16: Upper Extremity Exam

Question 1

Hot, swollen, red, extremely painful (especially with passive
motion) joint – r/o

Answer 1

septic joint

Question 2

Night pain (especially with constitutional signs e.g. weight loss) –r/o

Answer 2

tumor

Question 3

Deformity and loss of motion – r/o

Answer 3

dislocation &/or fracture

Question 4

Rapidly progressing neurologic changes

a) In forearm or leg with pallor, weak absent pulse, pain with passive motions – r/o

Answer 4

compartment syndrome

Question 5

Significant, sudden onset of limb swelling, pain, and bluish skin changes – r/o

Answer 5

DVT

Question 6

Point bony pain and bleeding – r/o

Answer 6

open fracture

Question 7

Morning stiffness – better with rest (worse with prolonged use) –suspicious for

Answer 7

arthritis

Question 8

Pain only with active motion (or resistance) – suspicious for

Answer 8

muscle or tendon injury

Question 9

Pain with both active and passive motion – suspicious for

Answer 9

articular injury/damage

Question 10

Weakness – suspicious for

Answer 10

muscle or tendon injury

Question 11

Instability – suspicious for

Answer 11

ligament injury

Question 12

Locking – suspicious for

Answer 12

loose body or cartilage injury

Question 13

ligament injury

Answer 13

Sprain

Question 14

muscle injury

Answer 14

Strain

Question 15

tendon injury

Answer 15

Tendonitis/tendinosis

Question 16

Basic strength grading scale
 5/5 =
 4/5 =
 3/5 = 
 2/5 =
 1/5 = 
 0/5 =

Answer 16

normal
weak
can only move against gravity
 can move, but not against gravity
muscle contractions, but no motion
no contraction

Question 17

Basic reflex grading scale
 4+ =
 3+ = 
 2+ = 
 1+ = 
 0 =

Answer 17

Clonus
hyperactive, but no clonus
“normal”
hypoactive
absent

Question 18

Capillary refill ________ = “normal”

Answer 18

< 2 seconds

Question 19

Pulse intensity grading scale
 0 =
 1+ = 
 2+ = 
 3+ = 
 4+ =

Answer 19

absent
faint, but detectable
diminished
“normal”
 bounding

Question 20

Back exam:

Appearance – check for:

Answer 20

symmetry & contour

Muscle bulk/wasting

Question 21

Palpation on shoulder exam:

Answer 21

1. Clavicle

2. AC joint

Question 22

Range-of-motion (0° is arms at sides)

1. Abduction 160+°

Answer 22

(mid-deltoid, supraspinatus)

Question 23

Range-of-motion (0° is arms at sides)

Adduction 45+°

Answer 23

(pectoralis major; latissimus dorsi)

Question 24

Range-of-motion (0° is arms at sides)

Flexion 160+°

Answer 24

(anterior deltoid; coracobrachialis)

Question 25

Range-of-motion (0° is arms at sides) | Extension 45+°

Answer 25

(latissimus dorsi; teres major; | posterior deltoid)

Question 26

Range-of-motion (0° is arms at sides) | External Rotation 45+°

Answer 26

(infraspinatus; teres minor)

Question 27

Range-of-motion (0° is arms at sides) | . Internal Rotation 80+°

Answer 27

(pectoralis major; latissimus dorsi; | teres major; subscapularis)

Question 28

Range-of-motion (0° is arms at sides) | Scapular Elevation

Answer 28

(trapezius; levator scapulae)

Question 29

Range-of-motion (0° is arms at sides) | Scapular Retraction

Answer 29

(rhomboids)

Question 30

Range-of-motion (0° is arms at sides) | Scapular Protraction

Answer 30

(serratus anterior)

Question 31

Painful arc of abduction 80-150° c/w

Answer 31

rotator cuff problems;

Question 32

Painful arc of abduction > 150 | c/w

Answer 32

ac pathology

Question 33

Internal rotation (IR) & external rotation (ER) may be_______ in dominant and non-dominant arms - especially in throwing athletes

Answer 33

different

Question 34

How do you strength test the Supraspinatus?

Answer 34

(1) Full can test – patient holds arms at 90° of abduction & 30° anterior to coronal plane with elbows extended and thumbs pointing up & resists examiner pushing downward

Question 35

How do you strength test the infraspinatous and teres minor?

Answer 35

(external rotation)

Question 36

How do you strength test the subscapularis?

Answer 36

Liftoff test – patient places hand behind back and | lifts hand off back with examiner resisting

Question 37

How do you test for joint stability of the shoulder?

Answer 37

Apprehension test – patient expresses apprehension to loading of joint in manner that simulates dislocation forces

Question 38

Testing Neurovascular status 1. Sensation on lateral shoulder for: 2. Sensation on lateral forearm:

Answer 38

Axillary nerve | Musculocutaneous nerve

Question 39

Elbow exam: check symmetry and contour for:

Answer 39

1. Popeye deformities | 2. Olecranon bursa

Question 40

ROM test for elbow

Answer 40

1. Functional 30-130° extension/flexion & 50° pronation supination 2. Flexion & extension 3. Forearm pronation & supination

Question 41

Joint stability of elbow: | 1. Valgus stress to test_______

Answer 41

ulnar collateral ligament (UCL)

Question 42

Appearance – symmetry & contour for hand and wrist of:

Answer 42

1. Thenar atrophy | 2. Finger deformities

Question 43

Palpation for what structure on the hand exam?

Answer 43

Snuffbox

Question 44

Tinel’s sign –

Answer 44

tapping over the median nerve in the carpal tunnel: "positive" for carpal tunnel causing tingling in the thumb, index, middle finger and the radial half of the fourth digit.

Question 45

Phalen’s sign –

Answer 45

holding wrists back-to-back in full flexion "positive" for carpal tunnel: causing tingling in the thumb, index, middle finger and the radial half of the fourth digit.