Neck and Upper Extremity Exam Flashcards by Claire Clifton

Torticollis

Sternocleidomastoid spasm causes ipsilateral sidebending and contralateral rotation

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Spondylolisthesis

forward displacement of one of the vertebra may compress the spinal cord

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Ankylosing spondylitis

spinal inflammatory degenerative arthritis that causes vertebral fusion

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Spurling’s maneuver evaluates what?

Cervical nerve impingement

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Spurling’s maneuver procedure?

Side bending to the affected side with compression down along the spinal axis- produces radicular symptoms

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Maximum cervical compression test -procedure

Add extension and rotation to the same side as the head is side bent

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Distraction Test

Used to alleviate radicular symptoms and support a diagnosis of radiculopathy

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Thoracic Outlet Syndrome

compression of vessels and nerves in the area of the clavicle.

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Thoracic Outlet Syndrome- s/s?

pain in the neck and shoulders

numbness in the last 3 fingers and forearm.

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Roo’s Test evaluates for what?

Thoracic outlet syndrome

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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.

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Adson’s Test evaluates for what?

Thoracic outlet syndrome

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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.

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Empty Can Test evaluates what?

supraspinatus test

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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.

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shoulder strength - supraspintus test

elbow at 90- pt abducts against resistance

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shoulder strength - subscapularis test

elbow at 90- pt rotates forearm medially against resistance

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shoulder strength - infraspinatus, teres minor test

elbow at 90- pt rotates forearm laterally against resistance

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shoulder strength - thoracohumeral group

elbow at 90- pt adducts forearm against resistance

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lift off test evaluates what?

subscapularis injury

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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.

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Bear hug test evaluates what

subscapularis injury

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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.