Upper Extremity Anatomy Tests Flashcards
4 Greek terms for upper extremity inspection
Rumor =. Redness
Tumor = mass
Dollar = pain
Calor =. Heat
4 joints of the shoulder
Acromioclavicular
Scapulothoracic
Glenohumeral
Sternoclavicular
Acromion
Long flat curved process of scapula that forms the AC joint and is the site of the middle deltoid attachment
Coracoid process
Deep scapular projection that serves as the origin of the short head of biceps and insertion of pectoralis minor and coracobrachialis
3 acromion types
Flat (least likely to cause impingement)
Curved
Beaked (most likely to cause impingement)
Impingement is the supraspinatus muscle w/ overhead activities
3 heads of deltoid origins
Clavicle
AC joint
Scapular spine
- pain along the insertion of the deltoid (lateral humerus) is most indicative of a rotator cuff tear*
Neutral shoulder ROM
Flexion = 150-170
Extension = 60
External rotation = 60
Internal rotation (in front of body) = 70
Internal rotation (behind back) = 95
Horizontal internal rotation vs horizontal external rotation degrees
Internal = 70 degrees
External = 90 degrees
- horizontal implies arms are abducted 90 degrees*
Abduction vs adduction degrees
Abduction = 180
Adduction = 20-40
Scapulohumeral motion
For every 30 degrees of shoulder abduction
20 degrees = humeral abduction
10 degrees = scapular rotation
Specific names of scapular rotation
“Up and down” =. A-P axis movement through AC joint
“Scapular winging” =. Vertical axis movement through AC joint
“Scapular tipping” = horizontal axis through the AC joint
(AC joint does abduction and both internal/external rotation)
Neutral plane of the scapula
30-45 degrees forward in coronal plane
Movements of the clavicle
Anterior/posterior
Superior/inferior
External/internal rotation
Boa’s sign
Pain in right shoulder/upper back is refereed pain from right abdominal organs (liver/gallbladder/ duodenum/ etc.)
Kehr’s sign
Pain in left shoulder/upper back is indicative of referred pain from the left abdominal organs
(Spleen, stomach and possibly renal damage)
Joints of the elbow
Humero-ulnar
(Flexion/extension)
Humero-radial
(Pronation/supination)
Proximal radio-ulnar
(Pronation/supination)
Elbow ROM from neutral position
Flexion = 145
Extension =. 0
Supination and pronation = 90
Carrying angle
Angle created from two lines at rest
From the proximal humerus to the elbow
From proximal forearm to tips of fingers
Males =. 5-10
Females =. 10-15
Abnormal carrying angles
Cubits valgus (> 15)
Cubits varus ( <5-10)
Supination and pronation with movement radius
Pronation = radius moves over the ulna posteriorly
Supination = radius moves over the ulna anteriorly
The ulna remains motionless
Wrist general ROM
Flexion = 80-90
Extension = 70
Adduction/ulnar deviation = 30
Abduction/radial deviation = 20
Reflexes of the arm with respect to their nerveroot
Biceps = C5
Brachioradials = C6
Triceps = C7
Reflex scale
0 = no reflex
1/4 =. Decreased present
2/4 = normal
3/4 = brisk with unsustained clonus
4/4 = brisk with sustained clonus
Motor strength scale
0 - absent
1/5 = slight contraction with no joint motion
2/5 = complete ROM without gravity
3/5 = complete ROM against gravity
4/5 = Complete ROM against gravity w/ light resistance
5/5 = complete ROM against gravity w/ full resistance
Difference between physiologic, restrictive and anatomical barrier
Physiological = farthest a patient Can actively move a joint
Restrictive barrier = farthest a joint can be moves just short of the physiological barrier
Anatomical barrier = farthest a patient can passively move a joint
Apley scratch test
Upper test over the shoulder to touch contralateral superior angle of the scapula: tests for external rotation and abduction of the arm
Lower test behind the shoulder to touch contralateral inferior angle of scapula: tests for internal rotation adduction
AC joint dysfunction
Cross arm over contralateral shoulder by adduction and raise elbow to 90 degrees
- push down on patient elbow and have them resist you
(+) = pain which indicates strain or tear at AC joint
Drop arm test
Patient abducts arms fully to 160-180 degrees
Patient is to slowly lower arms to each side
(+) If patient starts to unevenly drop one side at roughly 90 degrees, indicative of RCT specifically supraspinatus.
Empty can/jobe test
Patient abducts arm to 90 degrees, internally rotates 45 degrees and horizontally flexes 30 degrees (thumbs down)
(+) slight pressure downward on arm causes pain or inability for patient to resist, indicative of supraspinatus weakness
Infraspinatus/teres minor
Two tests:
1) patient flexes elbow 90 degrees and tries to rotate against physician resistance
(+) = cant do it and may cause pain, indicative of Infra and teres minor tears
2) patient flexes elbow to 90 degrees and externally rotates to max point passively
(+) = arm lags back to neutral, indicative of infra and teres minor tears
if patient shoulder shrugs when lifting arm, usually indicative of a tear
Subscapularis liftoff test
Place patient hand behind them with dorsum of hand on lumbar spine. Patient attempts to internally rotate against physcian resistance
(+) = cant do it and maybe slight pain = indicative for subscapularis tear
Neer’s and Hawkins tests
Both test sub acromion impingement of rotator cuff and biceps brachi
1) Hawkins: Patient elbow and shoulder flexed at 90 degrees and shoulder/arm forcefully internally rotated
(+) = pain
Neers: patient arm is internally rotated as close to 180 as possible (so that dorsum of hand is near the ear). Arm is then passively flexed up to 180
(+) pain is usually seen around 90 degrees
STABILIZE SCAPULA DURING BOTH PROCEDURES
Difference between dislocated and sublaxed shoulder
Dislocated = is dislocated and does not spontaneously fix itself
Sublaxed =. Dislocated and will spontaneously fix itself
Yergasons test
Tests stability of long head of biceps tendon and/or bicep tendonitis
Physcian stabilizes patients elbow and wrist and has patient make arm curl motion, with increases resistance each consecutive curl’
Physician eventually externally rotates the arm quickly
(+) popping sound (indicates sublaxed tendon) and pain (indicates bicep tendonitis)
Speeds test
Tests for bicep tendonitis
Patient with arm flexed at 90 degrees and supinate forearm
Physcian resists forward flexion of the arm arm at the wrist
(+) = pain
O’Brien’s test
Tests for GH Labrum tear
Patient has arm flexed to 90, adducted medial as far possible and internally rotated as far as possible
Physician then places a downward force on patient arm at forearm
(+) = pain
Wrights and adsons test
Test for impingement of the radial artery/nerve at both the pecterolis minor and Scalenes respectively
Physician finds patients radial pulse and then places them in the respective positions. (+)Weakened pulse or numbness
Roos test
Tests for thoracic outlet syndrome
(+) = numbness
Lateral epicondylitis
Pain at lateral epicondyle specifically at the extensor carpi radials brevis attachment
also known as tennis elbow
Maudsley and miles test (+) = pain with resisted extension
Also can experience pain with resisted supination
Medial epicondylitis
Pain at the medial epicondyle at the point of flexor carpi radialis attachment
also known as golfers elbow
Wrist flexion and resisted pronation elicits pain = (+)
Phalens and reverse phalens tests tests
Tests for carpal tunnel
Remain in position for 30-60 seconds (+) - numbness in the lateral hand
Finkelstein test
Tests for De Querviuan tenosynovits
*specifically tendonitis in the extensor pollicis brevis and abductor pollicis longus
(+) = pain over area and possible swelling
