Orthopedic Conditions of UE part 1

Question 1

Patient was found to have an inferior trunk brachial plexopathy.
Which of the following motions would most likely show weakness?

A. Elbow flexion
B. Shoulder Adduction
C. Scapular Upward Rotation
D. Scapular Adduction

Answer 1

B. Shoulder Adduction

Question 2

THORACIC OUTLET SYNDROME

A: _________ P: _________
M: _________ L: _________

Passage of: _________

Causes: _________

S/Sx: _________

Nn affected: _________

Sensory: _________

Motor: _________

Impaired circulation: _________

Tx:_________

Answer 2

THORACIC OUTLET SYNDROME
Boundaries:

A: Clavicle P: 1st rib
M: sternum L: coracoid process

Passage of: subclavian vessels & inf trunk BP (C8-T1)

Causes: trauma, congenital anomaly, hypertrophied neck ms

S/Sx: Pain at: neck & shoulder/arm pain

Nn affected: ulnar & med pectoral nn

Sensory: medial arm, FA & hand

Motor: ↓ power grip (4th & 5th finger) & Claw hand

Impaired circulation: pallor, cyanosis, pulselessness

Tx:nn mob, 1strib mob, postural reeduc, surgery for cervical
rib & fibrotic scalenes

Question 3

HR jt mob: _________
To increase flexion: _________
To increase extension: _________

Answer 3

HR jt mob: Same
To increase flexion: volar glide
To increase extension: dorsal glide

Question 4

PRU jt mob: _________
To increase supination = _________
To increase pronation = _________

Answer 4

PRU jt mob: opposite
To increase supination = anterior glide
To increase pronation = posterior glide

Question 5

TOS: COMMON AREAS OFCOMPRESSION

1.
2.
3.
4.

Answer 5

1. CERVICAL RIB SYNDROME
2. SCALENUS ANTICUS SYNDROME
3. COSTOCLAVICULAR SPACESYNDROME
4. Hyperabduction Syndrome

Question 6

1. CERVICAL RIB SYNDROME
   - _________
   - Extra ___ or ___ rib
   - May cause _________
   - Tx: _________

Answer 6

1. CERVICAL RIB SYNDROME
   - Congenital anomaly
   - Extra C6 or C7 rib
   - May cause dangerous clots
   - Tx: Cervical ribs surgery
   removal

Question 7

2. SCALENUS ANTICUS SYNDROME

Aka: _________

• _________and _________ hypertrophy

Stretch: _________
R SCM: action? _________
R SCM: _________
R Scalene: _________

Answer 7

2. SCALENUS ANTICUS SYNDROME

Aka: Scalene Triangle

• middle and ant scalenes hypertrophy

Stretch: same SCM
R SCM: A: R LF LRot
R SCM: stretch L LF, R Rot
R Scalene: stretch L LF, R Rot

Question 8

3. COSTOCLAVICULAR SPACESYNDROME

In between: _________ & _________

Causes: _________

Answer 8

3. COSTOCLAVICULAR SPACESYNDROME

In between: 1st rib & clavicle

Causes:postural, tumor, callus s/p Fx,
**heavy backpack (Military position)

Question 9

4. Hyperabduction Syndrome

Passes under: _________
Compression in: _________

PT goals: _________

Answer 9

4. Hyperabduction Syndrome

Passes under: Pecs Minor
Compression in: sub coracoid region

PT goals: Postural Reeducation

Question 10

Identify the 3 TOS locations

1.
2.
3.

Answer 10

1. Scalenus
2. Costoclavicular
   3.hyperabduction

Question 11

Shoulder Girdle Passive Elevation (Relief Test)
“RELEASE PHENOMENON”

Arterial: ___________________________
Venous: ___________________________
Neurological: ___________________________

Answer 11

Shoulder Girdle Passive Elevation (Relief Test)
“RELEASE PHENOMENON”
Arterial: stronger pulse, skin color changes (pinker) and increased hand temperature

Venous: decreased cyanosis and venous engorgement

Neurological: numbness to pins and needles

Question 12

Phases of Pitching (Muscle Activity)
Wind Up: ____________
Cocking: ____________
Acc: ____________
Dec/F-T: ____________

Answer 12

Phases of Pitching (Muscle Activity)
Wind Up: Conc – ER ms
Cocking: Ecc – IR ms
Acc: Conc – IR ms
Dec/F-T: Ecc – ER ms

Question 13

SPECIALTESTS FOR TOS

(+): ___________________________
Indicative: ____________

Answer 13

(+): diminished pulse + reproduction of sx

Indicative: TOS

Question 14

Adson Maneuver

❑ Palpate ____________
❑ Px rotates head to ____________
❑ PT ____________
❑ Ask the px to ____________
❑ (+):
❑ Muscle tested?

Answer 14

❑ Palpate radial pulse
❑ Px rotates head to tested Sh c head ext
❑ PT ext & ER the Sh
❑ Ask the px to take a breath & hold
❑ (+): Diminished pulse
❑ Muscle tested: Scalene

Question 15

Costoclavicular Syndrome
(Military Brace) Test

❑ Palpate ____________
❑ Head in ____________
❑ Draw the ____________
❑ **very particularly effective in px who
complains symptoms while they ____________

Answer 15

❑ Palpate radial pulse
❑ Head in neutral
❑ Draw the px Sh down & back
❑ **very particularly effective in px who
complains symptoms while they carry
a heavy coat or backpack

Question 16

Halstead Maneuver

❑ Palpate ____________
❑ Px ____________
❑ PT applies ____________

Answer 16

❑ Palpate radial pulse
❑ Px hypertext head & rotate towards
opp side
❑ PT applies downward traction

Question 17

Wright Test or Hyperabd Test

❑ Palpate ____________
❑ PT ____________

Answer 17

❑ Palpate radial pulse
❑ PT hyperabd the ER Sh
(palms facing backward)

Question 18

Allen Maneuver (modified wright test)

❑ Aka: ____________
❑ Palpate ____________
❑ PT ___________________________

Answer 18

❑ Aka: Modified Wright Test
❑ Palpate radial pulse
❑ PT places elbow to 90 flex. Sh ext
& ER c head rotated away

Question 19

Roo’s Test/EAST/Positive AER Test/
Hands Up Test

❑ Most accurate clinical test
(84% sensitivity)
❑ ____________
❑ ____________

❑ (+): ___________________________
❑ (-): ___________________________

Answer 19

❑ Most accurate clinical test
(84% sensitivity)
❑ Sh abd 90, ER, & flex elbow 90
❑ Open & close hands slowly for 3 mins

❑ (+): unstable to maintain position,
ischemic pain, heaviness or profound
weakness, numbness/tingling sensation
❑ (-): minor fatigue – Normal

Question 20

Shoulder Girdle Passive Elevation
(Relief Test)

❑ ____________
❑ Px ____________
❑ ____________
❑ (+): ____________

Answer 20

❑ Perform to px who presents
c symptoms
❑ Px sitting c PT grasping
from behind, passively elevate
Sh girdle up & forward into full
elevation (passive B Sh shrug)
❑ Hold 30 secs
❑ (+): relief of sx = “Release
Phenomenon”

(Dapat my pain ang patient)

Question 21

TRAUMATIC VS. ATRAUMATIC Shoulder Instabilities

TRAUMATIC
T - ____________
U - ____________
B - ____________
S - ____________

ATRAUMATIC
A - ____________
M - ____________
B - ____________
R - ____________
I – ____________

Answer 21

TRAUMATIC
T - Traumatic
U - Unidirectional (ant)
B - Bankart lesion (AI labrum detachment)
S - Surgery is required (Bankart repair)

ATRAUMATIC
A - Atraumatic
M - Multidirectional
B - Bilateral
R - Rehab is required but if conservative Tx fails…
I – Inf capsular shift – best alternative for surgical therapy

Question 22

Anterior Shoulder Dislocation
Aka: Dead Arm Syndrome
**MC Sh dislocation
Anatomical fault: ___________________________
___________________________

MOI: ____________ (common in baseball
____________ in late ____________)
Tx: ___________________________

Answer 22

Anterior Shoulder Dislocation
Aka: Dead Arm Syndrome
**MC Sh dislocation
Anatomical fault: assoc c Bankart, weakness
of ant Sh capsule, absent MGH ligament

MOI: Abd + ER (common in baseball
player/pitcher in late cocking & acceleration)
Tx: strengthening of Add IR
If unreduced for >6 wks: surgery

Question 23

Phases of Pitching (Muscle Activity)
Wind Up: ____________
Cocking: ____________
Acc: ____________
Dec/F-T: ____________

Answer 23

Wind Up: Conc – ER ms
Cocking: Ecc – IR ms
Acc: Conc – IR ms
Dec/F-T: Ecc – ER ms

Question 24

Anterior Shoulder Dislocation
COMPLICATIONS:
1.Hill-Sach’s Lesion – ___________________________ **Reverse Hill-Sach – ___________________________ ___________________________

2. Bankart lesion – ___________________________
   **If (+) Fx = Bony Bankart
3. SLAP – ___________________________
4. Axillary nn injury d/t ___________________________
   **mm involved:

Answer 24

COMPLICATIONS:
1.Hill-Sach’s Lesion – compression Fx of PL aspect of HHead
**Reverse Hill-Sach – compression Fx of AM aspect of HHead 2°
posterior dislocation

2. Bankart lesion – detachment of anteroinferior glenoid labrum
   **If (+) Fx = Bony Bankart
3. SLAP – Superior Labrum from Anterior to Posterior
4. Axillary nn injury d/t traction/compression ff ant dislocation
   **mm involved:

Question 25

Anterior Apprehension (Crank) Test ❑ ____________ ❑ **PT fist under HHead = ____________ ❑ (+): ____________ ❑ Indic: ____________ ❑ (+): ____________ ❑ Indic: ____________

Answer 25

❑ Abd + ER slowly ❑ **PT fist under HHead = FULCRUM TEST ❑ (+): apprehension>pain ❑ Indic: Ant Sh dislocation ❑ (+): pain @ post HHead ❑ Indic: Post internal impingement

Question 26

*Crank Test –Test for GH ligaments SGHL - MGHL - IGHL -

Answer 26

SGHL - Arms by the side MGHL - 45-60 abd IGHL - >90abd

Question 27

Active Compression Test of O’BRIEN A. ___________________________ B. ___________________________ (+): ___________________________ Indic: ___________________________

Answer 27

A. Px shoulder F flex, add, and IR c elbow ext then PT apply downward force B. Px same position but c shoulder ER then PT apply downward force (+): pain in A, ↓ or eliminated in B Indic: SLAP

Question 28

Inferior Shoulder Dislocation ❑ Can be ____________ or d/t ____________ (____________ & ____________) ❑ Use ____________ sign ❑ FES: ____________ & ____________

Answer 28

❑ Can be congenital or d/t ms weakness (post deltoids & supraspinatus) ❑ Use Sulcus sign ❑ FES: Supraspinatus & post deltoids

Question 29

Sulcus Sign ❑ ____________: best to test for inf instability ❑ ____________ ❑ (+): ____________ +1 = ____________ +2 = ____________ +3 = ____________ ❑ Indic: ____________

Answer 29

❑ 20-50 Abd: best to test for inf instability ❑ PT grasp distal arm, pull hand inferiorly ❑ (+): sulcus +1 = <1cm +2 = 1-2cm +3 = >2cm ❑ Indic: Inf GH instability

Question 30

Feagin Test ❑ Sh ____________ degrees ❑ PT holds hands over ____________ ❑ (+): ____________ ❑ Indic: ____________

Answer 30

❑ Sh 90 degrees ❑ PT holds hands over humerus & pushes down ❑ (+): sulcus @ coracoid process ❑ Indic: Multidirectional instab

Question 31

Posterior Shoulder Dislocation ❑ MOI: ___________________________ ❑ ___________________________ ❑ Assoc ____________

Answer 31

❑ MOI: axial loading of arm in FADIR or direct blow ❑ Rare & occurs c multidirectional laxity of GH jt ❑ Assoc congenitally

Question 32

Load & Shift Test ❑ ___________________________ ❑ 1st = ___________________________ ❑ 2nd = ___________________________ ❑ Compare to the N side ❑ If Bilat affectation, use grading system N: I: II & III:

Answer 32

❑ Grasp HHead & stabilize Sh ❑ 1st = seat the humerus on the G. fossa ❑ 2nd = push the humerus ant & post ❑ Compare to the N side ❑ If Bilat affectation, use grading system N: <25% - c in fossa I: 25-50% - at the rim II & III: >50% - over the rim

Question 33

Grades of Anterior glenohumeral translations 1. 2. 3. 4.

Answer 33

0-25% - Mild amount of translation 25-50% - Feeling of humeral head riding up to the glenoid rim >50% - Feeling of humeral head riding up to the glenoid rim, but spontaneously reduces. 50% - Feeling of humeral head riding up to the glenoid rim, but remains dislocated.

Question 34

Jerk Test ❑ ___________________________ ❑ ___________________________ ❑ ___________________________ ❑ Indic: ____________ ❑ Can be (+) c ____________

Answer 34

❑ Sh flex 90 & IR ❑ PT grasps elbow & apply axial load & then H. Add → (+) sudden jerk/clunk ❑ Return to orig position → (+) 2nd jerk ❑ Indic: Post Sh dislocation ❑ Can be (+) c PosteroInf labral tear

Question 35

SURGICAL MANAGEMENT 1. Bankart Repair: ___________________________ : ___________________________ 2. Putti-Platt: ___________________________ : ___________________________ 3. Capsular Shift: ___________________________ 4. Capsulorraphy: ___________________________

Answer 35

1. Bankart Repair: Operation of choice for Throwing athletes (ER is not compromised) : tightens the labrum & capsule anteriorly 2. Putti-Platt: subscapularis tendon transfer : not ideal for athletes bec ER is compromised (for sedentary) 3. Capsular Shift: tightening of capsule 4. Capsulorraphy: altering size/features of ant capsule

Question 36

POST-SURGICAL Rehabilitation AVOID: 1. 2. 3.

Answer 36

AVOID: 1. Flexion and horizontal abduction to 90 degrees or greater 2. External rotation to 80 degrees 3. Activities/sports that will induced shoulder dislocations.

Question 37

AC & SC Joint Disorders AC Jt ❑ MOI: ___________________________ ❑ (+) ___________________________ ❑ Tx: Acute phase: ___________________________ SC Jt ❑ MOI: ___________________________ ❑ Tx: ___________________________

Answer 37

AC Jt ❑ MOI: direct blow to Sh (Rugby) ❑ (+) Fountain sign = swelling of AC jt ❑ Tx: Acute phase: UE should be in neutral c the use of sling & avoid sh elevation SC Jt ❑ MOI: fall on lat aspect of Sh c UE Add ❑ Tx: No need = little disability

Question 38

Shear Test ❑ Landmark: ___________________________ ❑ ___________________________ ❑ (+) ___________________________ ❑ Indic: ___________________________

Answer 38

❑ Landmark: Clavicle & spine of scapula ❑ Squeeze c both hands ❑ (+) AbN movement of AC ❑ Indic: AC jt pathology

Question 39

Paxinos Sign ❑ ___________________________ ❑ Thumb ____________ ❑ Thumb ____________ ❑ (+): ____________

Answer 39

❑ 2nd & 3rd finger @ clavicle ❑ Thumb @ PL acromion ❑ Thumb applies AS force @ acromion while 2nd & 3rd finger apply post force @ clavicle ❑ (+): pain at AC jt

Question 40

Total Shoulder Arthroplasty VS. Reverse Total ShoulderArthroplasty INDICATION: persistent or incapacitating pain; loss of shoulder mobility or stability and/or upper extremity strength leading to inability to perform functional tasks

Question 41

Study exercise guidelines IN UR GDRIVE

Question 42

Supraspinatus tendinitis Most common cause of shoulder pain 2° to ___________________________ Patient Profile: ___________________________ : ____________ : ____________ (if young = baseball pitchers or ____________) : ____________, ____________, ____________ S/sx: ____________ Can lead to supraspinatus tear – less pain, nocturnal pain that can be altered c sleeping position, & full PROM

Answer 42

Most common cause of shoulder pain 2° to degenerative changes Patient Profile: Overhead activities : F>M : 35-50 y/o (if young = baseball pitchers or swimmers) : Sedentary, overuse, degenerative S/sx: weakness & painful arc (60-120 Abd) Can lead to supraspinatus tear – less pain, nocturnal pain that can be altered c sleeping position, & full PROM

Question 43

NEER’s CLASSIFICATION of RC PATHOLOGY I – ____________ *____________ II - ____________ *____________ III – ____________ IV – ____________

Answer 43

I – HE (hemorrhage and edema) *reversible & resolves c rest (<25 y/o) II - FT (fibrosis tendinitis) *recurrent pain c activity (25-40 y/o) III – BSTR (bone spurr, tendon rupture) (>40 y/o) IV – RCTear rotator cuff (>60 y/o)

Question 44

S/P ROTATOR CUFF REPAIR REHABILITATION 6 – 8 wks: ___________________________ 10 – 12 wks: ___________________________ 12 – 14 wks: ___________________________ 24 – 28 wks: ___________________________ 36 – 40 wks: ___________________________

Answer 44

6 – 8 wks: passive ROM, endurance, neuromuscular control and maintaining ROM, no CKC 10 – 12 wks: strengthening, no vigorous stretching 12 – 14 wks: task specific strengthening; activities in a controlled environment 24 – 28 wks: return to recreational activities; (80% regained) 36 – 40 wks:90% of strength is regained

Question 45

Acute Calcific Tendinitis Aka: Peritendinitis Calcarea * Deposition of ____________ in ____________ * S/Sx: ____________ : pain affecting sleep : Sh LOM d/t pain : No Abd & Rot * Iontophoresis:Acetic Acid * Tx:Immob : Aspiration (most effective)

Answer 45

Aka: Peritendinitis Calcarea * Deposition of Ca phosphate in tendon * S/Sx: severe localized intolerable pain that radiates to deltoid insertion : pain affecting sleep : Sh LOM d/t pain : No Abd & Rot * Iontophoresis:Acetic Acid * Tx:Immob : Aspiration (most effective)

Question 46

Subacromial Bursitis ❑ Acute phase: ❑ hard to distinguish bet supraspinatus tendinitis ❑ Both (+) pain c resist ❑ Chronic phase: ❑ (+) pain c resist = ❑ (-) pain c resist =

Answer 46

❑ Acute phase: ❑ hard to distinguish bet supraspinatus tendinitis ❑ Both (+) pain c resist ❑ Chronic phase: ❑ (+) pain c resist = supraspinatous tendinitis ❑ (-) pain c resist = subachromial bursitis

Question 47

Bicipital Tendinitis Caused by: ____________ Pain at: ____________, ____________, ____________ Special Test: SPEED’S vs YERGASON’S TEST

Answer 47

Caused by: inadequate depth of bicipital groove Pain at: anteromed Sh, biceps belly, Delts insertion Special Test: SPEED’S vs YERGASON’S TEST

Question 48

Speed’s Test aka: Biceps or Straight-Arm Test Procedure (+): Indic ❑ Maybe (+) in px c __________

Answer 48

❑ Resist F Flex while elbow ext & FA supinated 1st ❑ then pronated ❑ (+): tenderness in bicipital groove (esp. supination) ❑ Indic: Bicipital Paratenonitis/tendinosis ❑ Maybe (+) in px c SLAP Type 2 lesion LBC - Labral Biceps Complex most painful during supination

Question 49

Yergason’s ❑ 1° tests the ability of _____ to hold the _______ ❑ Palpate: _________ ❑ 1st = ❑ 2nd = ❑ (+): ❑ (+): tenderness =

Answer 49

❑ 1° tests the ability of THL to hold the biceps tendon ❑ Palpate: bicipital groove ❑ 1st = Elbow flex 90, FA pronated, Sh IR (used to give way to step 2) ❑ 2nd = Px ER & supination c PT resist ❑ (+): popping out of biceps tendon from groove = Torn THL ❑ (+): tenderness = Bicipital paratenonitis (+) = THL pathology

Question 50

Biceps Tendon Rupture ❑ may progress to ____________ tear: ❑ may be ____________; ❑ MOI: ____________ ❑ S/Sx: ____________ Popeye’s sign Heuter’s sign ❑ Tx: Young: ____________ Adults: non-op = ____________ ❑ Special Test:

Answer 50

❑ may progress to biceps tendon tear: ❑ may be avulsed anywhere in the mm; ❑ MOI: sudden indirect violence c a tendon that has already degen changes ❑ S/Sx: sharp pain c audible snap Popeye’s sign Heuter’s sign ❑ Tx:Young: surgery (tendon transfer to coracoid or bicipital floor) Adults: non-op = regain ms strength 4-6 mos ❑ Special Test: Ludington’s Test

Question 51

Ludington’s Test Procedure (+): Indic

Answer 51

❑ Alternate contxn of biceps ❑ (+): no palpable contxn ❑ Indic: Long head biceps tendon rupture

Question 52

Impingment Syndrome Characterized by soft tissue inflammation of the shoulder against the acromion with repetitive overhead AROM. PRIMARY SECONDARY POSTERIOR (INTERNAL) IMPINGEMENT

Answer 52

A. PRIMARY Impingment Syndrome * Inflammation at the subacromial space * Rotatorcuff tendon degeneration * Osteophytes under AC joint * Hooked acromion B. SECONDARY Impingment Syndrome * Abnormal glenohumeral/scapul othoracic arthrokinematics * Slouched posture * Poking chin * Muscle hypomobility * Capsule tightness (especially posterior) * Adhesions (especially inferiorly) C. Posterior Internal Impingement * MC in: overhead athletes (throwers, swimmers, tennis players) * Manifests at: late cocking/early acceleration * RC (supraspinatus) impinges against the PS edge of the G. fossa * occurs when the arm is in: EXABER * Dx Test:Arthrogram or MRI

Question 53

PRIMARY Impingment Syndrome

Answer 53

A. PRIMARY Impingment Syndrome * Inflammation at the subacromial space * Rotatorcuff tendon degeneration * Osteophytes under AC joint * Hooked acromion

Question 54

SECONDARY Impingment Syndrome

Answer 54

B. SECONDARY Impingment Syndrome * Abnormal glenohumeral/scapul othoracic arthrokinematics * Slouched posture * Poking chin * Muscle hypomobility * Capsule tightness (especially posterior) * Adhesions (especially inferiorly)

Question 55

Posterior Internal Impingement

Answer 55

C. Posterior Internal Impingement * MC in: overhead athletes (throwers, swimmers, tennis players) * Manifests at: late cocking/early acceleration * RC (supraspinatus) impinges against the PS edge of the G. fossa * occurs when the arm is in: EXABER * Dx Test:Arthrogram or MRI

Question 56

Neer Impingement Test Procedure (+): Indic

Answer 56

❑ Sitting ❑ PT depress scapula while other hand IR ❑ Max forced full arm elevation ❑ (+): apprehension – “when px face shows pain” ❑ But if (+) pain on ER = AC jt patho

Question 57

Hawkins-Kennedy test Procedure (+): Indic

Answer 57

❑ Sitting ❑ F Flex 90 ❑ Perform passive IR ❑ (+): pain

Question 58

Yocum’s Test Procedure (+): Indic

Answer 58

❑ Px hand is placed on opp Sh ❑ PT elevate elbow – Passive ❑ (+): pain = Sh impingement

Question 59

Dugas Test Procedure (+): Indic

Answer 59

❑ Px hand is placed on opp Sh ❑ Px lowers elbow to chest – Active ❑ (+): inability = ant Sh disloc s reduction

Question 60

Posterior Internal Impingement Test Procedure (+): Indic

Answer 60

❑ Supine ❑ PT Abd 90-110 c 15-20 Ext & full ER ❑ (+): pain at post aspect of Sh

Question 61

Impingement tests? 1. 2. 3. 4. 5.

Answer 61

Neer Impingement Test Hawkins-Kennedy test Yocum’s Test Dugas Test Posterior Internal Impingement Test

Question 62

Adhesive Capsulitis Aka: ____________, ____________, ____________ Characterized by a restriction in Sh motion as a result of ____________ usually d/t ____________ or ____________. Sex affected? ; age affected? Capsular pattern of limitation: Trick motions: to ↑ Sh Abd = : to ↑ Sh Flex = Reverse Scapulohumeral rhythm Self-limiting (up to 2 years)

Answer 62

Aka: Frozen Sh, Obliterative Arthritis, Diffused RC tendinitis Characterized by a restriction in Sh motion as a result of inflammation and fibrosis of the Sh capsule usually d/t disuse ff injury or repetitive micro trauma. F>M; 40-60 y/o Capsular pattern of limitation: ER>AB>IR DM pt. Dominant: IR = ER > AB > EXT Non-dominant: Hyperext = ER > ABD > IR : trick motions: for increase sh abd (lat bend trunk) increase sh flex (trunk ext) Trick motions: : to ↑ Sh Abd = : to ↑ Sh Flex = Reverse Scapulohumeral rhythm Self-limiting (up to 2 years)

Question 63

Stages of Adhesive Capsulitis check on Gdrive

Answer 63

Claim RPT!

Question 64

Brachial Plexus Injuries 1. 2.

Answer 64

1. ERB-DUCHENNE PARALYSIS 2. DEJERINE-KLUMPKE’S PARALYSIS

Question 65

ERB-DUCHENNE PARALYSIS Nn root: ____________ MOI: ____________ Strong mm: ____________ Weak mm: ____________ Prognosis: ____________ (____________& ____________)

Answer 65

Nn root: C5-C6 MOI:Overstretched upper trunk of BP Strong mm: Mm that asume waiters tip (adducted and IR) Weak mm: Sh. ER, AD, F, FA SUPINATOR, WRIST EXTENSION Prognosis: GOOD (hands & fingers not affected)

Question 66

DEJERINE-KLUMPKE’S PARALYSIS Nerve root: ____________ Affects: ____________, ____________, ____________ ____________ prognosis

Answer 66

Nerve root: C8-T1 Affects: FA pronators, Wrist flexors, Intrinsic ms of the hands POOR prognosis

Question 67

Long Thoracic Nerve Injury Can be injured by blows or pressure on the ____________ trunk or during the surgical procedure of ____________. Aka: ____________ Weakness: ____________ - ____________ - ____________ Occurs on: ____________ Difficulty in: ____________ Tx: Strengthen: ____________

Answer 67

Can be injured by blows or pressure on the posterior trunk or during the surgical procedure of radical mastectomy. Aka: Open Book Paralysis Weakness:SA - Medial winging - Scapula elevated & moves medially, Inf angle moves medially Occurs on: Abd & F Flex ≥90 Difficulty in: combing hair Tx: Strengthen: Push up c a Plus Wall Push-ups ❑ 15-20 reps ❑ Winging observed @ 5-10 reps

Question 68

Spinal Accessory Nerve Injury Causes the scapula to ____________ and move ____________, with the inferior angle rotated ____________. ____________ Aka: ____________ Weakness: CN XI = ____________ Occurs on: ____________

Answer 68

Causes the scapula to depress and move laterally, with the inferior angle rotated laterally. Radical neck dissection Aka: Sliding Door paralysis Weakness: CN XI = Trapz Occurs on: Lateral winging <90

Question 69

Punch out Test Procedure: (+): Indication:

Question 70

Apley’s Scatch Test R problematic: ____________

Answer 70

R problematic: difficulty in hooking bra

Question 71

Sprengel’s Deformity ____________ MC ____________ Presentation: Scapula is congenitally ____________ & ____________ LOM: ____________

Question 72

Scapula & its muscles are poorly developed Scapula is smaller than normal and is medially rotated/placed

Answer 72

Sprengel’s Deformity

Question 73

MCcongenital deformity in the Shcomplex Presentation: Scapula is congenitally high & undescended

Answer 73

Sprengel’s Deformity

Question 74

Complex Regional Pain Syndrome Previously known as ____________ * Usually occurs after ____________ (esp. ____________) * SEX? at ____________ * laterality? * S/sx: ____________ CRPSI – ____________ STAGEI STAGEII STAGEIII CRPSII – Causalgia – develop after trauma c nerve lesion

Answer 74

Previously known as Shoulder Hand Syndrome * Usually occurs after trauma (esp. Fracture) * F>M at 5th decade * Bilateral or unilateral at first * S/sx: pain, tenderness, stiffness, trophic skin changes, non pitting edema (impaired venous & lymphatic return) CRPSI – RSD (Reflex Sympathetic Dystrophy) – without nerve involvement STAGEI STAGEII STAGEIII CRPSII – Causalgia – develop after trauma c nerve lesion

Question 75

Complex Regional Pain Syndrome STAGES?

Answer 75

CRPS I – RSD (Reflex Sympathetic Dystrophy) Stage 1 – acute/reversible Stage 2 – dystrophic/vasoconstriction/ischemic Stage 3 - atrophic