Upper Extremity Orthopedics & Tenosynovitis

Question 1

Apley’s scratch testis two parts
What is the first part?
What strength is required for this motion?

Answer 1

Part 1: Have patient reach behind their head and attempt to touch the opposite superior scapular border (from inferior)
Requires abductors and external rotators and adequate length of adductors and internal rotators

Question 2

Apley’s scratch testis two parts
What is the second part?
What strength is required for this motion?

Answer 2

Part 2: Have patient reach behind their back and attempt to touch the opposite inferior scapular border (from superior)
Requires adductors and internal rotators and adequate length of the abductors and external rotators

Question 3

What is a positive finding for Apley’s test?

Answer 3

Exacerbation of the patient’s pain or inability to perform any portion of the maneuver or asymmetric end position when comparing the well side to the affected side

Question 4

What are good history questions regarding origin?

Answer 4

How/when did you hurt yourself?
Did this come on suddenly or a little at a time?

Question 5

What are good history question regarding progression?

Answer 5

Is it getting better or worse?
What makes it better/worse?

Question 6

What is a good history question regarding quality?

Answer 6

Can you describe the pain?

Question 7

What is a good history question regarding referral?

Answer 7

Do you have pain or discomfort anywhere else?

Question 8

What is a good history question regarding scoring?

Answer 8

On a scale of 1 to 10…

Question 9

What is a good history question regarding timing?

Answer 9

Is there a time of day that your shoulder/elbow/etc. is worse?

Question 10

What is the purpose of Yergason’s test?

Answer 10

Biceps tendon evaluation

Question 11

How is Yergason’s test performed?

Answer 11

1. Patient’s elbow is flexed and forearm partially pronated (thumb up)
2. Palpate the long head of the biceps while attempting to extend the elbow and pronate the forearm against patient resistance
3. Move shoulder into different aspects of internal and external rotation and repeat

Question 12

What are positive findings for Yergason’s test and what would they indicate?

Answer 12

Pain, a slip, or crepitus (audible or palpable popping or clicking) of the bicipital tendon indicating bicipital tendon instability or tendonitis/tenosynovitis

Question 13

What is tenosynovitis?

Answer 13

Tendon synovium or synovial fluid (which lubricate the tendon within a bursa or tendinous sheath) inflammation

Question 14

What is the purpose of Speed’s test?

Answer 14

Assess bicipital tendon

Question 15

How is Speed’s test performed?

Answer 15

1. Shoulder flexed to 90 degrees, elbow extended in a thumb-up position
2. Patient attempts to flex the shoulder and supinate the forearm while the examiner presses into extension and pronation

Question 16

What is a positive finding for Speed’s test and what would it indicate?

Answer 16

Pain or popping/clicking of the tendon of the long head of the biceps indicating bicipital tendon instability or bicipital tendonitis/tenosynovitis

Question 17

What is the purpose of Abbot-Saunder’s test?

Answer 17

Test the integrity of the transverse humeral ligament/coracohumeral ligament

Question 18

How is Abbot-Saunder’s test performed?

Answer 18

1. Patient is seated and forearm is pronated
2. Doctor passively abducts the shoulder to 180 degrees, then externally rotates the shoulder and lowers it to the patient’s side
3. Palpate and listen for click within the bicipital groove

Question 19

What is a positive finding for Abbot-Saunder’s test and what would it indicate?

Answer 19

Pain or instability (palpable or audible popping or snapping of the bicipital tendon) limiting completion of the test indicating bicipital tendon instability secondary to laxity of the transverse humeral ligament or tenosynovitis of coracohumeral ligament

Question 20

What is the purpose of performing impingement sign?

Answer 20

Compress the supraspinatus beneath the acromion

Question 21

How is impingement sign performed?

Answer 21

Patient’s arm is slightly abducted and passively moved into full flexion

Question 22

What is a present impingement sign and what would it indicate?

Answer 22

Exacerbation of shoulder pain at the acromion suggesting supraspinatus impingement beneath the acromion

Question 23

What is the Scaption exercise for shoulders?

Answer 23

• 90 degrees abduction
• 30 degrees of flexion
• 10-15 degrees down
• Thumb starts up then turns down

Question 24

How is the supraspinatus press test/Jobe test/empty can/stress test performed?

Answer 24

1. Patient’s shoulder is abducted to 90 degrees, then flexed 30 degrees, dropped down 10 degrees (scaption), then thumb down
2. Patient maintains this position against resistance while doctor stabilizes from other shoulder

Question 25

What is a positive finding for the supraspinatus press test and what would it indicate?

Answer 25

Weakness or pain at the supraspinatus indicating supraspinatus strain/tear

Question 26

How is Codman’s/drop arm test performed?

Answer 26

1. Elevate the patient’s arm past 90 degrees
2. Inform the patient that you are going to release their arm and they are to hold it up
3. Release the arm suddenly and note their ability/inability to maintain abduction
   (do not touch the supraspinatus; catch patient’s arm instead)

Question 27

When performing Codman’s/drop arm test, the patient can maintain abduction
What should be asked next?
What would be a positive finding?

Answer 27

Patient should slowly lower the arm to their side
Positive is a jerking motion, or a painful arc

Question 28

What is a positive finding of Codman’s/drop arm test and what would it indicate?

Answer 28

Pain or hunching of the shoulder with the attempt to maintain abduction indicating rotator cuff strain or tear, particularly involving supraspinatus

Question 29

How is Dugas test performed?

Answer 29

1. Have the patient reach across the front of the chest and touch the opposite shoulder
2. Instruct the patient to bring the elbow down to the chest wall

Question 30

What is a positive finding of Dugus test and what would it indicate?

Answer 30

The inability to approximate the elbow to the chest indicating acute glenohumeral dislocation

Question 31

Which test is appropriate for acute glenohumeral dislocation?

Answer 31

Dugas test

Question 32

How is apprehension test performed?
What is a positive finding and what would it indicate?

Answer 32

1. Bring patient’s shoulder into 90 degree abduction with elbow flexed
2. Externally rotate the shoulder
   Positive is evidence of apprehension, pain, or withdrawal indicating a tendency toward recurrent glenohumeral dislocation (glenohumeral instability)

Question 33

What is the purpose of Dawbarn’s pushbutton test?

Answer 33

Diagnose subacromial bursitis

Question 34

How is Dawbarn’s pushbutton test performed?

Answer 34

1. Apply pressure just inferior to the acromion process on the anterior aspect of the shoulder and note any pain
2. Relieve pressure a bit then elevate the patient’s arm beyond 90 degrees
3. Reapply pressure and note change in reported pain

Question 35

What is a positive finding of Dawbarn’s pushbutton test and what would it indicate?

Answer 35

Pain upon palpation which resolves with abduction beyond 90 degrees indicating subacromial bursitis