OSPE UL Flashcards
How do you test the function of the Pectoralis Major muscle?
Which nerves do you test when doing so?
Adduct the abducted arm against resistance (+palpate the muscle)
Test the Medial and lateral pectoral nerves (C5, C6, C7, C8, T1)
How would you test the function of the Serratus anterior muscle?
Which Nerve do you assess when doing so?
Both Arms of the subject outstretched with palms against the wall, asked to press forward strongly
–> See if scapula keeps attached to the thorax
Long-thoracic nerve C5,6
How would you test the function of the trapezius muscle?
Which nerve do you assess when doing so?
Raise both shoulders against resistance
Tests: Accessory nerve (CN XI)
How would you test the function of Latissimus dorsi muscle?
Which Nerve function do you test when doing so?
Abduct the Arm to 90°, then adduct against resistance
–> See+ palpate the muscle in the posterior axillary fold
Testing: Thoraco-dorsal nerve (C6,7,8)
How would you test the function of the deltoid muscle?
Which nerves do you test when doing it?
Abduct the arm against resistance
(Test Axillary nerve, C5, C6)
How do you test the function of the Teres Major?
Which nerve do you assess when doing so?
Adducting the arm against resistance (See+ palpate the muscle in the posterior axillary fold)
Test the: Lower-subscapular nerve C5,6
Identify on a skeleton
- clavicle
- scapula (cromion and scapula spine)
- humerus
- radius
- ulnar
- carpal bones
- metacarpals
- phalanages
Identify the differnt carpal bones on a skelton
Acromion of scapula
Spine of Scapula
What are the possible movements at the Sapulo-thoracic joint?
- Protraction
- Retraction
- Elevation
- Depression
Test the function of the trapezius
Which nerve do you test when doing so?
Patient: Sitting
Examiner: Stand behind the subject
-
Test: Upper and middle fibers
- Ask the subject to elevate the lateral ends of clavicle and scapula as in shrugging the shoulder.
- Examiner places a hand above each shoulder and with a firm downward pressure resists the subject’s action.
-
Test: Upper fibers only
- Ask the subject to extend the head backwards
- Examiner places a hand over the back of the head and resists the subject’s action.
- Nerve: Spinal accessory (XI)
Test the function of Sternomastoid
Which nerve do you test when doing so?
Patient: Sitting
Examiner: Stand in front or side
-
Test: One side only
- Ask the subject to turn the head to opposite side (of the muscle under test)
- Examiner places the palm of the hand against the side of the head (or face) and resists the subject’s action.
-
Test: Both sides
- Ask the subject to bend the head forward.
- Examiner places a hand on the forehead and applies firm pressure to resist the subject’s action.
- Nerve: Spinal Accessory (XI)
Test the function of the Deltoid muscle
Which Nerve do you test when doing so?
Patient: Sitting
Examiner: Faces the subject
-
Test: Main (middle) deltoid
- The subjects extended upper limb lies at the side of the trunk. Ask the subject to abduct the arm.
- Examiner places a hand on the lateral side of forearm and resists the subject’s action. The other hand is placed over the deltoid to feel the contraction.
-
Test: Anterior or posterior fibers
- Ask the subject to flex or extend the upper arm.
- Examiner resists the subject’s action with one hand and feel the contraction of anterior or posterior fibers of deltoid
- Nerve: axillary nerve, C5,6
How would you test the function of Serratus Anterior?
Patient: standing facing a wall
Examiner: standing behind or on the side of the subject
-
Test:
- The subject’s both arms outstretched and palms against the wall. Subject is asked to press forward strongly. –> looking for winging scapula
- Examiner places hand/fingers over the ribs forming the medial wall of axilla and feel the contracting muscle serrations.
- Nerve: long thoracic nerve, C5,6,7
How would you test the pectoral muscles?
Which nerves do you test when doing so?
Patient: Sitting
Examiner: Faces the subject
Test
- The subject’s upper limb is flexed to 90 at the shoulder whilst the elbow is fully extended elbow.
- Ask the subject to adduct the arm.
- Examiner places a hand on the forearm and resists the subject’s action. The other hand is placed over the pectoralis major to feel the contraction.
- Nerve: Medial Pectoral (C8,T1) & Lateral Pectoral (C5.6.7)
How would you test function of the triceps brachii?
Which nerve would you test when doing so?
Patient: Sitting or standing
Examiner: Stand or seated behind the subject
(can be done when the patient is supine on the couch)
Test:
- Start position: The subject slightly abducts the arm at the shoulder (5 -10º) and flexes the elbow to 90º.
- Ask the subject to straighten (extend) the elbow.
- Examiner pushes strongly against the back of the forearm to resist subject’s action.
- With the other hand the contracting long and lateral heads can be palpated (visible as well). The tendon of triceps can also be palpated above the olecranon process
Radial Nerve C6,7
How would you test function of the biceps brachii?
Which nerve would you test when doing so?
Patient: Sitting or standing
Examiner: Standing or sitting in front of the subject
(can be done when the patient is supine on the couch)
Test:
- Start position: The subject slightly abducts the arm at the shoulder (5 -10º) and flexes the elbow to 90º with hand pronated.
- Ask the subject to supinate the hand.
- Examiner grasps the subject’s hand firmly and resists this movement.
- With the other hand the contracting biceps can be palpated (visible as well). The tendon of biceps can also be palpated deeply in the cubital fossa
- Musculocutaneous nerve C5,6
How would you test the function of the dorsal and plamar interossei?
Which Nerve would you test with that?
Ask tha patient to adduct (palmar) /abduct (dorasal) the fingers (against resistance?)
Testing of ulnar nerve C8+T1
Suface mark the basislic, cephalic and mdeial cubital veins
Palpate the pulse of the brachial artery in th arm and in the cubital fossa
In the cubital fossa: medial to the biceps tendon
Palpate the radial and ulnar pulse
Where would you palpate the subclavian and axillary pulse?
Surface mark the dermatomes of the upper limb
Test the biceps reflex
Which nerve route would you test by doing so?
You would test C5,6 with the musculocutaneous nerve
- Subject: sits/ lies supine comfortably, elbow semiflexed, hand pronated
- Place the examiners thumb on biceps tendon
- Tap with a reflex hammer on the tendon
Recall the nerve route in the biceps tendon reflex
- Muscle spindles stretch by hammer –> stimmultaion of sensory neuron –> synapse directly onto motor neurons in anterior horn
- Motor goes back to to stretched muscle –> contraction
In biceps reflex: musculoskeletal with C5,6
How do you test the triceps reflex?
Which nerves do you test when doing so?
Testing the radial nerve (C7,8)
- Subject lies/sits with elbow semiflexed and hand pronated
- Examiner supports the elbow with one hand
- tap triceps tendon directly with hammer
- If intact: see extention of the elbow
How would you test the motor and sensory components of the Axillary nerve?
Which spinal nerves would you test when doing so?
Testing: posterior chord of C5,6
Axillary nerve innervates the Deltoid
- Test for motor Deltoid: Abduction of the shoulder joint
Sensory:
- Regimental batch testing
How would you test the musculocutaneous nerve integrety?
(Motor and sensory component?)
Musculocutaneous = C5,6:
Motor Testing
- flexor of the elbow
Sensory testing:
- lateral skin of the forearm
Test the motor and sensory components of the radial nerve at the
- Arm
- Forearm
Radial Nerve= C5-T1
- Arm
- Motor: Innervation to extensors of elbow
- Forearm
- supinator and wrist extensors (would see wrist lesion in damage)
- Sensory: dorsum of hand & lateral digits
Test the motor and sensory components of the ulnar nerve in the
- Forearm
- Hand
Where is it suspectible to damage?
Ulnar nerve:
Motor Testing
- Forearm:
- flexor carpi ulnaris and
- flexor digitorium profundus
- Hand
- Hypothenar muscles
- adductor of thumb
Senstory testing:
- Medial half of palm and 1.5 fingers. Medial side of upper arm & forearm
Suspectible to damage at the elbow
How would you test the motor and sensory function of the median nerve?
Motor
- Wrist flexors
- Pronators
- Flexion of digits (thumb, index and middle finger) (in damage: hand of benediction)
Sensory
- lateral half of palm and three and one half fingers.and nail beds
What is carpal tunnel syndrome?
What does it result in?
It is a chronic compression of the median nerve at the wrist (under the flexor retinaculum)
What are the boundaries of the Axilla?
- Base: skin + fascia from chest to the arm
- Apex: between 1st rib, superior border of subscpularis and clavicle
- Anterior: Pec Major and minor
- Posterior: Scapula + subscapularis, teres majro and latissimus dorsi
- Medial: Chest wall (Ribs 1-4) and Serratur anterior
- Lateral: intertubercular grove of humerus
What are the contents of the Axilla?
- Arteries – the axillary artery and its branches
- Veins – the axillary vein and its tributaries
- Lymphatic vessels and lymph nodes – axillary lymph nodes (important)
- Nerves – the infraclavicular part of the brachial plexus, long thoracic and intercostobrachial nerves
What are the boundaries of the cubital fossa?
What are its contents?
- Lateral: brachioradialis muscle
- Medial: pronator teres
- superior: line between the humeral epicondyles
What are the contents of the cubital fosa?
- Biceps tendon
- Brachial artery (devides in the cubital fosa)
- median nerve
- radial nerve
- median cubital vein
What are the borders and contents of the antomical snuffbox?
Anatomical snuffbox:
- formed by tendons of extensor pollicis longus and brevis
- Contains:
- radial artery
- close by: radial nerve
Can be used to palpate the scaphoid
Eyplain the surface markings and attachments of the flexor retinaculum
What does it form?
It forms the roof of the carpal tunnel
- attached to the: (connect all 4 points)
- pisiform
- distal end of flexor carpi ulnaris tendion
- hook of the hamate
- 1cm distal and lateral to pisiform, deep to hypothener muscles
- tubrecle of scaphoid
- Fully extens the wrist: along the line of Flexor carpi radialis tendon
- ridge of trapezium
- deep to the middle of the roots of thenar muscles, distal to scaphoid
Test the function of flexor digitorium profundus
Which Nerves are tested when doing so?
The examiner holds the proximal interphalangeal joint in extended position while the distal IP joint is flexed against resistance
- Ulnar Nerve C8+T1 for 4th and 5th digit
- Median Nerve (C8+T1) for 2nd and 3rd digit
Test the function of flexor digitorium superficialis
Which Nerve do you test when doing so?
Median Nerve (C7-T1)
Each digit is tested seperatly
- non-test fingers are heald in full extension
- the proximal IP joint of the test finger is flexed against resistance
Test the extensors of the digits
What is the mian muscle when doing so and where does it get its nerve supply?
Main muscle: Extensor digitorium (Radial Nerve C7,8)
- Hand pronated
- digits are extended at MCP joints
- examiner applies reisistance to the proximal digits–> extensor tendons should become visible and
Test the extors of the wrist
What is the main muscles involved and where does it gets it blood supply from?
Supplied by the radial nerve
- Extensor carpi radialis longus+ brevis
- extensor carpu ulnaris
Test
- let subject extend against resistance
Test the superficial wrist flexors of the forearm
What are the key muscles and what are they supplied by?
Mainly
- Flexor carpi radialis (Median Nerve)
Flexor carpi ulnaris (Ulnar Nerve, C6,7)
Test via wrist extension agaisnt resistance?
