UE MSK Exam

Question 1

Areas to be examined in UE MSK Exam

Answer 1

1. Shoulder
2. Elbow
3. Hands & wrists

Question 2

Components of shoulder exam

Answer 2

1. Inspection: check alignment and symmetry
2. Palpate surface features (ABCD
   • Acromioclavicular (AC) joint
   • (B) Sub-acromial Bursa
   • Coracoid process, Clavicle
   • Deltoid muscle insertion
3. ROM
4. Neer’s Impingement
5. Rotator Cuff tests
   a. supraspinatus
   b. infraspinatus
6. Biceps (elbow flex + supination)
   ?Triceps

Question 3

Shoulder ROM testing

Answer 3

1. Flexion - raise arms to vertical, palms facing downward
2. Extension – raise arms straight behind back as far as is comfortable
3. Abduction – raise arms at side, palms facing down to shoulder level
4. Adduction – cross extended arm across chest
5. External rotation – raise arms to shoulder level, bend elbows rotate toward ceiling
6. Internal rotation – place arms behind back and touch shoulder

Question 4

Proper Neer’s technique

Answer 4

• Examiner presses on the scapula to prevent motion
• Examiner internally rotates raises the patient’s arm in flexion with other hand
• This is a passive maneuver, examiner moves arm
(+) pain

Question 5

Proper supraspinatus technique

Answer 5

“EMPTY CAN TEST”
• Patient holds arms at shoulder height (90°, making a “V” shape (not directly in front, not abducted at sides, but in between), internally rotates arms and points thumbs down
• Examiner presses downward on forearms asking patient to resist the pressure
• WEAKNESS with this maneuver is a POSTIVE test and indicates a possible rotator cuff tear

Question 6

Proper infraspinatus technique

Answer 6

“Robot arm” test
• Patient places arms at side, elbows flexed to 90°.
• Examiner provides resistance as patient presses forearms outward/laterally
• WEAKNESS with this maneuver is a POSTIVE test and indicates a possible rotator cuff tear OR bicipital tendonitis

Question 7

Components of elbow exam

Answer 7

1. observe
2. palpate: M/L epicondyle, radial head, olecranon process, olecranon bursa
3. ROM
4. Tinel’s test
5. Lateral epicondylitis test

Question 8

Elbow ROM

Answer 8

• Flexion – bend the elbow
• Extension – straighten the elbow
• Pronation – flex elbows, turn palms downward
• Supination – flex elbows, turn palms upward

Question 9

Proper Tinel’s test

Answer 9

Tinel’s test = ulnar compression at the elbow*
• Tap, press the space in between the medial epicondyle and the olecranon process (this spot is commonly referred to as thefunny bone)
• Tenderness or sharp pain = positive test

Question 10

Proper tests for lateral epicondylitis

Answer 10

• Forced Wrist extension =
  
  • Stabilize the patient’s elbow in the examiner’s hand with the thumb of that hand positioned on the patient’s lateral epicondyle.
  • The patient makes a fist and pronates the forearm
  • Patient extends the wrist (pushes up) while the examiner applies a resisting force (pushes down) at the fist.
    * The test is positive if pain is elicited in the area of the lateral epicondyle
• Grip test
  * Patient grabs and squeezes two of the examiner’s fingers
  * The test is positive if pain is elicited in the area of the lateral epicondyle

Question 11

Hand/Wrist exam components

Answer 11

1. Observe
2. Palpate:
   •Radial and ulnar styloid processes
   •Thumb abductor tendons
   •Anatomical “snuff box”
3. Hand and wrist ROM
4. Assess for carpal tunnel

Question 12

Hand/wrist ROM

Answer 12

• Wrist flexion and extension – bend wrist downward and upward
• Radial and ulnar deviation – move wrist side to side
• Metacarpophalangeal joint (MCP) flexion and extension – bend straight fingers at first knuckle
• PIP and DIP flexion and extension – bend and straighten 2nd and 3rd knuckles
a. To isolate the PIP and DIP, examiner presses fingers against MCP joints and then PIP joints – this allows to test for tendon function
• Finger abduction and adduction (JAZZ hands!)
• Thumb opposition, flexion, extension, abduction and adduction
• Form a fist

Question 13

Proper tests for carpa tunnel

Answer 13

• Tinel’s sign – percuss median nerve lightly with finger at the base of hand/top of wrist
• Aching or numbness in the median nerve is a POSTIVE test
• Phalen’s test – hold patients wrists in acute flexion for 60 seconds OR ask patient to press the backs of both hands together to form right angles
• Numbness and tingling in the median nerve distribution is a POSITIVE TEST
• Assess thenar muscle mass by palpation (not just observation) –
• Atrophy of the muscle is a positive test