Upper and Lower Limbs

Question 1

How many flexors do we have in each finger ?

Answer 1

2

Question 2

Name both flexors for each finger?

Answer 2

FDS and FDP

FDS: flexor digitorum superficialis
FDP: flexor digitorum profundus

Question 3

Wrist:
What is meant by the terms gross composite flexion ?

Answer 3

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

Question 4

Wrist:
What’s it’s meant by normal cascade

Answer 4

When the fingers whilst palm facing upwards are relaxed and curl inwards alone.

Question 5

How to test the FDP of the finger ? There’s 2 ways

Answer 5

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

Question 6

Why is FDS known as the mass muscle

Answer 6

Because it is one 💪 muscle and 4 tendons (fingers) that are attached to it

Question 7

Why can some people not bend the PIP joint when all 3 fingers are outstretched

Answer 7

Because the Lil finger don’t have its own FDS

Question 8

What is the hands long extensor responsible for ?

Answer 8

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

Question 9

What’s the name of tendon that attached from the MCP to the PIP joint area?

Answer 9

Central slip

Question 10

Name of the tendon that would have been damaged if the patient can’t lift finger from the PIP joint ?

Answer 10

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&raquo_space; Elsons test «

Question 11

What compensatory measure will you see of a patient has a damaged central slip will a HCP see ??

Answer 11

Bent tip (hyper-extended)

Question 12

What test can be done to check for damage to the central slip tendon?

Answer 12

Elsons test !

Question 13

How to perform the Elsons test

Answer 13

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)

Question 14

What are the test you would perform if you identified that a patient had a scaphoid fracture?

Answer 14

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 📦

Question 15

Name of test that tests for lateral epicondylitis (tennis elbow)

Answer 15

Mills test

Question 16

What’s the easy term of medial epicondylitis ?

Answer 16

⛳️ (golfers) elbow

Question 17

Name of test that tests for frozen shoulder

Answer 17

Coracoid pain test

Question 18

Fancy medical name for frozen shoulder ?

Answer 18

Adhesive capsulitis

Question 19

How to perform the coracoid pain test

Answer 19

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

Question 20

Characteristics of coracoid process pain means that there is pain and thickening of the ……………………. Ligament ____________ interval and the ______________ triangle

Answer 20

Characteristics of coracoid process pain means that there is pain and thickening of the CORACOHUMERAL Ligament ROTATOR CUFF interval and the CORACOID triangle

Question 21

What does the pain arm test, test for ??

Supraspinatus Rotator cuff inj
Shoulder impingement
Subacromial shoulder impingement
Frozen shoulder

Answer 21

Subacromial Shoulder impingement

Question 22

What actually happens when you have a Subacromial shoulder impingement ? Like when you move it what happens internally ?

Answer 22

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.

Question 23

How to perform the painful ark test and what does it test for ?

Answer 23

Palms facing outwards towards HCP and slowly rise the arms!

Subacromial Impingement Syndrome.

Question 24

How to perform the painful ark test

Answer 24

Palms facing outwards towards HCP and slowly rise the arms!

Question 25

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.

Answer 25

60 - 120 degreees

Question 26

When a patient feels pain at the 170 - 190 degrees margin what can this indicate whilst doing the painful arc test?

Answer 26

Acromioclavicular problemsss

Question 27

When a patient feels pain at the 170 - 190 degrees margin what can this indicate ?

Answer 27

Acromioclavicular problemsss

Question 28

Explain how you would test range of movement of the shoulder There are 10 !!!

Answer 28

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)

Question 29

Difference between Hawkins Kennedy test and painfull arc test? Hint: They both test for subacromial impingement btw

Answer 29

Painfull arc: (standing) arms up and above head with palms facing forwards (at certain degrees you will have pain!! 60-120*degrees 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

Question 30

What test, tests for internal impingement of the shoulder? Extra points how do you perform this??

Answer 30

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

Question 31

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 )

Answer 31

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

Question 32

What bone is nearest to the musculocutaneous nerve?

Answer 32

Radius and it is on top of the radial bone

Question 33

What are the 4 joints of the shoulder (seen on canvas ppt)

Answer 33

Sternoclavicular Acromioclavicular Glenohumeral Scapulatgoracic

Question 34

How many glenohumeral ligaments are there in the shoulder ? And name them

Answer 34

3 Superior glenohumeral ligament Middle glenohumeral ligament Inferior glenohumeral ligament

Question 35

How many glenohumeral ligaments are there in the shoulder ? And name them

Answer 35

3 Superior glenohumeral ligament Middle glenohumeral ligament Inferior glenohumeral ligament

Question 36

Name all 7 ligaments we have - ones “joint capsule” so name 6 and state which one has 3 !!

Answer 36

Acromioclaviculat Sternoclavicular Coraacromial Corococlavicular Joint capsule Coracohumeral Glenohumerl

Question 37

Subscularis and pectolaris muscles move the shoulder but how ? Posteriorly ? Anteriorly ? Distally?

Answer 37

Anteriorly

Question 38

How does the teres minor and infraspinatus muscles move the shoulder ? Posteriorly ? Anteriorly ? Distally?

Answer 38

Posteriorly: backward

Question 39

Which of the 4 rotator cuff muscles that abduct and raise the humerus?

Answer 39

Suprapinatus muscle

Question 40

What are the 3 primary functions of home rotator cuff muscles ?

Answer 40

1) Stabilisation 2) concavity compression 3) movement

Question 41

What 2 structures are attached to the biceps brachii?

Answer 41

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

Question 42

What nerve causes deltoid and teres minor paralysis (loss of rounded contour of shoulder too)

Answer 42

Axillary nerve damage Note: sensory loss of the skin covering the deltoid part of arm (regimental badge anaesthesia) - loss of abduction from 15 - 90* degrees

Question 43

How many degrees can the Supraspinatus muscle abduct the arm?

Answer 43

0-15* degrees Then the deltoid abducts the rest of the arm to 90* degrees so it’s known as the major abductor the deltoid

Question 44

How does the the elevation to 180* degrees occur what structures allow this?? Rotation of…….upwards By the ……… and ……….. anterior muscles Not the rotator cuff muscles

Answer 44

It’s brought by the rotation of the scapula upwards by the trapezius and serratus anterior muscle

Question 45

What’s the cause of shoulder impingement ?

Answer 45

Repetition

Question 46

Pts have a high occurrence to have what shoulder problem ?

Answer 46

Frozen shoulder

Question 47

The 3 joints of the elbow are ?

Answer 47

Ulnotrochlear Radiocapitellar Radioulnar

Question 48

The 3 joints of the elbow are ?

Answer 48

Ulnotrochlear Radiocapitellar Radioulnar

Question 49

Bones of the elbow are?

Answer 49

Distal humerus Proximal radial Proximal ulna

Question 50

The 3 landmarks we would check on assessment of the elbow are?

Answer 50

Radial head Olecranon Medial and Lateral epicondyles

Question 51

The 3 landmarks we would check on assessment of the elbow are?

Answer 51

Radial head Olecranon Medial and Lateral epicondyles

Question 52

If a patient can lift their arm only between 40-60* degrees what condition can this indicate a pt having ? (Shoulder condition)

Answer 52

Frozen shoulder (adhesive capsulitis)

Question 53

If a patient can lift their arm only between 20-40* degrees what condition can this indicate a pt having ?

Answer 53

Axillary nerve damage

Question 54

If a patient can lift their arm only between 0-20* degrees what condition can this indicate a pt having ?

Answer 54

Full thickness tear of Supraspinatus tendon

Question 55

What muscles rotate the scapula upwards when arm is flexed to 180* degrees ?

Answer 55

Trapezius and serratus anterior

Question 56

What nerve does the axillary nerve come out from ?

Answer 56

Musculocutaneous nerve

Question 57

What is the term used to describe a partial dislocation?

Answer 57

Subluxation

Question 58

With a scapula fracture since it’s such a type that needs exceptional force what other things would you think about if someone had this??

Answer 58

? DIB HIGH intolerance for other #’s

Question 59

What is a rotator cuff tear?

Answer 59

Micro or macro tearing of the muscles or tendons

Question 60

What is Rotator cuff tendinitis

Answer 60

Acute inflammation of the RC soft tissue

Question 61

What is Rotator cuff tendinopathy?

Answer 61

Chronic irritation or degeneration of the RC soft tissue Think pathy like pathophysiology and it’ll be long term and chronic

Question 62

What is shoulder impingement?

Answer 62

Biomechanics dysfunction of the shoulder complex which causes abnormal wear and tear on the RC soft tissue

Question 63

Most common elbow injury ? Name 4 of them !!!

Answer 63

Pulled elbow Olecronon bursitis Dislocation 🎾 elbow ⛳️ elbow

Question 64

Explain how pulled elbow happiness? Hint: sudden ….. …. Pronated

Answer 64

Sudden longitudinal traction with arm extended and pronated

Question 65

In pulled elbow what ligament is trapped between the radial head and distal humerus?

Answer 65

Annular ligaments

Question 66

At what age is the annular ligament stronger which prevents subluxation

Answer 66

5+ yrs

Question 67

For persistent cases of olecronon bursitis what is the treatment?

Answer 67

Corticoid steroid injections

Question 68

Which bone is force travelled up into by a FOOSH injury and what structure of the distal humerus is effected

Answer 68

The radius The capitellum

Question 69

What kind of fracture is common in children when they have a FOOSH injury ?

Answer 69

Fracture of the distal humerus above the epicondyles Called: supraocondylar fracture

Question 70

What 2 issues a supracondylar fracture can cause and these are highlighted in red on the PowerPoint.

Answer 70

Can cause neuro-vascular compromise Can occlude the brachial artery

Question 71

Wrist bones: What is the name of the bone that is attached the distal middle carpal bone?

Answer 71

Capitate

Question 72

Which bone is distal attached to the thumb bone?

Answer 72

Trapezium

Question 73

What bone is distally attached to the index phalanges?

Answer 73

Trapezoid

Question 74

Which bone is attached to both ring and pinkie finger distally ?

Answer 74

Hamate

Question 75

Which 4 other wrist bones are in the wrist but not attached to phalanges

Answer 75

Scaphoid,lunate, triqestrum and pisciform

Question 76

What does this neumonic stand for! List the bones So Long To Pinky Here Comes The Thumb

Answer 76

So - Scaphoid Long - Lunate To - Triquerum Pinky - Pisiform Here - Hamate Comes - Capitate The - Trapezoid Thumb - Trapezium

Question 77

What is the name of the mmebrane that is inbetween the radius and ulnar ??.

Answer 77

Interosseous memebrane

Question 78

Which finger is the tendon of flexor pollicis within?

Answer 78

Thumb

Question 79

What are the lumbricals attached to in the hand

Answer 79

Attached to the FDP tendons Flexor digitorum profundus tendons

Question 80

What’s important to ask when assessing the hand for any inj and this wil be something that can be easily forgotten Hint: not medically related

Answer 80

Hand Dominancy

Question 81

Flexion fracture of the radius is called what? Cole’s fracture Smiths fracture

Answer 81

Smiths fracture

Question 82

Extension fracture of the radius is called what? Smiths fracture Coles fracture

Answer 82

Cole’s fracture Usually a 🚩: arteries involved could be comprimaised

Question 83

Which bone commonly lacks blood supply

Answer 83

Scaphoid

Question 84

What is preisers disease known as Hint: hand related

Answer 84

Avascular necrosis of the scaphoid is rare where ischaemia and necrosis of the scaphoid bone occurs w/o Hx of previous #

Question 85

3 tests to test for a scaphoid fracture ?

Answer 85

Telescoping the thumb Snuff box Scaphoid tubercle tenderness

Question 86

Palm side of hand: Which nerves supply the three fingers index, middle and thumb

Answer 86

Median nerve

Question 87

Palm side of hand: Which nerve supplies ring and pinkie finger ?

Answer 87

Ulnar nerve

Question 88

Outter aspect of hand: What nerve supplies the index, middle, small portion of the ring and half the thumb ?

Answer 88

Radial nerve

Question 89

Name the finger joints and state where they are ?

Answer 89

MCP PIP DIP

Question 90

What is a jersey finger

Answer 90

a rupture of the flexor tendon, which is the tendon that bends the fingertip down

Question 91

Rupture in the lateral band of the finger causes the flexious of the DIP joint what is this called? Boutonniere deformity Mallet finger Swan kneck

Answer 91

Mallet finger Forces hyperflexion Damage to the extensor tendon overlying the DIP Blood under nail needs a splint

Question 92

Rupture of the volar plate is referred to what ?

Answer 92

Swan neck Causes hyperextension of the PIP joint and flexion of the DIP joint

Question 93

Boutinniere deformity is the disruption of ?

Answer 93

The PIP central slip Volar slip of lateral bands PIP flexed DIP hyperextended Can be inflammatory weakening

Question 94

Swan neck deformity is the

Answer 94

Hyper extension of the PIP and Flexion of the DIP causes: rheumatoid arthritis or untreated mallet finger

Question 95

What’s a diagnostic tool for assessing the digital nerves

Answer 95

Biro pen

Question 96

Try name all the intrinsic muscles using the All For One One For All

Answer 96

A - Abductor pollicis brevis F - flexor pollicis brevis O - openens pollicis O - opponens digiti minimi F - flexor digiti minimi A - abductor digiti minimi

Question 97

Booklet Qs: What is The purpose of the extensor hood ? In the hand ?

Answer 97

Extends the finger How?: The extensor hood spreads out further distally into a median band which attaches to the middle phalanx and two lateral bands which attach to the distal phalanx. Contraction of the extensor digitorum muscle tightens this tendon which acts on these attachments and extends the fingers. Google answer

Question 98

What are the actions of the lumbricals ??

Answer 98

The lumbricals are essential for the fingers' precision grip and fine motor control. These muscles flex the MCP joints and extend the PIP and DIP joints, coordinating with other hand muscles

Question 99

What is the ulnar nerve paradox ?

Answer 99

Causes a claw like look of ur ring and small finger. If the ulnar nerve lesion occurs more proximally (closer to the elbow), the flexor digitorum profundus muscle may also be denervated. As a result, flexion of the IP joints is weakened, which reduces the claw-like appearance of the hand

Question 100

What is ulnar claw hand ?

Answer 100

Claw hand is usually caused by damage to your ulnar nerve, which controls muscles in your ring and pinkie fingers. If your ulnar nerve is damaged, the muscles it controls don't get some or all of the electrical signals that tell them to straighten.

Question 101

What is hand benediction and what causes it?

Answer 101

Damage of the median nerve at the elbow or at the wrist. It is an abnormal posture of the hand when the patient is asked to make a fist: the fourth and fifth finger flex actively, while the thumb, index, and middle finger remain extended in the MCP joint, PIP joint, and DIP joint.

Question 102

How does Klumpke’s palsy present in patients, what muscle groups are affected?

Answer 102

Klumpke's palsy: sometimes referred to as Dejerine-Klumpke palsy. In Klumpke's palsy, the muscles of the forearm, wrist and hand are most affected. It is caused by a birth injury to the neck and shoulder due to a difficult vaginal delivery, tumor of the lung or shoulder, or trauma to the arm and shoulder. Sensory loss at medial side of forearm Really thin forearm muscles (wasting) wrist dropped floppy and clawed hand

Question 103

How does Erb’s palsy present in patients, what muscle groups are affected?

Answer 103

Erb's palsy affects the shoulder, arm and elbow. In general, your hand muscles aren't affected, but your hands may experience tingling or numbness. Signs and symptoms of Erb's palsy include: Paralysis or limpness of the shoulder, arm and elbow. shoulder, arm and elbow. In general, your hand muscles aren't affected, but your hands may experience tingling or numbness.