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My PCM 2 > Neck UE exam (Pitcher) > Flashcards

Neck UE exam (Pitcher) Flashcards

1
Q

Common causes of hoarseness

A 
Acute infection 
Smoking
Tumors
Thyroid Enlargement 
 Damage to the Recurrent Laryngeal Nerve
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2
Q

Common causes of enlarged lymph nodes

A

metastatic cancer
lymphoma
infection

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3
Q

common causes of enlarged thyroid

A

goiter

thyroid cancer

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4
Q

common causes of neck/ arm pain

A

central or peripheral nerve impingement
torticollis
lymphadenopathy
thyroiditis

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5
Q

Common Neck Conditions

A

Somatic dysfunction
Muscle sprain or spasm
Torticollis- Sternocleidomastoid spasm causes ipsilateral sidebending and contralateral rotation
Thoracic outlet syndrome
Disc herniation- often causes nerve root impingement
Spondylolisthesis- forward displacement of one of the vertebra may compress the spinal cord
Osteoarthritis- chronic degenerative arthritis
Ankylosing spondylitis- spinal inflammatory degenerative arthritis that causes vertebral fusion
Vertebral fracture- caused by trauma, osteoporosis, malignancy,

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6
Q

TMJ

A

Temporomandibular Joint (TMJ): May radiate pain to neck region
Palpate at rest then during slow opening and closing of mouth
Crepitus, clicks, clunk, locking or fear of locking

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7
Q

Anterior neck triangle borders

A

Superior-Mandible
Medial-Midline of the Neck
Lateral-Sternocleidomastoid muscle

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8
Q

Posterior neck triangle borders

A

Inferior-Clavicle
Posterior-Trapezius Muscle
Anterior-Sternocleidomastoid Muscle

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9
Q

Cervical Triangles: Mass Differential

A

Preauricular and angle of jaw: salivary gland or parotid
Posterior triangle: high index of suspicion for malignancy
Supraclavicular (esp left): suggest malignancy.
Anterior triangle: enlarged LN, branchial cleft cyst
Central: thyroid or malignant origin, dermoid cyst, thyroglossal duct cyst

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10
Q

Cervical lymphatic drainage

A

Most lymphatic drainage is into the deep system
Deep nodes are deep to sternocleidomastoid muscle and normally not palpable except the supraclavicular node when enlarged
Virchow’s Node-palpable left sided supraclavicular node suggests thoracic or abdominal malignancies
Right sided enlarged supraclavicular lymph node suggests malignancy of mediastinum, lungs or esophagus

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11
Q

Goiter

A

Often grow slowly, may be due to Hashimoto’s thyroiditis or iodine deficiency, be asymptomatic , can cause some obstructive symptoms (most usual is exertional dyspnea, then cough)if large enough. Evaluation includes the search for nodules and cellular exam if found. Other causes are Graves, benign multinodular goiter, cancer

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12
Q

Thyroglossal duct cyst

A

Congenital epithelial remnant of the thyroglossal tract that forms a cyst due to an unknown stimulus. May contain thyroid cancerous cells.

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13
Q

Branchial Cleft Cyst

A

Typically near mandibular angle and anterior to SCM

Benign but get infected, typically removed

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14
Q

Structural Neck Exam. Inspection: Posture

A

Position of the head and trunk in 2 positions
Nose Midline
Laterally- Ear in line with the shoulder, greater trochanter, fibular head, and lateral malleolus
Spinal curves –
front to back
side to side

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15
Q

Structural Neck Exam: Palpation

A 
Lymph nodes
Range of motion
Thyroid
Clavicle, upper ribs
TART
- Spinous processes			       
- Paraspinal musculature
- Transverse Processes
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16
Q

Structural neck exam: range of motion- active and passive

A

Flexion- 45°
Extension- 60°
Rotation- 80°
Side bending- 45°

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17
Q

Range of neck motion and muscles involved

A

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

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18
Q

Radiculopathy

A

Radiculopathy: Central is true dermatomal

Screen with sensory exam and deep tendon reflexes bilaterally

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19
Q

Cervical Foraminal Compression Test

A

(Spurling’s maneuver)

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

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20
Q

Maximum cervical compression test

A

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

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21
Q

Distraction Test

A

Used to alleviate radicular symptoms and support a diagnosis of radiculopathy.

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22
Q

Thoracic Outlet Syndrome

A

Occurs when there is compression of vessels and nerves in the area of the clavicle.
Anomalous cervical rib
Tight fibrous band that connects the spinal vertebra to the rib
Muscle anomalies: variable insertion points
Injury: whiplash, repetitive motion (working overhead)
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 restore the gap

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23
Q

Roo’s Test

A

(for thoracic outlet syndrome)
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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24
Q

Adson’s Test

A

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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25
Q

Common causes of upper extremity trouble

A 
Injury
- Contusions 
- Fractures
- Tendon or ligament tears
- Repetitive use
             tendonitis
             bursitis
Muscular Disorders
- Muscular dystrophy
- Rabdomyolysis
Bone and Joint Disorders
- Arthritis- osteo or rheumatoid
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26
Q

Shoulder joint types

A 
Acromioclavicular: Synovial condylar
Glenohumeral
Synovial spheroidal type
Labral ring
Rotator cuff
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27
Q

Rotator Cuff Muscles

A

Supraspinatus
Infraspinatus
Teres minor
Subscapularis

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28
Q

Shoulder Exam Inspection and Palpation

A

Acromioclavicular Joint
Glenohumeral joint
- Arm extension exposes sub acromial structures
Scapula
- Winging of the scapula- Long thoracic nerve injury causing a weak serratus anterior muscle
Humerus

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29
Q

Shoulder exam range of motion

A 
Abduction- 180° 
Adduction- 75° 
Flexion- 180°
Extension- 60°
External Rotation- 90°                                                                                 
Internal Rotation- 100°
30
Q

Shoulder Strength movements and muscle actions

A 
Trapezius 
Superior- elevation
Middle- retraction 
Inferior- depression
Levator Scapula- elevation
Rhomboids- retraction
Pectoralis- depression (in and down)
Biceps- flexes humerus
Coracobrachialis- flexes and adducts the humerus
Latissimus Dorsi- extends and medially rotates humerus
31
Q

Strength Testing: Neurologic screening

A

Isolate the joint about which you are testing strength. For example, if you are testing strength of elbow flexion, hold the arm on both sides of the elbow.
Compare one side to other.
Use the following scale when recording and reporting strength so that the measured strength is the numerator, i.e. measured strength/5
0 - No active movement
1 - Muscle contraction, no movement
2 - Full active ROM with gravity eliminated e.g, horizontal to floor
3 - Full active ROM against gravity, e.g, perpendicular to
floor
4 - Full active ROM against partial resistance
5 - Full active ROM overcome full resistance

32
Q

Rotator Cuff Injuries

A

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.

 SITS: Supraspinatus, Infraspinatus, Teres Minor, Subscapularis
33
Q

To test supraspinatus

A

Hold resistance at elbow
Patient abducts against resistance
(arm bent 90 degrees)

34
Q

To test subscapularis

A

Patient rotates forearm medially against resistance

arm bent 90 degrees

35
Q

To test infraspinatus, teres minor

A

Patient rotates forearm laterally against resistance

arm bent 90 degrees

36
Q

To test thoracohumeral group

A

patient adducts forearm against resistance

arm bent 90 degrees

37
Q

Shoulder special test: supraspinatus injury

A

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.

38
Q

Shoulder special test: subscapularis injury

A
  1. 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.
    1. Bear Hug
      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.
39
Q

Infraspinatus

A

Use strength testing
maneuver comparing
bilaterally
(arms bent 90 degrees, looks like abducting)

40
Q

Shoulder special tests: Crossover Test

A

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.

41
Q

Shoulder special tests: Drop Arm Test

A

supraspinatus tendon rupture

42
Q

Shoulder special tests: Apley Scratch Test

A

Upper arm- Tests external rotation and abduction
Lower arm-Tests internal rotation and adduction
Tests ROM
If deficient, suggests adhesive capsulitis

43
Q

Apprehension Test

A

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.
Anterior dislocation 95-97% compared to posterior dislocation

44
Q

Shoulder Special Tests: O’Brien’s Test

A

Glenoid labrum stability

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 tear (SLAP- Superior labrum anterior to posterior).

45
Q

Shoulder Special Tests: Speed’s Test

A

Flex straight arm to 90° with the palm facing upward. The patient resists the student pushing down. If pain occurs in the area of the bicipital groove the test test is positive indicating biceps tendonitis.

46
Q

Shoulder Special Tests: Hawkin’s Impingement Sign

A

Examiner grasps patients elbow with one hand and their distal forearm with the other
Examiner passively internally rotates the shoulder
Impinges primarily supraspinatus
Confirm supraspinatus pathology (empty can, drop arm)

47
Q

Shoulder Special Tests: Neer’s Impingement sign

A

Stabilize scapula
Internally rotate and flex arm

Subacromial impingement
Supraspinatus pathology
48
Q

Shoulder special tests: Subacromial Bursa

A

Stabilize the shoulder and extend the humerus. Pain may indicate subacromial bursitis although the problem may the rotator cuff.

49
Q

Normal ranges of Elbow Motions

A

Extension: 0 degrees
Flexion: 150 degrees
Pronation: 70 degrees
Supination: 90 degrees

50
Q

Common Elbow Conditions

A

Sprains
Olecranon Bursitis
Epicondylitis- lateral and medial
Associated tendinitis- Flexor or extensor
Nursemaid’s elbow (radial head dislocation)
Posterior elbow (ulnar dislocation)
Somatic dysfunctions- radial head anterior/posterior
Osteoarthritis or rheumatoid arthritis
Fractures
Peripheral neuropathies
Cubital Tunnel Syndrome- ulnar nerve compression behind the medial epicondyle

51
Q

Radial Head somatic dysfunction

A

Normal Motion
Posterior with Pronation and Anterior with Supination
Radial Head Posterior Somatic Dysfunction
Does not move anteriorly with supination
Radial Head Anterior Somatic Dysfunction
Does not move posteriorly with pronation
Compare both sides

52
Q

Radial head subluxation

A

Also known as nursemaid’s elbow usually due to sudden pulling on the arm by an adult.
Grip the radial head and feel its movement during pronation and supination. Then try to glide it anteriorly and posteriorly.
Similar to looking for radial head somatic dysfunction
Reduce by applying mild posterior pressure on the radial head while fully pronating. Feel for a click
OR
Apply mild posterior pressure on radial head, fully supinate, apply some traction and flex the elbow.

53
Q

Lateral epicondylitis and Extensor Tendinitis

A

Tennis Elbow
Generally chronic not acute
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 tendinous attachment at the lateral epicondyle of the extensor carpi radialis brevis (ECRB), the supinator, extensor carpi radialis longus (ECRL), and the extensor digitorum communis (EDC)

54
Q

Medial epicondylitis and Flexor Tendinitis

A

Golfers Elbow
Generally chronic not acute
Symptoms: Pain in the medial elbow and volar region of the forearm. Worse with wrist flexion, gripping or lifting.
Cause: Repetitive use of forearm flexors
Pathology: microtears of the common tendinous attachment at the medial epicondyle of the flexor carpi radialis (FCR), pronator teres, palmaris longus, flexor carpi ulnaris (FCU), flexor digitorum superficialis.

55
Q

Elbow Special Tests: Lateral Epicondylitis Test (tennis elbow)

A

Palpate the lateral epicondyle while resisting the patients wrist extension. Pain is a positive test.
Associated with extensor tendonitis

56
Q

Elbow Special Tests: Medial Epicondylitis Test (pitcher’s or golfer’s elbow)

A

Palpate the medial epicondyle while resisting the patient’s wrist flexion. Pain is a positive test.
Associated with flexor tendonitis

57
Q

Elbow Special Tests: Collateral ligament disruption

A

Valgus and Varus Stress Tests-
For the valgus stress test, push on the lateral side
of the elbow while abducting the distal forearm
away from the body. Feel for looseness.
For the Varus stress test, do the opposite.

58
Q

Elbow Special Tests: Radiohumeral and ulnohumeral joint tests

A

Position the elbow where discomfort occurs, then radially or ulnarly deviate the wrist to compress the radial head or ulna into the humerus. Pain indicates a problem with that joint.

59
Q

Hand anatomy- joints

A 
a - Carpometacarpal joint 
	b - Metacarpophalangeal joints 
	c - Proximal interphalangeal joints 
	d - Distal interphalangeal joints 
	e - Interphalangeal joint of thumb
60
Q

Hand and Wrist Inspection

A

Hand
Rheumatoid arthritis:
Ulnar deviation
Boutonniére deformity

Osteoarthritis:
Heberden’s nodes-distal interphalangeal
Bouchard’s nodes-proximal interphalangeal

61
Q

Hand and Wrist Palpation

A 
Radius, ulnar styloid, and the radiocarpal and radioulnar joints. 
Anatomic snuffbox: scaphoid/navicular
Carpometacarpal joints 
Lateral and medial aspects  
- Metacarpal-phalangeal  (MCP)
- Proximal interphalangeal  (PIP)
- Distal interphalangeal  (DIP)
62
Q

Hand and Wrist ranges of motion

A

Most often checked with active range of motion
Wrist
Extension - 70 degrees
Flexion- 90 degrees
Radial deviation (abduction) - 20 degrees
Ulnar deviation (adduction) - 55 degrees

Hand  
MCP hyperextension - 30 degrees 
MCP flexion - 90 degrees 
PIP and DIP extension - 0 degrees 
PIP and DIP flexion - 90 degrees 
Opposition - thumb should touch the 5th MCP
63
Q

Wrist special tests: Tinel’s sign

A

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.
Tinel’s sign is not specific for carpal tunnel syndrome. It can be used in the diagnosis of any compression neuropathy.

64
Q

Wrist special test: 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 one minute. A positive test results in reproduction of the patient’s pain.

65
Q

Common Wrist and Hand problems

A

Tenosynovitis- DeQuervain’s disease and others
Ganglion cysts
Synovial lining extensions that fill with fluid that often becomes gelatinous
Osteoarthritis
OA of the hands shows Heberden’s nodes at the DIP joints.. May not be symmetric.
Rheumatoid arthritis
RA of the hands shows deformity of the wrist, MCP and PIP joints, but not the DIP joints. Ulnar deviation. Symmetric.
Psoriatic arthritis
Involves the DIP joints, and inflammation of the skin
Gout
Inflammation of the joint due to deposition of uric acid crystals
Carpal tunnel syndrome- median n. compression (more in neuro)

66
Q

Boxer’s Fracture

A

Distal 5th metacarpal fracture with volar angulation.

Often due to punching something like a wall

67
Q

Scaphoid fracture

A

Snuffbox tenderness
Often missed on x-ray
Doesn’t heal well due to poor blood supply

68
Q

Dupuytren’s contracture

A

Inflammation, thickening and contracture of the palmar fascia most commonly in the 4th and 5th digits.

69
Q

Trigger finger

A

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.

70
Q

Hand special tests: grind test

A

Tests for carpo-metacarpal osteoarthritis
Most commonly found at 1st carpo-metacarpa joint
Abduct thumb and grasp base of metacarpal and rotate it back and forth looking for discomfort.

71
Q

Hand special tests: Finkelstein’s test

A

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 for tenosynovitis of the extensor pollicis brevis and abductor pollicis longus (De Quervain’s Disease).

72
Q

Hand Special tests: Varus/ Valgus ligament stress, Thumb/ Ulnar collateral ligament stress

A

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.
Thumb/Ulnar collateral ligament stress
Put stress on the upper thumb joint, by pushing the thumb away from the hand. Compare bilaterally!

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