16: Upper Extremity Exam Flashcards Preview

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Flashcards in 16: Upper Extremity Exam Deck (45)
1

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

septic joint

2

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

tumor

3

Deformity and loss of motion – r/o

dislocation &/or fracture

4

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

compartment syndrome

5

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

DVT

6

Point bony pain and bleeding – r/o

open fracture

7

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

arthritis

8

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

muscle or tendon injury

9

Pain with both active and passive motion – suspicious for

articular injury/damage

10

Weakness – suspicious for

muscle or tendon injury

11

Instability – suspicious for

ligament injury

12

Locking – suspicious for

loose body or cartilage injury

13

ligament injury

Sprain

14

muscle injury

Strain

15

tendon injury

Tendonitis/tendinosis

16

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

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

17

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

Clonus
hyperactive, but no clonus
“normal”
hypoactive
absent

18

Capillary refill ________ = “normal”

< 2 seconds

19

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

absent
faint, but detectable
diminished
“normal”
bounding

20

Back exam:
Appearance – check for:

symmetry & contour
Muscle bulk/wasting

21

Palpation on shoulder exam:

1. Clavicle
2. AC joint

22

Range-of-motion (0° is arms at sides)
1. Abduction 160+°

(mid-deltoid, supraspinatus)

23

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

(pectoralis major; latissimus dorsi)

24

Range-of-motion (0° is arms at sides)
Flexion 160+°

(anterior deltoid; coracobrachialis)

25

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

(latissimus dorsi; teres major;
posterior deltoid)

26

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

(infraspinatus; teres minor)

27

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

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

28

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

(trapezius; levator scapulae)

29

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

(rhomboids)

30

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

(serratus anterior)

31

Painful arc of abduction 80-150° c/w

rotator cuff problems;

32

Painful arc of abduction > 150
c/w

ac pathology

33

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

different

34

How do you strength test the Supraspinatus?


(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

35

How do you strength test the infraspinatous and teres minor?

(external rotation)

36

How do you strength test the subscapularis?

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

37

How do you test for joint stability of the shoulder?

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

38

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

Axillary nerve
Musculocutaneous nerve

39

Elbow exam: check symmetry and contour for:

1. Popeye deformities
2. Olecranon bursa

40

ROM test for elbow

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

41

Joint stability of elbow:
1. Valgus stress to test_______

ulnar collateral ligament (UCL)

42

Appearance – symmetry & contour for hand and wrist of:

1. Thenar atrophy
2. Finger deformities

43

Palpation for what structure on the hand exam?

Snuffbox

44

Tinel’s sign –

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.

45

Phalen’s sign –

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.