Shoulder/elbow/wrist Flashcards
1
Q
Which bone is part of the scapula?
Acromion process
coronoid fossa
capitulum
deltoid tuberosity
A
Acromion process
2
Q
Which muscle covers most of the anterior aspect of the scapula?
Subscapularis
Infraspinatous
Teres minor
Teres major
A
Subscapularis
3
Q
What muscle is NOT part of the triceps?
Lateral head of the triceps
Medial head of the triceps
Short head of the triceps
Long head of the triceps
A
Short head of the triceps
4
Q
What is the insertion of the Posterior Deltoid?
A
Deltoid tuberosity
5
Q
Which of the following is the farthest from the greater tubercle?
Lesser tubercle
Spine of the scapula
Acromion process
Coracoid process
A
Spine of the scapula
6
Q
What muscle does not attach to the lateral boarder of the scapula?
Long head of the biceps
Teres major
Long head of the triceps
teres minor
A
Long head of the biceps
7
Q
What is the origin of pectoralis major?
A
Proximal 2/3 of the clavical
8
Q
Stability and integrity of the glenohumeral joint depends on what?
A
Muscles
9
Q
T/F Teres minor, teres major, subscapularis, and infraspinatus all attach to the humeral head?
A
True
10
Q
What action does the scapula move with shoulder abduction?
A
Rotation
11
Q
From 0-60 degrees of shoulder abduction, the scapula rotates how many degrees?
A
30 degrees
12
Q
What position incorporates the biceps in shoulder abduction?
A
Humerus externally rotated
13
Q
What is the condition called when the scapula moves more than the humerus during shoulder abduction?
A
Frozen shoulder
14
Q
How would you describe the first 30 degrees of shoulder abduction?
A
No scapular motion and the clavicle may elevate
15
Q
Glenohumeral painful arc is between what degrees of shoulder abduction?
A
45-120
16
Q
What nerve injury causes rotary winging or scapular tilt?
A
Spinal accessory nerve
17
Q
What muscle assists the deltoid with shoulder abduction?
A
Supraspinatus
18
Q
Shoulder pain is greater during which movement?
A
Going up in abduction
19
Q
Pain and tenderness at the anterior joint of the shoulder indicates?
A
Subacromial impingement
20
Q
Pain with horizontal flexion is indicative of?
A
Subcoracoid impingement
21
Q
What test would be positive for impingement syndrome?
Suluc sign
Cozens
Hawkins-Kennedy
Apprehension
A
Hawkins-Kennedy
22
Q
What muscles would you strengthen to avoid impingement syndrome?
A
Teres Minor (external rotators)
23
Q
Infraspinatus tendon impingement would cause pain where?
A
Posteriorly
24
Q
Which occupation would you expect to make impingement syndrome worse?
Painter
Professional bowler
Carpet installer
Cashier at grocery store
A
Painter (over head motion)
25
What position is known to relieve pain in patients with underlying instability and impingement?
AP support in apprehension position
26
Appropriate management/treatment for impingement syndrome would be:
avoid overhead activities
27
What structures are vulnerable for impingement?
Biceps tendon and supraspinatus tendon
28
Which is a structure that becomes impinged in the shoulder?
Teres minor tendon
Deltoid tendon
Subacromial bursa
Subscapularis tendon
Subacromial bursa
29
Which ROM is most affected by adhesive capsulitis?
External rotation and abduction
30
Lack of improvement in Adhesive capsulitis suggests what complication?
Bony blockage
31
What stage of adhesive capsulitis does a patient most likely come to the office with?
Stage 2
32
Most patients in the acute phase of adhesive capsulitis responds to which mode of treatment for pain control?
Transcutaneous electrical nerve stimulation
33
What occurs in Stage 2 adhesive capsulitis?
Stiffening
34
How should Rhythmic stabilization stretch be performed?
Have the patient resist against you and hold for 5 seconds
35
In the acute phase of adhesive capsulitis what is the best treatment option?
Medication to control pain
36
What stage of adhesive capsulitis does the patient report the most pain?
Stage 1
37
Which factor does not contribute to adhesive capsulitis?
Immobilization
Diabetes
Hyperthyroidism
Chronic Obstructive Lung Disease
Immobilization
38
If trauma was involved with adhesive capsulitis and lack of improvement persists, what condition most likely could be associated?
Posterior dislocation of the shoulder
39
Patient presenting with non traumatic instability of the shoulder are said to be...?
Born loose
40
With the instability that coexists impingement syndrome, which of the following are true?
Excess sup movement of humerus
Excess post capsule movement
Irritation to the infraspinatus
Increase in subacromial space
Excess sup movement of humerus
41
An anterior rim avulsion fracture of the shoulder capsule and glenoid labrum is called?
Bankard lesion
42
Patients can develop what syndrome because of non-traumatic instability?
Impingement syndrome
43
What are the two types of shoulder instability conditions?
Traumatic and non-traumatic
44
A patient complaining of sense of shoulder weakness with overhead activities is most likely presenting with?
Shoulder instability
45
With non-traumatic instability, a positive indicator of multidirectional instability is?
Bilateral sulcus sign
46
For patients with shoulder instability, treatment and management includes?
Standard strengthening program
47
In the load and shift test, the patients arm does all of the follwing except?
Popping
Grinding
Too little movement
Too much movement
Too little movement
48
Which of the following tests would be an orthopedic test for a labrum tear?
Wrights
Neers
O'Briens sign
Adsons
O'Briens Sign
49
The most common muscle torn in a rotator cuff tear?
Supraspinatus
50
With a rotator cuff tear, the patient will have a history of which of the following?
Heavy lifting
FOOSH
Both?
Both
51
Which orthopedic test will be positive if the patient has a torn rotator cuff?
Mills
Apprehension
Lift off
Lift off
52
What is the common cause of rotator cuff tears?
Dislocations
Immobilization
Process secondary to repetitive microtrauma degeneration
FOOSH
Process secondary to repetitive microtrauma degeneration
53
Full thickness rotator cuff tears are primarily found in which age group?
Middle aged adults
54
Patients will have pain preforming which activity if they have a rotator cuff tear?
Going for a run
Playing basketball
Mowing the lawn
Playing basketball
55
A 65 year old man comes in complaining of shoulder pain. No history of trauma. But last weekend he was hanging Christmas lights. What condition is most likely the cause of his pain?
Labrum tear
Rotator cuff tear
Acromioclavicular sprain
Instability
Rotator cuff tear
56
What shoulder condition is associated most commonly with a tear of the supraspinatus muscle?
Rotator cuff tear
57
What 4 muscles make up the rotator cuff?
Supraspinatus, infraspinatus, teres minor, subscapularis
58
If supraspinatus tendon is inflamed, what activity is difficult for the patient to perform?
Active arm abduction
59
Patient has tenderness and restriction of the shoulder joint which bursa is most likely the culprit?
Subacromial or subdeltoid bursa
60
Which is not a muscle of internal rotation?
Pectoralis major
Teres major
Subscapularis
Teres minor
Teres minor
61
It is painful to actively and passively move the arm this way with Bursitis?
All shoulder ROMs
62
Shoulder pain may radiate from this organ and be mistaken for bursitis?
Gallbladder
63
What is not a treatment for chronic bursitis of the shoulder?
AROM to painful point
Immobilization
PROM under LAD
Ultrasound
Immobilization
64
Which is not a sign or symptom of bursitis?
Crepitation
Arthritic stiffness
Palpable clicking
Palpable clunking
Palpable clunking
65
The most clinically significant bursae of the shoulder joints are?
Deltoid and Subacromial Bursa
66
Which muscle group is least important to strengthen in a patient with shoulder bursitis?
Extensors
67
What is the best treatment for acute bursitis of the shoulder?
PRICE
68
A grade 2 AC sprain separation shows?
Unstable with total separation
69
Which disruption is not shown in a grade 3 AC sprain separation?
Complete tearing of Coracoclavicular lig
Minor tearing of the AC lig
Complete tearing of the AC lig
Damage to deltoid muscle
Minor tearing of the AC lig
70
In an AC sprain/separation, which degree is stable?
Degree 1
71
The treatment of a type 3 AC sprain consists of all of the following except?
Sling for 6 weeks
Isometric exercises during immobilization
Permanent deformity
Out of competition for 1-4 weeks
Out of competition for 1-4 weeks (longer)
72
In a degree 2 AC sprain, what is the best treatment?
Immobilization, 1-4 weeks out of competition and Modified Kenny Howard Sling
73
19 year old basketball player with FOOSH during game. Comes in holding his arm and says lifting it is painful. You can see the clavicle is obviously elevated. He has limited ROM and a large amount of pain. What is the injury?
Degree 3 AC sprain / separation
74
16 year old soccer player fell on tip of shoulder. Presents with pain in shoulder with limited ROM, tenderness and swelling over AC and tender over coracoclavicular lig. What is the patients injury?
Degree 2 AC sprain
75
Grade 2 AC sprain separation shows what?
Unstable with total separation
Unstable with partial subluxation
Stable
Instability
Unstable with partial subluxation
76
In acromioclavicular separation surgery may be considered when...?
For cosmetic purposes
77
In a second degree acromioclavicular sprain, which is true?
Complete tear
Clavicle is stable
Severe acromioclavicular sprain
Damage to the deltoid and trapezium muscle
Severe acromioclavicular sprain
78
Which of the following is NOT a treatment for acute biceps tendonitis?
Heat
Compression
PRICE
Adjustment
Heat
79
What part of the biceps is injured in a biceps rupture?
Long head tendon
80
Acute rupture of this ligament can result in subluxation dislocation of the biceps tendon?
Transverse humeral
81
Which of the following is NOT true regarding the long head of the biceps tendon?
Located at proximal end of long head biceps
Travels on top of transverse lig
Originates from supraglenoid tubercles
Actions are elbow flexion and forearm supination
Travels on top of the transverse lig
82
Does the biceps ball up slightly in Partial Biceps Rupture?
No.
83
Which is NOT true with Complete Biceps Rupture?
Popping sound with sudden sharp pain at the top
Biceps balls up
Weakness flexing shoulder
Pain that continues and progressively worsens
Pain that continues and progressively worsens
84
In Non-Traumatic Bicipital Tendonitis which of the following is NOT a result of repetitive motion and damage?
Heavy bleeding
Micro-trauma
Scar Tissue
Inflammation
Heavy bleeding
85
T/F Labrum tears are a Non-traumatic cause of Biceps Rupture.
F
86
Pain in the anterior shoulder with passive wrist and elbow extension with the shoulder fully extended indicates?
Biceps tendonitis
87
When the bicep tendon is suggested to be unstable, which ligament holds the biceps tendon in the bicepital groove?
Transverse lig
88
In which stage of Traumatic/Reactive Calcific Tendonitis does pain occur?
Calcific
89
Which age would be more likely to have calcific tendonitis in the shoulder?
40 years old
90
Which stage of Traumatic/Reactive Calcific Tendonitis does the tendon change allowing for deposit of calcium crystals within the tendon tissue?
Pre-Calcific
91
What cause of calcific tendonitis does the following describe? Decreased blood supply and wear and tear to the supraspinatus tendon calcium deposits from in the tendon as part of the healing process?
Degenerative calcification
92
What muscle is most commonly affected in Calcific Tendonitis?
Supraspinatus
93
Which of the following is NOT one of the three stages of Traumatic Calcific Tendonitis?
Pre Calcific
Intermediate calcific
Calcific
Post calcific
Intermediate Calcific
94
A key diagnostic finding for calcific tendonitis is?
Severe pain, full passive ROM, calcium deposits on xray
95
In which stage of Traumatic/Reactive Calcific Tendonitis does the tendon heal and remodel with normal tissue?
Post Calcific
96
Which cause of calcific tendonitis is more likely to occur in younger patients?
Reactive calcification
97
What condition causes calcium deposits in the supraspinatus tendon?
Calcific tendonitis
98
What test would be preformed to diagnose a torn transverse lig?
Yergasons
99
The arm is abducted (blank) degrees during Drop arm test?
120-150
100
The relocation test checks for?
Stability
101
Which of the following would not indicate a positive finding of tendonitis?
Neers
Apleys Scratch
Yergasons
Dugas
Dugas (stability)
102
Which of the following is always performed supine?
Relocation test
Sulcus sign
Apprehension
Post dislocation
Post Dislocation test
103
Where does the doctor stand when preforming the apprehension test?
Behind
104
Patient supine, doctor abducts and externally rotates the arm to 90 degrees and applies an inferior force on the humerus. This describes which test?
Reverse Impingement
105
The sulcus appears (blank) to the humeral head and (blank) to the lateral acromion process?
Superior/Inferior
106
What is the costoclavicular test used to indicate?
TOS of the 1st rib
107
In medial epicondylitis that is pain during?
Passive pronation of the wrist
108
In the elbow joint specifically, where does osteochondritis dissecans most common?
Capitellum
109
Panners disease commonly presents as?
pain and stiffness at the elbow and inability to extend the elbow
110
How long does ossification take in myositis ossifcans?
3-6 months
111
How long after injury resulting in myositis ossificans should you take and xray?
3-4 weeks after injury
112
What muscle should be braced to help treat for lateral epicondylitis?
Extensor carpi radialis brevis
113
What nerve may cause tingling in lateral epicondylitis?
Radial
114
All of the following is consistent with Panners disease except?
Pain and instability to extend the elbow fully
Young baseball players
Chronic stress injury
Fragmentation of the radial head is seen in the acute phase
Fragmentation of the radial head is seen in the acute phase
115
In nursemaids the annular lig becomes entrapped between these two stuctures?
Radial head and capitulum
116
Which of these are considered to be unsual findings for and xray on a patient with diagnosed osteochondritis dissecans of the capitulum?
No loose bodies present
Cystic area over the olecranon
Irregular capitellum surface
Irregular surface of the radial head
Cystic area over the olecranon
117
When preforming Mills test, the doctor first does what to the patients elbow?
Flexes it
118
What instrument is used when performing Kaplans test?
Dynamometer
119
When preforming Cozens test, after the elbow flexes 90 degrees, the hand is in what position?
Pronated
120
Tinels sign at the elbow tests for what nerve?
Ulnar
121
What muscles are stressed when performing Mills?
Extensor Carpi Radialis
122
If there is a sprain of the lateral collateral lig in the elbow, which test would be positive?
Varus stress test
123
When preforming the Varus stress test the doctor pushes the proximal forearm in what direction?
Lateral
124
Cozens test is used for diagnosing lateral epicondylitis becuase?
It puts the patients wrist in resisted dorsiflexion reproducing the pain of lateral epicondylitis
125
When preforming Cozens, after the elbow is flexed and the hand is pronated, the wrist is what?
extended
126
When preforming Kaplans, the patients arm is in what position?
Extended
127
Dupuytrens affects?
The right hand more often
128
Dupuytrens can be treated using?
Posterior extension splints
129
All are positive tests for carpal tunnel except?
Tinels
Phalens
Kaplans
Carpal tunnel pressue
Kaplans
130
Carpal tunnel occurs more unilaterally or bilaterally?
Unilaterally
131
T/F The median nerve is deep to the flexor tendons?
False
132
T/F Carpal tunnel has an insidious onset?
True
133
Ganglions can be conservatively treated by?
Early icing, compression, late ultrasound.
134
Dupuytrens contracture is associated with playing what musical instrument?
Guitar
135
If there is pain in the anatomical snuff box what fracture would you consider mostly?
Scaphoid fracture
136
What common MOI for scaphoid fracture?
FOOSH
137
Finkelsteins test is preformed by?
Thumb in middle of the hand and ulnar deviate
138
Extensor tendonitis would be irritated by?
Flexion stress test
139
Phalens is a test for?
Carpal tunnel syndrome
140
What would be a positive Finkelsteins test to be lated at?
Runs along the radial styloid
141
Finkelsteins test may be positive when ADLS consist of?
Continuous ulnar deviation
142
Which of the following is NOT a positive finding for Froments?
Terminal phalanx of the thumb flexes as paper is pulled away
Paper rips
Doctor pulls the paper away
Doctor pulls the paper away
143
A twisting motion such as opening a jar lid or doorknob may produce which positive test?
Finkelsteins
144
What type of compression should be given in the Bracelet test?
Mild-moderate lateral compression
145
Suspected ulnar neuropathy can be confirmed by which test?
Froments
146
What is the correct patient position for Allens test?
Seated, arm supinated
