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
Name the superficial flexors and their nerve(s)
- FCR
- FCU
- FDS
- Pronator teres
- Palmaris longus
- all median nerve
Name the deep flexors and their nerve(s)
- FDP (2,3 = anterior interosseous, 4,5 = ulnar)
- pronator quadratura = ant int
- FPL = ant int
Name the superficial extensors and their nerve(s)
- ECRL
- ECRB
- ED
- Anconeous (radial)
- ECU
- EDminimi
- all innervated by posterior interosseous except anconeus
Name the deep extensors and their nerve(s)
- Supinator = radial
- Extensor indicis = post interosseous
- AbPL = post int
- EPB = post int
- EPL = post int
What are the spinal levels of musculocutaneous nerve? Axillary? radial? median? ulnar?
Musculocutaneous = C5-C7 Axillary = C5, C6 Radial = C5-T1 Median = C5-T1 Ulnar = C8, T1
What is the capsular pattern for humeroulnar joint? radio humeral? prox radioulnar? dist radioulnar?
Humeroulnar = Flexion, ext
Radiohumeral = Flex, ext, sup, pron
Prox radioulnar = sup, pron
dist radioulnar = pain at extremes
What may cause crepitus in the shoulder?
- Scarring of the subacromial soft tissue or ST bursae
- Torn glenoid labrum
- OA of AC or GH joint
- Intra-articular loose bodies
- Rotator cuff tears
When evaluating the shoulder, pain at extreme AROM, and associated crepitus, is almost always ___[injury]____ in nature
soft tissue
What are in extensor compartments 1-3?
1 = AbPL, EPB 2 = ECRB, ECRL 3 = EPL
What are in extensor compartments 4-6?
4 = ED, EIndicis 5 = EDMinimi 6 = ECU
What does horizontal adduction test?
- Injured AC joint
- Posterior inferior capsule
- Interior labrum (causes grinding of anterior labrum)
- May aggravate existing impingement of coracoacromial arch
- Stretches infra, supraspinatus, and trees
- pinches subscap, coracoid process, and subcoracoid bursa
With anterior instability, there is often abnormal ____ translation of the humeral head during scapular plane abd. What symptoms will be experienced during this motion?
Superior; pain and possible clicking, but not usually apprehension since pain is usually due to impingements
What is dead arm syndrome?
a sudden loss of ER and sharp paralyzing pain in full abduction due to anterior subluxation or impending dislocation
What portion of the MCL is the main stabilizer to valgus forces?
anterior oblique portion
- valgus stress test at 30*
What muscle is most affected with lateral epicondylosis/itis? medial?
- Extensor Carpi Radialis Brevis
- Flexor Carpi Ulnaris
Scapular dyskinesia type: characterized by prominence of the infermomedial border of the scapula due to abnormal posterior tilt around a horizontal axis in the plane of the scapula
Type I
- when isolated, affected scapular sits lower
Scapular dyskinesia type: consists in the prominence of its entire medial border due to excessive ER around a vertical axis through the plane of the scapula
Type II
- volley ball player
What injury is Type II dyskinetic pattern of the scapula often associated with?
SLAP lesion
Scapular dyskinesia type: displayed upward rotation of the superomedial border of the scapula around a horizontal axis, resulting in abnormal superior migration of the scapula
Type III
What injury is Type III dyskinetic pattern often associated with?
decrease in the size of the acromiohumeral space and potential rotator cuff injuries
What may be the cause of Type I scapula dyskinesia?
- weak muscles (lower trap, lats, serratus anterior)
- tight pectorals minor or major pulling
What may be the cause of Type II scapula dyskinesia?
weakness of the serratus anterior, rhioboids, lower middle and upper traps, long thoracic nerve problem, or tight humeral rotators
What may be the cause of Type III scapula dyskinesia?
overactivity of the levator scapula and upper trap along with imbalance of the upper and lower trap force couple
What ulnar variance (plus or minus) results in more stress exerted on the lunate in ulnar deviation, increasing the shear and compression fracture and avascular necrosis
plus
- ulna is relatively longer
- Kienbock’s disease
- minus = thin TFCC, plus = thick TFCC
inflammation of the tendon and sheath of the APL and EPB; result of overuse of thumb in pinching or excessive ulnar deviation; localized swelling, crepitus, and radiation of pain either primally or distally from the first dorsal wrist compartment; radial styloid typically is very tender
DeQuervain’s syndrome
What three conditions may involve APL, EPB, EPL?
- localized teninitis
- de Quervain’s syndrome
- Extensor intersection (pain at muscle bellies)
What are the clinical imaging rules for UE?
- Canadian C-spine rules
- Elbow extension test
- Point tenderness for scaphoid
What are the 5 items for the CPR of CTS?
- Shaking hands relieves symptoms (flick sign)
- a wrist-ratio index greater than .67
- an SSS score greater than 1.9 (symptom severity scale)
- diminished sensation in the median sensory field
- age greater than 45 years
What is Bennet’s fx? What is Keinboch’s disease? what is Preiser’s disease?
Bennet's = avulsed base of 1st MC Keinboch's = avascular necrosis of lunate Preiser's= avascular necrosis of scaphoid
