Midterm

Question 0

Adson’s - How long do you palpate the radial artery with this test?

Answer 0

10-20 seconds, enough to decide if the pulse volume has changed

Question 1

What syndrome(s) might cause a positive Allen’s test?

Answer 1

TOS
Cervical subluxation
Raynaud’s syndrome (patency loss of the extremity arteries)

Question 2

Positive Adson’s indicates ?

Answer 2

Scalenus anticus syndrome = pressure on the subclavian artery and brachial plexus

Question 3

What diagnosis is suspected with a positive Adson’s turning away from the side being tested?

Answer 3

Maybe a cervical rib or Scalenus medius syndrome

Question 4

Is a cervical rib that causes loss of patency….acute or chronic?

Answer 4

Usually an acute exacerbation, because bone will normally grow away from the artery.

Question 5

What is a positive for Eden’s test?

Answer 5

Decreased pulse volume.

Question 6

A positive Eden’s test indicates?

Answer 6

Costoclavicular syndrome

Question 7

What constitutes a positive Wright’s test?

Answer 7

10-15 degrees difference in left vs. right arm abduction. You’re comparing where you lose the palpable radial pulse from one arm to the other arm

Question 8

A positive Wrights test indicates?

Answer 8

Hyperabduction syndrome

Question 9

What constitutes a positive Yergason’s?
Indicates:
Differential Diagnosis:

Answer 9

Positive: Tendon pops out of the groove
Indicates: Bicepital Instability
Differential Diagnosis: pain w/o slipping may be an inferior humerus

Question 10

Dawburn’s:
Positive:
Indicates:
Negative:

Answer 10

Positive: Pain disappears on abduction
Indicates: Subacromial bursitis
Negative: Pain remaining throughout abduction may be an inferior humerus

Question 11

Dugas:
Positive:
Indicates:

Answer 11

Positive: Patient cannot touch chest with affected arm / elbow while grasping the opposite shoulder
Indicates: Shoulder dislocation / separation

Question 12

Shoulder apprehension:
Positive:
Indicates:

Answer 12

Positive: Look of alarm on face or patient pulling away from doctor’s pressure
Indicates: Glenohumeral instability / propensity to dislocate

Question 13

Visualization: St-Cl S

Answer 13

Proximal end of clavicle sits higher than the opposite side

Question 14

Visualization: A-C PS (posterior superior)

Answer 14

Distal end of the clavicle sits higher causing a visual prominence

Question 15

Visualization: G-H I

Answer 15

Dimpling or indent of soft tissue over the joint space

Question 16

Visualization: Lateral Scapula

Answer 16

Vertebral border of scapula has flared lateral in relation to the spine

Question 17

Fluid Motion Studies: St-Cl

Answer 17

Place fingers at St-Cl joints and ask pt. to shrug and roll their shoulders.

Question 18

Fluid Motion Studies: A-C PS

Answer 18

Compress humeral head into the glenoid fossa then apply S to I pressure over distal end of clavicle

Question 19

Fluid Motion Studies: G-H

Answer 19

Block A-C and scapular spine with one hand, apply I to S pressure at elbow

Question 20

Fluid Motion Studies: S-T (Scapulo-Thoracic)

Answer 20

Dr. places thumbs at medial inferior angle, applying M-L pressure;
then Dr. places thumbs at lateral inferior angle applying L-M pressure

Question 21

Give at least (3) indications of an inferior humerus?

Answer 21

1. Shoulder visualizes as being low w/ soft tissue dimpling/sulcus sign
2. Point tenderness at the anterior aspect of the G-H joint
3. Loss of fluid motion.
4. Loss of Appley’s external rotation
5. Anterior deltoid weakness.

Question 22

Indications of a posterior humerus?

Answer 22

visualizes normally, no apparent visual change.
lost fluid motion
point tenderness at posterior aspect of G-H joint
Loss of internal rotation
Teres major muscle weakness

Question 23

With any shoulder complaint the Dr. should routinely examine? (6 things)

Answer 23

St-Cl, A-C, G-H, Sc-Th, St-Co, & definitely the spine for subluxation

Question 24

On Scapulo-Thoracic Lateral (S-T L) what position do we place the patient’s arm?

Answer 24

Behind the pts. back (side lying) with doctor reaching through the patient's axillary/arm opening

Question 25

On Scapulo-Thoracic Lateral (S-T L) where are the fingers?

Answer 25

Over the G-H joint

Question 26

On Scapulo-Thoracic Lateral (S-T L) where is #11 of the stabilization hand?

Answer 26

Over the A-C joint

Question 27

On Scapulo-Thoracic Lateral (S-T L) in what direction does the stabilization hand push to bring the joint to tension?

Answer 27

S to I

Question 28

On Scapulo-Thoracic Lateral (S-T L) what's the pain point for S-T L?

Answer 28

Deep to or under the scapula, in the subscapularis muscle.

Question 29

How to differentiate S-T L (lateral) from S-T M (scapulo-thoracic medial)?

Answer 29

1. ) Fluid motion 2. ) visualization of distance from spine 3. ) S-T L = (lateral) Appley’s scratch in internal rotation is diminished 4. ) S-T M = (medial) Appley’s scratch in external rotation is diminished

Question 30

What part of the scapulo-humeral ratio would be decreased with a G-H P?

Answer 30

The Glenohumeral portion

Question 31

G-H posterior, prone-LOC?

Answer 31

P-A, be careful to not get any S-I

Question 32

G-H posterior where is the patient’s shoulder?

Answer 32

Supported on the table

Question 33

G-H posterior why is the shoulder on the table?

Answer 33

For stabilization; we don't want to dislocate it

Question 34

Indication of Yergason's positive?

Answer 34

Bicepetal tendon instability, usually caused by a shallow groove-or a tear or sprain of transverse humeral ligament

Question 35

Drop Arm test: describe 3 parts least-to-most invasive and diagnosis for each

Answer 35

1. ) Pt. lowers arm to side against gravity; if it drops fast, it’s often a severe tear of rotator cuff, grade 3. Supraspinatus muscle. 2) Apply a little pressure while they lower it; some resistance, moderate tear of rotator cuff, grade 2 3) Put an impulse in the abducted arm; fair resistance, mild tear or strain of rotator cuff, grade 1

Question 36

G-H P, seated: What is most important about LOC?

Answer 36

Straight P-A, drop elbow so it's level or below the wrist

Question 37

G-H P, seated: What ROM' s do you use to bring it to tension?

Answer 37

Abduction & extension

Question 38

G-H P, seated: Where is the pain point?

Answer 38

Over the posterior glenohumeral joint

Question 39

How to differentially diagnose a G-HP, from a G-H Inf.?

Answer 39

Pain point is posterior; visualizes as normal, not inferior G-HP is decreased ROM on internal rotation, not external rotation (Appley’s Scratch ROM loss on internal rotation, not external) X-ray shows humeral head is posterior and superior, not inferior Teres major muscle test is weak on G-H P, not the anterior deltoid as GH I

Question 40

G-H I (inferior): What is the move of choice for the G-H joint and why?

Answer 40

Supine traction Because you can feel the joint

Question 41

What are at least three other alternatives to differentiate this diagnosis from? (9) listed

Answer 41

G-H posterior, Subacromial bursitis, bicipetal tendonitis, bicipetal instability, sprain or tear of rotator cuff, dislocation, heart attack, gall bladder, spleen

Question 42

Frozen shoulder: Describe the 3 parts as you're doing them, be sure to support arm over pillow or back of chair

Answer 42

1) traction, release; if ROM is gained, go on to part 2 2) traction through ROM gained, back to neutral, release 3) after a few visits if no part 2 progress, traction and take it through the ROM gained, at end-ROM put an impulse down the shaft of the humerus, bring it back to neutral, return to part 2 until no more progress. Post check with ROM and comparing L side to R side.

Question 43

G-H traction, seated: Dr’s arm in Pt’s. armpit with thumb up. What are your limiting factors?

Answer 43

Patient tolerance & visualizing the joint space to open up | Note: it is important to be visualizing this during the practical

Question 44

G-H traction, supine: Is this the move of choice for a G-H fixation?

Answer 44

Yes, because you can palpate the joint space rather than just visualize it.

Question 45

Give at least “3” diagnoses that G-H traction, supine would work for?

Answer 45

``` Frozen shoulder Inferior humerus Posterior humerus Osteoarthritis with fixation G-H dislocation ```

Question 46

St-Cl superior: How do you bring this joint to tension before the thrust? Describe the thrust.

Answer 46

Bring the arm into abduction & extension. | Straight S-I, maybe a little torque, fingers point toward the Axillary

Question 47

St-Cl traction, seated: What are we doing with our opposite arm?

Answer 47

Holding the opposite shoulder back

Question 48

Why do we hold the shoulder back?

Answer 48

Isolating the st-cl joint, not rotating the thoracics

Question 49

St-Cl traction, supine: What direction does the clavicle most commonly subluxate?

Answer 49

Superior

Question 50

Is this traction move a post-check for St-Cl Superior?

Answer 50

NO, this is actually a procedure & should be done before St-Cl S

Question 51

A-C PS: Which part of this takes care of superiority? Which part takes care of the posteriority?

Answer 51

Superiority Pushing down on the distal end of the clavicle | Posteriority Pushing slightly forward and externally rotating the arm

Question 52

Most common muscle involved with Hyperabduction Syndrome or a positive Wright's?

Answer 52

Pectoralis minor

Question 53

What causes the pectoralis minor to be shortened or go into contracture?

Answer 53

(1. ) Cervical subluxation, (2. ) subacromial bursitis, (3. ) rolled shoulder posture (4. ) other types of TOS