UE OSCE

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9 Terms

1
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Thoracic Outlet Syndrome

Injury to the nerves/vasculature of the UE passing through the TO

Tests: Roos Test/Elevated Arm Stress Test

  • Hold shoulders 90 degrees abducted and externally rotated, elbows flexed for 3 minutes while opening and closing hands

  • ┗(-_-)┛

  • NOT DONE IN VIDEOS

Extra Tests: Neer, Hawkins-Kennedy

2
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Impingement Syndrome

Long head of bicep/supraspinatus tendons are compressed under the coracoacromial arch, especially under shoulder elevation

Tests: Hawkins-Kennedy test

  • Hold shoulders at 90 degrees Shoulder Flexion, then have the patient go into full Internal Rotation

  • Positive (pain, weakness) implicates impingement syndrome

  • NOT DONE IN VIDEOS

Neer Impingement Test

  • Passively Flex pt’s shoulder into end range, and then passively flex then passively flexed into end range with internal rotation to further challenge

  • Positive (pain, weakness) implicates impingement syndrome

  • NOT DONE IN VIDEOS

3
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Rotator Cuff Tear

Tearing of one or multiple rotator cuff muscle tendons, which can be partial or full thickness

Tests: Empty Can Test

  • Hold shoulders at 90 degrees flexion, with some horizontal abduction, then have patients go into Internal rotation (palms facing outwards). Apply resistance

  • Positive (pain or weakness) implicates Supraspinatus

Full Can Test

  • Hold shoulders at 90 degrees Flexion, when have patients go into Internal rotation (palms facing outwards). Apply resistance

  • Positive (pain or weakness) implicates Supraspinatus

Lift Off Test

  • Have the patient put their hands on their back in a diamond shape, then have them Raise their Hands Away from their body. Apply resistance if the pt can do this.

  • Positive (inability to raise, pain or weakness) implicates the Subscapularis

Other Tests: Speed’s Test

  • Hold shoulders at 90 degrees flexion with elbow extension and supination. Apply resistance on the arm, and Palpate for the long head of the biceps tendon (lowkey next to your armpit)

  • Positive (not able to palpate) implicates the Long Head of the Bicep


Palpate: clavicle → AC joint → coracoid process → scapular spine → supraspinatus → medial border

Treatment: stick shit, wall climbs (abd, flex), doorway stretch (ext), TheraBand exercises (all), table slides

ROM/Strengthening: ext rot, int rot, abd

*****

4
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Lateral Epicondylitis (Tennis Elbow)

Tendinitis of the forearm extensor musculature, primarily affecting the Extensor Carpi Radialis Brevis tendon on the Lateral Epicondyle

Cozen’s Test:

  • Elbow is in Extension and forearm in Pronation, have the pts Wrist in Radial deviation and Extension. Place pressure with your thumb on lateral epicondyle and apply Wrist Resistance.

  • Positive (pain on lateral epicondyle) implicates lateral epicondylitis

Extra Tests:

Mills’ Lateral Elbow Tendinopathy Test

  • NOT DONE IN VIDEOS

Varus Stress Test:

  • Elbow is in extension, supinated. Apply varus force to elbow (apply force medial to lateral)

  • Positive (pain, no firm endpoint) implicates LCL damage

  • NOT DONE IN VIDEOS

Treatment: wrist flexion + extension (eccentric extension), towel twists, avoid picking things up in pronation, pain management through meds, decrease repetitive activities, modify/compensate activity

5
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Medial Epicondylitis (Golfer’s Elbow)

Damage to the common flexor tendon at the medial epicondyle of the humerus, typically involving pronator teres and Flexor Carpi Radialis

Golfer’s Elbow Test

  • NOT DONE IN VIDEOS

Valgus Stress Test

  • Elbow is in extension, supinated. Apply valgus force to elbow (apply force lateral to medial)

  • Positive (pain, no firm endpoint) implicates MCL damage

6
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Thumb CMC Arthritis

Common site of arthritis in the hand, often an overuse injury

CMC Grind Test

  • Examiner grasps the metacarpal of the patient’s thumb and provides a slight circular movement with axial pressure into the CMC joint

  • Positive (pain or crepitus) implicates CMC arthritis

Extra Tests:

Eichhoff Test

  • Pt makes a fist with their thumb tucked within the fist. Ulnarly deviate the patient’s wrist

  • Positive (pain along first dorsal compartment) implicates De Quervain’s Tenosynovitis

Seme Weinstein’s?

Treatment: avoid power pinch, palmar abduction, letter Cs

7
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De Quervain’s Tenosynovitis

Tenosynovitis of the first dorsal compartment of the thumb, involving the abductor pollicis longus and extensor pollicis breavis

Eichoff Test

  • Pt makes a fist with their thumb tucked within the fist. Ulnarly deviate the patient’s wrist

  • Positive (pain along first dorsal compartment) implicates De Quervain’s Tenosynovitis

Extra Tests:

CMC Grind Test

  • Examiner grasps the metacarpal of the patient’s thumb and provides a slight circular movement with axial pressure into the CMC joint

  • Positive (pain or crepitus) implicates CMC arthritis

Treatment: eccentric radial deviation?

8
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Carpal Tunnel Syndrome

Compression of the median nerve at the carpal tunnel of the wrist

Phalen’s Test

  • The patient pushes the dorsal surfaces of their hands together and holds for 30-60 seconds.

  • Positive (abnormal sensation) implicates carpal tunnel syndrome

9
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Varus/Lateral Instability

LCL fuck up

Varus Stress Test:

  • Elbow is in extension, supinated. Apply varus force to elbow (apply force medial to lateral)

  • Positive (pain, no firm endpoint) implicates LCL damage

  • NOT DONE IN VIDEOS

Extra Test:

Cozen’s Test:

  • Elbow is in Extension and forearm in Pronation, have the pts Wrist in Radial deviation and Extension. Place pressure with your thumb on lateral epicondyle and apply Wrist Resistance.

  • Positive (pain on lateral epicondyle) implicates lateral epicondylitis

Treatment: maintain pronation, early AROM in pronation, avoid abd and internal rot