UE Random from Notes Flashcards
What is indicated when the neck is fixed in a position of lateral flexion, with or without a rotational deformity?
Torticollis
What is indicated with posterior protrusion of the medial border of the scapula (AKA scapular winging)?
Weak serratus anterior or injury to long thoracic nerve
What posture is present when the head is positioned anterior to the acromion process?
Forward head
Lower motor neuron lesion- hyporeflexia; Sensory problems start proximal and work distal; Neck pain present
If patient complains of symptoms distal to the elbow, is .71 sensitive for this condition
cervical radiculopathy
- occurs in the intervertebral foramen
- due to degenerative changes of the facets, uncovertebral joints, or herniation of intervertebral disc
Upper motor neuron lesion – hyperreflexia; Wasting of palmar and dorsal interossei; Positive Hoffman’s reflex – flick DIP of index or middle finger and see fasciculation of the thumb; Sensory problems start distal and work proximal; No neck pain
Cervical myelopathy
- occurs within the spinal canal
- due to osteophytes and/or disc degeneration
What are the Canadian C-Spine rule?
- Any high-risk factor for which mandates radiography?
- 65+ years
- dangerous mechanism (fall from elevation greater than 3 ft or 5 stairs, axial load to the head, MVC over 60 mph, Bicycle collision, Motorized recreational vehicle)
- paresthesia in extremities - If no to 1st question; Any low risk factors which allows safe assessment of ROM?
- Simple rear-end MVC (Pushed into oncoming traffic, Hit by bus/large truck, Rollover, Hit by high speed vehicle)
- Sitting position in ED
- Ambulatory at any time
- Delayed onset of neck pain
- Absence of midline c spine tenderness - If no to first two questions; Able to actively rotate neck 45 degrees left and right?
-If no to all 3 questions, no radiography
What is the difference in primary, secondary, and tertiary shoulder impingements?
Primary - Due to structural/ mechanical cause (acromion process shape)
Secondary - Due to instability (Can be capsulary, ligamentous, muscular, etc.; Humeral head rides up and bangs against structure)
Tertiary - internal impingement; Internal rotator cuff being sucked into fossa when humeral head translates forward
What may be an appropriate treatment if pain or stiffness is present while doing a passive inter-vertebral mobility test?
Manipulation or mobilization procedure
What is the “painful arc”?
pain elicited between 60* and 120* of elevation
- pain from 90-180 = may be AC
- associated with supraspinatus tendinitis and subacromial bursitis
What does the presence of excessive scapular elevation or external rotation, or a unilateral restriction of scapular movement indicate?
dysfunction of the GH joint
What is the capsular pattern of the cervical spine?
equal limitations in all directions, except for flexion
If a pt reports dizziness, tinnitius, or nystagmus after doing ROM for cervical extension and/or rotation, what should be considered?
vertebral artery insufficiency (may need to refer out for specialty service)
While testing for cervical radiculopathy and myelopathy, what dermatomes and myotomes yeild the most reliability?
C5, C7, and T1 dermatomes
MMT for deltoid, biceps brachii, and extensor carpi radialis
Where are common sites of entrapment for the median nerve?
- Ligament of struthers
- Cubital fossa
- between two heads of pronator teres (pronator teres test)
- Carpal tunnel
Where are common sites of entrapment for the ulnar nerve?
- Arcade of struthers (fascia covering triceps and part of medial intermuscular septum)
- cubital tunnel (under medial epicondyle) (elbow flex test)
- flexor carpi ulnaris aponeurosis
- Guyon’s canal
Where are common sites of entrapment for the radial nerve?
- radial groove (due to forceful adduction, extension, runners palsy)
- bicipital aponeurosis
- between radial head and humerus
- arcade of Froshe (Radial tunnel syndrome) (supinator syndrome test)
Where are common sites of entrapment for the posterior interosseous nerve?
- Between two heads of supinator in arcade of Frohse
2. Radial tunnel syndrome - entrance to tunnel anterior to head of radius
Where are common sites of entrapment for the superficial radial nerve?
under bracioradialis tendon near the radial head - wartenberg’s disease or cheiralgia paresthetica
Indicates loss of pinch strength between them and adjacent digits due to a weakness of AP, FPB, and 1st dorsal interosseous
Froment’s sign