MSK-UE

Question 1

1. Synovial Joint membrane
2. Synovial cavity
3. Joint capsule

Answer 1

1. lines synovial cavity, secretes fluid
2. separates the bones and cushions the joint
3. is fibrous structure that surrounds membrane-syndesmois (little healing)

Question 2

3 Type of jOints

Answer 2

1. Synovial- extra movement
2. Cartilaginous- bony surface separate by disc
3. Fibrous- bone direct contact

Question 3

1. Inspection:
   Palpation:
   ROM:
   Active ROM

Answer 3

1. joint symmetry, alignment and bony deformities
   Surrounding tissues for skin changes (erythema), nodules, muscle atrophy, swelling
   EX- squaring of shoulder= Anterior shoulder dislocation
2. joint for crepitus, tenderness, deformity
   Surrounding tissues for skin changes (warmth), nodules, muscle atrophy

3.test joint function and stability, integrity of ligaments

4.FIRST then passive ROM if appropriate.
Isolate GH place at 90deg ABD

Question 4

Strength testing:

Answer 4

test against resistance to grade strength of the muscle

evaluates muscular strength and nerve function which controls that muscle

Part of neurological exam

documented as part of musculoskeletal exam

scale from 0-5
5/5 is normal strength

Question 5

SHOULDER

Answer 5

Glenohumeral Joint
Ball and socket joint 
Large ROM
Sternoclavicular Joint 
Acriomoclavicular Joint

Question 6

Muscles of the Shoulder

Scapulohumeral Group

Answer 6

Rotator Cuff: SITS

Question 7

Axioscapular Group

Answer 7

Help rotate the scapula

Question 8

Axiohumeral Group

Answer 8

Internal rotation of the shoulder

Question 9

Biceps tendon

Answer 9

Long head of biceps enclosed in synovial sheath

Question 10

Subacromial bursa

Answer 10

Lies on top of supraspinatus tendon between head of the humerus and the acromion

Question 11

SHOULDER ROM

Answer 11

Flexion
Extension
Abduction
Adduction
Rotation
Internal
External
Circumduction

Question 12

Palpation of shoulder

Answer 12

Find
Acromion process
Acromioclavicular joint: find the anterior tip of the acromion, distal end of the clavical
Coracoid process

Question 13

Crossover Test

Answer 13

Adduct patient’s arm across chest as you palpate the AC joint
Pain= positive test
AC or SC joint disease

Question 14

Shoulder ROM and MMT

Answer 14

Flexion/extension
Adduction/abduction
Internal/external rotation
MMT-Shrug (CN XI)

Question 15

Sulcus Sign: Glenohumeral Instability

Answer 15

Sulcus sign: arm straight and relaxed to side of pt, elbow is grasped and downward traction is applied; a depression at the acromion indicates glenohumeral instability

Question 16

Drop Arm Test

Answer 16

: patient fully abducts arm to shoulder level, ask them to lower the arm slowly.
POSITIVE= If the patient cannot control the movement on the way down that is a “positive drop arm test,” which indicates a potential tear in a rotator cuff muscle
Stick to 90ABD bc above will be scapothoracic muscles helping

Question 17

Crepitus

Answer 17

grinding sensation. Articular cartilage irregular or loss

Question 18

Swelling

Answer 18

Synovitis- synoival membrane soft and buggy
Effusion- inc. synovial fluid firm, look swollen
Hemearthrosis
Soft tissue- tendon swelling

Question 19

Jobe’s(empty can) Test:

Answer 19

supraspinatus impingement

Question 20

Neer Test:

Answer 20

POS= posterior rotator cuff impingement or bicipital tendonitis

forces greater tuberosity against anterior acromion;

rotates posterior rotator cuff tendons under acromion (infraspinatus, teres minor);

“near to the ear”; start arm at side, elbow fully extended, thumb toward body, practitioner passively forward flexes shoulder 180 degrees overhead;

Question 21

Hawkins-

Answer 21

rotator cuff injury
Hawkins Test: shoulder flexed to 90 degrees, elbow flexed to 90 degrees, examiner grasps wrist with one hand and elbow with the other and passively internally rotates the shoulder (supraspinatus, teres minor, infraspinatus); pain suggests impingement of affected rotator cuff muscles

Question 22

Lift-off Test:

Answer 22

subscapularis tear or impingement

Question 23

Apprehension Test:

Answer 23

anterior shoulder instability or AC impingement
elbow flexed 90 degrees, shoulder abducted 90 degrees; examiner holds pt’s wrist, applies forward pressure from back of shoulder and externally rotate shoulder; pain or a look of apprehension is positive test. If positive, perform relocation maneuver: continue external rotation, apply posterior pressure from front of shoulder; if pain is reduced, anterior shoulder instability; if pain is not reduced, AC impingement

Question 24

Speeds Test: biceps tendonitis

Answer 24

arm forward flexed 50 degrees at shoulder, palm up, elbow flexed 15 degrees, pt forward flexes shoulder against resistance at forearm; pain sensitive for tendonitis of long head of biceps

Question 25

Elbow

Answer 25

Inspection: swelling, deformity Palpation: olecranon process, epicondyles, ulnar nerve ROM: flexion, extension, supination and pronation (with arm @ 90 deg, elbow into body) EX- note supercondylar condyle and radial head FX Strength: flexion and extension

Question 26

Elbow Structure and Pathology

Answer 26

Olecranon Bursitis Biceps Tendon Rupture Ulnar Nerve-Ulnar nerve runs posterior between medial epicondyle and olecranon process Olecranon Bursa

Question 27

Tennis Elbow:

Answer 27

Lateral Epicondylitis | grip tennis racket. Extensor mass inflamed

Question 28

Golfer

Answer 28

Medial Epicondylitis | Flexor mass inflamed

Question 29

Wrist and Hand Anatomy

Answer 29

``` Distal radius Distal ulna Carpal bones (8): scaphoid, lunate, triquetrium, pisiform, trapezium, trapezoid, capitate, hammate Metacarpals Phalanges ```

Question 30

Wrist and Hand Joint

Answer 30

``` Radiocarpal joint Distal radioulnar joint Midcarpal joint Carpometacarpal joint Metacarpophalangeal joint (MCP Joint) Proximal interphalangeal joint (PIP Joint) Distal interphalangeal joint (DIP Joint) ```

Question 31

Wrist Muscles

Answer 31

``` Flexor carpi ulnaris and radialis Extensor carpi radialis brevis and longus Extensor carpi ulnaris Supinator Pronator teres ```

Question 32

ROM

Answer 32

``` Flexion Extension Supination Pronation Deviation Radial Ulnar ```

Question 33

Carpal Tunnel

Answer 33

FPS, FPD and median nerve Channel beneath palmar aspect of wrist and proximal hand Median nerve provides sensation to digits 1-3 (and part of 4) Median nerve innervates thumb muscles

Question 34

Muscles of fingers

Answer 34

``` Extensor digitorum - fingers Thumb Snuff-Abductor pollicis longus Extensor pollicis longus Extensor pollicis brevis ``` Flexor pollicis longus

Question 35

Intrinsic muscles of hand

Answer 35

Intrinsic hand muscles Lumbricals (flexion) Dorsal interossei (abduction) Palmar interossei (adduction)

Question 36

ROM and MMT fingers

Answer 36

Forearm: pronation, supination Wrist: flexion, extension, ulnar and radial deviation Fingers: Flexion and extension: make fist, release Abduction and adduction: spread fingers apart THUMB: flexion and extension, abduction and adduction, opposition

Question 37

Wrist hand Exam

Answer 37

Inspection: swelling, deformity, thenar atrophy, flexion contractures of fingers Palpation: distal radius and ulna, carpal bones, fingers (phalanges), snuffbox (scaphoid) PIP, DIP stability

Question 38

Findings to note with Inspection

Answer 38

Thenar Atrophy | Dupuytren’s contracture

Question 39

Hand Motor Nerve

Answer 39

Radial nerve: Thumb extension (extensors) Median nerve: Thumb opposition (flexors) Ulnar nerve: Abduction fingers (dorsal interossei)

Question 40

Finkelstein

Answer 40

Tests for inflammation of muscles around base of thumb (DeQuervain’s tenosynovitis) Pt makes a fist with the fingers closed over the thumb and the wrist is bent toward the little finger Pain is positive result

Question 41

Tinel's Sign

Answer 41

Lightly percuss over the course of the median nerve on the volar aspect of the wrist along the carpal tunnel Tingling or electric sensations in the median nerve distribution caused by percussion is considered positive

Question 42

Phalen's Test

Answer 42

Compress the median nerve by holding patient’s wrist in an acutely flexed position for 60 seconds Numbness or tingling that develop as a result of compressing the median nerve is considered positive

Question 43

BATES MMT

Answer 43

0—No muscular contraction detected 1 barely detectable flicker or trace of contraction 2—Active movement of the body part with gravity eliminated 3—Active movement against gravity 4—Active movement against gravity and some resistance 5—Active movement against full resistance without evident fatigue. This is normal muscle strength.