Upper Extremity Anatomy Tests

Question 1

4 Greek terms for upper extremity inspection

Answer 1

Rumor =. Redness

Tumor = mass

Dollar = pain

Calor =. Heat

Question 2

4 joints of the shoulder

Answer 2

Acromioclavicular

Scapulothoracic

Glenohumeral

Sternoclavicular

Question 3

Acromion

Answer 3

Long flat curved process of scapula that forms the AC joint and is the site of the middle deltoid attachment

Question 4

Coracoid process

Answer 4

Deep scapular projection that serves as the origin of the short head of biceps and insertion of pectoralis minor and coracobrachialis

Question 5

3 acromion types

Answer 5

Flat (least likely to cause impingement)

Curved

Beaked (most likely to cause impingement)

Impingement is the supraspinatus muscle w/ overhead activities

Question 6

3 heads of deltoid origins

Answer 6

Clavicle

AC joint

Scapular spine

• pain along the insertion of the deltoid (lateral humerus) is most indicative of a rotator cuff tear*

Question 7

Neutral shoulder ROM

Answer 7

Flexion = 150-170

Extension = 60

External rotation = 60

Internal rotation (in front of body) = 70

Internal rotation (behind back) = 95

Question 8

Horizontal internal rotation vs horizontal external rotation degrees

Answer 8

Internal = 70 degrees

External = 90 degrees

• horizontal implies arms are abducted 90 degrees*

Question 9

Abduction vs adduction degrees

Answer 9

Abduction = 180

Adduction = 20-40

Question 10

Scapulohumeral motion

Answer 10

For every 30 degrees of shoulder abduction

20 degrees = humeral abduction

10 degrees = scapular rotation

Question 11

Specific names of scapular rotation

Answer 11

“Up and down” =. A-P axis movement through AC joint

“Scapular winging” =. Vertical axis movement through AC joint

“Scapular tipping” = horizontal axis through the AC joint

(AC joint does abduction and both internal/external rotation)

Question 12

Neutral plane of the scapula

Answer 12

30-45 degrees forward in coronal plane

Question 13

Movements of the clavicle

Answer 13

Anterior/posterior

Superior/inferior

External/internal rotation

Question 14

Boa’s sign

Answer 14

Pain in right shoulder/upper back is refereed pain from right abdominal organs (liver/gallbladder/ duodenum/ etc.)

Question 15

Kehr’s sign

Answer 15

Pain in left shoulder/upper back is indicative of referred pain from the left abdominal organs
(Spleen, stomach and possibly renal damage)

Question 16

Joints of the elbow

Answer 16

Humero-ulnar
(Flexion/extension)

Humero-radial
(Pronation/supination)

Proximal radio-ulnar
(Pronation/supination)

Question 17

Elbow ROM from neutral position

Answer 17

Flexion = 145

Extension =. 0

Supination and pronation = 90

Question 18

Carrying angle

Answer 18

Angle created from two lines at rest

From the proximal humerus to the elbow

From proximal forearm to tips of fingers

Males =. 5-10

Females =. 10-15

Question 19

Abnormal carrying angles

Answer 19

Cubits valgus (> 15)

Cubits varus ( <5-10)

Question 20

Supination and pronation with movement radius

Answer 20

Pronation = radius moves over the ulna posteriorly

Supination = radius moves over the ulna anteriorly

The ulna remains motionless

Question 21

Wrist general ROM

Answer 21

Flexion = 80-90

Extension = 70

Adduction/ulnar deviation = 30

Abduction/radial deviation = 20

Question 22

Reflexes of the arm with respect to their nerveroot

Answer 22

Biceps = C5

Brachioradials = C6

Triceps = C7

Question 23

Reflex scale

Answer 23

0 = no reflex

1/4 =. Decreased present

2/4 = normal

3/4 = brisk with unsustained clonus

4/4 = brisk with sustained clonus

Question 24

Motor strength scale

Answer 24

0 - absent

1/5 = slight contraction with no joint motion

2/5 = complete ROM without gravity

3/5 = complete ROM against gravity

4/5 = Complete ROM against gravity w/ light resistance

5/5 = complete ROM against gravity w/ full resistance

Question 25

Difference between physiologic, restrictive and anatomical barrier

Answer 25

Physiological = farthest a patient Can actively move a joint Restrictive barrier = farthest a joint can be moves just short of the physiological barrier Anatomical barrier = farthest a patient can passively move a joint

Question 26

Apley scratch test

Answer 26

Upper test over the shoulder to touch contralateral superior angle of the scapula: tests for external rotation and abduction of the arm Lower test behind the shoulder to touch contralateral inferior angle of scapula: tests for internal rotation adduction

Question 27

AC joint dysfunction

Answer 27

Cross arm over contralateral shoulder by adduction and raise elbow to 90 degrees - push down on patient elbow and have them resist you (+) = pain which indicates strain or tear at AC joint

Question 28

Drop arm test

Answer 28

Patient abducts arms fully to 160-180 degrees Patient is to slowly lower arms to each side (+) If patient starts to unevenly drop one side at roughly 90 degrees, indicative of RCT specifically supraspinatus.

Question 29

Empty can/jobe test

Answer 29

Patient abducts arm to 90 degrees, internally rotates 45 degrees and horizontally flexes 30 degrees (thumbs down) (+) slight pressure downward on arm causes pain or inability for patient to resist, indicative of supraspinatus weakness

Question 30

Infraspinatus/teres minor

Answer 30

Two tests: 1) patient flexes elbow 90 degrees and tries to rotate against physician resistance (+) = cant do it and may cause pain, indicative of Infra and teres minor tears 2) patient flexes elbow to 90 degrees and externally rotates to max point passively (+) = arm lags back to neutral, indicative of infra and teres minor tears *if patient shoulder shrugs when lifting arm, usually indicative of a tear*

Question 31

Subscapularis liftoff test

Answer 31

Place patient hand behind them with dorsum of hand on lumbar spine. Patient attempts to internally rotate against physcian resistance (+) = cant do it and maybe slight pain = indicative for subscapularis tear

Question 32

Neer’s and Hawkins tests

Answer 32

Both test sub acromion impingement of rotator cuff and biceps brachi 1) Hawkins: Patient elbow and shoulder flexed at 90 degrees and shoulder/arm forcefully internally rotated (+) = pain Neers: patient arm is internally rotated as close to 180 as possible (so that dorsum of hand is near the ear). Arm is then passively flexed up to 180 (+) pain is usually seen around 90 degrees STABILIZE SCAPULA DURING BOTH PROCEDURES

Question 33

Difference between dislocated and sublaxed shoulder

Answer 33

Dislocated = is dislocated and does not spontaneously fix itself Sublaxed =. Dislocated and will spontaneously fix itself

Question 34

Yergasons test

Answer 34

Tests stability of long head of biceps tendon and/or bicep tendonitis Physcian stabilizes patients elbow and wrist and has patient make arm curl motion, with increases resistance each consecutive curl’ Physician eventually externally rotates the arm quickly (+) popping sound (indicates sublaxed tendon) and pain (indicates bicep tendonitis)

Question 35

Speeds test

Answer 35

Tests for bicep tendonitis Patient with arm flexed at 90 degrees and supinate forearm Physcian resists forward flexion of the arm arm at the wrist (+) = pain

Question 36

O’Brien’s test

Answer 36

Tests for GH Labrum tear Patient has arm flexed to 90, adducted medial as far possible and internally rotated as far as possible Physician then places a downward force on patient arm at forearm (+) = pain

Question 37

Wrights and adsons test

Answer 37

Test for impingement of the radial artery/nerve at both the pecterolis minor and Scalenes respectively Physician finds patients radial pulse and then places them in the respective positions. (+)Weakened pulse or numbness

Question 38

Roos test

Answer 38

Tests for thoracic outlet syndrome (+) = numbness

Question 39

Lateral epicondylitis

Answer 39

Pain at lateral epicondyle specifically at the extensor carpi radials brevis attachment *also known as tennis elbow* Maudsley and miles test (+) = pain with resisted extension Also can experience pain with resisted supination

Question 40

Medial epicondylitis

Answer 40

Pain at the medial epicondyle at the point of flexor carpi radialis attachment *also known as golfers elbow* Wrist flexion and resisted pronation elicits pain = (+)

Question 41

Phalens and reverse phalens tests tests

Answer 41

Tests for carpal tunnel Remain in position for 30-60 seconds (+) - numbness in the lateral hand

Question 42

Finkelstein test

Answer 42

Tests for De Querviuan tenosynovits *specifically tendonitis in the extensor pollicis brevis and abductor pollicis longus (+) = pain over area and possible swelling