners effort is subscapularis weakness.
Crossover test evaluates what
disruption or arthritis in the AC joint
crossover test procedure
adduct the arm across the chest which compresses the acromioclavicular joint. Pain = positive
Drop arm test evaluates what?
supraspinatus tendon rupture
Apley scratch test tests what
shoulder ROM- if deficit suggest adhesive capsulitis
Shoulder apprehension test evaluates what
shoulder dislocation
O’Brien’s test evaluates what?
Glenoid Labrum stability
O’Brien’s test procedure
flex arm to 90 and adduct across the chest. Internally rotate with the thumb pointing down and push on the arm
Speed’s Test evaluates what?
biceps tendonitis
Speed’s Test procedure?
flex straight arm to 90 with palm up, The pt resist a force down. If this reproduces pain in the bicipital groove the test is positive
Hawkin’s Impingement Sign evaluates what?
supraspinatus evaluation
Hawkin’s Impingement Sign- procedure
Examiner grasps patients elbow with one hand and their distal forearm with the other
Examiner passively internally rotates the shoulder
Neer’s impingement sign evaluates what
Subacromial impingement
Supraspinatus pathology
Neer’s impingement sign- procedure
Stabilize scapula
Internally rotate and flex arm above head
Subacromial Bursa
Stabilize the shoulder and extend the humerus. Pain may indicate subacromial bursitis although the problem may the rotator cuff.
Radial Head Subluxation
AKA: nursemaids elbow
Lateral epicondylitis and extensor tendinitis
AKA tennis elbow- pain over lateral epicondyle or extensors with palpation
Medial epicondylitis and flexor tendonitis
AKA golfers elbow- pain over medial epicondyle or flexors
Rheumatoid Arthritis Findings (hand)
ulnar deviation and boutonneir deformity (wavy finger)
Osteoarthritis finding (hand)
heberden’s (DIP) and bouchards (PIP) nodes
Tinel’s sign evaluates for what?
compression neuropathy- carpal tunnel syndrome
Tinel’s sign procedure
Sharply tap over the location of the median nerve in the carpal tunnel, on the palmar surface of the wrist, using your index and middle finger, or a reflex hammer.
A positive test is noted by reproduction of the patient’s pain typically a shooting pain or parasthesias in the distribution of the median nerve.
Phalen’s maneuver evaluates for what?
carpal tunnel
Phalen’s maneuver procedure
Ask the patient to flex both wrists to 90 degrees and place the dorsal aspect of the hands together, and hold them in that position for one minute. A positive test results in reproduction of the patient’s pain.
Colles’ Fracture
distal radius fx w/ distal fx fragment displaced posteriorly. Often due to a FOOSH
Boxer’s Fracture
Distal 5th metacarpal fx with solar angulation- often due to punching something hard
Scaphoid Fracture
Pain in the snuffbox
Dupuytren’s contracture
Inflammation, thickening and contracture of the palmar fascia most commonly in the 4th and 5th digits.
Trigger finger
Inflammation of the flexor digitorum tendon sheath which becomes trapped under the A-1 pulley (retinaculum) just proximal to the MCP joints during flexion, and extension of the finger requires assistance and often snaps/triggers as it slips past the pulley.
Grind Test
procedure
Abduct thumb and grasp base of metacarpal and rotate it back and forth looking for discomfort.
Finkelstein’s test- procedure
Put the patient’s thumb inside their fist, and then gently ulnar deviate the wrist. If pain occurs along the thumb or wrist, the test is positive .
Grind test evaluates for what?
Tests for carpo-metacarpal osteoarthritis
Finkelstein’s test evaluates for what
tenosynovitis of the extensor pollicis brevis and abductor pollicis longus (De Quervain’s Disease).
Thumb/Ulnar collateral ligament stress
Put stress on the upper thumb joint, by pushing the thumb away from the hand. Compare bilaterally!
Finger Varus/Valgus ligament stress tests
Varus/Valgus ligament stress
Stabilize the proximal bone with one hand while using the other hand to deviate the distal bone to the ulnar and radial sides checking for ligamentous instability.
