Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

PHTH 550- Orthopaedic Management Final > UE Palpation > Flashcards

UE Palpation Flashcards

1
Q

How do you palpate:
A) Olecranon process and fossa
B) Epicondyles of the humerus
C) Supracondylar ridges of the humerus

A

A)
Process: Shake hand with partner and explore the large superficial knob of the elbow. Passively flex and extend the elbow.

Fossa: Find the olecranon process. Go proximal to the top of the process pressing through the triceps tendon and into fossa. Flex and extend the elbow to feel a change in the fossa.

B) Locate the olecranon. Slide medially and laterally off the olecranon to find epicondyles. When the elbow is flexed and extended epicondyles should remain stationary.

C) Find the medial or lateral epicondyle. Move proximally following the ridge of the humerus.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How do you palpate:
A) Shaft of the Ulna
B) Head of the Ulna
C) Styloid Process of the Ulna

A

A) Hand shaking position. Start at olecranon process and slide finger distally along the shaft.

B) Slide distally along the shaft of the ulna. Proximal to wrist shaft will budge to become head of the ulna.

C) Passively adduct the wrist. Use thumb to locate the ulnar head. Slide distally off head to locate the styloid process. Should remain stationary if you flex and extend the wrist.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q 
How do you palpate: 
A) Head of the radius
B) Shaft of radius 
C) Styloid Process of radius 
D) Lister's tubercle
A

A) Shake hands. Locate lat epicondyle and slide distally across a small ditch onto the head of radius. Place thumb on head and passively pronate and supinate forearm.

B) Find head of radius, slide distally along the arm until it becomes superficial at the wrist. Pronate/supinate to feel shaft of radius pivot around the ulna.

C) Grasp distal shaft of radius between thumb and finger. Palpate lateral side of radius to tip of styloid process. Should be proximal to flexor crease of the wrist.

D) Locate dosas surface of styloid process of the radius. Slide thumb in direction of head of ulna and explore knob of the tubercle. Passively flex and extend the wrist, tissue over tubercle will move, but tubercle will remain stationary.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the difference between extrinsic and intrinsic muscles?

A

Intrinsic: Short muscle bellies in the body of the hand or foot.
Extrinsic: Long muscles with bellies in the forearm or leg.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Abduction and adduction of the wrist are also called?

A

Abduction is radial deviation

Adduction is ulnar deviation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Brachialis:

  1. AOI
  2. How can you palpate the brachialis?
A

A: Flex the elbow
O: Distal half of the anterior surface of the humerus
I: Tuberosity and coronoid process of the ulna

  1. It is important to distinguish between the biceps and the brachialis.
    -Flex elbow to 90 degrees. Ask partner to flex elbow against resistance to find biceps.
    -With arm relaxed, slide laterally off the distal biceps. The edge of the brachialis can be detected by rolling finger on the surface. Follow it distally to where it disappears at the elbow.
    Verify that you are on the lateral side of the arm between the triceps and biceps.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q 
Brachioradialis: 
What is unique about brachioradialis? 
1. AOI
2. What is a great way to have the brachioradialis pop out?  
How can you palpate the brachioradialis?
A

It is the only forearm muscle that does not cross the wrist joint.
A: Flex the elbow. Helps to pronate and supinate when these movements are resisted.
O: Proximal 2/3 lateral supracondylar ridge of the humerus
I: Styloid process of the radius.

  1. Press fist up into a table.
    • Flex elbow 90, forearm in neutral. Ask pt to flex elbow against resistance. Look for brachioradialis bulging out on the lateral side of the elbow.
    • Locate the lat supracondylar ridge of the humerus and slide distally.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How can you distinguish between the flexor and extensor groups of the forearm?

A

Use the brachioradialis and shaft of the ulna as dividing lines.
1. Locate brachioradialis and shaft of the ulna when the partner’s arm is flexed to 90.

  1. Flexors: move medially from the shaft of the ulna. Ask partner to flex wrist against resistance.
  2. Extensors: Move lateral shaft of the ulna. Ask partner to extend wrist against resistance.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the extensors of the forearm (wrist and fingers)?

What are their AOI?

A

Extensor Carpi Radialis Brevis
Extensor Carpi Radialis Longus
A: Extend the wrist, Abduct the wrist, flex the elbow
O: Longus: Distal one third of the lateral supracondylar ridge of the humerus.
Brevis: Common extensor tendon from the lateral epicondyle of the humerus.
I: Longus: Base of 2nd metacarpal. Brevis: Based of 3rd metacarpal.

Extensor Carpi Ulnaris
A: Extend the wrist, adduct the wrist.
O: Common extensor tendon from the lateral epicondyle of the humerus.
I: Based of the 5th metacarpal.

Extensor Digitorum
A: Extends the second through fifth fingers (MCP and IP)
Extend the wrist (assist)
O: Common extensor tendon
I: Based of the middle and distal phalanges of the second through fifth fingers.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

1.How do you palpate the entire extensor group?

2.How do you palpate specifically?
ECR
ED
ECU

A
  1. Locate the brachioradialis and the shaft of the ulna. Lay hand between these landmarks and ask pt to alternatively extend and relax wrist against resistance. Palpate the common extensor tendon at the lateral epicondyle.
  2. A) Find brachioradialis and slide laterally. Ask partner to alternatively abduct and relax against resistance to differentiate between the ECR and brachioradialis.

B) Slide laterally of the ECR fibres. Ask partner to extend and relax wrist and fingers. Follow the bellies distally into the tendons. Ask partner to wiggle fingers as if typing to feel the contraction.

C) Find the shaft of the ulna and slide laterally to ECU. Ask partner to alternatively adduct wrist against resistance.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q
  1. Anconeus:
    AOI
    Palpation
  2. Extensor Indicis
A

1.
A: Extend the elbow
O: Lateral epicondyle of the humerus
I: Olecranon process and posterior proximal surface of the ulna.

  • Locate the olecranon process and the proximal shaft of the ulna and the lateral epicondyle.
  • Lay index finger on the proximal ulna and the middle finger on the lateral epicondyle. V is the anconeus.
  1. A: Extend the second finger. Adduct the second finger.
    O: Posterior surface of the distal shaft of the land and interosseous membrane.
    I: Tendon of extensor digitorum at the second metacarpal.

Extend finger to see 2 side by side tendons.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q
  1. What are the layers of the forearm flexors?
  2. What are the flexors of the wrist and fingers?
    What are their AOI?
A
  1. Superficial layer: FCR, PL, FCU
    Middle Layer: Flexor digitorum superficialis
    Deep Layer: Flexor digitorum profundus

2.
Flexor carpi radialis
A: Flex the wrist. Abduct the wrist. May assist elbow flex.
O: Common flexor tendon from medial epicondyle of the humerus.
I: Based of the second and third metacarpals.

Palmaris longus
A: Tense the palmar fascia, flex wrist. May assist elbow flex.
O: Common flexor tendon.
I: Flexor retinaculum and palmar aponeurosis.

Flexor carpi ulnaris
A: Flex the wrist, adduct the writs. May assist to flex elbow.
O: Humeral head: Common flexor tendon. Ulnar head: posterior surface of the proximal 2/3 of the ulna.
I: Pisiform, hook of hamate and base of the 5th metacarpal.

Flexor digitorum superificialis
A: Flexes the 2-5 MCP and PIP. Flex the wrist.
O: Common flexor tendon, ulnar collateral ligament, coronoid process of the ulna, interosseous membrane and proximal shaft of the radius.
I: Sides of the middle phalanges 2-5.

Flexor digitorum profundus
A: Flexes the MCP, and DIP. Flex the wrist.
O: Anterior and medial surface of the proximal 3/4 of the ulna.
I: Distal phalanges, palmar surface 2-5.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q
  1. How do you palpate the flexors as a group?
  2. FCR and PL
    FCU
    FDS/FDP
A
  1. Locate the brachioradialis and the shaft of the ulna. Lay hand between these landmarks. Ask pt to alternately flex and relax wrist. Locate their origin at the common flexor origin of the medial epicondyle of the humerus.

FCR/PL: Begin at distal tendons and have pt alternately flex and relax wrist. Ask pt to alternatively abduct and relax the wrist to isolate the FCR.

FCU: Find the pisiform, slide proximally off the pisiform to the superficial tendon of the FCU. Ask pt to alternatively adduct and relax the wrist.

FDS: Locate the tendons of the superficial flexors. Passive flexion of the wrist will soften these tendons. Work thumb between tendons for the deeper digitorum tendons and bellies. Have pt wiggle tips of fingers to detect undulating contractions.

FDP: Simultaneously flex elbow and wrist. Locate ulnar shaft and slide off its edge to the flexors. Ask pt to squeeze the tips of the 5th finger and thumb together and relax. Should feel a distinct contraction of the digitorum muscles as they contract.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Pronator Teres

A

A: Pronate the forearm and flex the elbow.
O: Common flexor tendon and the coronoid process of the ulna.
I: Middle of the lateral surface of the radius.

Locate distal tendon of biceps brachii. Slide distally off the tendon into valley between the brachioradialis and the flexors.
Pronator runs obliquely.
Flow fibres from the medial epicondyle to the middle radius.
Ask pt to profane against resistance to feel the contraction.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Pronator Quadratus

A

A: Pronate the forearm
O: Medial anterior surface of the distal ulna
I: Medial anterior surface of the distal radius

  • Isolate pulse of the radial artery. Locate radius styloid process and slide anterior surface.
  • Flex and pronate the wrist slightly. Use thumb to find tissue.
  • Ask partner to pronate gently to feel a small contraction.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Supinator

A

A: Supinate forearm
O: Lateral epicondyle of the humerus, radial collateral ligament, annular ligament and supinator crest of the ulna.
I: Anterior lateral surface of the proximal 1/3 radial shaft.

Locate lateral epicondyle and the proximal shaft of the radius.
Place finger pads on the landmarks and palpate through the extensor fibres for the deep supinator belly.
Ask pt to alternately supinate and relax forearm against resistance. The contraction should be felt deep to the brachioradialis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How many carpal bones are there and what are they?

A 
8 
Scaphoid
Lunate 
Triquetrum 
Pisiform 
Hamate 
Capitate
Trapezoid
Trapezium
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

How do you palpate the carpals as a group?

A
  • Position hand w/ palm up, locate styloid process of the ulna and radius
  • Slide distal from the styloid processes to explore the palmar surface of the carpals.
  • Rest thumb pads on the heel of the hands and passively move the wrist in all directions. Note how the carpals shift and undulate slightly. Then explore dorsal surface.
  • Flex wrist: carpals press into palm of hand
  • Extend wrist: carpals become more prominent on hand’s dorsal surface.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q
  1. How do you palpate the pisiform?

2. What muscle attaches on the pisiform?

A
  1. Locate the flexor crease of the wrist, slide to pinkie side. Move distal to crease rolling thumbpad in small circles.
    - Passively flex wrist: pisiform moves from side to side
    - Extend wrist: pisiform immobile
    - Active adduction wrist: Feel tendon of flexor carpi ulnaris
  2. Flexor carpi ulnaris
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

How can the triquetrum be palpated?

A
  1. Pt hand facing away from you. Find styloid process of ulna, slide distally along a ditch before rising to the surface of the triquetrum.
    - Abduct wrist and notice how the triquetrum protrudes to the side.
    - Adduct and the bone should disappear back into wrist.
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q
  1. How do you palpate the hamate?

2. What inserts on the pisiform and hamate?

A
  1. Locate pisiform. Draw imaginary line from pisiform to based of index finger.
    - Slide off pisiform along line. Approximately half an inch from the pisiform is a subtle mound the hook of the hamate.
  2. Flexor retinaculum.
22
Q
  1. What is the most commonly fractured carpal bone?

2. How can it be palpated?

A
  1. Scaphoid
  2. -Locate styloid process radius. Slide thumb distally off process. Fall in natural ditch where scaphoid is found.
    - Maintain position and passively adduct the wrist-> scaphoid buldge into thumb.
    - Abduct-> scaphoid disappears.
    - Explore scaphoid tubercle on palmar surface.
23
Q

How do you palpate the trapezium?

A

Palpate radial/dorsal side of the scaphoid, slide distally. If you pass trapezium onto base of 1st metacarpal slide back down proximally.
-To check if you are on the base of the first metacarpal instead of the trapezium have pt flex and extend thumb slowly.

24
Q
  1. What attaches on the scaphoid and trapezium tubercles?

2. How do you palpate these structures?

A
  1. Lateral aspect of the flexor retinaculum.
  2. Locate radial surface of scaphoid along flexor crease. Walk thumb to palmar surface of the scaphoid. Find the body knob distal to flexor crease. Flex wrist slightly.
25
Q
  1. What is the most frequently dislocated carpal bone?

2. How do you palpate the lunate? capitate?

A
  1. Lunate
  2. Locate lister’s tubercle and base of 3rd MC. W/ the wrist slightly extended lay thumb between these two points and it should fall into a cavity.
    - Proximal end of cavity: flex wrist and feel lunate press into finger. Extend and bone will disappear
    - Distal end of cavity: flex wrist and feet capitate press into finger.
26
Q

Trail 1: Along the Edges

How do you palpate:

  • Spine of the scapula
  • Medial Border
  • Inferior Angle
  • Superior Angle
  • Lateral Border
  • Infraglenoid tubercle
A

Spine of Scapula:

  • Place hand oblique angle lat from acromion and med to vertebral column
  • Should feel a ditch of soft tissue above and below the spine.
  • Check: Have pt elevate scapula and spine should raise as well.

Medial Border:

  • Pt prone. Have the put HBB.
  • Locate spine of scapula and slide fingertips medially until they slide off the spine.

Inferior Angle:
-Pt prone, HBB. Glide inferiorly along the medial border until you reach the corner. Pinch inferior angle between fingertip and thumb.

Superior Angle:

  • Not easy to isolate (deep to muscle)
  • Prone or sliding. Scoop shoulder w/ hand. Locate medial border and slide fingers superiorly along the border to find the superior angle. Should be 1 inch superior to spine of scapula.

Lateral Border:
-Pt prone (HBB or arm draped off side of table). Find inferior angle and slide thumb superiorly along the lateral border. Follow towards axilla.

Infraglenoid Tubercle:

  • Prone, locate lat border.
  • Slide along lat border to superior portion. Compress overlying muscles or slide under them (triceps, teres minor and deltoid).
27
Q

What is a winged scapula?

A

When the medial border falls away from the rib cage and protrudes posteriorly.

  • weak serrates anterior
  • Or muscles that pull shoulder girdle anteriorly (pec maj and min)
28
Q

Trail 2: In the Trenches

How do you palpate:

  • Infraspinous Fossa
  • Suprapinous Fossa
  • Subscapular Fossa
A

Infraspinous Fossa:
-Pt prone. Locate spine scapulae, med and lat borders. Cradle inf angle b/w index and thumb. Place finger other hand along spine of scapula: this is the infraspinous fossa (triangular area).

Supraspinous Fossa:
-Prone find spine of scapula. Raise superiorly into the fossa. Strum fingers vertically to feel supraspinous muscle fibers.

Subscapular Fossa:
Method 1: Side lying (or prone): Find middle of lateral border. Sink and curl thumbpad into the fossa. Can only sink 1 in into fossa. Hard to access b/c of muscles.

Method 2: Medial portion of subscapular fossa: Side lying, flex pt’s shoulder. Lay 1 hand on medial border and other hand slide scapula posteriorly off the rib cage. Curl fingers around muscle onto the fossa.

29
Q

Trail 3: Springboard Ledge

How do you palpate:

  • Acromion
  • Clavicle
  • A/C Joint
  • S/C Joint
  • Coracoid process
  • Deltoid Tuberosity
A

Acromion:
- Locate spine of scapula, follow it as it rises superiorly and laterally to the top of the shoulder. On the posterior edge you should feel the acromial angle.

Clavicle:

  • Locate acromion and move medially onto the clavicle. Explores body from the acromion to the sternum. Acromial end rises superiorly and the sternal end curves inferiorly.
  • Have pt move shoulder anteriorly to feel the clavicle protrude.
  • W/ one finger on either side of the scapula, have pt elevate/depress and abduct/adduct the scapula to feel the clavicle shift.

A/C Joint:
-Locate acromion, slide medially towards clavicle (should rise up onto clavicle). Btwn these two landmarks will be the small ditch of the A/C joint.
Check: place finger on A/C joint. Have partner elevate (Ac widens) and depress (ac joint diminish) scapula.

S/C Joint:
-Slide medially along the clavicle, sternal end of clavicle will broaden. Locate S/C joint by sliding fingers off the sternal end.
Check: Passively elevate, depress and abduct scapula.

Coracoid Process:
-Start at the lateral shaft of the clavicle and slide inferiorly about an inch and a half. Locate tip of coracoid by pressing finger into tissue.
Check: Passively move scapula and feel coracoid follow movement.

Deltoid Tuberosity:
-Locate acromion and slide laterally down the arm to the halfway point between the shoulder and elbow.
Check: have partner abduce shoulder.

30
Q

Trail 4: Two hills and a Valley

How do you palpate:

  • Greater Tubercle
  • Lesser tubercle and inter tubercle groove
A

-Deep to muscles to hard to palpate.

Greater tubercle:

  • SHWP (Shake hands w/ partner), locate the acromion.
  • Slide inferiorly and laterally off the acromion (1 inch)
  • Larger solid surface deep to deltoid is GT

Lesser tubercle:

  • Place them on greater tubercle. Rotate arm laterally.
  • As arm rotates greater tubercle will roll out from under thumb and be replaced by inter tubercular groove.
  • Continue to laterally rate and the thumb will rise onto the lesser tubercle.

Check: lateral rotation arm bump-ditch-bump sequence.
Should be horizontally at the level of the coracoid process.

31
Q

What muscles do the following movements?

  • Shoulder Flexion
  • Shoulder Extension
  • Horizontal Abduction
  • Horizontal Adduction
  • Abd
  • Add
  • Lateral (external) rotation
  • Medial (internal) rotation
  • Scapular Elevation
  • Scapular Depression
  • Scapular Abd (protraction)
  • Scapular Add (retraction)
A

Flex: Deltoid, Pec maj UF, biceps brachii, coracobrachialis.
Ext: Deltoid PF, Lat dorsi, teres major, pec major LF, triceps brachii long head.
Hoz Abd: Deltoid (PF)
Hoz Add: Deltoid (AF) and Pec Maj (UF)
Abd: Deltoid, supraspinatus
Add: Lat dorsi, teres major, infraspinatus, pec, triceps, coracobrachialis.
Lat: Deltoid (PF), Infraspinatus teres minor
Med: Deltoid (AF), Lat dorsi, teres major, subscapularis and pec major.
Elevation: trapezius, Rhomboids (major and minor), levator scapula
Depression: Traps, serrates anterior, pec minor.
Protraction: serrates anterior and pec minor
Retraction: trapezius and rhomboids

32
Q

Deltoid:

1) AOI
2) How do you palpate?
3) How do you isolate between the anterior and posterior fibers?

A
  1. A: All- Abd shoulder
    AF: Flex, medially rotate and horizontal Abd
    PF: Ext, laterally rotate and horizontally Add
    O: Lateral 1/3 of the clavicle, acromion and spine of the scapula.
    I: Deltoid Tuberosity

2.
- Locate spine of scapula, acromion and lateral 1/3 of clavicle. Note V of this landmark
-Find the deltoid tuberosity
-Palpate between these landmarks to isolate the superficial convergent fibers of the deltoid.
Check: Have pt alternatively abduct and relax arm.

  1. Shake partner’s hand.
    - Place other hand on the deltoid.
    - Feel ant fibers contraction during medial rotation
    - Feel post fibers contraction during lateral rotation
33
Q

Trapezius:

1) AOI: UF, MF, LF
2) UF palpation
3) MF palpation
4) LF palpation

A

1) A:
UF: Extend the head and neck (Bilat). Unilaterally: Laterally flex head and neck to the same side, rotate head and neck to opposite side, elevate the scapula, upward rotation of the scapula.
MF: Adduct the scapula and stabilize
LF: Depress scapula and upward rotation of scapula
O: External occipital protuberance, medial portion of the superior nuchal line of the occiput, ligamentum nuchae and spinous process of C-7 to T-12.
I: Lateral 1/3 of clavicle, acromion and spine of scapula.

2) Prone.
-Flap of muscle lying across top of the shoulder. Grasp superficial tissue of the shoulders. Follow superiorly towards the based of the head at the occiput.
-Follow inferiorly to the lateral clavicle.
Check: Ask partner to extend neck. Or, have partner elevate scapula towards ears. Should feel fibers contract.

3) Prone, locate spine of scapula. Slide medially off the spine of the scapula to the superficial fibers of the trapezius.
Check: Have pt adduct the scapula or bring shoulder off the table.

4) Draw a line from the spine of the scapula, to the spinous process of T12. Palpate along this line.
Check: ask pt to hold arms out like superman and feel superficial fibers contract. or Ask pt to depress shoulder.

34
Q

Latissimus Dorsi

1) AOI
2) Palpation: Method 1 and 2

A

1)
A: Extend shoulder, medially rotate and adduct
O: Inferior angle of the scapula, spinous process of the last 6 thoracic vertebrae, last 3-4 ribs, thoracolumbar aponeurosis and posterior iliac crest.
I: Intertubercular groove of the humerus

2)
Method 1:
Prone w/ arm off the side of the table.
-Grasp tissue lateral to the lateral border of the scapula.
Check: ask pt to medially rotate shoulder against resistance.

Method 2: Supine.

  • Cradle arm in flexed position
  • Ask pt to extend shoulder against resistance to feel lat dorsi contract.
35
Q

Teres Major

1) AOI
2) Palpation

A

1)
A: Extend, adduct, medially rotate (same as lat doors)
O: Inferior angle and lower 1/3 of the lateral border of the scapula.
I: Crest of the lesser tubercle of the humerus.

2) Prone w/ arm off the table.
- Find lat dorsi, move to lateral border of the scapula (medially). This will be the teres major.
- Move fingers towards axilla where fibers blend w/ lat dorsi.

To distinguish between the lat dorsi and the teres major, have pt medially rotate the arm. Fibers that attach directly to lat border are TM and ore lateral fibers are the Lat Dorsi.

36
Q

Supraspinatus

1) AOI
2) Palpation

A

1)
A: Abduct the shoulder and stabilize the head of the humorous in the glenoid cavity
O: Supraspinous fossa
I: Greater tubercle of the humerus

2) Prone. Locate spine of scapula.
-Slide superiorly onto the supraspinous fossa. Go deep to the trapezius onto its fibers. Follow laterally until they run under the acromion.
Check: Have partner alternatively abduct and relax their arm to feel the supraspinatus contract (the trapezius will remain inactive).

37
Q

Infraspinatus

1) AOI
2) Palpation

A

1)
A: Laterally rotate shoulder, Adduct the shoulder and stabilize
O: Infraspinous fossa
I: Greater tubercle of the humerus posterior to the supraspinatus.

2) Prone. Locate spine of scapula, medial and lateral borders. Form a triangle around the infraspinatus. Follow fibers laterally as they converge underneath the deltoid to attach on the humerus.

Check: Have partner alternately raise elbow off the table and relax to feel it contract.

38
Q

Teres Minor

1) AOI
2) Palpation

A

1)
A: Laterally rotate the shoulder, adduct the shoulder and stabilize
O: Upper 2/3 of the lateral border of the scapula
I: Greater tubercle of the humerus posterior to the infraspinatus

2) Prone. Locate lateral border of the scapula (superior half) and slide off laterally onto the teres minor. Can grab the muscle in the axilla like a hamburger grip.
Check: Have pt laterally rotate shoulder lift elbow towards the ceiling.

To differentiate between the major and the minor: make sure pt has elbow on the table. Alternatively medially rotate (major) and laterally rotate (minor).

39
Q

Subscapularis

1) AOI
2) Palpation

A

1)
A: Medially rotate the shoulder, stabilize the shoulder
O: Subscapular fossa of the scapula
I: Lesser tubercle of the humerus

2) Side lying (can also be done supine)
-Flex shoulder and pull arm anteriorly
-Locate lateral border w/ thumb and slide under the lat doors and teres major fibers. Curl thumb onto sub scapular fossa.
Check: ask pt to medially rotate.

40
Q

How do you palpate the rotator cuff tendons?

  1. Supraspinatus
  2. Infraspinatus and teres minor tendons
  3. Subscapularis
A
  1. A. Seated w/ arm at side of body. Locate acromion and slide inferiorly onto the greater tubercle. Btwn these landmarks there should be a palpable portion of the tendon. Sink thumb deep to the deltoid.
    Check: surface of the greater tubercle.
    OR
    B. HBB: Passively extend arm as far as comfortable to bring the supraspinatus tendon out from under the acromion.
    Check: Palpate inferior to A/C joint.
  2. Supien or seated. Flex shoulder to 90 degrees. Horizontal adduct and laterally rotate slightly. This makes the tendon accessible although still deep to the deltoid. Locate acromion angle and slide inferiorly to tendon on the greater tubercle.
  3. Seated arm next to trunk. Find coracoid process and slide 1 in inferiorly and laterally btwn 2 tendons of the biceps.
    Palpate through deltoid fibers to lesser tubercle.
41
Q

Rhomboids Major and Minor

1) AOI
2) Palpation

A

1)
A: Adduct the scapula, Elevate the scapula (ST), Downwardly rotate the scapula
O: Maj: T2-T5 Min: T1 and C7
I: Maj: Medial border of the scapula between the spine and inferior angle.
Min: Upper portion of the medial border across from the spine of the scapula.

2) Prone. Locate medial border of the scapula and spinous process C7-T5. Palpate through trapezius, strum vertically to feel the fibers of the rhomboids.
Check: Fibers should run at an oblique angle.
Place HBB and raise elbow to ceiling. This will engage the superficial traps as well as rhomboids.

42
Q

Levator Scapula

1) AOI
2) Palpation

A

1)
A: Elevate the scapula, downwardly rotate the scapula, laterally flex the neck and rotate the head and neck to the same side. Bilaterally: Extend the he’d and neck.
O: Transverse processes of C1-C4
I: Medial border of the scapula between the superior angle and the superior portion of the spine of the scapula.

2) Method 1: Palpate through the trapezius to the superior angle of the scapula, place fingers just off the angle and strum across the belly of the elevator. Follow fibers superior (LS will go to the lateral side of the neck, but the trapezius will not).

Check: ask partner to alternately elevate and relax scapula. Feel elevator snap relax and contract. Upper traps not capable of this action.

43
Q

Serrates Anterior:

1) AOI
2) Palpation

A

1)
A: Abduct the scapula, upwardly rotate the scapula, depress the scapula, hold the medial border of the scapula against the rib cage,
O: External surfaces of the upper 8 ribs
I: Anterior surface of the medial border of the scapula.

2) Supine. Locate the lower edge of the pec major and the lat dorsi. Place fingers along the side of the ribs between the lats and pec maj. Strum fingers across ribs to feel the fibers of lat dorsi.

Check: Have partner flex shoulder w/ a fist. Place one hand on top of SA and one overtop of the raise fist. Ask pt to raise fist toward the ceiling and relax to fee SA fibers contract and soften.

44
Q

Pectoralis Major:

1) AOI
2) Palpation

A

1) Clavicular, sternal and costal fibers. Upper and lower fibers have opposing actions.
A: All: Adduct the shoulder and medially rotate.
Upper: Flex the shoulder and horizontally adduct.
Lower: Extend the shoulder.

O: Medial half of the clavicle, sternum and costal cartilage of 1-6 ribs.

I: Crest of the greater tubercle.

2)
Method 1: Supine
-Slightly abduct the arm. Locate the medial shaft of the clavicle and move inferiorly onto clavicular fibers.
-Follow fibers laterally as they blend with the deltoid and the greater tubercle.
-Grasp pec mag between thumb in the axilla.
Check: have pt medially rotate shoulder against resistance.

Method 2: Differentiate between upper and lower fibers.
Supine w/ hand raised towards the ceiling.
- Ask partner to bring hand over head (flex shoulder) to feel upper fibers.
-Ask partner to bring arm towards hip against resistance (extend shoulder to feel lower fibers).

Method 3: Side lying.
Flex shoulder and pull it anteriorly towards you. Passively flex and extend shoulder to feel changes in tissue tension.

45
Q

Pectoralis Minor:

1) AOI
2) Palpation

A

Under pec maj!

1) A: Depress scapula, abduct the scapula, downwardly rotate the scapula. Assists to elevate thorax during forced inhalation.
O: 3,4,5 ribs
I: Medial surface of coracoid process of the scapula.

2)
Method 1: Supine
-Abd arm and place fingers lateral edge of pec maj.
-Slowly slide under pec man along ribs.
-Ask pt to slight press shoulder down towards hips (depress scapula)

Method 2: Side lying
-Support arm in flexed position and pull anteriorly.
-Slide thumb under pec maj along the surface of the ribs.
Check: Ask pt to depress scapula to feel minor contraction.

46
Q

Subclavius:

1) AOI
2) Palpation

A

1)
A: Depress the scapula, elevate the first rib, stabilize S/C joint.
O: First rib and cartilage
I: Inferior middle 1/3 of the clavicle.

2) Side lying, support arm in flexed and pull anteriorly.
- Place thumb and fingers at the centre of the clavicle. Slowly curl thumb around clavicle’s underside to access subclavius.
- Fibers should be parallel to clavicle, hard to isolate.

47
Q

Biceps Brachii:

1) AOI
2) Palpation
3) Tendon of the long head of the biceps.

A

1)
A: Flex the elbow, supinate the forearm, flex the shoulder.
O: SH: Coracoid process of the scapula LH: Supraglenoid tubercle of the scapula.
I: Tuberosity of the radius and aponeurosis of the biceps brachii.

2)
Seated. Bend elbow and shake partner’s hand. Ask to flex against resistance.
-Palpate anterior surface of the arm. Follow the belly distally to inner elbow where it becomes a thick solid distinct tendon.
-Follow proximally to where it tucks under the anterior deltoid.
Check: Ask pt to alternatively pronate and supinate to feel the biceps contract during supination.

3) Locate inter tubercular groove (laterally rotating the arm helps). As partner to flex elbow against resistance to fell the biceps tendon become that in the groove.

48
Q

Triceps Brachii:

1) AOI
2) Palpation
3) Long head of the triceps.

A

1) A: All: Extend elbow
Long: Extend the shoulder and adduct the shoulder.
O: Long: Infraglenoid tubercle. Lateral: Posterior surface of the proximal shaft of the humerus. Medial: Posterior surface of the distal half of the humerus.
I: Olecranon process of the ulna.

2) Prone
Arm off the side of the table, palpate the posterior aspect of the arm.
-Locate olecranon to find the distal tendon of the triceps.
Check: Ask pt to extend elbow against resistance to feel the tendon and then the medial and lateral heads on either side.

3) Prone. Ask pt to bring elbow towards ceiling against resistance. Locate belly of long head along the proximal medially aspect of the arm. Follow in as it disappears under the posterior deltoid towards the infraglenoid tubercle.

49
Q

Coracobrachialis:

1) AOI
2) Palpation

A

1) A: Flex the shoulder and adduct the shoulder.
O: Coracoid process of the scapula
I: Medial surface of the mid-humeral shaft.

2) Supine laterally rotate arm and abd shoulder to 45 degrees. Locate pec major as a reference point.
- Lay one hand on medial arm and move into the armpit.
- Have pt horizontally adduct against resistance. Ilsoate the edge of pec major and slide posteriorly off fiber into the axilla.

50
Q

What muscle form the 4 walls of the axilla?

A

Lateral Wall: Biceps and coracobrachialis
Posterior: Subscapularis and Lat Dorsi
Medial Wall: Serratus anterior and rib cage.
Anterior: Pectoralis major

51
Q

How do you palpate:

1) Coracoclavicular ligament
2) Coracoacromial Ligament
3) Brachial Artery

A

1) Provides stability A/C joint.
Abduct and medially rotate shoulder.
-Locate coracoid process and clavicle. Palpate in these spaces between these landmarks. Feel like a solid taught band.

2) Attaches 2 process of the same bone.
Protects the rotator cuff tendons and the subacromial bursa.
-Locate coracoid process and anterior aspect of the acromion. Palpate deep to deltoid fibers for the ligament between these two landmarks.
-Try to extend the arm to bring the ligament closer to the surface.

3) Go medial to the distal tendon of the biceps brachii to locate the pulse.

PHTH 550- Orthopaedic Management Final (13 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions