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PCM MIDTERM Flashcards

1
Q

Direct pupillary light reflex

A

when light is shined in the eye, that pupil constricts

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2
Q

Consensual pupillary light reflex

A

when light shined in eye, pupil of the other eye also constricts

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3
Q

Red reflex

A

normal reflection of the retina

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4
Q

Snellen eye chart

A

20/20 normal
held at 14 inches from eyes
be sure to test both eyes open, then covering one eye at a time

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5
Q

What movement is allowed in the coronal plane?

A

sidebending (lateral flexion)

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6
Q

What axis runs perpendicular to the coronal/frontal plane?

A

anterior/posterior axis

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7
Q

What movement is allowed in the sagittal plane?

A

flexion and extension

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8
Q

What axis runs perpendicular to the sagittal plane?

A

the transverse (right-left axis)

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9
Q

What movement is allowed in the transverse plane?

A

rotation

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10
Q

What axis runs perpendicular to the transverse plane?

A

longitudinal axis (superior-inferior axis)

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11
Q

Explain the gravitational line

A

viewing the patient from the side:
imaginary line that starts at or slightly anterior to the lateral malleolus, passes across the lateral condyle of the knee, the greater trochanter, through the lateral head of the humerus at the tip of the shoulder to the external auditory meatus.
if plane is through the body, would intersect body of third lumbar vertebrae (L3 or L2) and anterior sacrum

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12
Q

Postural decompensation in the coronal, horizontal, and sagittal plane lead to what?

A

Coronal: scoliosis
Horizontal: rotation
Sagittal: kyphosis/lordosis

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13
Q

Detail kyphosis

A

concavity anteriorly and convexity posteriorly

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14
Q

Detail lordosis

A

convexity anteriorly and concavity posteriorly

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15
Q

Detail scoliosis

A

lateral curvature in the coronal/frontal plane can create a C or S shaped deviation

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16
Q

Kypholordotic

A

head forward; exaggerated kyphosis/lordosis; anterior pelvic shift; abdomen anterior; hips slightly flexed

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17
Q

Swayback

A

head forward; decreased lumbar lordosis; posterior tilt of pelvis

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18
Q

Flatback

A

head forward; lower thoracic kyphosis flattening; lumbar lordosis flattened

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19
Q

Pectus excavatum

A

funnel chest
abnormally depressed lower sternum
compression of structures

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20
Q

Pectus carinatum

A

pigeon chest
abnormal prominence of sternum anteriorly
AP diameter increased

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21
Q

What does the central compartment consist of?

A

labrum; ligamentum teres; articular surfaces

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22
Q

What does the peripheral compartment consist of?

A

femoral neck; synovial lining

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23
Q

What does the lateral compartment consist of?

A

gluteus minimus; gluteus medius; iliotibial band; trochanteric bursae (deep and superficial)

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24
Q

What does the psoas (anterior) compartment consist of?

A

iliopsoas insertion; iliopsoas bursae

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25
Q

What is C-sign?

A

if you ask the patient where you hurt and make a C with their hand

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26
Q

Symptoms of central compartment problems

A

C-sign
Catching and locking
Pain in the lumbar spine; groin (medial); pelvic rim; in the a.m. or after a run
Instability
Can have low back pain that radiates into the groin

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27
Q

Causes of central compartment problems

A

trauma; twisting on a hip that has excess weight on it; repetitive strain (Golfers)

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28
Q

Pathology of central compartment

A 
labral tears
ligamentum teres disruption
osteochondral defects 
chondromalacia/osteoarthritis 
loose bodies (float around in the central compartment causing problems)
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29
Q

Log Roll Test

A

have patient lay supine
take extremity and roll it as a log
contain above and below the knee and just roll the leg; if it hurts then +
specific to central and peripheral compartment

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30
Q

labral loading test

A

FOR CENTRAL C
take hip and knee and flex to 90 degrees
support patient and press down; pressing the femoral head into the acetabulum so forcing pressure on the ring

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31
Q

labral distraction test

A

FOR CENTRAL C
then hook underneath the knee and lift the hip
Pain should be relieved

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32
Q

Scour test

A

FOR CENTRAL C
start at 90 degrees of hip and knee flexion
instead of loading straight down he is going to run the extremity through an omega sign or annular movement

(You are taking the femoral head and grinding it around in the acetabulum so if you have a loose body that will not feel well)

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33
Q

Apprehension (FABER) test for central compartment

A

abduct and external rotate flexed hip and the doctor will press down; if pain +
stabilize the ASIS on opposite side

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34
Q

Symptoms of peripheral compartment issues

A

catching/locking
pain with hip movement (deep hip and groin)
limited range of motion

INJURY: congenital; post trauma (fall and MVA)

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35
Q

Pathology of the peripheral compartments

A

Loose bodies; impingement syndrome (PINCER type: when the socket is affected of the ball and socket joint; CAM type: the femoral neck instead of being tapered it can be more cylindrical in nature)
Synovitis (synovial lining that gets irritated that can cause PCP)

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36
Q

Describe Ely’s test.

A

FOR PERIPHERAL C
lay patient prone; flex knee 90 degrees and we can push them even further
looking for it he has tension then when he goes to flex his foot to the gluteal then his hip will lift off the table and thats a + test because the rectus femoris is tight

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37
Q

Describe Rectus Femoris test.

A

FOR PERIPHERAL C
slide towards edge of the table and he will hug both knees and then let go of one knee and thats what we are going to test
we are looking for how much flexion his knee has; should have 90 degrees of flexion so if less then its a + test

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38
Q

Symptoms of a lateral compartment issue

A

weakness (difficulty with lifting leg to climb stairs)
pain (lateral hip, pelvic rim, radiating down leg to knee, knee pain)
instability

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39
Q

Pathology of the lateral compartment

A

overuse “training for a marathon”
IT Band syndrome: tension in the IT band where it gets shortened
Bursitis
Rotator cuff tendonopathies: gluteus medius and minimus

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40
Q

Bursitis test.

A

“jump sign” find greater trochanter and we press on it and if he jumps or withdrawals then thats +

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41
Q

ITB Syndrome

A

FOR LATERAL C
“Straight leg test”

can be used for tight hamstrings, nerve root compression for lumbar disc pathology or IT band problems

With IT band problems the pain will be in the lateral aspect and it will be at greater than 15 degrees once you engage the IT band

“Ober’s Test”

lay the patient on the left side (you can stand anterior or posterior to them)

If IT band is shortened he is going to want to abduct so he won’t want to adduct INABILITY TO ADDUCT

He will bend the knee a little bit and stabilize at the hip and then let go. And he should fall down correctly; if the leg stays up then that would be a + test

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42
Q

Testing for Rotator cuff pathology in the LATERAL C

A

PIRIFORMIS TEST
patient supine; flex the knee up and lay the foot flat on the table; cross the opposite foot over that knee so we are testing the left side because that is the opposite foot; have patient push the opposite knee against you if there is pain then its +

TRENDELENBURG
have patient stand up; us stand behind him; have patient lift one foot of the ground and we are looking for what his pelvis does; look at the hip of the opposite foot because that is the weight bearing side

if there is weakness then when he lifts his foot off the ground the pelvis will drop on the lifted side because the weight bearing side muscles aren’t strong enough to hold the hips level

FABER
place hand on lateral aspect of bended knee and then have him try to push against me (my hand under the knee) and his hip will lift off the table; if weakness or pain then thats a + test

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43
Q

Symptoms of Anterior compartment

A

Pain (anterior hip; medial groin; anterior deep thigh)

Hyperextension (jumping, running) overuse

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44
Q

Pathology of Anterior compartment

A

Psoas tendonitis; iliopsoas bursitis (at the insertion site)

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45
Q

FABER test for ANTERIOR C

A

put hand on top of knee and have him press up against our hand

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46
Q

Psoas Test

A

FOR ANTERIOR C

have patient place foot flat against the table and have him lift his leg against our hand on the knee

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47
Q

Thomas Test

A

FOR ANTERIOR C
slide patient to the end of the table; we are looking for the inability to extend his hip and if his hip stays up flexed then that is the iliopsoas muscle being tight
INABILITY TO EXTEND

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48
Q

What is the Q angle and whats the normal degree?

A

Normal 15 degrees

Angle measured between straight lines created from ASIS to center of the patella and tibial tuberosity to center of the patella

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49
Q

Genu valgum

A

posture with knees close together and feet farther apart (knock-kneed)

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50
Q

Genu varus

A

posture where the legs appear bowed with feet together (bow-legged)

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51
Q

Genu recurvatum

A

posture seen from a lateral view, where the knee has a backward curvature

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52
Q

Patellar reflex tests what dermatome

A

primarily L4

L2-4

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53
Q

Testing to MCL ligament

A

VALGUS
patient supine and examiner supports the patient’s lower leg, with the knee flexed to 30 degrees
hands are placed on the medial and lateral aspects of the patient’s knee
while providing lateral resistance at the knee, move the lower leg so that the ankle shifts laterally while holding the distal femur in place
+ test: increased laxity, soft or absent endpoint or pain
INDICATES MCL disruption

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54
Q

Testing LCL ligament

A

VARUS
examiner and patient in same position as the valgus stress test. while providing medial resistance, examiner moves the lower leg so that the ankle shifts medially.
This test is done at 30 degrees of flexion and neutral

+ test: increased laxity, soft or absent endpoint or pain
INDICATES LCL disruption

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55
Q

Anterior draw test: explain it and what its testing?

A

patient supine with knee flexed to 90 degrees; examiner sits on the patient’s foot and grasps the proximal tibia with both hands, pulling the tibia anteriorly
+ test: excessive translation when compared to the other knee
INDICATES: ACL insufficiency

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56
Q

Lachlan’s Test: explain it and what its testing

A

Patient supine; examiner places cephalad hand on the distal thigh, superior to the patella; ciudad hand grasps the proximal tibia; flexing the knee to 15-30 degrees, the examiner uses his ciudad hand to pull the tibia anteriorly while the cephalad hand stabilizes the thigh
+ test: increased laxity; soft or absent end point
INDICATES: ACL insufficiency

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57
Q

Posterior drawer test: explain it and what its testing

A

patient supine with knee flexed to 90 degrees; examiner sits on the patients foot and grasps the proximal tibia with both hands, translating the tibia posteriorly

+ test: excessive translation, particularly when compared to the opposite side

INDICATES: PCL deficiency, posterior capsular injury or disruption

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58
Q

Reverse Lachman’s Test: explain it and what its testing

A

patient supine; examiner places cephalad hand on the distal thigh, superior to patella; ciudad hand grasps the proximal tibia; flexing the knee to 15-30 degrees
the proximal hand stabilizes the femur while the distal hand pushes the tibia posterior

+ test: increased laxity; soft or absent end point when compared to the opposite joint

INDICATES: PCL deficiency/post capsule deficiency

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59
Q

McMurray’s Test: explain it and what its testing

A

patient is supine, with hip and knee flexed; examiner uses caudad hand to control the ankle and cephalad hand placed on distal femur
Rotate the tibia into internal rotation and applies a VARUS stress, then continues the leg into extension
Rotate the tibia into external rotation and applies a VALGUS stress, then continues the leg into extension

+ test: pain or a painful click during extension
INDICATES: possible medial (external rotation) or lateral meniscus tear (internal rotation)

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60
Q

Apley Grind–Compression test (PART 1)

A

TESTS MENISCAL INJURY
patient prone with knee flexed to 90 degrees
use downward force on the foot to provide a compressive force on the meniscus, while rotating the foot internally and externally

+ test: pain with rotation and/or compression

INDICATES: possible meniscal injury (Collateral ligament or both)

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61
Q

Apley Grind–Distraction test (PART 2)

A

TESTS COLLATERAL LIGAMENTOUS INJURY
patient prone with knee flex to 90 degrees
stabilize the thigh, then applies upward traction to the leg while rotating it (traction reduces meniscal pressure, but increases ligamentous strain)

+ test: pain with distraction and rotation

INDICATES: possible collateral ligament damage

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62
Q

Patella Laxity Test

A

one hand above and one hand below the joint; thumbs placed against the medial side of the patella; examiner pushes laterally, assessing range of motion

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63
Q

Patellar Apprehension Test

A

when testing laxity to the point of restriction, ask the patient if the maneuver provokes any discomfort or sense of instability

+ test: sense of apprehension or instability

INDICATES: possible previous patellar dislocation or severe instability

64
Q

Patellar Compression (Grind) Test

A

patient supine and knee extended; provide compressive load to the patella with one hand while moving the patella medial and lateral

+ test: pain with compression
if it reproduces symptoms that could be indicative of something with patella femoral articulation
INDICATES: possible inflammation, chondromalacia, or injury to the patellofemoral articular surfaces

65
Q

Patella-Femoral Grinding

A

compress patella caudally into trochlear groove and instruct patient to tighten quadriceps against resistance

+ test: crepitation or pain

INDICATES: roughness of articulating surfaces (i.e. chondromalacia)

66
Q

Patellar Glide Test

A

patient sitting or supine will slowly extend and flex the knee, while physician notes quality of the articular motion; placing hand lightly over the patella can increase sensitivity of the test

+ test: palpable or audible crepitus, pain, or catching of the patella

INDICATES: possible damage to the articular surface

67
Q

Chondromalacia

A

cartilage degeneration, softening

poor alignment/tracking of the patella

can be associated with an abnormal Q angle

68
Q

Osgood-Schlatter disease

A

overuse injury
common in adolescents
avulsion of secondary ossification center of tibial tubercle

69
Q

Where is the deltoid ligament located?

A

medial ankle

70
Q

Where would you take the posterior tibial pulse?

A

right behind the medial malleolus

71
Q

How would you test for capillary refill of the toes

A

blanch out the toes and see how fast the color returns

72
Q

Forefoot adduction & abduction are testing what joints?

A

talonavicular & calcaneocuboid joints

73
Q

Inversion & Eversion are testing what joints?

A

talocalcaneal, talonavicular & calcaneocuboid joints

74
Q

Dorsiflexion & Plantar flexion are testing what joints?

A

talus, tibia & fibula

75
Q

What makes the medial longitudinal arch?

A

talus, navicular, cuneiforms 1-3 & metatarsals 1-3

76
Q

What makes up the lateral longitudinal arch?

A

calcaneus, cuboid & metatarsals 4-5

77
Q

What makes up the transverse distal tarsal arch?

A

navicular, cuboid, cuneiforms 1-3 & proximal metatarsals

78
Q

Monofilament test

A

test is performed on the plantar aspect of the foot
doctor has patient close their eyes
monofilament is placed on the 1st and 4th pad of toes and at base of first, third and fifth plantar MTP joints with enough pressure to cause a slight bend of the monofilament

+ test: if patient cannot feel the monofilament
IMPORTANT IN DIABETIC FOOT EXAM

79
Q

ROM of dorsiflexion

A

15-20 degrees

80
Q

ROM of plantarflexion

A

55-65 degrees

81
Q

ROM of subtalar inversion

A

20-30 degrees

82
Q

ROM of subtalar eversion

A

10-20 degrees

83
Q

ROM of forefoot adduction

A

20 degrees

84
Q

ROM of forefoot abduction

A

10 degrees

85
Q

Components of pronation

A

dorsiflexion, abduction & eversion of calcaneus

5 degrees

86
Q

Components of supination

A

plantar flexion, adduction & inversion of calcaneus

20 degrees

87
Q

What innervates the dorsiflexors of the foot?

A

deep fibular nerve (L4/L5) mainly L5

88
Q

What innervates the plantar flexors of the foot?

A

tibial nerve (L5, S1/S2)

89
Q

What innervates fibularis longus/brevis?

A

superficial fibular nerve (L5)

90
Q

The achilles reflex tests what nerve root?

A

S1

91
Q

Anterior Drawer test of the foot

A

grasp the posterior calcaneus with one hand and cup the distal tibia/fibula with the other hand, monitoring anteriorly at the anterior talus

provide anterior force on calcaneus while stabilizing the distal tibia/fibula

normal springing of calcaneus back to neutral should occur

+ test: pain (sprain), no springing, excessive motion, gapping (tear)
anterior/laxity: ATF ligament pathology/tear

92
Q

Talar Tilt Test

A

grasp the distal tibia/fibula with one hand and the inferior calcaneus with the other, blocking motion of the calcaneus on the talus

invert the talus to evaluate ROM

+ test: laxity, increased ROM or pain
calcaneofibular ligament pathology/tear and some ATF

93
Q

Eversion test

A

grasp distal tibia/fibula with one hand and grasps the mid foot from the plantar surface of the foot with the other hand

doc everts/pronates the foot to evaluate ROM

+ test: laxity, increased ROM or pain = deltoid ligament pathology

94
Q

Squeeze test (HIGH ANKLE SPRAIN)

A

wrap hands around leg proximal to the ankle, contacting the distal tibia/fibula with both thenar eminences: squeeze for 2-3 seconds–rapidly release

+ test: pain at syndesmosis: syndesmosis pathology, high ankle sprain

95
Q

Cross Leg Test

A

for evaluating high ankle sprain:
Patient seated
patient crosses affected leg over opposite knee
patient then applies pressure to proximal fibular of affected leg

+ test: pain at distal ankle = syndesmotic injury

96
Q

Thompson Test

A

patient prone with foot off the table
doc squeezes the calf

+ test: absence of plantar flexion; achilles tendon rupture

97
Q

Homan’s Sign

A

indicates thrombophlebitis or acute deep venous thrombosis

patient laying or seated with knee extended; doc dorsiflexes the foot (some add lateral compression of calf as well) with knee extended

+ test is pain with dorsiflexion

98
Q

Venous thrombosis

A

the presence of edema, erythema and increased warmth of the skin of the lower leg increases suspicion for DVT

need to get a venous doppler to rule out clot

99
Q

Moses Sign

A

indicates deep vein thrombosis of the posterior tibial veins

patient seated or supine
induce an anterior compression on the gastrocnemius muscle into the posterior aspect of the tibia

+ test: pain with anterior compression–not lateral compression

100
Q

Inversion ankle sprain (LATERAL SPRAIN)

A

80-85% of all ankle sprains

ankle inversion with plantar flexion

Involves: ATF, calcaneofibular and PTF ligaments

swelling and ecchymosis over involved area

101
Q

High Ankle sprains

A

10% of all ankle sprains

ankle eversion and rotation (some dorsiflexion)

Involves: anterior inferior tibiofibular and syndesmosis

Pain more common on medial aspect with minimal swelling; pain worse with weight bearing

102
Q

Plantar Fascitis

A

inflammation of origin of plantar aponeurosis

worse with first steps, improves through day: patient will complain pain is worst when they get out of bed in the morning

point tenderness of calcaneus

Causes: tight calves, repetitive high impact activities, high arches, obesity, new/changes in activities

103
Q

Morton’s Neuroma

A

inflammation and thickening of tissue that surrounds the nerve between toes

most commonly between 3rd and 4th toes

reports feeling like they are walking on a marble; palpable in web space, which will replicate pain

104
Q

Turf toe

A

inflammation and pain at base of 1st MTP

pain and bruising at base of great toe

caused by hyperextension of great toe causing damage to the joint capsule: can damage sesamoids and flexor tendon

common due to activities performed on hard surface

105
Q

Achilles Tendonitis

A

inflammation at achilles tendon

presents as sharp heel pain and stiffness at mid-Achilles tendon to insertion: worse with strenuous exercising, better with walking

Causes: tight calf muscles, sudden change in activity, poorly fitting shoes, incorrect running technique

106
Q

What nerve root supplies the big toe and the pinky toe?

A

L5-big toe and S1-pinky toe

107
Q

What muscles are used in shoulder flexion?

A

anterior deltoid and coracobrachialis: 180 degrees

108
Q

What muscles are used in shoulder extension?

A

latissimus dorsi and teres major: 60 degrees

109
Q

What muscles are used in shoulder abduction?

A

supraspinatus and mid-deltoid: 180 degrees

Horizontal abduction: 40-55 or 130-145

110
Q

What muscles are used in shoulder adduction?

A

pectoralis major and latissimus dorsi

horizontal adduction: 40-50 and 130-140

111
Q

What muscles are used in shoulder external rotation?

A

infraspinatus and teres minor: 90 degrees

112
Q

What muscles are used in shoulder internal rotation?

A

subscapularis and pectoralis minor: 90 degrees

113
Q

How much rotation happens at the AC joint?

A

10 degrees

114
Q

What muscles are used in scapular retraction?

A

rhomboid major and minor

115
Q

What muscles are used in scapular protraction?

A

serratus anterior

116
Q

What muscles are used in scapular elevation?

A

upper trapezius and levator scapulae

117
Q

What muscles are used in scapular depression?

A

lower trapezius and lower rhomboids

118
Q

What nerve root supplies the thumb and lateral side of the arm?

A

C6

119
Q

What nerve root supplies the 2nd and 3rd phalanges?

A

C7

120
Q

What nerve root supplies the ring and pinky finger?

A

C8

121
Q

Empty Can Test

A

TEST ROTATOR CUFF Ms.

flex patients shoulders to 90 degrees while also abducting approximately 45 degrees.
then internally rotate both arms so thumbs are pointing down and press down on the forearms while patient resists

+ test: pain or weakness
INDICATES: rotator cuff pathology (specifically supraspinatus)

122
Q

Drop-Arm Test

A

patient abducts arm 90-180 degrees then slowly drops arm.

+ test: arm will drop or gentle tap on wrist will cause arm to drop

INDICATES: full thickness tear of supraspinatus

123
Q

Apprehension shoulder test

A

patient is seated or supine
shoulder abducted to 90 degrees and elbow flexed to 90 degrees
stabilize patient’s shoulder with one hand and force arm into external rotation with the other hand

+ test: patient apprehensive of repeat dislocation

INDICATES: glenohumeral instability

124
Q

Sulcus Sign

A

grasp patient’s elbow and apply inferior traction

+ test: indentation appears in area beneath the acromion

INDICATES: glenohumeral instability

125
Q

Yergasons Test

A

patients arm at side with elbow flexed 90 degrees

examiner uses one hand to palpate the bicipital groove and monitors there, while the other hand grasps the patient’s wrist; have patient supinate and externally rotate against doctor’s resistance

+ test: pain and/or tendon subluxation out of the groove

INDICATES: unstable bicipital tendon/subluxation, bicipital tendonitis

126
Q

Speeds Test

A

patients arm forward flexed at the shoulder with hand supinated

slightly flex patient’s elbow; resist at forearm while patient further flexes shoulder

+ test: pain in bicipital groove

INDICATES: bicipital tendonitis of long head of biceps

127
Q

Neer Impingement Test

A

stabilize patient’s shoulder; forearm is pronated; passively flex shoulder to fully flexed position

+ test: pain

INDICATES: subacromial bursa or rotator cuff impingement

128
Q

Hawkins Test

A

flex shoulder to 90 degrees, flex elbow to 90 degrees, slightly adduct and passively rotate the humerus into internal rotation

opposes the rotator cuff against the coracoacromial ligament and acromion

+ test: pain

INDICATES: rotator cuff (usually supraspinatus) or subacromial bursa impingement

129
Q

Apley Scratch Test (testing AROM)

A

Upper: patient abducts arm placing palm of hand behind their neck with palm facing toward the body; patient should attempt to scratch the lowest possible vertebrae
**coupled external rotation and abduction

Lower: patient places arm behind their back with palm facing outward and dorm of hand resting on their mid back ; patient should attempt to scratch the highest possible vertebrae
**coupled internal rotation and adduction

130
Q

Lift Off Test

A

place patient’s arm into internal rotation and adduction
patient extends arm into as doctor resists

+ test: weakness (inability to resist)

INDICATES: subscapularis weakness

131
Q

Biceps brachii reflex

A

tap on your thumb over tendon; C5

132
Q

Brachioradialis reflex

A

tap on tendon; C6

133
Q

Triceps reflex

A

tap on tendon; C7

134
Q

Upper extremity dermatomes

A 
C5 = lateral arm
C6 = lateral forearm & thumb 
C7 = middle finger 
C8 = medial forearm & pinky finger 
T1 = medial arm
135
Q

What muscles are involved in elbow flexion?

A

biceps brachii; brachialis; brachioradialis

136
Q

What muscles are involved in elbow extension?

A

triceps brachii, anconeus

137
Q

What muscles are involved in elbow supination?

A

supinator, biceps brachii

138
Q

What muscles are involved in elbow pronation?

A

pronator teres, pronator quadratus

139
Q

Valgus stress test of the elbow

A

arm slightly abducted and externally rotated; forearm supinated and flexed (to approximately 30 degrees)

slight medial directed valgus stress is applied to elbow joint

+ test: pain/tenderness with palpation and valgus stress; increased laxity (degree of laxity correlates to degree of injury to UCL or MCL)

140
Q

Varus Stress test of the elbow

A

arm slightly abducted and internally rotated; elbow flexed

a slight varus stress is applied to the elbow joint

+ test: pain or increased laxity in LCL (radial collateral ligament)

141
Q

Tinel Test

A

For ulnar nerve entrapment

tap between olecranon and medial epicondyle in ulnar groove

+ test: eliciting tingling sensation down forearm within ulnar nerve distribution

INDICATES: ulnar nerve entrapment, cubital tunnel syndrome

142
Q

Golfer’s Elbow Test

A

for medial epicondylitis

patient’s elbow is flexed to 90 degrees and forearm is placed in supination with the wrist neutral and palm facing up

the examiner places one hand under the proximal forearm for stabilization and the other hand over the patient’s wrist to resist movement. instruct the patient to flex the wrist

+ test: pain/tenderness around the medial epicondyle

143
Q

Tennis Elbow Test (COZENS TEST)

A

for lateral epicondylitis

patients elbow is flexed to 90 degrees and forearm is placed in pronation with wrist neutral and palm facing down

examiner places one hand under proximal forearm for stabilization and the other hand over the patient’s hand to resist movement. instruct patient to extend the wrist

+ test: pain/tenderness around lateral epicondyle; may radiate down lateral forearm

144
Q

Olecranon bursitis

A

olecranon bursa lies superficial to posterior elbow joint

posterior elbow distention and discomfort due to overuse
or occupational or athletic injury
region is often painless and range of motion is normal

145
Q

Little League Elbow

A

pain over the medial epicondyle, initially after throwing (repetitive valgus distraction forces), progresses to persistent pain

most common elbow injury during childhood (growth plates not fused)

146
Q

Radial head instability “Nursemaids elbow”

A

annular ligament tear and/or radial head subluxation from annular ligament

pain with palpation of radial head with anterior displacement of radial head and restriction to posterior glide

elbow will be slightly pronated; flexed and held close to trunk

147
Q

Coupled motions at the elbow:

A

ulnar adduction with supination
ulnar abduction with pronation
radial head anterior glide with supination
radial head posterior glide with pronation

148
Q

Ok Sign Test

A

testing for the anterior interosseous nerve

patient cannot make an O with thumb and forefinger pinched together they would make more of a triangle

149
Q

Tinel’s Sign

A

indicates entrapment of median nerve or carpal tunnel syndrome

can be elicited by tapping over the transverse carpal ligament with either the tip of the examiners finger or reflex hammer with the patient’s wrist held in extension

+ test: parasthesias/numbness/tingling/pain radiating to the thumb; index and middle finger

150
Q

Phalen’s Sign

A

place dorsal aspects of patient’s hands together and force into wrist flexion. Hold for 60 seconds

+ test: any reproduction of symptoms: paresthesias in the distribution of the median nerve

151
Q

Allen Test

A

evaluates functioning of radial and ulnar arteries

occlude both arteries while patient makes a fist; have patient open and close fist; palm should be pale

release pressure on ulnar artery and observe for color return to hand within 5-10 seconds. Repeat with radial artery

152
Q

DeQuervain’s Tenosynovitis

A

pain and inflammation from repetitive overuse of tendons in first dorsal compartment
patients complain of dorsal-lateral wrist and thumb pain, occasionally with radiation into lateral hand and thumb

Possible inflammation sites: abductor pollicis longus; extensor pollicis brevis;

Will have positive Finkelstein test

153
Q

Finkelstein test

A

utilized to assess for tenosynovitis of the 1st dorsal compartment

examiner asks patient to make a fist encompassing their thumb and ulnar deviate the wrist

+ test: increased pain in first dorsal compartment/lateral wrist

154
Q

Scaphoid fracture

A

most common carpal bone fracture due to falling forwards/backwards on outstretched hand

patient complains of dull ashiness deep in radial aspect of wrist after a fall

155
Q

Colle’s Fracture

A

fracture of the distal radius in the forearm with dorsal (posterior) and radial displacement of the wrist and hand

PCM (1 decks)

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