Upper Extremities Flashcards
Rotator cuff muscles
SItS
supraspinatus - abduction of arm
Infraspinatus - external rotation of arm
Teres minor - external rotation of arm
Subscapularis - internal rotation of arm
Deltoid primary actions
Anterior portion - flexor
middle - abductor
posterior - extensors
Arterial supply of upper extremity
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
Sympathetics to upper extremity
T2-T8
Motion of shoulder - abduction
180 degrees abduction
- 120 of glenohumeral motion
- 60 scapulothoracic joint
Common SD of shoulder
MC: restriction in internal and external rotation (rotator cuff)
2nd MC: restriction in abduction
least common: restriction in extension
Clavicle motion
see saw motion - A/P or Sup/Inf
rotate around transverse axis - w/ internal or external rotation of arm
MC SD of SC joint
Clavicle - anterior and superior on sternum
MC SD of AC joint
Clavicle - superior and lateral on acromion
Thoracic outlet syndrome
compression of neurovascular bundle between:
- anterior and middle scalenes - Adson test
- clavicle and 1st rib - Costoclavicular/military test
- 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
Supraspinatus tendinitis
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
Bicipital tenosynovitis
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
Rotator cuff tear
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
Adhesive capsulitis/frozen shoulder syndrome
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
Shoulder dislocation
usually anteriorly and inferiorly
injury to axillary nerve can occur
Winging of scapula
weakness of anterior serratus m. d/t long toracic nerve injury
scapula protrudes posteriorly when pushing on wall
Erb-Duchenne palsy
C5-C6 nerve root inj during childbirth
paralysis of deltoid, external rotators, biceps, brachioradialis, supinator
Klumpke’s palsy
C8, T1 injury
paralysis occurs in intrinsic muscles of hand
Radial nerve injury
Crutch palsy, humeral fractures, Saturday night palsy
wrist drop and triceps weakness
Primary flexors of wrist and hand
originate on or near medial epicondyle of humerus
innervated by median nerve - except flexor carpi ulnaris - ulnar n.
Primary extensors of the wrist and hand
originate at lateral epicondyle of humerus
innervated by radial nerve
arm carrying angle greater than 15 degrees
cubitus valgus
abduction of ulna, medial glide of olecranon (proximal ulna), radius pushed distally -> adduction of wrist
arm carrying angle less than 3 degrees
cubitus varus
adduction of ulna, lateral glide of olecranon (proximal ulna), radius pushed proximally -> abduction of wrist
Posterior radial head
falling forward on pronated forearm
pronation, radial head glides posteriorly
- restricted supination of forearm
- restricted anterior glide of radial head
Anterior radial head
falling backward on supinated forearm
supinated, radial head glides anteriorly
- restricted pronation of forearm
- restricted posterior glide of radial head
Carpal tunnel syndrome
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
Lateral epicondylitis (tennis elbow) and Medial epicondylitis (golfer’s elbow)
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
Swan-neck deformity
flexion contracture of MCP and DIP
Extension contracture of PIP
Contracture of intrinsic muscles
RA
Boutonniere deformity
extension contracture of MCP and DIP
Flexion contracture of PIP
Rupture of hood of extensor tendon at PIP
RA
Claw hand
extension of MCP, flexion of PIP and DIP
Median and ulnar injury - loss of intrinsic muscles and overactivity of extensor muscles
Ape hand
wasting of thenar eminence w/ claw hand
thumb adducted
median nerve damage
Hand of Benediction
contracture of last two digits w/ atrophy of hypothenar eminence
ulnar nerve damage
Dupuytren’s contracture
flexion contracture of MCP and PIP
contracture of last two digits
contracture of palmar fascia
Assoc with liver cirrhosis
Wrist drop
radial nerve damage - paralysis of extensor muscles
