Upper and Lower Limbs Flashcards
How many flexors do we have in each finger ?
2
Name both flexors for each finger?
FDS and FDP
FDS: flexor digitorum superficialis
FDP: flexor digitorum profundus
Wrist:
What is meant by the terms gross composite flexion ?
When you press the inner arm that’s relaxing on a table palm facing upwards and press the forearm and you see the finger flexing
Wrist:
What’s it’s meant by normal cascade
When the fingers whilst palm facing upwards are relaxed and curl inwards alone.
How to test the FDP of the finger ? There’s 2 ways
Hold the middle phalanges, ask the pt to then bend tip of finger! Then do this again with resistance
Then to isolate the test: have palm facing up cover with hand the middle, ring and pinkie finger down and ask them to flex the finger! by doing this it helps isolate the FDS for that specific finger
Why is FDS known as the mass muscle
Because it is one 💪 muscle and 4 tendons (fingers) that are attached to it
Why can some people not bend the PIP joint when all 3 fingers are outstretched
Because the Lil finger don’t have its own FDS
What is the hands long extensor responsible for ?
Extension at the MCP joint
metacarpophalangeal (MCP)
Fact: If a patient cannot extend at the MCP joint they have an injury to the long extensor
What’s the name of tendon that attached from the MCP to the PIP joint area?
Central slip
Name of the tendon that would have been damaged if the patient can’t lift finger from the PIP joint ?
Central slip
How ever if they have injured their Central slip tendon they still can have secondary pull from the finger from the DIP due to the bands on the sides.
A way you can tell extension is from the DIP joint due to a damaged central slip is bu doing the»_space; Elsons test «
What compensatory measure will you see of a patient has a damaged central slip will a HCP see ??
Bent tip (hyper-extended)
What test can be done to check for damage to the central slip tendon?
Elsons test !
How to perform the Elsons test
3 modifications:
1st modification: Pt hand at the edge of the desk and have the PIP joint flexed and see if the DIP joint is floppy or can the patient extend not flex tip of the finger
2nd modification: get the hand flex the middle finger at the PIP joint then ask them to try and extend (outwards) at the DIP joint
3rd modification: Ask the patient to place both middle fingers PIP Joints together and ask them if they can push at the DIP joint (make their nails touch) if so there’s damage to the Central slip
Floppy at the DIP = intact Central slip tendon
Extend at DIP & no floppiness at DIP = damage (split into 2 the central slip tendon)
What are the test you would perform if you identified that a patient had a scaphoid fracture?
Not that specific:
1) hold pts hand like your shaking it then you bend upwards so that the base of thumb and radius head meet
2). (Slightly more specific but not enough)
Telescope the thumb so grab it and grab the wrist and compress it once. (the wrist meaning the distal radius and the thumb these structures should compress the scaphoid)
3). Snuff box tenderness:
🚩Problem doing a finger in the snuff box is bcs you have a lot of other anatomical structures in that place. This won’t give u too much information about the scaphoid! 🚩
More specific would be by doing ulnar deviation of the wrist opening the snuff box and press right on the scaphoid bone
For the MOST SPECIFIC have the pts palm facing upwards, dorsal flex hand alil back then palpat the bone u see popping out (scaphoid tubercle) at the base of the palm near the radial head! - VERY SPECIFIC FOR DISTAL SCAPHOID INJ
So it’s axial loading of the thumb on scaphoid, scaphoid tubercle tenderness and snuff box tenderness & testing with ulnar deviation w/ no snuff box 📦
Name of test that tests for lateral epicondylitis (tennis elbow)
Mills test
What’s the easy term of medial epicondylitis ?
⛳️ (golfers) elbow
Name of test that tests for frozen shoulder
Coracoid pain test
Fancy medical name for frozen shoulder ?
Adhesive capsulitis
How to perform the coracoid pain test
Palpate the AC joint, anterior lateral subacromial area and the coracoid process with your index finger
Possitive when pain on coracoid process when pain is greater than the AC joint and anterior - lateral subacromial area
Characteristics of coracoid process pain means that there is pain and thickening of the ……………………. Ligament ____________ interval and the ______________ triangle
Characteristics of coracoid process pain means that there is pain and thickening of the CORACOHUMERAL Ligament ROTATOR CUFF interval and the CORACOID triangle
What does the pain arm test, test for ??
Supraspinatus Rotator cuff inj
Shoulder impingement
Subacromial shoulder impingement
Frozen shoulder
Subacromial Shoulder impingement
What actually happens when you have a Subacromial shoulder impingement ? Like when you move it what happens internally ?
When you abduct your arm the glenohumeral joint will glide downwards but with Subacromial shoulder impingement the glide does not work properly so your major tubercle will collide with the acromion which squeezes on the Supraspinatus tendon or coracoid ligaments.
How to perform the painful ark test and what does it test for ?
Palms facing outwards towards HCP and slowly rise the arms!
Subacromial Impingement Syndrome.
How to perform the painful ark test
Palms facing outwards towards HCP and slowly rise the arms!
During the painful arc test at what degrees would you expect to see the patient complaining of pain at the “glenohumeral painful arc” area - which is possitive for subacromial shoulder impingement.
60 - 120 degreees
When a patient feels pain at the 170 - 190 degrees margin what can this indicate whilst doing the painful arc test?
Acromioclavicular problemsss
When a patient feels pain at the 170 - 190 degrees margin what can this indicate ?
Acromioclavicular problemsss
Explain how you would test range of movement of the shoulder
There are 10 !!!
1) elevation thru abduction 170-180* degrees:
Palms facing outwards, ask to raise arms slowly like the painfull arc test and do this looking at the front of patient then the back
2) elevation through forwards flexion @ 160-170* degrees:
Palms to body ask the pt with forward flex their arms all the way up forwards
And extension 50-60* degrees: patients arms go back - ensure they don’t compensate from the spine by leaning forwards or by scapular retraction.
3) Lateral/ external rotation 80-90* degrees:
Pts Elbow to stomach and ask them to bring the wrist outwards as far as possible without moving the elbow. (Carefull doing this to pts with dislocations)
4) medial/ internal rotation 60-100* degrees
There are 2 ways to test this:
1: hitch hiking-thumb:
- Ask the patient to use their thumb to reach as far up the back they can with both hands.
(Landing on T5 - T10 represent normal internal rotation degrees)
2: ask pt to abduct the arms 90* degrees and perform internal rotation:
- bring elbows up and drop forarms so palms facing back and try rotate / touch the palms to a wall
5) Adduction: 50-75* degrees
Arm move to the opposite side of body (both)
6) Horizontal adduction/ crossed flexion:
Ask pt to abduct arms to 90* degrees like In the painful arc test but head level then ask them to bring the arm forward past their face to the other side of their body
7). Scapular protraction
Bring shoulders as far out forward (anteriorly) as possible
8). Scapular retraction:
Same as protraction but squeeze shoulder blades together
9) shoulder elevation: shrug shoulders
10) shoulder depression (self explanatory)
Difference between Hawkins Kennedy test and painfull arc test?
Hint: They both test for subacromial impingement btw
Painfull arc: (standing) arms up and above head with palms facing forwards (at certain degrees you will have pain!! 60-120degrees it’s glenohumeral pain and at 170/180 degrees it’s acromioclavicular pain
Hawkins Kennedy: (sitting) pts arm is elevated at 90* degrees forward flexion 💪 and have it rest on one of the HCPs arms then perform passive internal rotation. Pain in Supraspinatus area. Hawkins will be negative for internal impingement
What test, tests for internal impingement of the shoulder?
Extra points how do you perform this??
By using the posterior impingement sign ✍️
Firstly this seen in overhead throwing athletes where they experience posterior shoulder pain from internal impingement !
The greater tuberosity of the humerus and the articular surgfaces if the rotator cuff touches the posterior superior Glenoid when the arm is in a throwing position.
HOW:
Passively abduct shoulder 100 degrees, extend shoulder off the side of the bed by 1 degree. Support the arm below the elbow and at the wrist and passively externally rotate the shoulder.
Positive test: pain behind should (posteriorly)
If the patient seems apprehensive note this down as this is very similar to the apprehension instability test
3 tests for rotator cuff tear?
1). These could be partial thickness tear - no surgery needed
2). Full thickness tear
3). Full thickness tear with complete detachment from humeral ball (surgery )
1) Empty can test with resistance from HCP
2) DROP ARM TEST:
Ask pt to raise arm up all the way assisted by themselves (arm 180* degrees) then ask them to lower down slowly.
3) teres minor and infraspinatus: (internal test)
Elbows to body and extend the wrists outwards with resistance from HCP if it slaps stomach - indicates teear!!!
Lift off test: hand on back (outter part of hand) lift hand away from your back NOT upwards but away from body
What bone is nearest to the musculocutaneous nerve?
Radius and it is on top of the radial bone
What are the 4 joints of the shoulder
(seen on canvas ppt)
Sternoclavicular
Acromioclavicular
Glenohumeral
Scapulatgoracic
How many glenohumeral ligaments are there in the shoulder ? And name them
3
Superior glenohumeral ligament
Middle glenohumeral ligament
Inferior glenohumeral ligament
How many glenohumeral ligaments are there in the shoulder ? And name them
3
Superior glenohumeral ligament
Middle glenohumeral ligament
Inferior glenohumeral ligament
Name all 7 ligaments we have
- ones “joint capsule” so name 6 and state which one has 3 !!
Acromioclaviculat
Sternoclavicular
Coraacromial
Corococlavicular
Joint capsule
Coracohumeral
Glenohumerl
Subscularis and pectolaris muscles move the shoulder but how ?
Posteriorly ?
Anteriorly ?
Distally?
Anteriorly
How does the teres minor and infraspinatus muscles move the shoulder ?
Posteriorly ?
Anteriorly ?
Distally?
Posteriorly: backward
Which of the 4 rotator cuff muscles that abduct and raise the humerus?
Suprapinatus muscle
What are the 3 primary functions of home rotator cuff muscles ?
1) Stabilisation
2) concavity compression
3) movement
What 2 structures are attached to the biceps brachii?
short head originates from the coracoid process of the scapula Coracoid process.
&
supraglenoid tubercle of the scapula, Scapula
The coracoid process is an anteriorly projecting, hook-like structure, on the lateral edge of the superior anterior portion of the scapula
