Upper Extremity Physical Diagnosis

Question 1

Palpation of Shoulder

Answer 1

SC joint, clavicle, AC joint, tuberosities of humerus, bicipital groove, muscles around arm

subacromial bursa (lift arm posteriorly and feel at front)

Question 2

ROM of shoulder

Answer 2

Flexion
Extension 
Abduction
Adduction
External/internal rotation

Question 3

Muscles of Rotator cuff

Answer 3

Supraspinatus, infraspinatus, teres minor, subscapularis

Bicipital tendon

Question 4

Impingement tests

Answer 4

Neer and Hawkins

Question 5

Neer’s Impingement Sign

Answer 5

Press on scapular to prevent scapular motion with one hand, raise (abduct) patient’s arm with the other. Compresses greater tuberosity of the humerus against the acromion.

Pain = positive

Question 6

Hawkins’ Impingement Sign

Answer 6

Forward flex the arm to 90 degrees with the elbow bent to 90 degrees.
The arm is then internally rotated. A positive test, noted by pain on internal rotation, may signify subacromial impingement
including rotator cuff tendinopathy or tear.

Question 7

Drop-Arm Rotator Cuff Test

Answer 7

The arm is passively raised to 160 degrees. The patient is then asked to
slowly lower the arm to the side. A positive test, noted by an inability to control the lowering phase and a dropping or
giving way of the arm, may indicate a large rotator cuff tear.

Question 8

Empty Can Test tests what?

Answer 8

Supraspinatus

Question 9

Empty Can test process

Answer 9

The arms are
abducted to 90 degrees and forward flexed 30 degrees.
With the thumbs turned downward, the patient actively
resists a downward force applied by the examiner. A positive
test is indicated by weakness compared with the contralateral
side and may indicate rotator cuff pathology,
including supraspinatus tendinopathy or tear.

Question 10

External Rotation tests what?

Answer 10

Infraspinatus

Question 11

External Rotations test process

Answer 11

The patient’s arms are held at their sides with the elbows
flexed to 90 degrees. The patient actively externally
rotates against resistance. A positive test is indicated by
weakness compared with the contralateral side and may
be associated with infraspinatus or teres minor tendinopathy
or tear.

Question 12

Lift Off tests what

Answer 12

Subscapularis

Question 13

Lift Off Test process

Answer 13

With the arm internally
rotated behind the patient’s lower back, the patient
internally rotates against the examiner’s hand. A positive
test is indicated by the inability to lift the hand off of the
back and may indicate subscapularis tendinopathy or tear

Question 14

Cross Body Adduction tests what?

Answer 14

AC joint OA or chronic sprain

Question 15

Cross body adduction test process

Answer 15

The arm is passively
adducted across the patient’s body toward the contralateral
shoulder. Pain may indicate acromioclavicular joint
pathology, including chronic sprain or osteoarthritis

Question 16

Apprehension and Relocation Tests

Answer 16

With
the patient supine, the patient’s arm is abducted to
90 degrees and the elbow is flexed to 90 degrees. Pain
and a sense of instability with further external rotation
may indicate shoulder instability. Relief of these symptoms
with a posteriorly directed force on the proximal
humerus is a positive relocation test and further supports
diagnosis of shoulder instability.

Question 17

ROM of elbow

Answer 17

Flexion/Extension

Pronation/Supination

Question 18

Medial Epicondylitis

Answer 18

Golfer’s Elbow

Pain with resisted wrist flexion and pronation

Flexors attach here - test flexion

Question 19

Lateral Epicondylitis

Answer 19

COMMON. Tennis elbow.

Pain and decreased strength
with resisted gripping and
with wrist supination and
extension; pain at the
lateral elbow with isolated
resisted extension of the
middle finger

Extensors attach here - test extension

Question 20

Olecranon bursitis

Answer 20

Warm, swollen, redness, limited ROM
Hx?
Bursa fluid analysis

Question 21

Most commonly fractured carpal bone

Answer 21

Scaphoid

Question 22

Wrist ROM

Answer 22

Flexion, Extension

Adduction (radial), abduction (ulnar)

Question 23

Tenderness in anatomical snuffbox —>

Answer 23

Scaphoid fracture

Question 24

ROM fingers

Answer 24

Flexions, extension, abduction/adduction (in regards to middle finger)

Question 25

ROM thumb

Answer 25

Flexion (in front of hand)
Extension (out straight to side)
Abduction/Adduction (from palmar angle)
Opposition

Question 26

Tinel’s sign

Answer 26

Tap lightly over median nerve at volar wrist – aching tingling and numbness in 2,3,4 fingers = positive. Carpal tunnel.

Question 27

Phalen’s sign

Answer 27

Flex wrists against each other for 60 sec

Aching/tingling in 2,3,4 = positive for carpal tunnel

Question 28

Ulnar neuropathy

Answer 28

Positive tinel over Guyon cannel or positive Phalen w/ sensory in 4/5 fingers

Question 29

DeQuervain Tenosynovitis

Answer 29

Finkelstein test
Grab thumb with own fingers, ulnar deviate
Thumb tendons stretched