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DIT OMM > Upper Extremities > Flashcards

Upper Extremities Flashcards

1
Q

Rotator cuff muscles

A

SItS

supraspinatus - abduction of arm
Infraspinatus - external rotation of arm
Teres minor - external rotation of arm
Subscapularis - internal rotation of arm

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2
Q

Deltoid primary actions

A

Anterior portion - flexor
middle - abductor
posterior - extensors

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3
Q

Arterial supply of upper extremity

A

subclavian artery passes between anterior and middle scalenes

becomes axillary artery at lateral border of first rib

becomes brachial artery at inferior border of teres minor muscle

Divides into ulnar and radial arteries at bicipital apopneurosis

radial artery - lateral aspect of forearm - elbow, wrist, dorsal hand, forms deep palmar arterial arch

Ulnar artery - medial forearm - elbow, resit, dorsal aspect of hand, forms superficial palmar arterial arch

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4
Q

Sympathetics to upper extremity

A

T2-T8

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5
Q

Motion of shoulder - abduction

A

180 degrees abduction

  • 120 of glenohumeral motion
  • 60 scapulothoracic joint
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6
Q

Common SD of shoulder

A

MC: restriction in internal and external rotation (rotator cuff)

2nd MC: restriction in abduction

least common: restriction in extension

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7
Q

Clavicle motion

A

see saw motion - A/P or Sup/Inf

rotate around transverse axis - w/ internal or external rotation of arm

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8
Q

MC SD of SC joint

A

Clavicle - anterior and superior on sternum

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9
Q

MC SD of AC joint

A

Clavicle - superior and lateral on acromion

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10
Q

Thoracic outlet syndrome

A

compression of neurovascular bundle between:

  1. anterior and middle scalenes - Adson test
  2. clavicle and 1st rib - Costoclavicular/military test
  3. pectoralis minor and upper ribs - Wright hyperabduction

Neck pain or radiation to arm - ache or paresthesias

Tx: OMT to C2-C7, T1, Rib 1, thoracid inlet, clavicle, scalenes if SD present
Exercise to strengthen trapezius and levator scapula

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11
Q

Supraspinatus tendinitis

A

Continuous impingement of greater tuberosity against acromion as arm flexed and internally rotated

Tender at tip of acromion

Gradual onset, preceded by strain, exacerbated by abduction 60-120 degrees - painful arc
Use empty can test

Chronic tendinitis -> calcification of supraspinatus tendon

Tx: Rest, Ice, NSAIDs, OMT at shoulder complex

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12
Q

Bicipital tenosynovitis

A

tendon and sheath of long head of biceps inflammation
Over use, subluxation of tendon out of bicipital groove

Pain anterior portion of shoulder radiates to biceps

Tender over bicipital groove, aggravated by resisted flexion or supination of forearm

Tx: rest, ice for acute injury OMT to free restriction in glenohumeral area and myofascial release

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13
Q

Rotator cuff tear

A

usually supraspinatus
Trauma

tender just below tip of acromion

Transient sharp pain -> steady ache lasting for days

positive drop arm test and weakness in active abduction - tear of supraspinatus
Atrophy, pain for months, esp at night

tx: minor tears - rest, ice, NSAIDs in acute stages; complete avulsion - surgery

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14
Q

Adhesive capsulitis/frozen shoulder syndrome

A

pain and restriction of shoulder motion, increasingly worse over course of 1 year

decreased ROM w/ active and passive movements

pain at end of ROM

over 40 yo
Prolonged immobility of shoulder
tender at anterior portion of shoulder

Main goal - prevention, OMT, Spencer techniques

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15
Q

Shoulder dislocation

A

usually anteriorly and inferiorly

injury to axillary nerve can occur

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16
Q

Winging of scapula

A

weakness of anterior serratus m. d/t long toracic nerve injury

scapula protrudes posteriorly when pushing on wall

17
Q

Erb-Duchenne palsy

A

C5-C6 nerve root inj during childbirth

paralysis of deltoid, external rotators, biceps, brachioradialis, supinator

18
Q

Klumpke’s palsy

A

C8, T1 injury

paralysis occurs in intrinsic muscles of hand

19
Q

Radial nerve injury

A

Crutch palsy, humeral fractures, Saturday night palsy

wrist drop and triceps weakness

20
Q

Primary flexors of wrist and hand

A

originate on or near medial epicondyle of humerus

innervated by median nerve - except flexor carpi ulnaris - ulnar n.

21
Q

Primary extensors of the wrist and hand

A

originate at lateral epicondyle of humerus

innervated by radial nerve

22
Q

arm carrying angle greater than 15 degrees

A

cubitus valgus

abduction of ulna, medial glide of olecranon (proximal ulna), radius pushed distally -> adduction of wrist

23
Q

arm carrying angle less than 3 degrees

A

cubitus varus

adduction of ulna, lateral glide of olecranon (proximal ulna), radius pushed proximally -> abduction of wrist

24
Q

Posterior radial head

A

falling forward on pronated forearm

pronation, radial head glides posteriorly

  • restricted supination of forearm
  • restricted anterior glide of radial head
25
Q

Anterior radial head

A

falling backward on supinated forearm

supinated, radial head glides anteriorly

  • restricted pronation of forearm
  • restricted posterior glide of radial head
26
Q

Carpal tunnel syndrome

A

entrapment of median nerve at wrist

parasthesias on thumb, first 2 1/2 digits

weakness, atrophy late

Tinel’s, Phalens, prayer tests

Tx: splints, NSAIDs, steroid inj, surgery if medical tx fails

Tx rib and upper thoracic SD to decrease sympathetic tone
Tx cervical SD and myofasical restriction to enhance brachial plexus function, remove potential sites of additional compression
Tx carpal tunnel w/ direct release techniques to increase space in carpal tunnel

27
Q

Lateral epicondylitis (tennis elbow) and Medial epicondylitis (golfer’s elbow)

A

lateral:
strain of extensor muscles of forearm near lateral epicondyle
overuse of forearm extensors and supinators - hitting racquet sports, turning screwdriver
pain over lateral epicondyle, worse with wrist extension against resistance

Medial:
Flexor m of forearm near medial epicondyle
overuse of forearm flexors and pronators

tx: NSAIDs, rest, ice; OMT to cervical, upper thoracic SD, counterstrain muscles, decrease fascial restrictions

28
Q

Swan-neck deformity

A

flexion contracture of MCP and DIP
Extension contracture of PIP

Contracture of intrinsic muscles

RA

29
Q

Boutonniere deformity

A

extension contracture of MCP and DIP
Flexion contracture of PIP
Rupture of hood of extensor tendon at PIP

RA

30
Q

Claw hand

A

extension of MCP, flexion of PIP and DIP

Median and ulnar injury - loss of intrinsic muscles and overactivity of extensor muscles

31
Q

Ape hand

A

wasting of thenar eminence w/ claw hand

thumb adducted

median nerve damage

32
Q

Hand of Benediction

A

contracture of last two digits w/ atrophy of hypothenar eminence

ulnar nerve damage

33
Q

Dupuytren’s contracture

A

flexion contracture of MCP and PIP
contracture of last two digits

contracture of palmar fascia

Assoc with liver cirrhosis

34
Q

Wrist drop

A

radial nerve damage - paralysis of extensor muscles

DIT OMM (18 decks)

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