Examinations

Question 1

Shoulder examination

Answer 1

Look
Feel
Active and passive movements

Ddx for shoulder pain
- septic arthritis, bursitis, gout, arthritis, rotator cuff injury

Painful arc - first 30 supraspinatus, then deltoid
Empty can test - supraspinatus
Push off test - subscapularis
External rotation - teres minor and infraspinatus

Question 2

Wrist drop

Answer 2

Radial nerve neuropathy
- compression in the radial groove (Saturday night palsy)
- mid-shaft humeral fracture
- distal radius fracture

• if injury above bifurcation then complete paralysis, if after then weakness of wrist and finger extension
• also weakness of supination

Dislocation or fracture humerus will also have lack of triceps/elbow extension
Weak with radial groove palsy
No effect if at wrist

• supportive care with wrist splint

Improves in 6-12 weeks

Question 3

Ulna nerve injury

Answer 3

Entrapment in guyon’s canal at wrist or at elbow.
Sensory loss over the 1st web space and dorsum of the hand.
Cross index and ring finger
Froment’s sign
Claw hand if below mid forearm (unable to extend 4th and 5th fingers)

Question 4

Median nerve injury

Answer 4

Carpal tunnel syndrome
Median nerve neuropathy
Hand of benediction (unable to make fist with 2nd and 3rd metacarpal)
Phalens sign
Tinels sign
Sensory paraesthesia over palmar lateral 3.5 digits.

Question 5

Foot drop

Answer 5

L5 lesion - numbness in L5 distribution, lose inversion, eversion, and dorsiflexion
Sciatic nerve injury - trauma, injection (generalised paraesthesia, loss of ankle jerk, loss of eversion and inversion)
Peroneal nerve injury - fibula head fracture, cast causing compression, inversion and ankle jerk intact

Question 6

Hand examination - flexor injury

Answer 6

Look: at the finger cascade
Feel: forearm squeeze test
Move: active and passive movement of FDP (DIP) and FDS (whole finger)
Little finger may not have FDS insertion