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H+ P exam 2 > Upper Extremity Exam > Flashcards

Upper Extremity Exam Flashcards

1
Q

Protectors

A

Rotator cuff

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2
Q

Positioners

A

Deltoid

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3
Q

Stabilizers

A

Trapezius, levator scapulae, rhomboid major / minor, pectoralis minor & serratus anterior

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4
Q

Propellers

A

Pectoralis major & latissimus dorsi

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5
Q

Rotator Cuff (Protectors)

A

-Synergistically stabilize the humeral head against glenoid -Supraspinatus Abduction / “scaption” -Infraspinatus External rotation -Teres minor External rotation -Subscapularis Internal rotation

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6
Q

General Upper Extremity Inspection

A

“The shoulders, elbows, wrists, & fingers are symmetric without any discoloration, swelling, deformities, atrophy, or tremors.” -Dominant shoulder girdle may be slightly elevated -Guarding of movement patterns (e.g. removing shirt, transitioning from seated to standing) -Posture

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7
Q

Shoulder – Palpation

A

-Start on the uninvolved extremity -Modify palpation pattern so you palpate the painful area last -Ask the patient to report any tenderness during palpation

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8
Q

Flexion

A

Principle muscles -Anterior deltoid -Pectoralis major (clavicular head) -Coracobrachialis -Biceps brachii

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9
Q

Extension

A

Principle muscles -Latissimus dorsi -Teres major -Posterior deltoid -Triceps brachii (long head)

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10
Q

Abduction

A

Principle muscles -Supraspinatus -Middle deltoid

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11
Q

Horizontal adduction

A

Principle muscles -Pectoralis major -Coracobrachialis

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12
Q

Internal rotation

A

Principle muscles -Subscapularis -Anterior deltoid -Pectoralis major -Teres major -Latissimus dorsi

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13
Q

External rotation

A

Principle muscles -Infraspinatus -Teres minor -Posterior deltoid

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14
Q

Acromioclavicular Joint Sprain

A

Mechanism of injury -Fall on AC joint with arm at side; collision sports -Force applied to superior aspect of acromion → forces acromion inferior and medial

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15
Q

Acromioclavicular Joint Sprain Exam

A

-Inspection Elevated distal clavicle, “step” deformity (Grades II & III) Swelling -Palpation Tenderness with palpation of the AC joint, swelling, “step” deformity (Grades II & III) Trapezius muscle spasm -Special exams (+ for all 3 suggests AC joint sprain) Cross adduction body test (72/85) AC resisted extension test (AC shear test) (77/79) Active compression test (79/50)

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16
Q

Anterior Shoulder Instability

A

-Mechanism Forced combination of abduction and external rotation -20 – 40% sustain neurologic injury Axillary nerve Brachial plexus -Subluxation vs. dislocation

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17
Q

Anterior Shoulder Instability EXAM

A

-Inspection Flattened deltoid Fullness of anterior chest Prominence of acromion Guarding / protecting -Palpation -Provocative testing – not performed at the time of acute injury Apprehension test (98/72) Relocation test (97/78) Release test (92/84)

18
Q

Subacromial Impingement Syndrome (SAIS)

A

-Prevalence of shoulder pain is 7-27% in US adult population -Most frequent cause of shoulder pain is SAIS -Mechanism: Repetitive microtrauma leads to inflammation and degeneration with the potential for tearing of the rotator cuff tendon(s) over time Supraspinatus Infraspinatus

19
Q

Acromion Morphology & Shape

A

-Hooked = increased subacromial pressure Decrease subacromial space More contact with RC tendons Increased risk of SAIS → increased risk of RC tear

20
Q

Subacromial Impingement Syndrome (SAIS) EXAM

A

Objective findings: Tenderness with palpation of the long head of the biceps tendon and rotator cuff insertion Potential pain and/or strength deficit with strength testing of the rotator cuff Special tests Painful Arc test (63/76) Hawkins-Kennedy test (80/56) Modified Hawkins-Kennedy test Neer test (72/60)

21
Q

Rotator Cuff Tear

A

-Etiology Overuse MC Age-related degeneration Chronic mechanical impingement Traumatic -Generally originate in the supraspinatus tendon (90%) and may progress -Full-thickness tears uncommon < 40 y/o incidence increases > 40 y/o, especially >60 y/o

22
Q

Rotator Cuff Tear - Clinical Presentation

A

-Recurrent shoulder pain for several months (overuse) -Specific injury that triggered the onset of the pain (traumatic) -Subacromial pain and pain localized to deltoid tuberosity -Night pain and difficulty sleeping on affected side -Weakness, catching, and grating especially when lifting the arm overhead

23
Q

Rotator Cuff Tear – Physical Exam

A

-Tenderness with palpation of the rotator cuff insertion -AROM decreased Shoulder “shrug” with abduction -PROM normal -Pain / weakness with isolation of involved RC Supraspinatus Infraspinatus / teres minor Subscapularis -Special tests External rotation lag sign Drop arm (73/77) Empty can test (74/30)

24
Q

Medial Elbow - Palpation

A
25
Q

Lateral Elbow - Palpation

A
26
Q

Palpation of elbow

A
  • Attempt to palpate the epitrochlear nodes
  • About 3cm above medial epicondyle, in groove between biceps & triceps
  • Not usually palpable
  • If palpable, may indicate local or distant infection
  • If nodes palpable, note size, shape, consistency
27
Q

Lateral Epicondylitis “Tennis Elbow”

A
  • Overuse inflammatory injury involving common extensor tendon.
  • Repetitive wrist or combined wrist and finger extension.
  • Pain with palpation of the common extensor tendon insertion
  • Mill’s test
  • Pain and weakness with resisted wrist and finger extension, especially 3rd digit extension
28
Q

Medial Epicondylitis “Golfer’s Elbow”

A
  • Pain with palpation of the common flexor tendon insertion
  • Golfer’s elbow stretch test
  • Pain / weakness with resisted wrist flexion & grip strength
29
Q

Wrist & Hand - Palpation

A
  • Palpate the anatomical snuff box
  • Palpate the patient’s joints between your thumb & index finger.
  • “Capillary refill is < 2 seconds.”
30
Q

Allen Test

A
  • Test done before puncture of the radial artery to assure patency of the ulnar artery
  • Instruct pt to make a fist
  • Occlude the radial & ulnar arteries
  • Release pressure over the ulnar artery
  • Palm should flush within 3-5 seconds
31
Q

Median Nerve

A

Motor

  • Abductor pollicis brevis
  • Flexor pollicis brevis (superficial head)
  • Opponens pollicis
  • First and second lumbricals
32
Q

•Carpal tunnel

A
  • Vague aching that radiates into the thenar area
  • Pain accompanied by numbness in the median distribution
  • Frequently drop objects, cannot open jars or twist off lids
  • Pain worsened by repetitive motion/activities or remaining stationary for prolonged periods
  • Symptoms worse at night
  • Patient awakens at night with pain or numbness and needs to “shake out” the involved hand / wrist
  • Flick sign → 93% sensitivity and 95% specificity for CTS
  • Inspect the hand for thenar atrophy
  • Testing thumb opposition against resistance may reveal weakness of thenar muscles
  • Evaluate sensation over the median nerve distribution
33
Q

Phalen’ Test

A
  • Efficacy
  • Test Sensitivity: 70 to 80%
  • Test Specificity: 80%
  • Inverse praying position
  • Place each hand dorsum against each other
  • Positive test suggests median neuropathy
  • Wrist flexion reproduces carpal tunnel symptoms
  • Most specific if symptoms occur within first 30 seconds
34
Q

Tinel’s sign

A
  • Efficacy
  • Test Sensitivity: 44-70%
  • Test Specificity: 94%
  • Technique
  • Percuss median nerve at carpal tunnel in wrist
  • Positive test suggests median neuropathy
  • Reproduces pain and tingling along median nerve course
35
Q

DeQuervain’s tenosynovitis

A
  • Inflammation of the sheath that surrounds the abductor pollicus longus and extensor pollicus brevis tendons
  • Tendon sheath thickens and constricts the tendons
  • Pain and tenderness in the first dorsal extensor compartment (anatomic snuffbox) aggravated by attempts to move thumb or make a fist
  • Swelling may be noted
  • Crepitation as patient flexes and extends thumb may be noted
  • Pain with passive stretching of the tendons (a.k.a. Finklestein Test):
36
Q

Flexor Tendon Injury “Jersey Finger”

A

•Spontaneous (RA) or Traumatic (forced extension of actively flexed finger)

  • MC flexor digitorum profundus
  • 4th (ring) finger affected most commonly 75%
37
Q

Finklestein Test

A
  • Direct the patient to place the thumb in their palm.
  • Have them cover the thumb with the fingers of the same hand, forming a fist.
  • Gently deviate the wrist towards the ulna. This stretches the inflamed tendons over the radial styloid, reproducing the patient’s pain.
38
Q

Mallet Finger

A
  • MC due to traumatic injury to the tip of a fully extended finger
  • Rupture, avulsion or laceration of extensor tendon at base of distal phalanx
  • Pain and inability to extend at the DIP
39
Q

Trigger Finger

A
  • Nodular thickening of the flexor tendon
  • MC at the MP joint
  • MC idiopathic (but RA and DM at increase risk)
40
Q

Dupuytren’s Contracture

A
  • Palmar fibromatosis
  • “Viking disease”
  • Men >50, northern European descent
  • Nodular thickening and contraction of palmar fascia
  • Minimal discomfort
  • MC ring finger
  • Flexion of finger at MCP then PIP
41
Q

Ganglia of Wrist and Hand

A

•Synonyms

Synovial Cyst

Mucous cyst

  • Cystic swelling overlying a joint or tendon sheath
  • Herniation of synovial tissue from a joint capsule or tendon sheath
  • Generally affect persons 15-40 years of age
  • Common locations

Dorsum of the wrist

Volar radial aspect of wrist

•Less common locations

Base of finger

DIP joint

42
Q

Osteoarthritis of the hand

A
  • DIP and PIP joints are most often involved
  • Stiffness and loss of motion in the fingers
  • Heberden nodes = nodules at the DIPs
  • Bouchard nodes = bony nodules at the PIPs

H+ P exam 2 (4 decks)

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