UE MSK Exam Flashcards

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1
Q

Areas to be examined in UE MSK Exam

A
  1. Shoulder
  2. Elbow
  3. Hands & wrists
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2
Q

Components of shoulder exam

A
  1. Inspection: check alignment and symmetry
  2. Palpate surface features (ABCD
    • Acromioclavicular (AC) joint
    • (B) Sub-acromial Bursa
    • Coracoid process, Clavicle
    • Deltoid muscle insertion
  3. ROM
  4. Neer’s Impingement
  5. Rotator Cuff tests
    a. supraspinatus
    b. infraspinatus
  6. Biceps (elbow flex + supination)
    ?Triceps
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3
Q

Shoulder ROM testing

A
  1. Flexion - raise arms to vertical, palms facing downward
  2. Extension – raise arms straight behind back as far as is comfortable
  3. Abduction – raise arms at side, palms facing down to shoulder level
  4. Adduction – cross extended arm across chest
  5. External rotation – raise arms to shoulder level, bend elbows rotate toward ceiling
  6. Internal rotation – place arms behind back and touch shoulder
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4
Q

Proper Neer’s technique

A

• Examiner presses on the scapula to prevent motion
• Examiner internally rotates raises the patient’s arm in flexion with other hand
• This is a passive maneuver, examiner moves arm
(+) pain

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5
Q

Proper supraspinatus technique

A

“EMPTY CAN TEST”
• Patient holds arms at shoulder height (90°, making a “V” shape (not directly in front, not abducted at sides, but in between), internally rotates arms and points thumbs down
• Examiner presses downward on forearms asking patient to resist the pressure
• WEAKNESS with this maneuver is a POSTIVE test and indicates a possible rotator cuff tear

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6
Q

Proper infraspinatus technique

A

“Robot arm” test
• Patient places arms at side, elbows flexed to 90°.
• Examiner provides resistance as patient presses forearms outward/laterally
• WEAKNESS with this maneuver is a POSTIVE test and indicates a possible rotator cuff tear OR bicipital tendonitis

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7
Q

Components of elbow exam

A
  1. observe
  2. palpate: M/L epicondyle, radial head, olecranon process, olecranon bursa
  3. ROM
  4. Tinel’s test
  5. Lateral epicondylitis test
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8
Q

Elbow ROM

A
  • Flexion – bend the elbow
  • Extension – straighten the elbow
  • Pronation – flex elbows, turn palms downward
  • Supination – flex elbows, turn palms upward
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9
Q

Proper Tinel’s test

A

Tinel’s test = ulnar compression at the elbow*
• Tap, press the space in between the medial epicondyle and the olecranon process (this spot is commonly referred to as thefunny bone)
• Tenderness or sharp pain = positive test

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10
Q

Proper tests for lateral epicondylitis

A
  • Forced Wrist extension =
    • Stabilize the patient’s elbow in the examiner’s hand with the thumb of that hand positioned on the patient’s lateral epicondyle.
    • The patient makes a fist and pronates the forearm
    • Patient extends the wrist (pushes up) while the examiner applies a resisting force (pushes down) at the fist.
      * The test is positive if pain is elicited in the area of the lateral epicondyle
  • Grip test
    * Patient grabs and squeezes two of the examiner’s fingers
    * The test is positive if pain is elicited in the area of the lateral epicondyle
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11
Q

Hand/Wrist exam components

A
  1. Observe
  2. Palpate:
    •Radial and ulnar styloid processes
    •Thumb abductor tendons
    •Anatomical “snuff box”
  3. Hand and wrist ROM
  4. Assess for carpal tunnel
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12
Q

Hand/wrist ROM

A

• Wrist flexion and extension – bend wrist downward and upward
• Radial and ulnar deviation – move wrist side to side
• Metacarpophalangeal joint (MCP) flexion and extension – bend straight fingers at first knuckle
• PIP and DIP flexion and extension – bend and straighten 2nd and 3rd knuckles
a. To isolate the PIP and DIP, examiner presses fingers against MCP joints and then PIP joints – this allows to test for tendon function
• Finger abduction and adduction (JAZZ hands!)
• Thumb opposition, flexion, extension, abduction and adduction
• Form a fist

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13
Q

Proper tests for carpa tunnel

A
  • Tinel’s sign – percuss median nerve lightly with finger at the base of hand/top of wrist
  • Aching or numbness in the median nerve is a POSTIVE test
  • Phalen’s test – hold patients wrists in acute flexion for 60 seconds OR ask patient to press the backs of both hands together to form right angles
  • Numbness and tingling in the median nerve distribution is a POSITIVE TEST
  • Assess thenar muscle mass by palpation (not just observation) –
  • Atrophy of the muscle is a positive test
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