Random Facts to memorize Flashcards
Anterior triangle border
Superior-Mandible
Medial-Midline of the Neck
Lateral-Sternocleidomastoid muscle
Posterior Triangle
Inferior-Clavicle
Posterior-Trapezius Muscle
Anterior-Sternocleidomastoid Muscle
Where does most cervical lymphatic drainage occur?
Deep nodes are deep to sternocleidomastoid muscle and normally not palpable except the supraclavicular node
Virchow’s Node-supraclavicular node of the deep chain that is sometimes palpable in thoracic or abdominal malignancies
Spurling’s Maneuver?
- Tests for radicular nerve pain
Cervical foarminal compression test
- Side bending to the affected side with compression down along the spinal axis- produces radicular symptoms
Maximum cervical compression test
- Add extension and rotation to the same side as the head is side bent
Distraction test
pulling superior on the head: used to alleviate radicular symptoms and support a diagnosis of radiculopathy
what does testing the strength of the SCM and trapezius also assess?
functionality of cranial nerve XI
Thoracic Outlet Syndrome
- Occurs when there is compression of vessels and nerves in the area of the clavicle.
- Happens when there is an extra cervical rib or because of a tight fibrous band that connects the spinal vertebra to the rib.
Symptoms include:
- pain in the neck and shoulders
- numbness in the last 3 fingers and forearm.
Thoracic outlet syndrome is usually treated with physical therapy which helps strengthen and straighten the shoulders.
Roo’s Test
- tests for thoracic outlet syndrome
- Arms abducted to 90°, externally rotated
- Elbows flexed at 90°
- Patient slowly opens and closes his hands for 3 minutes.
- If there is weakness, numbness or tingling of the hand or arm the test is positive.
Apley’s scratch test
gross measurement of shoulder range and motion - tests external rotation and abduction with hand over the - internal roation and adduction
Adson’s Test
- evaluates for any compression on the subclavian artery by a cervical rib or tight scalene muscle
- palpate radial pulse with elbow and shoulder in extension- then move arm into abduction and external rotation and flex elbow. Have patient turn their head away from the side being tested
- if pulse diminishes, then test is positive
Rotator Cuff Muscles
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
Winging of scapula
due to long thoroacic nerve injury causing a weak serratus anterior muscle
Shoulder ROM: Rotator Cuff muscles???
- Abduction- 180°
- Adduction- 75°
- Flexion- 180°
- Extension- 60°
- External Rotation90°
- Internal Rotation- 100°
Supraspinatus: abducts *** most often injured ***
Infraspinatus, Teres Minor: externally rotate
Subscapularis: internal rotation
Thoracohumeral group: adduction of forearm
Rotator Cuff Injuries:
- Lifting heavy objects or repetitive abduction or overhead use of the arm.
- Symptoms: pain inferior to the anterior border of the acromion or referred pain to the anterior deltoid insertion on the humerus
Drop Arm Test
abduct patient’s arm to 90 degrees, then gently push down on the arm - pain or weakness suggest rotator cuff tear
Empty Can Test
- hold arms out in front of patient with thumbs down - put pressure downward on both arms - pain or weakness shows a tear in the supraspinatus muscle
Lift-Off Test
- tests subscapularis injury
- With arm internally rotated so dorsum of hand rests on low back, have patient lift the hand off their low back posteriorly against your resistance.
Crossover Test
- adduct arm across the chest - compresses the acromioclavicular joint and causes pain if there has been disruption of the AC joint or arthritis.
Apprehension Test
- put patient’s arm in the surrender position (Arm is abducted to 90° and externally rotated)
- put one hand on forearmand other on back of shoulder and push gently forward
- any look of alarm on patients face is positive test for a loose joint capsule and potential subluxation of shoulder or dislocation.
O’Brien’s Test
- adduct arm across chest with flex armed at 90 degrees - internally rotate with the thumb pointing down and push down on the arm
- pain is positive test for glenoid labrum tear (SLAP - superior labrum anterior to posterior)
- confirmed by repeating with thumb pointing up with no pain
- different from crossober test due to internal rotation of the arm with downward pressure
Speed’s Test
- Tests biceps tendon
- Flex straight arm to 90° with the palm facing upward. The patient resists the student pushing down. If pain occurs in the area of the bicipital groove the test is positive indicating biceps tendonitis
Hawkin’s Impingement Sign
Examiner grasps patients elbow with one hand and their distal forearm with the other
Examiner passively externally rotates the shoulder
- Impinges subscapularis muscle
Examiner passively internally rotates the shoulder
- Impinges supraspinatus muscle, teres minor muscle, and Infraspinatus muscle
Examiner internally rotates the arm by applying upward force at the elbow and downard force on teh forearm
- this compresses the greater tuberosity against the coracoacromial ligament
how to test for subacromial bursitis?
Stabilize the shoulder and extend the humerus. Pain may indicate subacromial bursitis although the problem may the rotator cuff.
Lateral epicondylitis/ Extensor Tendinitis
- Tennis Elbow
Symptoms: Pain in the lateral elbow and dorsal region of the forearm. Worse with wrist extension, gripping or lifting.
Cause: Repetitive use of forearm extensors
Test: Palpate the lateral epicondyle while resisting the patients wrist extension. Pain is a positive test.
Medial Epicondylitis/ Flexor Tendinitis
- Golfer’s Elbow/ Climber’s elbow
Symptoms: Pain in the medial elbow and volar region of the forearm. Worse with wrist flexion, gripping or lifting.
Cause: Repetitive use of forearm flexors
Test: Palpate the medial epicondyle while resisting the patient’s wrist flexion. Pain is a positive test.
Valgus and Varus Stress Tests
- test for collateral ligament disruption
- For valgus stress test: push on lateral side of elbow while abducting the distal forearm away from the body (medial glid and abduction)
- For Varus stress test push on medial elbow while adducting the distal forearm (lateral glide and adduction)
Tinel’s Sign
- Sharply tap over the location of the median nerve in the carpal tunnel, on the palmar surface of the wrist, using your index and middle finger, or a reflex hammer.
- A positive test is noted by reproduction of the patient’s pain typically a shooting pain or paresthesias in the distribution of the median nerve.
- Tinel’s sign is not specific for carpal tunnel syndrome. It can be used in the diagnosis of any compression neuropathy.
Phalen’s Test
- upside down prayer test: flex both wrists at 90 degrees with dorsal aspect of the hands together. pain is positive.
- can indicate carpal tunnel - more sensitive than tinel’s sign
Prayer test
- dorsiflexing wrists - positive pain is indicative of carpal tunnel syndrome
Colle’s Fracture
Distal radius fracture with distal fracture fragment displace dorsally.
Often due to falling on an outstretched hand.
Boxer’s Fracture
Distal 5th metacarpal fracture with volar angulation.
Often due to punching something like a wall
Finkelstein test
Put the patient’s thumb inside their fist, and then gently ulnar deviate the wrist.
If pain occurs along the thumb or wrist, the test is positive for tenosynovitis of the extensor pollicis brevis and abductor pollicis longus (De Quervain’s Disease).
Hand special tests
Varus/Valgus ligament stress
- Stabilize the proximal bone with one hand while using the other hand to deviate the distal bone to the ulnar and radial sides checking for ligamentous instability.
Thumb/Ulnar collateral ligament stress
- Put stress on the upper thumb joint, by pushing the thumb away from the hand.
Intradermal injections (ID)
10-15 degrees; directly under epidermis
- primarily used for diagnostic purpose
- use small syringes (1 cc) and small gauge (27 gauge, 1/2’’)
subcutaneous (SQ)
administred at a 45 degree angle
use a variety of syringes (1-3 cc) and needle sizes (23-25 guague, 1/2 - 5/8’’ needle)
- allows for slow sustained absorption of medications (insulin, hormones, opiates)
- done wherever there is a good layer of SQ fat (i.e. posterior upper arm)
Intramuscular Injections (IM)
administered into a well perfused muscle at 90 degree angle along with aspiration
- uses a variety of syringes (3 cc) and 21-25 gauge with 1- 1.5 ‘’ needle.
- provides rapid systemic acttivation of large doses with least amount of tissue damage
- injection site at deltoid
- Includes vaccines such as Hep A/B, MMR,DPT Pentacel, tetanus, B12, epinephrine, opiates, promethazine.
complications of injections?
Vasovagal syncope
Skin infection
Toxic rxn. to local anesthetics
Hematoma formation
Neuritis
Rebound pain
Pneumothorax or Compartment syndrome
Contraindications for Joint Injections
Absolute
- Local cellulitis
- Septic arthritis
- Acute fracture
- Bacteremia
- Joint prosthesis
- Achilles or patella tendinopathies
- History of allergy or anaphylaxis to injectable pharmaceuticals or constituents
- More than 3 previous corticosteroid injections within the past year in a single joint*.
Relative
- Minimal relief after 2 previous corticosteroid injections
- Underlying coagulopathies
- Anticoagulation therapy
- Evidence of surrounding joint osteoporosis
- Anatomically inaccessible joints
- Uncontrolled diabetes mellitus
What are common local anesthetics?
Lidocaine - 1 min onset (.5-1 hour duration)
- can cause vasodilation
- use in contaminated wounds
- safe in figers, nose, penis, toes and ear lobes
lidocaine w/ epi - 1 min onset (2-4 hours)
- causes vasoconstriction
- use in highly vascular areas
- use in clean wounds
Bupivacaine w/ epi - 5 min onset (2-4 hours)
Bupivicaine - 5 min onset (3-7 hours)
- longer duration - fore nerve blocks
Use epi (vasoconstrictor) when have area that is extremely vascular and need to control the bleeding , it also makes the wound longer. Want to make sure wound is clean in order to use epi
Do not use epi in finger, toes, penis, nose and earlobes (not vascular – could cause necrosis)
Spinous Process Landmarks
T3 spine of scapula
T7 inferior angle scapula
L4 located at level of Iliac crest
Dermatomes on lower body
Patella tendon reflex: L4
- middle of foot
Achilles tendon reflex: S1
- lateral portion of foot
** note: L5-S1 is most common area of injury and source of lower back pain
Viscero-Somatic Reflexes
Small Intestine T10-11
Colon and Rectum T12-L2
Bladder T12-L2
Ovaries/Testes T10-11
Uterus T12-L2
Prostate T12-L2
Straight Leg Raise
Raise leg, if reproduce leg pain radiation, lower leg just to point of no pain then dorsiflex foot. This stretches sciatic nerve so if dermatomal pain reproduced again, more likely is sciatic nerve. Most commonly positive for sciatica if pain found between 40-60 degrees of extension
Trendelenburg test
Evaluates gluteus medius muscle
Observe PSIS dimples standing on both legs
Next have patient stand on one leg
Gluteus medius on supported side should contract elevating pelvis on opposite side (“negative” normal test)
If pelvis descends shows weakened muscle (“positive” test)
Gluteus medius keeps hips stable during gait
