Upper Extremity Assessment Flashcards
What causes winged scapula?
Paralysis of the serrratus anterior from injury to the long thoracic nerve.
What direction does a glenohumeral dislocation happen in 95% of the time?
Anteriorly
What are the signs of a glenohumeral dislocation?
The arm is head in a position of protection and positive sulcus sign
What is the sulcus sign?
The Sulcus sign is an orthopedic evaluation test for glenohumeral instability of the shoulder
What muscle in the rotator cuff is responsible for abduction?
Supraspinatus
What muscles in the rotator cuff are responsible for external rotation?
80% infraspinatus, 20% teres minor
What muscle in the rotator cuff is responsible for internal rotation?
Subscapularis
How should you test muscle strength in the shoulders?
By testing the muscle strength against resistance
“Done let me push your arms down”
What is the painful arc test?
- passively adduct the arm from 0 to 180 degrees.
- Determine at what degree the patient has pain. It is a positive test if they have pain between 60 and 120 degrees
How do you test for Neers sign?
1) Stabilize scapula with one hand
2) Passively Raise extended arm in external and internal rotation
3) Observe for pain that is worse with internal rotation
What is a postive Neers sign?
Pain with internal rotation. The amount of impingement correlates with degree of flexion
- 90 degrees: Mild
- 60-70 degrees: Moderate
- 45 degrees: severe
How do you perform the Hawkins test?
- Stabilize the shoulder with one hand
- Flex the elbow to 90 degrees
- passively flex the shoulder to 90 degrees
- Internally rotate the shoulder
How do you test for the external lag sign?
1) Flex elbow to 90 degrees
2) Passively externally rotate shoulder fully
3) ask the patient to maintain the positive.
What is a positive external lag sign?
Inability to maintain position and resist antagonistic muscles
How do you perform the external rotation test?
1) Ask pt to flex elbows to 90 degrees in supination
2) Stabilize one arm
3) Apply internal pressure at wrist
4) Ask patient to externally rotate against resistance
Positive if pain or weakness is present
How do you perform the Gerber lift off test?
1) Patient seated or standing
2) Ask patient to rest dorsum of hand on low back/sacrum
3) Ask patient to lift off to increase amount of internal rotation
4) Apply gentle resistance to hand
What is a postive gerber lift off test?
Inability to lift off or maintain resistance
How do you perform the empty can (Jobes test)?
1) Passively forward flex shoulders while maintaining hyperpronation (thumbs down), elbow extension, and slight abduction
2) Ask patient to resist downward pressure
What is a positive empty can test and what can this indicate?
Inability to maintain resistance and may indicate supraspinatous injury or tear
How do you perform the drop arm test?
1) Passively abduct shoulder to 120 degrees
2) Ask patient to slowly lower arm back to side
What is a positive drop arm test?
Inability to fully abduct the arm or maintain a smooth transition back to side. Secondary weakness and/or pain
What are the tests that can evaluate for impingement syndrome?
Painful arc test, Neers sign, and Hawkins sign
What are the tests that can assess for rotator cuff tear?
External lag sign, external rotation resistance test, gerber lift off, empty can (Jobes test), and drop arm
What symptom should you be testing for if you are suspicious for rotator cuff tear?
Weakness
What symptom should you be testing for if you are suspicious for impingement syndrome?
Pain
What is adhesive capsulitis also known as?
Frozen shoulder
What is the presentation of adhesive capsulitis?
- Diffuse, dull, aching pain usually without localize tenderness
- Progressive restriction of ROM in multiple planes
- Usually unilateral
What is the test for adhesive capsulitis?
Apley scratch test
How do you perform the Apley scratch test?
1) Ask pt to reach for opposite scapula (Abduction/ external rotation or adduction/internal rotation)
2) compare ROM of both sides
Side with Frozen shoulder will be very restricted
How do you test for the sulcus sign?
1) Arm in neutral relaxed position
2) one hand stabilizes shoulder
3) Downward pressure applied at antecubital fossa
What is a positive sulcus test?
Depression or “sulcus” of the shoulder greater than 2 cm near the acromion
- Evaluates for inferior instability
- Patient may voluntarily show this sign
How do you perform the apprehension, relocation, and release test?
1) Patient is supine
2) Elbow is flexed 90 degrees and arm is abducted 90 degrees
3) Gently apply external rotation at the shoulder while observing for apprehension
4) Apply posterior pressure to humerus
5) Abruptly remove pressure from humerus
What is a positive apprehension, relocation, and release test?
Pain and apprehension with ROM testing AND pain is relieved with relaxation/relocation
How do you perform the Yergason test?
1) flex elbow to 90 degrees pronation
2) place hand in patients palm
3) Ask patient to supinate and externally rotate against resistance
What is a positive Yergason test?
Pain along the biceps tendon
-May appreciate popping/clicking associated with biceps subluxation
How do you perform the speeds test?
1) Extend elbow with full supination
2) 30 degrees shoulder flexion
3) Ask pt to resist downward pressure
What is a positive speeds test?
Pain along biceps tendon
What are the two tests for Biceps tendinitis?
Yergason test and speeds test?
How do you perform cross body adduction?
1) examiners adduct patients arm across body towards the other arm
What is a positive cross body adduction test?
Pain elicited and localized at AC joint
What does the cross body adduction test do?
Assesses the AC joint
How do you perform O’Brien’s test?
Arm is flexed to 90 degrees and addicted 10-15 degrees with pronation. Ask patient to resist downward force.
What is O’Brien’s test used for?
Labral pain, AC pain, or biceps pain so you can better asses where the injury is.
What is medial epicondylitis?
Golfers epicondylitis
-Pain with resisted wrist flexion
What is lateral epicondylitis?
Tennis elbow
-pain with resisted wrist extension
What is olecranon bursitis?
Inflammation of the bursa with fluid accumulation.
-May be due to local irrigation, trauma, or infection (pain with trauma or infection)
How do you test for tinels sign at the elbow?
1) flexion elbow 90 degrees
2) Externally rotate arm
3) tap over ulnar nerve
What is a positive tinels sign at the elbow?
Shooting electric sensation or paresthesias over ulnar nerve distribution
What does a positive tinels sign in the elbow indicate?
Cubital tunnel syndrome
What is carpal tunnel syndrome?
When the median nerve becomes compressed by inflammation of synovium. Results in compression neuropathy with pain, paresthesias, and thenar atrophy
How do you test for tinels sign at the wrist?
1) Slightly extend at the wrist
2) Percuss over the median nerve
What is a positive tinels sign at the wrist?
Shooting electric sensation or paresthesia in the distribution of the medial nerve
What are the two tests for carpal tunnel?
Tinels sign at the wrist and Phalens sign
How do you test for phalens sign?
1) ask patient to full flex or hyperextend wrists
2) Maintain position for 30-60 seconds
What is a positive phalens test?
Paresthesias in the distribution of the median nerve
What is de Quervains tenosynovitis?
Inflammation of the 1st dorsal compartment involving the sheath of the abductor pollicis longus and the extensor pollicis brevis
-Causes are overuse and repetitive gripping
How do you perform Finkelstein test?
1) Ask patient to create a fist over thumb
2) Actively ulnar deviate wrist
3) May consider passively increasing the ulnar deviation
What is a positive Finkelsteins test?
Pain along the 1st dorsal compartment
What does a positive Finkelsteins test indicate?
De Quervains tenosynovitis
What is a Ganglion cyst?
Collection of synovial fluid within a joint or tendon sheath
-May be a herniation of synovial tissue from capsule or tendon sheath
If a patient has a scaphoid fracture, where are they going to have tenderness?
Anatomic snuffbox
What is a Boutonnière deformity?
Flexion of the PIP joint, hyperextension at the DIP
What is a swan neck deformity?
Hyperextension of PIP joint and flexion of the DIP joint
When are heberdens nodes commonly seen?
- Osteoarthritis
- commonly seen at the dorsolateral aspects of DIP joints
- Usually hard and painless
What are Bouchards nodes commonly seen?
RA and OA
-Nodes at PIP joints (more typical of RA)
Where are Rheumatoid nodules commonly seen?
Dorsum of hand
How do you test capillary refill?
Place pressure over nail beds to cause blanching then quickly remove. Observe the time elapsed for full return of color ( normal is less than 2 seconds)
How do you test grip strength?
Ask pt to grab your two fingers and squeeze
