DESCRIPTION: Have patient supinate forearm against resistance.
Yergason test
FINDINGS: A positive test produces pain in bicipital groove and is suggestive of bicipital tendinitis.
Yergason test
DESCRIPTION: Ask patient to externally rotate and abduct shoulder.
Rotator cuff tear
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.
Rotator cuff tear
DESCRIPTION: Have patient resist forearm supination with elbow flexed 90 degrees.
Tennis elbow
FINDINGS: Pain with this movement indicates lateral humeral epicondylitis.
Tennis elbow
DESCRIPTION: Have patient flex fingers over a clenched thumb; then passively deviate wrist ulnarly.
Finkelstein test
FINDINGS: Movement produces pain in de Quervain disease (first dorsal compartment tenosynovitis).
Finkelstein test
DESCRIPTION: Tap over median nerve (palmar surface of wrist) to assess for compression neuropathy.
Tinel sign
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.
Tinel sign
DESCRIPTION: Ask patient to maintain palmar flex¬ ion for 1 min with dorsal surfaces of each hand pressed together.
Phalen test
FINDINGS: Test is positive if maneuver produces numbness and paresthesia in fingers innervated by median nerve.
Phalen test
Repetitive trauma activities; pain with movement
Tenosynovitis (tendinitis)
Swelling over tendon, crepitus
Tenosynovitis (tendinitis)
DIAGNOSTIC STUDIES OF Tenosynovitis (tendinitis)?
None
History of overuse; aching pain over affected bursae that radiates along limb
Bursitis
Local tenderness, swelling; limited joint motion; muscle weakness
Bursitis
DIAGNOSTIC STUDIES OF Bursitis?
None
Pain in trigger sites throughout body, joint stiffness, disturbed sleep
Fibrositis
Fatty, fibrous nodules in muscles; palpation of trigger points elicits pain
Fibrositis
DIAGNOSTIC STUDIES OF Fibrositis?
None
Presentation depends on age, location of infection; history of infection, trauma, penetration, invasive procedure; refusal to bear weight (hip); constant pain
Osteomyelitis
Fever, chills, vomiting; pain localized over affected area but progressively worsens; soft tissue injury or abscess
Osteomyelitis
DIAGNOSTIC STUDIES OF Osteomyelitis?
Increased WBCs, ESR, CRP; radiographs
Older adults; asymmetrical joint pain and stiffness that improves throughout day; history of repetitive joint trauma; obesity
Osteoarthritis
DIP, PIP joints enlarged; Heberden nodes; limited cervical spine ROM
Osteoarthritis
DIAGNOSTIC STUDIES OF Osteoarthritis?
ESR; radiograph may reveal osteophytes, loss of joint space
Morning stiffness of small joints; symmetrical involvement; anorexia, weight loss
Rheumatoid arthritis
Fever, rheumatoid nodules, ulnar deviation of wrists
Rheumatoid arthritis
DIAGNOSTIC STUDIES OF Rheumatoid arthritis?
Increased ESR, positive rheumatoid factor, anemia on CBC count; radio¬ graph shows bony erosion
History of systemic infection, malaise, diaphoresis, refusal to bear weight (hip), acute joint pain
Septic arthritis
Fever; red, swollen joint; limited range of motion
Septic arthritis
DIAGNOSTIC STUDIES OF Septic arthritis?
WBCs,culture of joint aspirate, ESR, CRP, ultrasound of joint
History of trauma, pain
Shoulder dislocation
Limited rotation, arm abduction, and hand supination
Shoulder dislocation
DIAGNOSTIC STUDIES OF Shoulder dislocation?
Radiograph of shoulder with AP view and internal/external rotation
History of trauma, pain
Acromioclavicular joint injury
Limited shoulder movement; obvious deformity
Acromioclavicular joint injury
DIAGNOSTIC STUDIES OF Acromioclavicular joint injury
Radiograph of shoulder with AP view and internal/external rotation
History of overuse of biceps; pain worse with movement
Bicipital tendinitis
Positive Yergason test; pain localized over intertubercular groove
Bicipital tendinitis
DIAGNOSTIC STUDIES OF Bicipital tendinitis?
Radiograph (Fisk view)
Acute: younger people, history of trauma, severe pain; chronic: older, pain worse with overhead movement, sleep disturbance
Rotator cuff tear
Acute: inability to raise arm laterally, shrug shoulders; chronic: tenderness over AC joint, crepitus, weakness in external shoulder rotation
Rotator cuff tear
DIAGNOSTIC STUDIES OF Rotator cuff tear?
Radiograph may reveal humeral displacement or spurs; MRI
Repetitive motion of or pressure to elbow; localized pain
Olecranon bursitis
Warmth, redness, and swelling over joint; full ROM
Olecranon bursitis
DIAGNOSTIC STUDIES OF Olecranon bursitis?
Radiograph to rule out fracture of olecranon process
History of repetitive contraction of extensor and supinator muscles; pain over lateral epicondyle that progresses
Lateral humeral epicondylitis
Tenderness over lateral epicondyle; palpation produces pain, motion does not; supination against resistance worsens pain
Lateral humeral epicondylitis
DIAGNOSTIC STUDIES OF Lateral humeral epicondylitis?
NONE
Occurs in children; pain in elbow or arm
Subluxation of radial head
Affected arm is flexed; child cries when attempts are made to move joint
Subluxation of radial head
DIAGNOSTIC STUDIES OF Subluxation of radial head?
Radiograph of elbow
History of fall on an outstretched hand; pain and swelling of forearm and wrist
Wrist fracture
Palpation of snuffbox increases pain; observe for joint deformity
Wrist fracture
DIAGNOSTIC STUDIES OF Wrist fracture?
Three-view radiographs to determine scaphoid or Collies fracture
History of trauma or fall, joint tenderness
Finger fracture
Joint swelling, instability
Finger fracture
DIAGNOSTIC STUDIES OF Finger fracture?
Three-view radiographs (PA, lateral, and oblique)
Noticeable lump on dorsal surface of wrist
Ganglion
Gelatinous filled nodule, soft, transilluminates
Ganglion
DIAGNOSTIC STUDIES OF Ganglion?
None
History of upper respiratory tract infection; malaise, chills, cold symptoms, general muscle aches
Viral infections
Fever, ill-appearing adult or child
Viral infections
DIAGNOSTIC STUDIES OF Viral infections?
Viral serum titer
Diffuse pain; varies in pattern of activity, setting; history of depression or anxiety
Psychogenic
Normal examination or patient response to examination maneuvers disproportionate to physical findings or subjective complaints
Psychogenic
DIAGNOSTIC STUDIES OF Psychogenic?
None
Female 20-50 yr old; history of depression, sleep disturbance, chronic fatigue, general muscle and joint aches
Fibromyalgia
Palpation of trigger pointswill produce pain; normal physical examination
Fibromyalgia
DIAGNOSTIC STUDIES OF Fibromyalgia?
none
African American, family history; appears after age 6 mo; acute pain with swelling of hands and feet, abdominal pain, decreased appetite, malaise
Sickle cell disease
Normal examination
Sickle cell disease
DIAGNOSTIC STUDIES OF Sickle cell disease?
Hemoglobin S genotype
Female; transient arthritis of small joints, malar rash
Systemic lupus erythematosus
Normal examination may have joint tenderness on palpation
Systemic lupus erythematosus
DIAGNOSTIC STUDIES OF Systemic lupus erythematosus?
Kidney function tests, antinuclear anti¬ body, CBC
History of sleeping with arm against head; morning shoulder pain; pain worse with lifting; paresthesia, weakness, or clumsiness of hand; symptoms worse at night
Thoracic outlet syndrome
Bruit over supraclavicular fossa; pallor, decreased pulses of upper extremity, weakness, skin and nail atrophy
Thoracic outlet syndrome
DIAGNOSTIC STUDIES OF Thoracic outlet syndrome?
None
History of repetitive upper extremity motion; paresthesia, weakness, or clumsiness of hand; symptoms worse at night
Carpal tunnel syndrome
Positive Phalen test andTinel sign; weakness of hand; dry skin over distribution of median nerve
Carpal tunnel syndrome
DIAGNOSTIC STUDIES OF Carpal tunnel syndrome?
none
