Skill Check 2 Flashcards
What should you observe of the upper quadrant
- Position (symmetry)
- Carrying angle of arms
- General posture
- Thoracic spine position
- Cervical spine position
Where to palpate olecranon process
– Proximal end of the ulna
– Elbow flexion moves the olecranon process out of the fossa making it easier to palpate
Where to palpate olecranon fossa
Palpated with the elbow slightly flexed
Where to palpate triceps tendon insertion
Palpated at insertion to olecranon process, fully extend elbow
Where to palpate medial epicondyle
Found on the medial side of the distal end of the humerus
Where to palpate medial supracondylar ridge
Palpate proximally from the medial epicondyle, move into flexion to feel ridge
Where to palpate lateral epicondyle
-Located lateral to the olecranon process
– Smaller and less well defined than the medial epicondyle
-put into elbow flexion
Where to palpate lateral supracondylar ridge
-Longer and better defined than the medial side
– Proximal to the lateral epicondyle, slide upwards
-put into flexion and move into extension to feel ridge
Where to palpate the ulnar nerve
Palpate the groove between the medial epicondyle and the olecranon process
Where to palpate ulnar head
Where to palpate radial head
-Flex elbow to 90°
– Feel radial head approximately 1-2 cm distal to the
lateral epicondyle and confirm with pronation/
supination
Where to palpate radio-humeral joint
Extend elbow fully and palpate the posterolateral
dimple
Where to palpate radial collateral ligament
Rope like, passes from the lateral epicondyle to the lateral side of the annular ligament of the radius
Where to palpate ulnar collateral ligament
Fan shaped ligament, passes from the medial epicondyle to the trochlear notch of the ulna
– Palpated directly for tenderness
Where to palpate radial collateral ligament
Where to palpate annular ligament
Flexion/extension and pronation/supination
Where to palpate ulnar-humeral joint
Flexion/extension
Where to palpate cubital fossa
What are the borders and contents of the cubital fossa
– Borders
* Lateral border: brachioradialis
* Medial border: pronator teres
* Superior border: line joining the two epicondyles
– Contents
* Biceps brachii tendon
* Brachial artery
* Median nerve
T or F: Hand should be flexed when palpating carpals
T
Where to palpate trapezium
-on thumb posterior side
- At the base of the 1st metacarpal bone, just distal to the scaphoid
– Tubercle of the trapezium lies anteriorly at the base of the thenar
eminence
Where to palpate trapezoid
-next to trapezium on posterior side
– At the base of the 2nd metacarpal bone on the dorsum of the hand
Where to palpate hamate
-Hook palpated just distal and radial to the pisiform on palmar aspect
– Found at the base of the 4th and 5th metacarpal
Where to palpate capitate
-directly down from digits 3 (posterior)
- Depression just proximal to the base of the 3rd metacarpal bone on the dorsum of the wrist
Where to palpate triquetrum
-posterior side by capitate/slightly below
- Radially deviate wrist and palpate just distal to the ulnar styloid process
Where to palpate pisiform
hook on palmar medial side below and attached to the top of triquetrum (anterior)
Where to palpate lunate
right below capitate (posterior)
Where to palpate scaphoid
large and on palmar side right by lunate and below trapezium
Where to find guyon tunnel and what is its role
– Between pisiform and hook of hamate
– Passage of ulnar nerve and ulnar artery to the hand
Where to palpate ulnar styloid process
Ulnar deviate
Where to palpate radial styloid process
Make into snuff box (radial styloid)
Where to palpate distal radioulnar joint
Where to palpate Lister’s tubercle
Flexion/extend wrist
Name the 4 wrist flexor forearm pronator muscles and how you would palpate them
-In full forearm supination and elbow extension,
place opposite hand over the forearm with the
thenar eminence over the medial epicondyle
– Allow the fingers to spread over the forearm
* Pronator teres: thumb
* Flexor carpi radialis: index finger
* Palmaris longus: middle finger
* Flexor carpi ulnaris: ring finger
What are the 3 wrist extensor muscles and where to palpate them
– Brachioradialis: lateral supracondylar ridge to distal lateral radius at the styloid process (functionally elbow flexor)
– Extensor carpi radialis longus: radial supracondylar ridge to the base 2nd MC
– Extensor carpi radialis brevis: lateral epicondyle to the base of the 3rd MC
Where to palpate flexor retinaculum
-Carpal tunnel area
– Attached laterally to the tubercle of scaphoid and tubercle of trapezium
– Attached medially to pisiform and hook of hamate
Name the extensor muscle group (7) and where to find them
Where to find abductor pollicis longus
Thumb abduction resistance
Where to palpate flexor carpi ulnaris and function
– Resist wrist flexion and ulnar deviation
– Feel the tendon as it attaches to the pisiform and then proceeds on to the hamate bone as the pisihamate and pisometacarpal ligament
Where to palpate hypothenar eminence and name the 3 muscles involved
– Abductor digiti minimi (superficial)
– Opponens digiti (middle)
– Flexor digiti minimi (deep)
Where to palpate ulnar artery
– Just lateral to the flexor carpi ulnaris in the wrist
Where to palpate radial artery
Just lateral to flexor carpi radialis in wrist
Where to palpate thenar eminence and the 3 muscles involved
– Abductor pollicis brevis (superficial)
– Opponens pollicis (middle)
– Flexor pollicis brevis (deep)
Where to palpate anatomic snuff box and its 2 borders
What actions can be performed at elbow and forearm
-Flexion
-Extension
-Pronation
-Supination
What actions can be performed at the wrist
-Flexion
-Extension
-Pronation
-Supination
-Radial/ulnar deviation
Radial vs Ulnar Deviation
How to measure ROM with supination and pronation for forearm/wrist
Have them hold a pen in hand sideways get them to twist arm either way measuring with the goniometer where the ben goes
NOTE: PROM -> have their arm lie on corner of bed, twist the arm and push the goniometer with your thumb
How to measure ROM for ulnar/radial deviation
Line up goniometer with the top of the hand and move the hand left and right
How to measure myotome for C5
Have patient raise both arms to 90 degrees and press down
How to measure myotome C6
Assess:
1) biceps brachii: have elbows flexed at 90 degrees and supinated. Ask patient to resist force applied
2) Wrist extensors: place pronated forearm on table, have their fist closed and apply a force against half extended wrist
How to measure myotome C7
Assess:
1) triceps brachii: Flex patients elbow to 90 degrees and perform resisted extension
2) wrist flexors: place supinated forearm on table, have their fist closed and apply a force against have flexed wrist
How to measure myotome C8
Assess the abductor pollicis brevis by have the patients arm on its side, pinky side down, with wrist at edge of table and ask patient to resist thumb adduction
How to measure myotome T1
Assess the first dorsal interosseus by separating the last 3 digits and apply an adduction force against the index finger
How to test the slump test
-Tests extensibility of dura (Slow gentle progressive “winding up” of dura).
-Patient seated at side of bed with feet unsupported and hands clasped behind back.
-Test is performed actively with input to patient.
-Normal responses include central T8-9 pain when neck flexion is added.
-Most patients will be unable to completely straighten knee because of stretch in posterior thigh and knee area.
Thoracic flexion : Ask patient to slump or “sag in the middle” but do not allow pelvis to rotate backwards.
Neck flexion: “Chin to chest” (with gentle hold).
Knee extension (asymptomatic side first, ankle stays relaxed).
Record angle of knee extension and any symptoms produced.
- have arm and hand on neck
How to perform passive neck flexion
Without chin tuck = lower l-spine
How to perform upper limb tension test
Flex neck away from arm (lateral)
How to test cranial nerve 1 (olfactory)
1) Have eyes closed
2) Test smell in one nostril at a time using non-irritants (coffee, lemon, mint)
How to test cranial nerve 2 (optic)
- Check pupil size and symmetry
- Assess visual field by having one finger on each hand in place where only one eye sees one finger. Move fingers and ask which side the fingers are moving on (right or left)