UE abnormal Flashcards
what are you assessing for when palpating a nodule
- tenderness
- mobile/fixed
- soft/hard
Loss of contour of normally rounded shoulder. What condition do you suspect
dislocation of shoulder
Examination reveals this. What do you suspect
- paralysis of serratus anterior
- injury to long thoracic nerve
what test is this?
sulcus sign: indicates glenohumeral instability of the shoulder
- arm in neutral relaxed position, provider will pull the arm downward
what percentage of shoulder dislocations are anterior vs posterior
- 95% anterior (pictured
- 5% posterior
If there is injury to rotator cuff muscles, what is the likely order in which the muscles will be torn
SITS
- Supraspinatous
- Infraspinatus
- Teres Minor
- Subscapularis
What rotator cuff muscle is responsible for abduction of shoulder
supraspinatous
Which rotator cuff muscle is responsible for internal rotation of shoulder
subscapularis
Which muscles are responsible for external rotation of shoulder
- 80% infraspinatus
- 20% teres minor
What test goes with the maneuver: patient touches superior and inferior aspects of opposite scapula? What diagnosis is suggested by a positive result?
- apley scratch test
- loss of range of motion: rotator cuff problem
How can you test for a supraspinatous injury/tear
- empty can test
- resistance against forward flexion in hyperpronation (thumbs down), elbow extension, and abduction
How would test for a subscapularis injury/tear
- Lift off test
- place hand on the back with shoulder internally rotated
- push against resistance
How would you test for a rotator cuff injury
- Drop arm test
- poriver passively abduct arm to 120 degrees and asks the patient to slowly lower his/her arm
- positive test: inability to complete this secondary to pain
what is impingement syndrome
impingement of tendons or bursa in the shoulder from bones of the shoulder
How can you test for impingement sydrome
have patient raise arms laterally to side
- patient will not feel pain for the first 70 degrees
- patient will feel pain from 70 to 120 degrees
- if you guide patient’s arm above 120 degrees, patient will not feel pain above 120 degrees
How would you test for supraspinatous tendon impingement
- Hawkin’s test
- passive flexion to 90 degrees and forceful internal rotatation of the shoulder
- look for pain
How would you test for subacromial impingment
- neer’s sign
- passive flexion with arm pronated and scapula is stabilized
- look for pain
How would you test for biceps tendon instability or tendonitis
- Yergason test
- flex elbow at 90 degress with forarm pronated
- supinate forearm and externally rotate humerus against resistance
What is another method, other than Yergason test, to test for Biceps tendonitis
- Speed’s test
- arm extended in full supination with shoulder flexed. Elevate arm against resistance
How would you test for anterior glenohumeral instability
- apprehension and relocation test
- elbow flexed at 90 degress, arm abducted at 90 degress
- apply external rotation at the shoulder and note apprehension
- Notice if there is pain and apprehension with ROM testing and if pain is relieved with relaxation/relocation
how would you test for acromioclavicular joint arthritis
- cross body adduction test
- forward elevation to 90 degress and active adduction
clinical symptoms
- diffuse, dull, aching pain
- usually no localized tenderness
- progressive restriction of ROM
- usually unilateral
adhesive capsulitis (frozen shoulder)
clinical symptoms
- localized pain and swelling to medial aspect of elbow
- reproducible pain with wrist flexion against resistance
medial epicondylitis: golfer’s elbow
- flexor pronator muscle group
clinical symptoms
- localized pain and swelling to lateral aspect of elbow
- reproducible pain with wrist extension against resistance
lateral epicondylitis: tennis elbow
- extensor supinator muscle group
identify
olecranon bursitis
- inflammation of the bursa with fluid accumulation
- may be due to local irritation, trauma, or infection
What is nursemaid’s elbow? Cause?
- subluxation/dislocation of radial head
- common cause is sudden pull of pronated arm
- pediatrics 1-4 yrs
identify
gouty tophi
identify
- Colles’ fracture: distal radius
- “dinner fork deformity”
how would you check patency of ulnar artery
- allen test
- make fist
- occlude radial and ulnar arteries
- release pressure over ulnar artery
- palm should flush within 3-5 seconds
clinical symptom
- compression neuropathy with pain, paresthesias in hand (lateral 3 and 1/2 digits)
- thenar atrophy
Carpal tunnel syndrome
- median nerve becomes compressed by inflammation of synovium
Tinel’s sign
- percuss over median nerve
- positive: tingling sensation in the distribution of the median nerve
- evaluate: carpal tunnel syndrome
phalen test
- flex wrists x 30-60 seconds
- positive: paresthesia in the distribution of median nerve
- tests for carpal tunnel syndrome
what is de Quervain’s Tenosynovitis
- inflammation of the 1st dorsal compartment involving the sheath of the abductor pollicis longus and extensor pollicus longus
- causes: overuse/repetitive gripping
how would you test for Quervain’s Tenosynovitis
finkelstein test
- fist over thumb and ulnar devation
- positive: pain
Clinical presentation
- inspection: commonly seen on dorsal radial and volar aspects of wrist
- palpation: soft mobile mass
- ROM: may restrict motion or become painful with repetitive activity
ganglion cyst: collection of synovial fluid within a joint or tendon sheath
clinical presentation:
- tenderness to palpation in “anatomical snuffbox”
scaphoid fracture
what muscles border the snuffbox
Lateral border
- extensor pollicis brevis
- abductor pollicis longus
medial border
- extensor pollicis longus
what is the boutonniere deformity
- flexion of PIP joint
- hyperextension at the DIP
- ruptured cental slip extensor tendon mechanism
what is the swan neck deformity
- hyperextension of PIP joint
- flexion of DIP joint
- volar plate attenuation of PIP joint
A sign of this disease is ulnar deviation at the MCP and PIP joints
rheumatoid arthritis
These nodules are characteristic of osteoarthritis (OA): seen on dorsolateral aspects of DIP joints; they usually hard and painless
Heberden’s nodes
These Nodules are seen in either OA and/or RA (but more typically associated with RA). Nodes are at PIP joints
Bouchard’s nodes
where are rheumatoid nodules commonly located
on the dorsum of the hand
what causes trigger thumb/finger?
Clinical presentation:
- nodule at volar aspect of MCP
- digit catches or locks with passive/active flexion of IP/PIP
- flexor tendon becomes irritated and inflamted forming nodule
- nodule unable to pass through A1 pulley freely
clinical presentation
- painless masses that develop into cords along palm
- unable to flatten hand on table
Dupuytren’s contracture
- connective tissue disorder affecting palmar fascia
clincal presntation
- usually occurs after puncture wound
- swelling, tenderness
- ROM reduced
septic tenosynovitis
- infection in space between the two layers of synovium which cover the flexor tendons of the fingers and thumb
what is the name for a fracture to the base of 1st metacarpal
Bennett’s fracture
Where would you test for radial, median, and ulnar deviation in hand
- radial: dorsum of hand near digits 1-3
- median: palm of hand on first 3 and 1/2 digits
- ulnar: palm of hand on pinkie
