Upper Limb Assessment Techniques Flashcards
What is the routine assessment for MSK
OBSERVATION- alignment,atrophy,swelling PALPATION-swelling,temperature, atrophy ACTIVE AND PASSIVE ROM RESISTED TESTING ACCESSORY MOVEMENTS LIGAMENTS SPECIAL TESTS FUNCTIONAL TESTS PALPATION-tissue tenderness
What to look for when assessing the elbow
Observation-posture and carrying angle 5-10degrees in males and 10-15 degrees in females
-Asymmetry
Muscle form
Soft tissues swelling, colour, inflammation
What movements. to assess in the GHJ
Shoulder girdle- elevation, depression, protraction and retraction
Glenohumeral- flexion, extension, abduction, lateral rotation, medial rotation, horizontal flexion and horizontal extension
Accessory movements of the glenohumeral joint
A-p, PA, distraction, Longitudinal caudal
Accessory movements of the ACJ and SCJ joints
AP,Cephalocaudad glides
What does the HAWKINS KENNEDY test consist of?
It tests for an impingement or rotator cuff tendinopathy
Passive flexion to 90 degrees , fix the scapula, passively medially rotate the Humerus, positive test means pain like symptoms
It will cause compression in SACS or CAS
Consider flexion/abduction, search for symptoms
what does Neers test consist of?
Neers test can confirm an impingement or rotator cuff tendonopathy. The structures involved in the impingement are SITS.
Fix the scapula, medially rotate the arm
A positive test = pain reproduction, pain can be searched for in Abduction or flexion
What is the empty can test?
The empty can test tests for shoulder impingement issues or a rotator cuff tendinopathy.
90 degrees in scapula plain
Full medial rotation
Abduction to 90
Maintain position whilst therapist pushes down
Weakness and pain means a positive test
What to test for instability tests?
Normally will only test one direction at a time
Several tests may be positive with multidirectional instability
Test passive structures (not active]
What is the Apprehension/Jones relocation test
The Apprehension test tests for anterior instability of the glenohumeral joint capsule
Supine lying
Abduction arm to 90 degrees
Extension rotating the arm
Positive test= apprehension, fear, muscle spasm, conscious, limitation of movement and not pain
The test should be repeated with an AP glide to head of humerus, a positive test shows increased ROM/ reduction in apprehension
What does the load and shift test consist of?
It tests for anterior and posterior laxity or instability of the shoulder joint
Start by stabilising the scapula, perform a mild compression into the glenoid and apply AP force to the humeral head
Movement 25%= N, up to 50% is grade 1, over 50% is grade 2
How to do a sulcus sign test and what does it test for?
The sulcus sign tests for inferior instability
Sit/stand or lying, place arm by side, place elbow at 90degrees
Perform a caudad mobilisation and assess for excessive movement.
(The examiner pulls the humeral head in a downwards motion.)
You can check at 20-50degrees as the most sensitive position.
What is the lift off test?
The lift off test tests for the rupture of subscapularis.
The patient is in a standing position, the patient lifts off the back and must maintain this position.
The therapist can provide a resistance if needed.
Problems will occur if lack of movement or pain will reduce the contraction.
What does Medial epicondylitis test consist of?
The medial epicondylitis test tests for Golfer’s Elbow.
Passive test
Palpate the medial epicondyle
Supinate the forearm
Extend the wrist
Extend the fingers
A positive test indicates pain over the medial epicondyle -Why? There is compression of various tendons here
What is mill’s test?
It is the test for lateral epicondylitis (tennis elbow)
Same starting position as medial epicondylitis tesT
It is a passive stretch test
Pronate the forearm
Flex the wrist into a fist and extend the elbow
A positive test shows pain reproduction
What happens in Cozen’s test
Tests for LE This is an ACTIVE RESISTED test There is active contraction of the extensor tendons The elbow is placed at 90degrees The forearm is placed into pronation The wrist is extended The wrist is radially deviated A positive test is pain, the site of pain can be palpated for
What is The Finkelstein test and what does it test for?
For Dequervains -paratenitis-Abduct pollucis longus and extend pollucis brevis
The patient then grips their own thumbs
The patient then ulnar deviates and if pain occurs, it is a positive test
What happens in Tinel’s sign?
It tests for elbow, ulnar nerve and wrist median nerve.
Tap over the carpal tunnel and continue until reaching the elbow.
This is a median nerve test which indicates carpal tunnel syndrome
A positive test shows pain and parenthesia[ a term used to reflect a perception of abnormal sensation, including pins and needles and prickling etc]
What is phalen’s test?
Phalan’s test tests for carpal tunnel/ median nerve
Flex the patients wrists maximally and hold for 1 minute
A positive test shows tingling in the thumb, index finger and 1/2 the ring finger
What is the grip strength test?
Use the 5 consecutive hand spacing in order
Both hands tested alternately and readings are recorded
There is 5-10% difference between dominant hand
It can be shown on the bell curve distribution
Special questions of the upper limb
Red flags- non mechanical pain, history of cancer, sudden loss of external rotation- Pancose tumour PMH- diabetes- relates to adhesive capsulitis Trauma/ fracture/ cuff tear- Previous dislocations/ instability Clicking/locking with pain Age- arthritis or capsulitis Neck pain Alteration to sensation Inability to do functional activities
What is shoulder sulbluxation?
Inferior subluxation- scapula loses stability
Anterior subluxation- tightness of the pecs and latissimus dorsi (most common)
Superior subluxation- tightness of supraspinatus and deltoid
What is a rotator cuff impingement?(Suva domino pain syndrome)
Subacromial pain syndrome is also called impingement. It is inflammation and irritation of the shoulder tendons and rotator cuff as they pass through the sub acromial space. This can result in pain, weakness and reduced ROM.
You can do Hawkins Kennedy, neers or empty can test to test the surrounding structures.
Why are the special tests not that accurate?
They aren’t that specific or sensitive
