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PCM 2.1 > Neck + UE > Flashcards

Neck + UE Flashcards

1
Q

common cervical symptoms

A
  1. hoarseness
  2. enlarged lymph nodes
  3. enlarged thyroid
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2
Q

anterior triangle borders

A
  1. superior - mandible
  2. medial - midline of the neck
  3. lateral - SCM mm
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3
Q

posterior triangle borders

A
  1. inferior - clavicle
  2. posterior - trapezius mm
  3. ant - SCM mm
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4
Q

cervical lymphatic drainage

A
  • most drains into deep system
  • deep nodes are deep to SCM mm and normally not palpable except supraclavicular node
  • Virchow’s Node - supraclavicular node of the deep chain that is sometimes palpable in thoracic or abdominal malignancies
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5
Q

thryoglossal duct cyst

A
  • during embryonic development, thryoid tissue migrates from base of the tongue through the thyroglossal duct into the neck
  • if the duct does not close before birth, a thyroglossal duct cyst may form
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6
Q

inspection of the neck - posture

A
  • position of the head and trunk in 2 positions:
    1. nose midline
    2. laterally - ear, shoulder, greater trochanter, fibular head, and lateral malleolus
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7
Q

ROM and mm - flexion

A
  • 45 degrees

- anterior neck mm

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8
Q

ROM and mm - extension

A
  • 85 degrees

- posterior neck mm

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9
Q

ROM and mm - rotation

A
  • 90 degrees

- trapezius, scalene, SCM, splenius, longissimus, semispinalis, and obliqus capitis

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10
Q

ROM and mm - side bending

A
  • 40 degrees

- trapezius, scalene, SCM, splenius longissimus, semispinalis, obliqus, longus and rectus capitis

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11
Q

cervical foraminal compression test (Spurling’s maneuver)

A
  • side bending to the affected side with compression down along the spinal axis
  • produces radicular symptoms
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12
Q

maximum cervical compression test

A
  • add extension and rotation to the same side as the head is side bent
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13
Q

distraction test

A
  • used to alleviate radicular symptoms

- support a dx of radiculopathy

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14
Q

thoracic outlet syndrome

A
  • occurs when there is a compression of the vessels and nerves in the area of the clavicle
  • happens when there is an extra cervical rib or cus of tight fibrous band that connects the spinal vertebra to the rib
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15
Q

thoracic outlet syndrome symptoms

A
  • pain in neck and shoulders

- numbness in the last 3 fingers and forearm

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16
Q

thoracic outlet syndrome tx

A

PT which helps strengthen and straighten the shoulder

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17
Q

Roo’s test

A
  • arms abducts to 90 degree, externally rotated
  • elbows flexed 90 degrees
  • patient slowly opens and closes his hands for 3 min
  • pos: weakness, numbness, or tingling of the hand or arm
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18
Q

Adson’s test

A
  • palpate the radial pulse with the elbow and shoulder in extension
  • continue to palpate pulse and move the arm into abduction and external rotation and flex elbow
  • have patient turn their head away form the side being tested
  • pos: pulse diminishes
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19
Q

winging of the scapula

A

long thoracic n. injury causing a weak serratus anterior mm

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20
Q

shoulder ROM

A
  • abduction - 180
  • adduction - 75
  • flexion - 180
  • extension - 60
  • external rotation - 90
  • internal rotation - 100
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21
Q

mm strength scale

A
  • 0 - no active mvmt
  • 1 - mm contraction, no mvmt
  • 2 - full active ROM with gravity eliminated
  • 3 - full active ROM against gravity
  • 4 - full active ROM against partial resistance
  • 5 - full active ROM overcome full resistance
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22
Q

shoulder strength - supraspinatus

A

patient abducts against resistance

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23
Q

shoulder strength - subscapularis

A

patient rotates forearm medially against resistance

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24
Q

shoulder strength - infraspinatus, teres minor

A

patient rotates forearm laterally against resistance

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25
Q

shoulder strength - thoracohumeral group

A

patient adducts forearm against resistance

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26
Q

empty can test

A
  • abduct arms to 90 degree and forward flex to 45 degree. internally rotate to point thumb downward
  • put gentle pressure downward on both arms
  • pos: pain or weakness = injury to supraspinatus mm
27
Q

lift-off test

A
  • arm internally rotated so dorsum of the hand rests on low back
  • patient lift the hand off their low back post against resistance
  • pos: can’t lift off = subscapularis injury
28
Q

crossover test

A
  • adduct the arm across the chest which compresses the AC joint
  • pos: pain = disruption of the AC joint or arthritis
29
Q

rotator cuff injuries

A
  • cause: lifting heavy objects or repetitive abduction or overhead use of the arm
  • symptoms: pain inferior to the ant 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
30
Q

drop arm test

A
  • examiner abducts patient’s arm to 90 degrees and ask patient to slowly lower arm to their side
  • pos: patient’s arm drops to the their side = rotator cuff problem (most often supraspinatus)
31
Q

Apley scratch test

A
  • upper arm - tests external rotation and abduction
  • lower arm - tests internal rotation and adduction
  • pos: adhesive capsulitis
32
Q

apprehension test

A
  • arm is abducted to 90 degrees and externally rotated. put the other hand on the back of the shoulder and push gently forward while gently extending the arm
  • pos: look of alarm on patient’s face or pain = loose joint capsule and potential subluxation or dislocation
33
Q

O’Brien’s test

A
  • flex arm to 90 degrees and adduct across the chest
  • internally rotate with the thumb pointing down and push down on the arm
  • pos: pain = labral tear (SLAP)
  • confirm by repeating with thumb up and no pain
34
Q

Speed’s test

A
  • flex straight arm to 90 degrees with palm facing upward
  • patient resists the student pushing down
  • pos: pain in the area of the bicipital groove = biceps tendonitis
35
Q

Hawkin’s impingement sign

A
  • examiner grasps the patient’s elbow with one hand and their distal forearm with the other
  • examiner passively externally rotates the shoulder (impinges subscapularis mm)
  • examiner passively internally rotates the shoulder (impinges supraspinatus, teres minor, and infraspinatus)
36
Q

subacromial bursa

A
  • stabilize the shoulder and extend the humerus

- pos: pain = subacromial bursitis

37
Q

elbow ROM

A
  • extension - 0
  • flexion - 150
  • pronation - 70
  • supination - 90
38
Q

radial head SD

A

normal motion

  • posterior with pronation
  • anterior with supination
39
Q

nursemaid’s elbow (radial head subluxation)

A
  • due to sudden pulling on the arm
  • grip the radial head and feel its mvmt during the pronation and supination. then try to glide it anteriorly and posteriorly
40
Q

lateral epicondylitis and extensor tendinitis (tennis elbow)

A
  • generally chronic
  • symptoms: pain in the lateral elbow and dorsal region of the forearm. worse with wrist extension, gripping, or lifting
  • cause: repetitive use of forearm extensors
  • pathology: microtears of the extensor mm
41
Q

medial epicondylitis and flexor tendinitis (golfer’s elbow)

A
  • generally chronic
  • symptoms: pain in the medial elbow and volar region of the forearm, worse with wrist flexion, gripping, or lifting
  • cause: repetitive use of the forearm flexors
42
Q

lateral epicondylitis test

A
  • palpate lateral epicondyle while resisting the patient’s wrist extension
  • pos: pain
43
Q

medial epicondylitis test

A
  • palpate the medial epicondyle while resisting the patient’s wrist flexion
  • pos: pain
44
Q

radiohumeral and ulnohumeral joint tests

A
  • position the elbow where discomfort occurs
  • radially and ulnarly deviate the wrist to compress the radial head or ulna into the humerus
  • pos: pain = problem with that joint
45
Q

inspection of hand

A
  • rheumatoid arthritis
    1. ulnar deviation
    2. boutonniere deformity
  • osteoarthritis
    1. heberden’s nodes - DIP
    2. bouchard’s nodes - PIP
46
Q

inspection of wrist

A

ganglion cyst

47
Q

wrist ROM

A
  • extension - 70
  • flexion - 90
  • radial deviation (Abduction) - 20
  • ulnar deviation (adduction) - 55
48
Q

hand ROM

A
  • MCP hyperextension - 30
  • MCP flexion - 90
  • PIP and DIP extension - 0
  • PIP and DIP flexion - 90
  • opposition - thumb should touch 5th MCP
49
Q

Tinel’s sign

A
  • sharply tap over the location of the medial nerve in the carpal tunnel, on the palmer surface of the wrist
  • pos: reproduce patient’s pain, typically shooting pain or parasthesias in the distribution of the media nerve
  • not specific for carpal tunnel syndrome. can be used to dx any compression neuropathy
50
Q

Phalen’s maneuver

A
  • 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 1 min
  • pos: reproduce patient’s pain
51
Q

common wrist and hand problems

A
  • tenosynovitis
  • ganglion cysts
  • osteoarthritis
  • rheumatoid arthritis
  • psoriatic arthritis
  • gout
  • carpal tunnel syndrome
52
Q

ganglion cysts

A

synovial lining extensions that fill with fluid that often becomes gelatinous

53
Q

psoriatic arthritis

A

involves DIP joints and inflamm of the skin

54
Q

gout

A

inflamm of the joint due to deposition of uric acid crystals

55
Q

colle’s fracture

A
  • distal radius fracture with distal fracture fragment displace dorsally
  • often due to falling on an outstretched hand
56
Q

boxer’s fracture

A
  • distal 5th metacarpal fracture with volar angulation

- often due to punching something like the wall

57
Q

scaphoid fracture

A
  • snuffbox tenderness
  • doesn’t heal well due to poor blood supply
  • often misse on x-ray
58
Q

dupuytren’s contracture

A
  • inflamm, thickening and contracture of the palmar fascia most commonly in the 4th and 5th digits
59
Q

trigger finger

A
  • inflamm of the flexor digitorum tendon sheath which becomes trapped under the retinaculum just proximal to the MCP joints during flexion
  • extension of the finger requires assistance and often snaps/triggers as it slips past the pulley
60
Q

grind test

A
  • tests for carpo-metacarpal osteoarthritis
  • most commonly found at 1st carpol-metacarpal joint
  • abduct thumb and grasp base of the metacarpal and rotate it back and forth looking for discomfort
61
Q

Finkelstein’s test

A
  • put the patient’s thumb inside their first, and then gently ulnar deviate the wrist
  • pos: pain occurs along the thumb or wrist = tenosynovitis of the extensor pollicis brevis and abductor pollicis longus (De Quervain’s disease)
62
Q

thumb/ulnar collateral ligament stress

A

put stress on the upper thumb joint by pushing the thumb away from the hand

63
Q

varus/valgus ligament stress of the hand

A

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

PCM 2.1 (5 decks)

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