Upper Extremities Flashcards
What is the bracelet test and what does it test for?
lateral compression around ulna and radius (in area of a bracelet)
- tests for wrist fracture
what is froment’s sign, and what does it test for?
“pinch” test
“Duck beak” is normal
normally pinch with pad of thumb and first finger (using adductor pollicis - ULNAR n),
if pinch with tips of fingers, over pads - this is the “OK” sign and it’s abnormal (flexor pollicis brevis - MEDIAN nerve).
sign of ulnar nerve involvement* cubital tunnel syndrome
ask pt to hold piece of paper b/w fingers while you watch
describe phalen’s test - what does it test for?
Tests for carpal tunnel syndrome
- pt seated
- both wrists are maximally flexed, with back of hands held together, held in front of trunk.
- hold for 60 seconds
How do you perform the median nerve compression test?
pt seated
double thumb compression just prox. to the transverse carpal ligament x15s-2min
(+)= median nerve symptoms in hand
What is tinel’s sign?
when examiner gently taps over capal tunnel with fingertips/reflex hammer
- reproduction of median nerve sx = positive
What is Finkelstein’s Test and what is it testing for?
pt seated/standing
pt makes fist with thumb inside the fingers, either passively or actively the patient moves wrist into ULNAR deviation
- testing for tenosynovitis of the (ABL/EPB) ABductor pollicis longus and Extensor pollicis brevis
- test is positive if it reproduces sx
Where do the extensors of the wrist insert?
lateral epicondyle of the humerus (radial n. C7)
where do the flexors fo the wrist insert?
medial epicondyle of the humerus (median n. C7)
Which two tests, test for LATERAL epicondylitis?
Mills
Cozen’s
Which two tests, test for MEDIAL epicondylitis?
Reverse Mills
Reverse Cozen’s
How do you perform Cozen’s test?
pt: make a fist, pronate forearm, extend wrist with radial deviation
examiner: palp lateral epicondyle while doing resisted extension (ie - apply force toward wrist flexion)
(+) is reproduction of lateral epicondylitis sx
How do you perform Mill’s test?
palpate lateral epicondyle extend elbow posterior of pt pronate forearm flex wrist stretch common extensor tendon which stretches RADIAL n
How do you perform Reverse Cozen’s test?
pt: flex elbow to 120 deg, supinate forearm with slight wrist flexion and ulnar deviation
examiner: palpate medial epicondyle while doing resisted flexion (ie apply force toward wrist extension)
How do you perform Reverse Mill’s Test?
Pt: extends elbow, supinates forearm and extends the wrist
examiner applies flexion pressure to stretch common flexor tendon
How do you perform the valgus and varus stress tests for sprain and instability?
Valgus
- elbow extended first, then flexed 30 deg, with forearm in supination
- apply pressure L to M while pulling wrist laterally
Varus
- again, elbow extended then flexed 30, supination
- apply pressure M to L while pushing wrist medially
Where do you perform tinel’s sign on the elbow? what syndrome is this testing for?
percuss the ULNAR nerve b/w the medial epicondyle and the ulna
testing for cubital tunnel syndrome
Froment’s sign is also a test of cubital tunnel syndrome
What is the active ulnar tension test?
put both hands up as if carrying tray for waitressing
(flex elbow past 90, supinate forearm, extend wrist, abduct shoulder)
Positive if discomfort or paresthesia within 60s
Cubital tunnel syndrome
What is the PASSIVE ulnar tension test
pt supine support arm with thigh flex elbow past 90 abduct and depress shoulder extend wrist and fingers pronate forewarm ext. rotate shoulder flex the patient's writst
positive if discomfort of paresthesia within 60s
cubital tunnel syndrome
Where does the subscapularis insert and what are it’s actions?
inserts at the LESSER tuberosity of humerus
- internal rotation
- adduction
Where does the supraspinatus insert and what is it’s main action?
inserts at GREATER tuberosity of humerus
- ABduction
Where does the infraspinatus insert and what are its actions?
inserts at GREATER tuberosity of humerus
- ext. rotation
- ABduction
(opp of subscap)
Where does the teres minor insert and what are its actions?
inserts at GREATER tuberosity of humerus
- ext. rotation
- ADduction
what is a typical presentation when assessing for adhesive capsulitis?
shoulder elevation on the effected side
- this can be observed during flow
What is Speed’s test and what is it testing for?
with elbow extended and supinated
dr palpates biceps tendon and asks pt to flex shoulder against resistance
pos = biceps tendinopathy
