Flashcards in Musculoskeletal Disorders Deck (61)
What are some sources of referred shoulder pain?
cervical spine, gallbladder, spleen, heart
What is "casualty or culprit"?
Implies that the site of pain may not be the source of the problem
What is Spurling's position?
extension and rotation of the neck to the side of pain - indicates pathology of the cervical spine that may cause shoulder pain
What is the most common neuropathy associated with shoulder pain?
compression of the suprascapular nerve
What are the essential elements of the examination for shoulder pain?
inspection, palpation, tests of motion and strength
What is the "Popeye deformity"?
deformity of the upper arm indicating rupture of the long head biceps tendon
What is the most common cause of shoulder pain?
rotator cuff injury
What is Jobe's test (empty can test)?
Straight arm at 90 degrees abduction and 30 degrees forward flexion with arm internally rotate completely (thumb pointing down) - clinician adducts arm: pain w/o weakness = tendinopathy; pain w/weakness = tendon tear
What is Apley scratch test?
used to assess shoulder ROM - patient reaches across chest (assess adduction), behind head (external rotation and abduction), and behind back (internal rotation and adduction)
What is the push off (Gerber's) test?
patient places one hand behind back and pushes posteriorly against resistance - assesses subscapularis muscle
What is the Neer test?
passive painful arc maneuver - passively flexing the glenohumeral joint while preventing shoulder shrugging (used to assess shoulder impingement)
What is the drop arm test?
patient is unable to lower arm from a fully abducted position with a smooth coordinated motion (assesses rotator cuff tear)
Which tests should be used together to assess rotator cuff tear?
active painful arc test (pain with active abduction beyond 90 degrees), drop arm test, weak in external rotation
What is the Hawkins Kennedy test?
used to assess shoulder impingement - clinician stabilizes shoulder with one hand with elbow flexed at 90 degrees and internally rotates the shoulder using other hand - pain with internal rotation = positive test
What is tendinopathy?
clinical syndrome characterized by tendon thickening and chronic localized tendon pain - due to acute trauma or overuse - failed healing response within the tendon tissue
What is "tissue creep"?
sustained or repetitive loading of extracellular matrix in tendons displaces water ("wringing out" the tendon) and reduces capacity to absorb force - load that is initially manageable produces tendon damage
What are treatments for tendinopathy?
limit the volume and intensity of loads placed on the tendon; ergonomics; slow, controlled, progressive heavy load exercises; sustained stretching; NSAIDs; glucocorticoids (acute tendinopathy)
What is impingement syndrome?
symptoms and signs that result from compression of the rotator cuff tendons and the subacromial bursa between the greater tubercle of the humeral head and the lateral edge of the acromion process
What is frozen shoulder?
adhesive capsulitis - stiffened glenohumeral joint that has lost significant range of motion (abduction and rotation) - lidocaine injection does not improve ROM
What is the lidocaine injection test?
used to confirm rotator cuff tendinopathy (normal strength with pain relief versus persistent weakness despite pain relief with rotator cuff tear)
What are the primary imaging modalities for shoulder injuries?
plain film radiography (first modality), MRI soft tissue injuries), bone scan (infections), arthrography (rotator cuff tears)
What is the Tinel test?
light percussion over the median nerve to detect nerve inflammation (carpal tunnel syndrome) - sensation of tingling or pins and needles
What is the Phalen maneuver?
full flexion of the wrist for 60 seconds causes paresthesias in the distribution of the median nerve (backs of hands placed together with wrists flexed)
What is the Finkelstein test?
patient forms fist around thumb - clinician stabilizes forearm and holds patient's fist with other hand then moves wrist into ulnar deviation (rotates fist up and out) - used to diagnose de Quervain's tenosynovitis
What is the Thomas test?
patient brings one leg to chest and leaves other relaxed and flexed - + findings: (1) lack of hip extension with knee flexion > 45 degrees = iliopsoas tightness, (2) full hip extension with knee flexion < 45 degrees = rectus femoris tightness, (3) lack of hip extension with knee flexion < 45 degrees = both
What is the Trendelburg test?
shows whether hip remains straight when lifting healthy leg - if pelvis and hip drop when lifting healthy leg, may indicate gluteus medius injury
What is Ober's test?
test of contracted/inflamed tensor fasciae latae or iliotibial band - patient lies on unaffected side with knee flexed 90 degrees and slightly extended, leg allowed to drop (+ if leg does not fall to parallel)
What is Ely's test?
patient lies prone - able to fully flex knee without creating hip flexion (rectus femoris tightness if hip flexes with knee flexion)
What is Patrick's (FABER) test?
patient flexes, abducts, and externally rotates leg (creates figure 4 with leg) - examiner pushes down on hip and knee - pain with maneuver indicates problem with iliosacral joint