UE MSK Exam Flashcards
Areas to be examined in UE MSK Exam
- Shoulder
- Elbow
- Hands & wrists
Components of shoulder exam
- Inspection: check alignment and symmetry
- Palpate surface features (ABCD
• Acromioclavicular (AC) joint
• (B) Sub-acromial Bursa
• Coracoid process, Clavicle
• Deltoid muscle insertion - ROM
- Neer’s Impingement
- Rotator Cuff tests
a. supraspinatus
b. infraspinatus - Biceps (elbow flex + supination)
?Triceps
Shoulder ROM testing
- Flexion - raise arms to vertical, palms facing downward
- Extension – raise arms straight behind back as far as is comfortable
- Abduction – raise arms at side, palms facing down to shoulder level
- Adduction – cross extended arm across chest
- External rotation – raise arms to shoulder level, bend elbows rotate toward ceiling
- Internal rotation – place arms behind back and touch shoulder
Proper Neer’s technique
• 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
Proper supraspinatus technique
“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
Proper infraspinatus technique
“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
Components of elbow exam
- observe
- palpate: M/L epicondyle, radial head, olecranon process, olecranon bursa
- ROM
- Tinel’s test
- Lateral epicondylitis test
Elbow ROM
- Flexion – bend the elbow
- Extension – straighten the elbow
- Pronation – flex elbows, turn palms downward
- Supination – flex elbows, turn palms upward
Proper Tinel’s test
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
Proper tests for lateral epicondylitis
- 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
Hand/Wrist exam components
- Observe
- Palpate:
•Radial and ulnar styloid processes
•Thumb abductor tendons
•Anatomical “snuff box” - Hand and wrist ROM
- Assess for carpal tunnel
Hand/wrist ROM
• 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
Proper tests for carpa tunnel
- 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