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USMLE Step 2 CS > UE MSK Exam > Flashcards

Flashcards in UE MSK Exam Deck (13):
1

Areas to be examined in UE MSK Exam

1. Shoulder
2. Elbow
3. Hands & wrists

2

Components of shoulder exam

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

3

Shoulder ROM testing

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

4

Proper Neer's technique

• 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

5

Proper supraspinatus technique

"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

6

Proper infraspinatus technique

"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

7

Components of elbow exam

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

8

Elbow ROM

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

9

Proper Tinel's test

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

10

Proper tests for lateral epicondylitis

•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

11

Hand/Wrist exam components

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

12

Hand/wrist ROM

• 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

13

Proper tests for carpa tunnel

• 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