Practical skills Flashcards
Palpate tubercle of scaphoid, hook of hamate, pisiform, ridge of trapezium
Scaphoid - distal to wrist crease in line with base of thumb
Pisiform - distal to wrist crease medial side
Hamate - 1-1.5cm diagonal from pisiform
Trapezium - 1cm distal and diagonal from scaphoid, in line with index
Surface mark SCJ or ACJ
SCJ - C shaped line at medial clavicle
ACJ - lateral end of clavicle and medial border of acromion
End feel of shoulder flex/ext/ abduction?
Flexion - firm (shoulder extensors)
Extension - firm (shoulder flexors)
Abduction - Firm (shoulder adductors)
Put supraspinatus or infraspinatus into action and palpate the contraction
Supraspinatus = first 30• abduction
Infraspinatus = lateral rotator
Palpate head of humerus
Neutral arm, palpate rounded prominence anterior aspect of shoulder
Surface mark superior RUJ or inferior RUJ
Superior = vertical line between head of radius (between lateral epicondylitis and olecranon) and ulna
Inferior = vertical line between head of ulna and distal end of radius
Cervical flexion end feel?
Firm (ligamentum nuchae)
PAM at wrist or Inferior RUJ
Wrist - AP, use both hands, one to stabilise wrist and one to push carpals from anterior to posterior
Inferior RUJ - PA, use thumb to push down on ulna head while stabilising radius
Elbow joint line
2cm below medial epicondyle, 1cm below lateral
End feel wrist ext/ flex
Flexion = firm (dorsal radiocarpal ligament)
Extension = firm (palmar radiocarpal ligament)
Palpate greater/lesser tubercle/ corocoid process
Corocoid - 1 inch below lateral clavicle, protraction brings corocoid forward
Lesser tubercle - slightly down and laterally from corocoid
Greater tubercle - lateral border of acromion, move fingers laterally onto lateral aspect greater tubercle
Surface mark GH
Just lateral of corocoid, joint line is a line 3km long down from this point
Elbow end feel
Flex - soft (bicep on forearm)
Ext - hard (olecranon into olecranon fossa)
demonstrate longitudinal caudad/ lateral distraction/ AP/PA at GH joint
Distraction - bend elbow, hand in armpit, other hand on lateral elbow, push with inner hand
Caudad - hold hand under elbow, lean backwards towards yourself
PA - Patient prone, hand on trap, lift shoulder, palm of hand, push head of humerus down
AP - Hand on shoulder joint line, palm of hand on head of humerus, downwards pressure
Surface mark wrist joint
Between styloids of ulna and radius, concave proximally
Test flexibility of flexor digi superficialis/ profundus
Superficialis - extend wrist and fingers expect DIP
Profundus - extend wrist and fingers including DIP
Longitudinal caudad/ AP/ PA at elbow
Caudad - slight flex, stabilise proximal elbow, pull lower arm
AP - stabilise upper arm, apply downward force
PA, pull lower arm up
Palpate spine of scap/ inferior angle
Spine = runs up/laterally from vertebral border to point of shoulder
Inferior angle = Easily visible, lies level with 7th rib when arm is by side
Surface mark 1st CMC or MCPs
1st CMC = run down thumb lateral aspect, flex and extend thumb to check location
MCPs = Flex MCP, large bony prominence is head of metacarpal
