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Emma - Physical Diagnosis > PD - upper limb > Flashcards

PD - upper limb Flashcards

1
Q

Shoulder complex: 3 joints and 1 articulation

A

glenohumeral joint
acromioclavicular joint
sternoclavicular joint
scapulothoracic articulation

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2
Q

Muscles and tendons surrounding the shoulder joint

A

rotator cuff (SItS: supraspinatus, infraspinatus, teres minor, subscapularis)

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3
Q

Causes of referred shoulder pain

A

coronary artery disease
pulmonary tumors
gallbladder disease

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4
Q

Shoulder ROM 3 main components

A

GH motion
scapulothoracic motion
combined GH/scapulothoracic motion

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5
Q

Shoulder ROM (motions and angle)

A 
aBduction: 0-180 (2:1, GH and scapulothoracic) 
aDduction: 0-45
flexion: 90
extension: 45
internal rotation: 55
external rotation: 40-45
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6
Q

2 general screening maneuvers to evaluate AROM of shoulder

A
  1. Apley scratch test

2. “Shoulder Arc”

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7
Q

Apley scratch test

A

tests AROM of shoulder

pt…
reaches up behind head and touches superior medial angle of opp scapula w/ fingertips (external rotation, abduction)

reaches in front of the chest to touch opposite acromion (internal rotation, adduction)

reaches down behind back to touch inferior aspect of opp scapula (internal rotation, adduction)

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8
Q

shoulder arc

A

tests AROM of shoulder

pt aBducts arms to 90 degrees w/ elbows straight, turns palms up, then continues to aBduct until hands are over head

pain –> “painful arc”

  • pain btwn 60-120 –> subacromial (tendonitis or impingement)
  • pain after 120 –> acromioclavicular
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9
Q

Grading of muscle strength

A

5 – Normal: Complete range of motion against gravity with full resistance
4 – Good: Complete range of motion against gravity with some resistance
3 – Fair: Complete range of motion against gravity
2 – Poor: Complete range of motion with gravity eliminated
1 – Trace: Evidence of muscle contraction, but no joint motion
0 – Zero: No evidence of muscle contractility

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10
Q

Shoulder abduction muscles

A 
middle deltoid (C5, 6)
supraspinatous (C5, 6) - 1st 15

secondary: serratus anterior, remainder of deltoid

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11
Q

Shoulder adduction muscles

A 
pectoralis major (C5-T1) 
latissimus dorsi (C6-C8))

secondary: teres major, anterior deltoid

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12
Q

shoulder flexion muscles

A 
Anterior deltoid (C5)
corocobrachialis

Secondary: teres major, anterior deltoid

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13
Q

Shoulder extension muscles

A 
Latissimus dorsi (C6-8)
Teres major and minor (C5-6)
Posterior deltoid (C5-6)

Secondary: triceps, teres minor

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14
Q

Shoulder internal rotation muscles

A 
Subscapularis (C5-6)
pectoralis major (C5-T1)
latissimus dorsi (C6-8)
teres major (C5-6)

Secondary: deltoid

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15
Q

Shoulder External rotation muscles

A 
Infraspinatous (C5-6) 
Teres minor (C5)

Secondary: deltoid

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16
Q

Shoulder Scapular elevation muscles

A 
Trapezius (CN XI)
Levator scapulae (C3, 4)

Secondary: rhomboids

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17
Q

dermatome vs. peripheral nerve distribution

A

dermatome: specific area of skin sensation supplied by a particular spinal nerve root

Peripheral nerve distribution: specific area of skin sensation supplied by a particular peripheral nerve (* peripheral n. may receive input from multiple spinal nerve roots)

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18
Q

How to test C5 dermatome

A

touch a round patch of skin on lateral aspect of deltoid muscle

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19
Q

How to test T1 dermatome

A

touch medial aspect of arm

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20
Q

T4

A

nipple line

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21
Q

Which nerve is frequently damaged in shoulder dislocation?

A

Axillary nerve

If injured —> patch of decreased sensation on lateral aspect of deltoid & deltoid muscle itself will be weak

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22
Q

Special tests for shoulder

A 
Impingement test
Apprehension test
Drop arm test
Inferior sulcus sign
Empty can test
Subscapularis lift-off test
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23
Q

Impingement test

A

tests for impingement of rotator cuff m. and tendons

  • Hawkin’s test: pt internally rotates arm w/ thumb facing downward, flex pt’s arm (if impingement —> pain as arm is flexed)
  • Neer’s test (modified Hawkin’s test)
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24
Q

Apprehension test

A

tests for anterior shoulder instability

  • Pt supine, shoulder abducted to 90 and ext. rotated.
  • Attempt to further ext. rotate shoulder while simult. apply ant. force on post. side of humeral head
  • If shoulder ready to dislocate —> will be a look of apprehension on pt’s face and/or pt will resist addl forced ext. rotation
  • Relocation test: if post. directed force on ant. shoulder alleviates sx —> evidence of compromised ant. capsule.
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25
Q

Drop arm test

A

Detects tears in rotator cuff

  • Fully abduct pt’s arm, ask pt to slowly lower arm to their side
  • Tear in rotator cuff (supraspinatus) will cause arm to drop to side from 90 and pt will be unable to lower arm smoothly
  • (aBduction > 90 —> mainly deltoid)
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26
Q

Inferior sulcus sign

A
  • tests for inferior glenohumeral instability
  • Distract arm inferiorly (pull downward)
  • Simult. palpate AC joint on same side (should be little/no movement)
  • Laxity —> indicates inferior GH instability
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27
Q

Empty can test

A
  • Tests supraspinatus (rotator cuff)

- Pt aBducts arm to 90, flex shoulder to 30, and internally rotate as if pouring liquid

28
Q

Subscapularis lift-off test

A
  • tests subscapularis function
  • Pt int. rotates arm behind the back w/ dorsum of hand in contact w/ small of back against resistance
  • Inability to lift hand off back —> subscapularis dysfunction
29
Q

Referred elbow pain

A

Can be related to pathology of wrist, shoulder and cervical spine

30
Q

Elbow ROM and angles

A

Flexion: 180
Extension: 0
Supination: 90
Protonation: 90

31
Q

Elbow flexion muscles

A

Brachialis (C4, 6)
Biceps (C5,6)
Secondary: brachioradialis, supinator)

32
Q

Elbow extension muscles

A

Triceps (C7)

Secondary: anocneus

33
Q

Elbow supination muscles

A

Biceps (C5, 6)
Supinator (C6)
Secondary: brachioradialis

34
Q

Elbow protonation muscles

A 
Protonator teres (C6)
Pronator quadratus (C8-T1)
Secondary: flexor capri radialis
35
Q

Biceps reflex

A

C5

  • Pt’s flexed and relaxed arm is rested on their thigh or abd, your hand supporting arm under medial elbow, your thumb placed on biceps tendon in antecubital fossa
  • Tap your thumbnail w/ narrow end of reflex hammer
36
Q

brachioradialis reflex

A

C6

  • Pt’s flexed and relaxed arm is rested on their thigh or abd, your hand supporting arm under medial elbow, your thumb placed on biceps tendon in antecubital fossa
  • tap brachioradialis tendon at distal end of radius w/ flat edge of reflex hammer
37
Q

triceps reflex

A

C7

  • Pt’s flexed and relaxed arm is rested on their thigh or abd, your hand supporting arm under medial elbow, your thumb placed on biceps tendon in antecubital fossa
  • w/ pt relaxed, tap triceps tendon where it crosses olecranon fossa w/ narrow end of hammer
38
Q

C5 sensation

A

lateral arm

sensory branches from axillary n.

39
Q

C6 sensation

A

lateral forearm to thumb and index

sensory branches from musculocutaneous n.

40
Q

C8 sensation

A

medial forearm; antebrachial cutaneous n.

41
Q

T1 sensation

A

medial arm; brachial cutaneous n.

42
Q

Tinel sign (elbow)

A

designed to elicit tenderness over a neuroma/area of compression within a n.

tap on area of ulnar n. in groove between olecranon and medial epicondyle

If neuroma or narrowing of passageway –> tingling sensation sent down forearm to ulnar side of hand

43
Q

lateral epicondylitis (tennis elbow) test

A

stabilize pt’s forearm w/ their elbow extended, forearm protonated, wrist flexed

ask pt to EXTEND wrist against resistance while palpating lateral epicondyle
(like tennis back hand)

pain in lateral epicondyle (site of origin for wrist extensors) –> + sign

44
Q

medial epicondylitis (golfer’s elbow) test

A

pt holds arm w/ elbow flexed to 90 degrees, forearm supinated

pt FLEXES wrist and protonates forearm against resistance while you palpate medial epicondyle

pain in medial epicondyle (site of origin for wrist flexors) –> medial epicondylitis

45
Q

Additional ROM tests for fingers

A

Test FDP (ask pt to flex at DIP)
Test FDS (ask pt to flex at PIP)
Extensor testing
Abduction/adduction

46
Q

Tinel sign (hand)

A

tap median n. at volar wrist to test for damage/compression of median n.

tingling felt in distribution of median n.

47
Q

Allen test

A

evaluates blood supply to hand, demonstrates an intact palmar arch and collateral circulation in hand

(apply pressure to radial and ulnar a. at same time to occlude them, open/close hand several times, pt relaxes hand, first release pressure from radial a., then repeat releasing pressure from ulnar a. Hand should flush pink w/ release of either a.)

48
Q

Phalen’s test

A

carpal tunnel syndrome

compression of median n. in carpal tunnel

+ if pt experiences pins/needles when dorsal aspect of hands are placed together, fingers pointing downward w/ wrists flexed to about 90 degrees, held for 60 sec

49
Q

Finkelstein test

A

tenosynovitis in wrist

pt makes a fist w/ fingers wrapped around thumb, then deviates hand in ulnar direction

pain over aBductor pollicis longus and extensor pollicis brevis –> tenosynovitis

50
Q

There are no intrinsic muscle in the hand that are innervated by the __________, and so to test the muscle strength component of this nerve, examine ___________ against resistance.

A

There are no intrinsic muscle in the hand that are innervated by the RADIAL N., and so to test the muscle strength component of this nerve, examine WRIST EXTENSION against resistance

51
Q

Wrist extension m.

A

C6
extensor carpi radialis (radial n.)

sec: extensor carpi ulnaris

52
Q

Wrist flexion m.

A

C7
flexor carpi radialis (median n.)

sec: flexor carpi ulnaris

53
Q

Finger extension

A

C7

extensor digitorum

54
Q

Finger flexion

A

C8
PIP: FDS
DIP: FDP
MCP: lumbricals

55
Q

Thumb extension

A

C7
MCP flexion: flexor pollicis brevis
IP flexion: flexor pollicis longus

56
Q

Thumb flexion

A

C7,8
MCP flexion: flexor pollicis brevis
IP flexion: flexor pollicis longus

57
Q

Thumb aBduction

A

abductor pollicis longus and brevis (C7)

58
Q

Thumb aDduction

A

adductor pollicis (C8)

59
Q

hand sensation dermatomes/nerve roots

A

C6 –> thumb, index finger
C7 –> middle finger
C8 –> ring finger and small finger

60
Q

radial n. sensory innervation to hand

A

web space between the thumb and index finger and the dorsum of the hand to about the level of the PIP joints

61
Q

median n. sensory innervation to hand

A

portions of the thumb, index, long and radial side of the ring finger

62
Q

ulnar n. sensory innervation to hand

A

lateral surface of the tip of the little finger, ulnar side of ring finger

63
Q

Allen test

A

evaluates blood supply to hand and demonstrates intact palmar arch/collateral circulation in the hand
(occlude radial and ulnar a. at wrist, pt open and closes hand, release pressure from one a., hand should flush immediately)

64
Q

Tinel’s sign

A

assessing median n. damage or compression, usu at carpal tunnel

tap on median n., tingling will be felt in distribution of median n. sometimes will travel prox toward elbow

65
Q

Phalen’s test

A

tests for carpal tunnel syndrome…
compression of median n. in carpal tunnel

pt will feel pins/needles when dorsal aspect of hands are placed together, fingers pointing downwards with wrists flexed to ~90 degrees. Hold position for 60 sec. If no numbness/tingling after this, - result

66
Q

Finkelstein tests

A

for tenosynovitis in wrist

pt makes a fist with the fingers wrapped around the thumb, then deviates the hand in an ulnar direction.

pain over the abductor pollicis longus and the extensor pollicis brevis –> tenosynovitisn

Emma - Physical Diagnosis (12 decks)

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