Neck and upper limb exam Flashcards
Identify clinically important anatomical structures of the cervical vertebrae
- Vertebral structure : Body, Cartilaginous discs, Synovial facets, Spinous processes (C7 Vertebra prominence) Transverse processes
- Sternocleidomastoid
- Thyroid gland (causes the most pathology)
Anterior Triangle Borders
- superior
- medial
- lateral
– Superior-Mandible
– Medial-Midline of the Neck
– Lateral-Sternocleidomastoid muscle
Describe important surface anatomical landmarks of the neck
• Hyloid, thyroid cartilage, and cricoid cartilage (this ligament in between there is very little cartilage and it is very thin so if a patient is chocking, you can make an incision, you can save their life (cricothyoidotomy)
Explain proper technique for examining cervical lymph nodes
- preauricular
- occipital
- deep cervical
- submandibular
- submental
- supraclavicular
- Preauricular
- Occipital (stretch around the neck→ drainage over the ear and over to the back of the head)
- Deep cervical -get your hand under the SCM
- Submandibular (midway bw the mandible and submental area
- Sumbental- right in front of the chin
- Supraclavicular- right on top of the clavicle
Describe cervical lymph node and lymphatic drainage of the neck
- Most lymphatic drainage is into the deep system
- Deep nodes are deep to sternocleidomastoid muscle and normally not palpable except the supraclavicular node
- Virchow’s Node-supraclavicular node of the deep chain that is sometimes palpable in thoracic or abdominal malignancies
what muscles allow for different range of motion
- flexion
- ext
- rotation
- SB
– Flexion- anterior neck muscles
– Extension- posterior neck muscles
– Rotation- trapezius, scalene, sternocleidomastoid (SCM), splenius, longissimus, semispinalis, and obliqus capitis
– Side bending- trapezius, scalene, SCM, splenius, longissimus, semispinalis, obliqus, longus and rectus capitis
Cervical Foraminal or Compression Test or Spurling’s maneuver
– Side bending to the affected side with compression down along the spinal axis- produces radicular symptoms and should exaggerate them. If this doesn’t work, try max cervical compression test
Maximum cervical compression test
– Add extension and rotation to the same side as the head is side bent
Distraction Test
– You provide traction (pull up the head) to alleviate radicular symptoms and support a diagnosis of radiculopathy. So if this makes it better then you could support that there was compression
Etiology of thoracic outlet syndrome
- Occurs when there is compression of vessels and nerves in the area of the clavicle.
- Happens when there is an extra cervical rib or because of a tight fibrous band that connects the spinal vertebra to the rib.
Symptoms and treatment of thoracic outlet syndrome
Symptoms include:
– pain in the neck and shoulders
– numbness in the last 3 fingers and forearm.
• Thoracic outlet syndrome is usually treated with physical therapy which helps strengthen and straighten the shoulders.
Roo’s test
Diagnose thoracic outlet:
– 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
Diagnose thoracic outlet
– 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→ it means subclavian a is being impingement
Supraspinatus Injury–> empty can test
• 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.
Subscap injury–> Lift-off test
• 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.
Crossover Test
• Adduct the arm across the chest which compresses the acromioclavicular joint and causes pain if there has been disruption of the AC joint or arthritis.
Rotator Cuff test
Common injury, can be acute or chronic. Cause: Lifting heavy objects or repetitive abduction or overhead use of the arm. Symptoms: pain inferior to the anterior border of the acromion or referred pain to the anterior deltoid insertion on the humerus. Pathology: Acromial spurring, subacromial impingement and bursitis, microtears of the supraspinatus, or complete tear.
Drop arm test (supraspinatous)
– Examiner abducts patient’s arm to 90° and asks patient to slowly lower arm to their side.
– If the patient’s arm drops to their side, the test is positive indicating a rotator cuff problem, most often the supraspinatus
Apley scratch tes
Upper arm- Tests external rotation and abduction. Lower arm-Tests internal rotation and adduction. Suggest adhesive capsulitis→ repetitive damage to shoulder joint, the capsul around the joint itself gets stiff and decreases motion.
Apprehension test
Arm is abducted to 90° and externally rotated. Put the other hand on the back of the shoulder and push gently forward while gently extending the arm. Any look of alarm on the patients face or pain is a positive test for a loose joint capsule and potential subluxation or dislocation. If the shoulder is too lax and the rotator cuff muscle isn’t holding their shoulder enough so when you do if feels like you might be dislocating their shoulder so they become apprehensive.
O’Brian’s Test
Done for biceps tendonitis
– Flex arm to 90°and adduct across the chest
– Internally rotate with the thumb pointing down and push down on the arm
– Pain is a positive test for a labral tear (SLAP- Superior labrum anterior to posterior).
– Confirmed by repeating with thumb pointing up and no pain.
