Chapter 23, Module 6; UE Limb Pain

Question 1

DESCRIPTION: Have patient supinate forearm against resistance.

Answer 1

Yergason test

Question 2

FINDINGS: A positive test produces pain in bicipital groove and is suggestive of bicipital tendinitis.

Answer 2

Yergason test

Question 3

DESCRIPTION: Ask patient to externally rotate and abduct shoulder.

Answer 3

Rotator cuff tear

Question 4

FINDINGS: In a partial tear, patient can raise arm but cannot maintain position against resistance; in a complete tear, attempts to abduct arm will produce a shoulder shrug.

Answer 4

Rotator cuff tear

Question 5

DESCRIPTION: Have patient resist forearm supination with elbow flexed 90 degrees.

Answer 5

Tennis elbow

Question 6

FINDINGS: Pain with this movement indicates lateral humeral epicondylitis.

Answer 6

Tennis elbow

Question 7

DESCRIPTION: Have patient flex fingers over a clenched thumb; then passively deviate wrist ulnarly.

Answer 7

Finkelstein test

Question 8

FINDINGS: Movement produces pain in de Quervain disease (first dorsal compartment tenosynovitis).

Answer 8

Finkelstein test

Question 9

DESCRIPTION: Tap over median nerve (palmar surface of wrist) to assess for compression neuropathy.

Answer 9

Tinel sign

Question 10

FINDINGS: In a positive test, patient reports a tingling or prickling sensation distal to site tapped along first three digits, wrist pain, and weak grip.

Answer 10

Tinel sign

Question 11

DESCRIPTION: Ask patient to maintain palmar flex¬ ion for 1 min with dorsal surfaces of each hand pressed together.

Answer 11

Phalen test

Question 12

FINDINGS: Test is positive if maneuver produces numbness and paresthesia in fingers innervated by median nerve.

Answer 12

Phalen test

Question 13

Repetitive trauma activities; pain with movement

Answer 13

Tenosynovitis (tendinitis)

Question 14

Swelling over tendon, crepitus

Answer 14

Tenosynovitis (tendinitis)

Question 15

DIAGNOSTIC STUDIES OF Tenosynovitis (tendinitis)?

Answer 15

None

Question 16

History of overuse; aching pain over affected bursae that radiates along limb

Answer 16

Bursitis

Question 17

Local tenderness, swelling; limited joint motion; muscle weakness

Answer 17

Bursitis

Question 18

DIAGNOSTIC STUDIES OF Bursitis?

Answer 18

None

Question 19

Pain in trigger sites throughout body, joint stiffness, disturbed sleep

Answer 19

Fibrositis

Question 20

Fatty, fibrous nodules in muscles; palpation of trigger points elicits pain

Answer 20

Fibrositis

Question 21

DIAGNOSTIC STUDIES OF Fibrositis?

Answer 21

None

Question 22

Presentation depends on age, location of infection; history of infection, trauma, penetration, invasive procedure; refusal to bear weight (hip); constant pain

Answer 22

Osteomyelitis

Question 23

Fever, chills, vomiting; pain localized over affected area but progressively worsens; soft tissue injury or abscess

Answer 23

Osteomyelitis

Question 24

DIAGNOSTIC STUDIES OF Osteomyelitis?

Answer 24

Increased WBCs, ESR, CRP; radiographs

Question 25

Older  adults;  asymmetrical  joint pain  and  stiffness  that  improves throughout  day;  history  of repetitive  joint  trauma;  obesity

Answer 25

Osteoarthritis

Question 26

DIP,  PIP  joints  enlarged; Heberden  nodes;  limited cervical  spine  ROM

Answer 26

Osteoarthritis

Question 27

DIAGNOSTIC  STUDIES OF Osteoarthritis?

Answer 27

ESR;  radiograph  may reveal  osteophytes, loss  of  joint  space

Question 28

Morning  stiffness  of  small  joints; symmetrical  involvement; anorexia,  weight  loss

Answer 28

Rheumatoid  arthritis

Question 29

Fever,  rheumatoid  nodules, ulnar  deviation  of  wrists

Answer 29

Rheumatoid  arthritis

Question 30

DIAGNOSTIC  STUDIES OF Rheumatoid  arthritis?

Answer 30

Increased  ESR, positive  rheumatoid factor,  anemia  on CBC  count;  radio¬ graph  shows  bony erosion

Question 31

History  of  systemic  infection,  malaise,  diaphoresis,  refusal  to  bear weight  (hip),  acute  joint  pain

Answer 31

Septic  arthritis

Question 32

Fever;  red,  swollen  joint; limited  range  of  motion

Answer 32

Septic  arthritis

Question 33

DIAGNOSTIC  STUDIES OF Septic  arthritis?

Answer 33

WBCs, culture  of  joint aspirate,  ESR,  CRP, ultrasound  of  joint

Question 34

History  of  trauma,  pain

Answer 34

Shoulder  dislocation

Question 35

Limited  rotation,  arm abduction,  and  hand supination

Answer 35

Shoulder  dislocation

Question 36

DIAGNOSTIC  STUDIES OF Shoulder  dislocation?

Answer 36

Radiograph  of  shoulder with  AP  view  and internal/external rotation

Question 37

History  of  trauma,  pain

Answer 37

Acromioclavicular joint  injury

Question 38

Limited  shoulder  movement;  obvious  deformity

Answer 38

Acromioclavicular joint  injury

Question 39

DIAGNOSTIC  STUDIES OF Acromioclavicular joint  injury

Answer 39

Radiograph  of  shoulder with  AP  view  and internal/external rotation

Question 40

History  of  overuse  of  biceps;  pain worse  with  movement

Answer 40

Bicipital  tendinitis

Question 41

Positive  Yergason  test;  pain localized  over  intertubercular  groove

Answer 41

Bicipital  tendinitis

Question 42

DIAGNOSTIC  STUDIES OF Bicipital  tendinitis?

Answer 42

Radiograph  (Fisk view)

Question 43

Acute:  younger  people,  history  of trauma,  severe  pain;  chronic: older,  pain  worse  with  overhead movement,  sleep  disturbance

Answer 43

Rotator  cuff  tear

Question 44

Acute:  inability  to  raise  arm laterally,  shrug  shoulders; chronic:  tenderness  over AC  joint,  crepitus,  weakness  in  external  shoulder rotation

Answer 44

Rotator  cuff  tear

Question 45

DIAGNOSTIC  STUDIES OF Rotator  cuff  tear?

Answer 45

Radiograph  may reveal  humeral displacement or  spurs;  MRI

Question 46

Repetitive  motion  of  or  pressure  to elbow;  localized  pain

Answer 46

Olecranon  bursitis

Question 47

Warmth,  redness,  and  swelling  over  joint;  full  ROM

Answer 47

Olecranon  bursitis

Question 48

DIAGNOSTIC  STUDIES OF Olecranon  bursitis?

Answer 48

Radiograph  to  rule out  fracture  of olecranon  process

Question 49

History  of  repetitive  contraction  of extensor  and  supinator  muscles; pain  over  lateral  epicondyle  that progresses

Answer 49

Lateral  humeral epicondylitis

Question 50

Tenderness  over  lateral  epicondyle;  palpation  produces  pain,  motion  does not;  supination  against resistance  worsens  pain

Answer 50

Lateral  humeral epicondylitis

Question 51

DIAGNOSTIC  STUDIES OF Lateral  humeral epicondylitis?

Answer 51

NONE

Question 52

Occurs  in  children;  pain  in  elbow or  arm

Answer 52

Subluxation  of  radial head

Question 53

Affected  arm  is  flexed;  child cries  when  attempts  are made  to  move  joint

Answer 53

Subluxation  of  radial head

Question 54

DIAGNOSTIC  STUDIES OF Subluxation  of  radial head?

Answer 54

Radiograph  of  elbow

Question 55

History  of  fall  on  an  outstretched hand;  pain  and  swelling  of forearm  and  wrist

Answer 55

Wrist  fracture

Question 56

Palpation  of  snuffbox  increases  pain;  observe  for joint  deformity

Answer 56

Wrist  fracture

Question 57

DIAGNOSTIC  STUDIES OF Wrist  fracture?

Answer 57

Three-view  radiographs  to  determine scaphoid  or  Collies fracture

Question 58

History  of  trauma  or  fall,  joint tenderness

Answer 58

Finger  fracture

Question 59

Joint  swelling,  instability

Answer 59

Finger  fracture

Question 60

DIAGNOSTIC  STUDIES OF Finger  fracture?

Answer 60

 Three-view  radiographs  (PA,  lateral, and  oblique)

Question 61

Noticeable  lump  on  dorsal  surface of  wrist

Answer 61

Ganglion

Question 62

Gelatinous  filled  nodule, soft,  transilluminates

Answer 62

Ganglion

Question 63

DIAGNOSTIC  STUDIES OF Ganglion?

Answer 63

None

Question 64

History  of  upper  respiratory  tract infection;  malaise,  chills,  cold symptoms,  general  muscle  aches

Answer 64

Viral  infections

Question 65

Fever,  ill-appearing  adult  or child

Answer 65

Viral  infections

Question 66

DIAGNOSTIC  STUDIES OF Viral  infections?

Answer 66

Viral  serum  titer

Question 67

Diffuse  pain;  varies  in  pattern of  activity,  setting;  history of  depression  or  anxiety

Answer 67

Psychogenic

Question 68

Normal  examination  or  patient  response  to  examination  maneuvers  disproportionate  to  physical findings  or  subjective complaints

Answer 68

Psychogenic

Question 69

DIAGNOSTIC  STUDIES OF Psychogenic?

Answer 69

None

Question 70

Female  20-50  yr  old;  history  of depression,  sleep  disturbance, chronic  fatigue,  general  muscle and  joint  aches

Answer 70

Fibromyalgia

Question 71

Palpation  of  trigger  points will  produce  pain;  normal physical  examination

Answer 71

Fibromyalgia

Question 72

DIAGNOSTIC  STUDIES OF Fibromyalgia?

Answer 72

none

Question 73

African  American,  family  history; appears  after  age  6  mo;  acute pain  with  swelling  of  hands  and feet,  abdominal  pain,  decreased appetite,  malaise

Answer 73

Sickle  cell  disease

Question 74

Normal  examination

Answer 74

Sickle  cell  disease

Question 75

DIAGNOSTIC  STUDIES OF Sickle  cell  disease?

Answer 75

Hemoglobin  S genotype

Question 76

Female;  transient  arthritis  of  small joints,  malar  rash

Answer 76

Systemic  lupus erythematosus

Question 77

Normal  examination  may have  joint  tenderness  on palpation

Answer 77

Systemic  lupus erythematosus

Question 78

DIAGNOSTIC  STUDIES OF Systemic  lupus erythematosus?

Answer 78

Kidney  function  tests, antinuclear  anti¬ body,  CBC

Question 79

History  of  sleeping  with  arm against  head;  morning  shoulder pain;  pain  worse  with  lifting; paresthesia,  weakness,  or clumsiness  of  hand;  symptoms worse  at  night

Answer 79

Thoracic  outlet syndrome

Question 80

Bruit  over  supraclavicular fossa;  pallor,  decreased pulses  of  upper  extremity,  weakness,  skin  and nail  atrophy

Answer 80

Thoracic  outlet syndrome

Question 81

DIAGNOSTIC  STUDIES OF Thoracic  outlet syndrome?

Answer 81

None

Question 82

History  of  repetitive  upper  extremity motion;  paresthesia,  weakness, or  clumsiness  of  hand;  symptoms  worse  at  night

Answer 82

Carpal  tunnel syndrome

Question 83

Positive  Phalen  test  and Tinel  sign;  weakness  of hand;  dry  skin  over  distribution  of  median  nerve

Answer 83

Carpal  tunnel syndrome

Question 84

DIAGNOSTIC  STUDIES OF Carpal  tunnel syndrome?

Answer 84

none