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Physical Diagnosis > Upper Extremity > Flashcards

Upper Extremity Flashcards

1
Q

Type of joints

A

Cartilaginous, Synovial, Fibrous

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2
Q

How do you evaluate UE?

A

Proximal to Distal.

Painful area last.

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3
Q

Always _______!

A

Compare

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4
Q

Volar refers to:

A

anterior forearm

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5
Q

Inspection of UE

A

symmetry, size: edema or atrophy, alignment, deformity, color: skin, nails, masses, guarding

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6
Q

When do you palpate tender areas?

A

last

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7
Q

What type of deformities can exist?

A

angulation, shortening

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8
Q

Nodules description

A

tender/non-tender; mobile/fixed; soft/hard

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9
Q

Pulses

A

Compare bilaterally

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10
Q

Tenderness to Palpation (TTP) process

A
  • localize as specifically as possible “ONE finger”
  • anatomical location usually provides diagnosis - bone, muscle, bursa, tendon, ligament, or combo
  • correlate with positive findings on inspection
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11
Q

Range of motion test

A

test each major joints for active range of motion followed by passive range of motion

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12
Q

Know ROM and watch for:

A

limitations of movement, instability, spasticity or pain

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13
Q

Compare ROM to:

A

opposite side of previous measurements if available suggestive of underlying problem

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14
Q

Muscle function chart gradings:

No muscle contraction

A

0

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15
Q

ROM quantified based on:

A

degrees of motion

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16
Q

Muscle function chart gradings:

Visible contraction, no joint movement

A

1

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17
Q

Muscle function chart gradings:

Joint motion, but not against gravity

A

2

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18
Q

Muscle function chart gradings:

Movement against gravity only

A

3

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19
Q

Muscle function chart gradings:

Movement with some resistance

A

4

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20
Q

Muscle function chart gradings:

Full strength with full resistance

A

5

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21
Q

Shoulder inspection

A

for color, size, symmetry, contour, deformity, and swelling

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22
Q

Shoulder asymmetry:

Could be indicative of:

A

loss of rounded contour

dislocation of shoulder or atrophy

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23
Q

Winged Scapula

A

paralysis of serratus anterior from injury to long thoracic nerve

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24
Q

Glenohumeral dislocation

A

dislocation: 95% anterior, 5% posterior

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25
Q

Inspection of glenohumeral dislocation and what is the sign called?

A

arm held in position of protection; sulcus sign

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26
Q

Shoulder palpation

A

Palpate and verbalize muscles and bony landmarks of the shoulder: clavicle, AC joint - acromion and coracoid process, Humerus, and Bicipital groove.

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27
Q

Shoulder ROM testing

A

Should be done both passive and active:
flexion/extension
abduction/adduction
internal/external rotation

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28
Q

Rotator Cuff Function:

Abduction

A

supraspinatus

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29
Q

Rotator cuff function:

External rotation

A

80% infraspinatus

20% teres minor

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30
Q

Rotator cuff function:

internal rotation

A

subscapularis

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31
Q

Strength testing of shoulder: testing against ROM example: “Don’t let me push them down” as you try to push down on distal upper arm

What are you testing?

A 
Abduction strength (arm to side of body)
Forward flexion - strength  (arm in front of body)
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32
Q

Strength testing of shoulder: testing against ROM example: “Don’t let me push them up” as you try to push arms up

A 
Adduction strength (arm to side of body
Extension strength (arms in front body)
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33
Q

Rotator Cuff Assessment: Empty can test

A

resistance against forward flexion in hyperpronation (thumbs down), elbow extension, and abduction

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34
Q

What does rotator cuff assessment: empty can test: test for?

A

supraspinatus injury/tear

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35
Q

Rotator cuff assessment: Gerber’s Lift Off Test

A

place hand on back with shoulder internally rotated: push against-resistance

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36
Q

What are you testing for with Gerber’s Lift Off Test

A

subscapularis injury/tear

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37
Q

Rotator Cuff testing: Drop arm

A

provider passively abducts arm to 120 degrees - ask patient to slowly lower it

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38
Q

Positive drop arm test indicates

A

inability to complete this secondary to weakness and/or pain

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39
Q

Impingement syndrome is what kind of phenomenon? What does this syndrome result in?

How do you test for it?

A

mechanical phenomenon

results in painful arc of ROM (70-120 degrees)

Arc from 0 degrees to 180 degrees

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40
Q

Impingement Syndrome: Hawkin’s test

A

Passive flexion to 90 degrees and forceful internal rotate the shoulder

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41
Q

Hawkins Test tests for

A

impingement

if Hawkin’s test is painful –> impingement –> rotator cuff concerns

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42
Q

Impingement syndrome results in

A

PAIN

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43
Q

Hawkins and Arc looking for

A

PAIN

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44
Q

Empty can, drop arm, and gerber’s lift off tests test for

A

weakness

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45
Q

Neer’s impingement sign:
looking for?
how do you do it?

A

looking for pain –> subacromial impingement –> rotator cuff concerns

passive flexion with arm pronated and scapula is stabilized

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46
Q

Biceps Tendon Assessment : Yergason test

A

Elbow flex at 90 degrees with forearm pronated. Supinate forearm and externally rotate humerus against resistance.

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47
Q

Biceps Tendon Assessment : Yergason test

A

Elbow flex at 90 degrees with forearm pronated. Supinate forearm and externally rotate humerus against resistance.

Pt tries to supinate while PA resists them.

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48
Q

Biceps tendon assessment: Speed’s test

A

Arm extended in full supination with shoulder flexed. Elevate arm against resistance.

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49
Q

Deformities of upper arm (4)

A

acute trauma: fracture,
previous trauma - malunion, nonunion
biceps rupture
tumor

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50
Q

Glenohumeral instability: sulcus sign

Tests for:

A

arm in neutral relaxed position, provider will pull the arm downward.

depression or “sulcus” in shoulder near acromion

evaluates for inferior instability
patient may voluntarily show this sign

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51
Q

Glenohumeral instability: apprehension and relocation test

A

elbow flexed at 90 degrees, arm abducted at 90 degrees - apply external rotation at the shoulder and note apprehension

Pain and apprehension with ROM testing - Pain is relieved with relaxation/relocation.

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52
Q

AC Joint

A

cross-body adduction test

53
Q

Cross Body Adduction test

A

examiners adducts patient’s arm across body toward other arm. Positive sign: pain elicited and localized to the AC joint

54
Q

Adhesive Capsulities

A

frozen shoulder

55
Q

Frozen shoulder symptoms

A

diffuse, dull, aching pain - usually no localized tenderness; progressive restriction of ROM; usually unilateral

56
Q

Apley scratch test tests for:

A

frozen shoulder (adhesive capsulitis)

Comparison is key

57
Q

What is Apley scratch test?

A

Put arm behind back and itch from inferior and superior angles

58
Q

Anatomy of Elbow: veins and lymphatics

A

Superficial: cephalic, basilic

Lymph nodes: axillary, epitrochlear

59
Q

When do you check epitrochlear nodes?

A

infection concern

60
Q

Bony prominences of elbow

A

olecranon process
medial epicondyle
lateral epicondyle
radial head

61
Q

What pulse do you check when inspecting and palpating elbows?

A

brachial pulse

62
Q

How to differentiate between radial head and lateral epicondyle?

A

Radial head moves when supinating

63
Q

Inspecting elbow for:

A

guarding - acute trauma, repetitive activity
deformity - acute trauma
redness - infection
swelling - acute trauma, infection, rheumatologic condition, repetitive activity
Masses - hard/soft, mobile/nonmobile

64
Q

Elbow palpation and ROM - important to identify these bony prominences

A

LOCATION: distal humerus, medial epicondyle, lateral epicondyle, radial head, olecranon, proximal forearm

65
Q

Elbow decreased ROM

A

flexion/extension

pronation/supination

66
Q

How to test elbow movement?

A

Flexion and extension - flex 150 degrees back to head, extend to 0 degrees

Supination/pronation WITH HUMERUS stabilized

67
Q

Epicondylitis

A

overuse syndrome

68
Q

Inspecting/palpation of epicondylitis

A

localized pain and swelling

69
Q

Epicondylitis: reproducible pain with:

A

wrist flexion (medial) or extension (lateral) against resistance

70
Q

Medial epicondylitis: Golfer’s elbow

A

flexor pronator muscle group

71
Q

Lateral epicondylitis: Tennis elbow

A

extensory supinator muscle group

72
Q

Olecranon bursitis

A

inflammation of bursa with fluid accumulation

73
Q

What causes olecranon bursitis?

A

local irritation, trauma, infection

74
Q

Pain in olecranon bursitis suggests what?

A

trauma or infection

75
Q 
Nursemaid's elbow
Affects what ages?
What is it?
What causes it?
How does child present?
How to test for it?
A

1-4 ages
subluxation/dislocation of radial head
common cause is sudden pull of pronated arm
Child guards extremity and limits ROM - holds elbow slightly flexed, forearm pronated
Feel radial head - will pop out

76
Q

Forearm/wrist inspection

A

guarding, asymmetry, redness, swelling, masses, deformities: angular or rotational, contour, number of digits

77
Q

Subcutaneous nodules

A

gouty tophi, rheumatoid arthritis

78
Q

Colles’ Fracture

A

Dinner fork deformity

79
Q

Common cause of Colles’ Fracture

A

fall backwards and distal radius pops out and overrides the rest of the bone

80
Q

Hand and wrist palpation

A

distal radius and ulna (styloids)
carpals
metacarpals
MCP joints, PIP and DIP joints

81
Q

Wrist palpation questions to ask

A

Maximal point of tenderness, radiating pain, distinguish between radius, ulna, or carpal bones, check for scaphoid tenderness - “snuff box”, distal neurovascular check - numbness, tingling

82
Q

Carpal Tunnel Syndrome affects which nerve

A

median

83
Q

____ tendons pass through carpal tunnel

A

flexor tendons

84
Q

Median nerve in carpal tunnel becomes:

A

compressed by inflammation of the synovium

85
Q

Carpal tunnel results in:

A

compression neuropathy with pain, paraesthesias, and thenar atrophy

86
Q

Chronic carpal tunnel most likely results in:

A

thenar atrophy

87
Q

Tinel’s Sign - how to perform

A

percuss over median nerve

88
Q

What does a positive tinel’s sign look like?

A

Tingling sensation in the distribution of the median nerve

89
Q

Phalen’s Test - how to perform

A

Flex wrists x 30-60 seconds

90
Q

What is a positive phalen’s test result?

A

paresthesia in the distribution of the median nerve

91
Q

de Quervain’s Tenosynovitis

A

inflammation of the 1st dorsal compartment involving the sheath of the abductor pollicis longus and extensor pollicis brevis

92
Q

Causes of de Quervain’s Tenosynovitis

A

overuse/repetitive gripping

93
Q

What test tests for de Quervain’s tenosynovitis?

A

finkelstein test - fist over thumb and ulnar deviation

94
Q

What is a positive de Quervain’s Tenosynovitis?

A

pain

95
Q

Ganglion cysts

A

collection of synovial fluid within a joint or tendon sheath - herniation of synovial tissue from capsule or tendon sheath

96
Q

Inspecting for ganglion cysts:

A

dorsal radial and volar aspects of wrist

97
Q

Palpation for ganglion cysts

A

soft mobile mass

98
Q

ROM for ganglion cysts:

A

may restrict motion or become painful with repetitive activity

99
Q

Scaphoid fracture

A

tender to palpation in the anatomical snuffbox

100
Q

Lateral and medial borders of anatomical snuffbox

A

Lateral: extensor pollicis brevis and abductor pollicis longus
Medial: extensor pollicis longus

101
Q

Radial deviation of hand is indicative of:

A

osteoarthritis

102
Q

Ulnar deviation of hand is indicative of:

A

rheumatoid arthritis

103
Q

Swan neck

A

hyperextension of PIP joints with fixed flexion of DIP

104
Q

Boutonniere

A

flexion of PIP joint with hyperextension of DIP joints

105
Q

Where are Heberden and Bouchard nodes located?

A

Heberden: DIP joints
Boucahrd: PIP joints

106
Q

What type of nodes are found with osteoarthritis?

A

heberden’s nodes

107
Q

What type of nodes are found with rheumatoid arthritis?

A

bouchard’s nodes

108
Q

Heberden’s nodes are:

A

hard and painless

109
Q

Bouchard’s nodes are:

A

boney enlargement

110
Q

Rheumatoid nodeules

A

common on dorsum of hand

111
Q

RA symptoms:

A

bouchard’s nodes
ulnar deviation
PIP joints - including swelling at proximal phalanx

112
Q

OA symptoms

A 
heberden's nodes
DIP joints 
PIP joints (SOMETIMES) - EXCEPT AT PROXIMAL PHALANX
113
Q

Capillary Refill

A

place pressure over nail beds to cause blanching then quickly remove

114
Q

Normal capillary refill

A

observe time elapsed for full return of color - should be equal to or less than 2 seconds

115
Q

Wrist and Hand ROM

A

wrist flexion and extension
radial and ulnar deviation
MCP, PIP, DIP flexion - “make a fist”
Digit extension with abduction/adduction

116
Q

How to test MCP, PIP, and DIP flexion?

A

make a fist

117
Q

Can miss a rotational deformity if:

A

you do not ask them to perform ROM

118
Q

How to test wrist flexion and extension?

A

test grip strength: ask patient to grip your two fingers and squeeze

119
Q

Neurologic check - sensory

A

axillary, radial, median, ulnar

120
Q

Saddle joint example

movements

A

trapezium and carpal bone and 1st metacarpal bone
adduction/abduction
flexion/extension
circumduction

121
Q

Hinge joint example

movements

A

Elbow

Flexion/extension

122
Q

Pivot joint example

movements

A

Between C1 and C2 vertebrae

Rotational

123
Q

Ball and socket joint example

movements

A

Hip joint
Flexion/extension
adduction/abduction
rotation

124
Q

Condyloid joint example

movements

A

Between radius and carpal bones of wrist
Flexion/extension
Abduction/adduction

125
Q

Plane joint example

movements

A

between tarsal bones

gliding movements

126
Q

Which joint(s) produce nonaxial movement?

A

plane joint

127
Q

Which joint(s) produce unilateral movement?

A

hinge joints, pivot joints

128
Q

Which joint(S) produce bilateral movement

A

condylar joint, saddle joint

129
Q

What joint(s) produce multiaxial movement?

A

ball and socket joint

Physical Diagnosis (4 decks)

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