Week 3 - Upper Extremity Diagnostic Skills Session

Question 0

What muscle does external rotation (rotating forearms out) test?

Answer 0

Infraspinatus & Teres minor

Question 1

What is the drop-arm test and what does it look for?

Answer 1

Abduct the arm to 90 degrees and slowly lower it - if rotator cuff tear, hand will drop at 90 and cannot be held there.
This checks for a large rotator cuff tear

Question 2

What is the empty can test and what muscle does it test?

Answer 2

Supraspinatus
-Put arms up to 90 (or 45) degrees, rotate internally with thumbs down - physician applies downward force as patient holds and feels for pain

Question 3

What is the lift off test and what muscle does it test?

Answer 3

Subscapularis

-Placing hands on back and lifting up palms

Question 4

What does cross-body adduction test?

Answer 4

Acromioclavicular joint OA (osteoarthritis) or chronic sprain

Question 5

What does the apprehension sign/relocation test test?

Answer 5

Glenohumeral instability

Question 6

What are the impingement tests?

Answer 6

Neers- straight arm, hold shoulder, lift up past 180 (posterior side up) - long head of biceps brachii or rotator cuff muscle group impingement
Hawkins- Hold arm at 90 at elbow and rotate forearm down - palm facing patient’s face - long head of biceps brachii tendon or rotator cuff muscle group impingement

Question 7

Hold your forearm out with palms up and push up. What muscles does this test?

Answer 7

Biceps brachii

Question 8

What is Obrien’s test? What does it test?

Answer 8

Put patient’s arm out, 15 degrees toward midline, twist arm inward (thumb pointing down) - Physician pushes down and patient resists - should also do test on other side of arm (palms up) - If pain or clicking in glenohumoral joint - may indicate labril teal or slap lesion

Question 9

What is the crank test?

Answer 9

It is rotating the forearm with the elbow bent - physician is pushing in a little toward glenohumeral joint - arm is rotated up and down (180 degrees) - looking for pain or clicking

Question 10

What is the apprehension-relocation test and what does it test?

Answer 10

• Tests for glenohumeral joint stability
• Patient can stand or sit
• Hold one hand on patient shoulder
• Lift the patient arm to 90, externally rotate humerus/forearm
• Positive test = apprehension on patient’s face
• Relocation test - applying pressure to humeral joint after positive test and seeing patient’s relief

Question 11

What is lateral epicondylitis?

Answer 11

-Tennis elbow, entrapment of the medial nerve

Question 12

What is medial epicondylitis?

Answer 12

Golf elbow, impingement of the ulnar nerve - numbness in 4th and 5th fingers

Question 13

What is ulnar neuropathy?

Answer 13

Ulnar nerve entrapment - numbness, tingling in the 4th and 5th digits

Question 14

How do you find the olecranon bursa?

Answer 14

Palpate the posterior elbow

Question 15

What does medial nerve entrapment cause?

Answer 15

Discomfort, numbness, tingling in thumb, 2nd & 3rd fingers

Question 16

What are scaffoid fractures and in what population are they common?

Answer 16

They are common in teens and its the fracture of the bone closest to the anatomical snuff box. Causes pain in the anatomical snuffbox.

Question 17

What is De Quervain Tenosynovitis?

Answer 17

It’s not uncommon for a mother who’s constantly picking up children. It’s caused by repetitive motion.
-Usually it’s pain on top of thumb
Finkelstein test- patient flexes thumb across palm and fingers are then wrapped around thumb. Then patient is asked to deviate the wrist toward the ulnar styloid - pain will exhibit over radial styloid

Question 18

What does the Finkelstein test look for?

Answer 18

De Quervain Tenosynovitis

Question 19

What is the phalen test?

Answer 19

Hold backs of hands together for 30 seconds and see if the patient notices numbness, tingling or pain in median nerve distribution - tests for carpal tunnel

Question 20

What is the thenar test?

Answer 20

Tapping from distal to proximal wrist/palm, looking for pain, tingling, numbness associated with carpal tunnel.

Question 21

What happens in medial and lateral epicondylitis?

Answer 21

Muscle and tendon units around elbow end up getting enflamed - usually from overuse

Question 22

Testing for Lateral Epicondylitis:

Answer 22

Fully flex elbow into a stretch or resist the hand when patient is trying to extend for a flexed position - positive test if pain shows over the elbow area on lateral/median nerve side