| O, I, A, N's | Organization of soft tissue structures | Diagnosing the problemo | Special and Sensitive Tests | Miscellaneous |
|---|---|---|---|---|
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Teres minor and all deltoid muscles
What muscles does the axillary nerve innervate?
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Pronator Teres, Flexor Carpi Radialis, Palmaris Longus, Flexor Carpi Ulnaris
What is the order of the 4 superficial wrist flexors from lateral to medial? Hint: Pass, Fail, Pass, Fail
|
Rotator Cuff Pathology
** fyi, pain with resisted ER and abduction are common with partial tears of the infraspinatus and teres minor A 60 y/o patient comes in with shoulder pain that worsens at night. When you test her active ROM, she has pain in the midrange of shoulder abduction and shrugs her shoulder to complete the motion. MMT show 3/5 on abduction and ER with pain, but she has no pain with passive accessories. Based on this info, what diagnosis is highest on your differentials? |
It is a sensitive test to rule OUT shoulder impingement. Patient is in sitting you put their shoulder in 90° of flexion, elbow flexed to 90°, and then internally rotate the arm while keeping 90° of flexion. Test is positive if pain is reproduced as you more into more IR.
What does Hawkin's Kennedy Test test for? Now demonstrate it correctly on a teammate! |
- compartment syndrome - radial head fracture - symptoms of tingling, burning, numbness - hx of trauma or surgery - symptoms unchanged by position or movement - neurological symptoms - unexplained weight loss - hx of corticosteroid exposure - alcohol use
What are red flags to be aware of when evaluating the elbow/forearm?
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- humeral head: (A) medial epicondyle of humerus (B) medial supracondylar ridge of humerus - ulnar head: coronoid process of ulna
What is the origin of the pronator teres?
|
- Floor - scaphoid and trapezium
- Lateral border - tendons of abductor pollicis longus and extensor pollicis brevis - Medial border - tendon of extensor pollicis longus
What structures make up the anatomical snuffbox?
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Primary; secondary
** this is due to primary being a problem of hypomobility, and secondary being a problem of hypermobility With which type of impingement would repeated PA and AP glides make it feel better? Which type does that make it worse? |
- Moving Valgus stress test; + pain reproduced when elbow is extended
- Medial elbow instability test; + if pain with palpation on joint line or laxity with palpation - Valgus stress test; + if pain reproduced What special tests could you perform if you suspect ligamentous laxity or instability in the medial elbow? |
Median nerve; ulnar nerve
Carpal tunnel syndrome involves entrapment of the _____ nerve, and cubital tunnel syndrome involves entrapment of the ____ nerve.
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biceps brachii, brachialis, brachioradialis
What muscles are responsible for elbow flexion?
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surrounds the radial head and maintains the relationship between head of radius and humerus/ulna
What does the annular ligament do?
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DIP; MCP and PIP
Rheumatoid Arthritis Osteoarthritis typically occurs in the ____ joints of the fingers, while rheumatoid arthritis typically occurs in the _____ joints. And which one results in stiffness and aching that lasts longer than 1 hour? |
Ruling IN and OUT carpal tunnel syndrome
What does Phalen's test test for? |
10° flexion and slight ulnar deviation
What is resting position of the wrist? |
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1. long head: infraglenoid tubercle of scapula 2. lateral head: upper 1/2 of posterior humerus 3. medial head: distal 2/3 of medial and posterior humerus
What is the origin & insertion of all three heads of the triceps?
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Acromioclavicular (AC), Sternoclavicular (SC), Scapulothoracic (ST)
** ST joint is really a pseudojoint.. not a true synovial joint What are the 3 joints within the glenohumeral joint? |
posterior dislocation, labral tear, AC joint dysfunction
If a young healthy patient came to you with shoulder pain that developed after falling hard on an outstretched hand, what would be on your list of differentials for diagnosing? |
- Drop arm test; + if pt can't control lowering of the arm when abducted with elbow straight
- Full can test; + if significant weakness in one arm or pain produced - External rotation lag sign; + if pt can't maintain ER in 20° abduction (arm falls into IR) - Drop sign; + if pt unable to maintain ER while in 90° abduction - Hornblower's sign; + if pt unable to maintain ER at 90° abduction when clinician resists into IR If you suspect rotator cuff tear, and think it might be supraspinatus or external rotators, what special tests could you perform to rule in? |
wrist flexion
Mobilizing the wrist in an anterior to posterior direction helps increase what motion? |
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Scaphoid, Lunate, Triquetrum, Pisiform, Trapezium, Trapezoid, Capitate, Hamate
Name all of the carpal bones in the hand and point to where they are located!!
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median nerve, brachial artery & vein, tendon of biceps brachii
What are the contents of the cubital fossa?
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- UCL sprains show hypermobility with valgus force in glides
- ME affects females more How would you differentiate between medial epicondylagia and UCL sprain? Give at least 2 reasons to get full points. - ME has pain with active wrist flexion and pronation, and passive wrist extension and supination - UCL sprains often develop from repetitive overload from throwing (esp pitching) but could occur from acute rupture - chronic UCL sprains have pain-free and normal ROM |
Sensitive for thumb tenosynovitis; pt makes fist with thumb inside fingers. clinician stabilizes the proximal forearm and deviates the wrist in an ulnar direction. test is + if pt has pain over the abductor pollicis longus (APL) and extensor pollicis brevis (EPB) tendons.
What does Finkelstein's Test test for and how is it performed? |
shoulder horizontal adduction, IR, and flexion
Posterior glides of the glenohumeral joint help facilitate what motions? |
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