PD MSK Upper Extremities Practice

Which range of motion describes the patient doing the movement with their own strength?

Active ROM

Should you assess the active or passive ROM first?

active before passive ROM

Jim, 32 year old male, comes into the office complaining of jaw pain and "clicking" sensation. He says that it's usually worse in the morning and especially after eating a meal. What do you most likely suspect?

TMJ

Jim, 32 year old male, comes into the office complaining of jaw pain and "clicking" sensation. He says that it's usually worse in the morning and especially after eating a meal. You suspect TMJ. How should you treat Jim? (3 things)

NSAIDs

Soft diet

Night guard

Which portion of the spinal column supports weight bearing?

Anterior column

Which portion of the spinal column encloses the spinal cord?

Posterior

How many lumbar vertebrae do we have normally?

5

What is the landmark that you can feel posteriorly at the base of your neck and is prominent with neck flexion?

C7/T1

What landmark is usually marked by dimples?

Posterior superior iliac spine

What spinous level is in line between the iliac crests?

L4

What is the typical curvature of the cervical spine?

Lordosis

What is the typical curvature of the sacral spine?

Kyphosis

What is the term that you can see radiographically, described as an angular deformity due to collapsed vertebrae and usually secondary to osteoporosis, TB spine (Potts) disease, and metastasis?

Gibbus

What is the most common cause of scoliosis?

idiopathic (65%)

Pam, 13 y/o/f, comes in for an annual physical. When assessing her spine, you notice than her scapula and pelvis are uneven, and when standing up straight you notice a curve in her spine. What is your most likely diagnosis?

Scoliosis

Sabrina, 25 y/o/f, comes in complaining of back pain radiating down her right leg. Upon assessment, straight leg raise is positive and ankle dorsiflexion reproduces sharp pain. What is your most likely diagnosis?

Sciatica

Sabrina, 25 y/o/f, comes in complaining of back pain radiating down her right leg. Upon assessment, straight leg raise is positive and ankle dorsiflexion reproduces sharp pain. You suspect sciatica, what is another special test you could do to assess for sciatica?

Crossed straight leg raise "cross over"

Where would you measure to you get true leg length?

ASIS to medial malleolus

The shoulder anatomy includes which 3 bones?

Humerus, clavicle, scapula

The shoulder girdle holds how many joints?

3 joints

The should girdle holds how many articulation?

1 articulation

There are 3 joints in the shoulder girdle: sternoclavicular, acromioclavicular, what's the other one?

Glenohumeral joint

What is the only 1 articulation in the shoulder girdle?

Scapulothoracic articulation

There are 3 groups of muscles attached at the shoulder, axioscapular group is one of them. What are the other two?

Axiohumeral

scapulohumeral

What are the rotator cuff muscles?

Supraspinatus

Infraspinatous

Teres minor

Subscapularis

Which group of muscles in the shoulder girdle allow the shoulder to be pulled backward?

Axioscapular group

Which group do muscles in the shoulder girdle allow adduction and internal rotation?

Axiohumeral group

What type of joint is the shoulder?

Ball and socket joint

What is the principal bursa in the shoulder, abduction of the shoulder compresses the bursa and inflammation would cause pain with rotation and abduction?

Subacromial bursa

Which tendon is the super-stabilizer of the shoulder?

Long head of the bicep

John, 26 year old male, comes in complaining of right shoulder pain with limited range of motion. Upon assessment, he has a positive drop arm test. What would you most likely suspect?

Rotator cuff tear

True or false: if a pt is having pain in the shoulder, you can rule out cardiac or abdominal causes/sources?

FALSE! Pt can have referred pain from CAD, pulmonary tumors, or GBD

Zach, 24 y/o/m, comes in complaining of left shoulder pain and loss of motion. He says the pain gets worse at night and right now he can't really move his arm. Onset 2 days ago after he was pitching baseball with his siblings. You elicit impingement by flexing his arm and elbow extended with resistance. What is your most likely diagnosis?

Impingement syndrome/Rotator cuff tendonitis

Zach, 24 y/o/m, comes in complaining of left shoulder pain and loss of motion. He says the pain gets worse at night and right now he can't really move his arm. Onset 2 days ago after he was pitching baseball with his siblings. You elicit impingement by flexing his arm and elbow extended with resistance. You suspect impingement syndrome. How should you treat Zach (3 things)?

Rest, NSAIDs, refer to PT (strengthening exercises)

(possible steroid injection)

If all measures fail in treating impingement syndrome/rotator cuff tendonitis, pt is still in pain after resting, icing, using NSAID, steroid injection, and PT- what would be your next course of treatment?

Surgery

Which motion is severely limited in a rotator cuff tear?

ABduction

In a rotator cuff tear, where would tenderness be located?

over greater tuberosity local to SITS

What is a characteristic of rotator cuff tear when examiner attempts to abduct the pt's arm?

shoulder shrug

Where would shoulder bursitis be located (2 possible answers)?

Subacromial or subdeltoid

How would you treat shoulder tendonitis?

same as rotator cuff tendonitis - rest, NSAID

What is the most common type of shoulder dislocation?

Anterior dislocation

What should you do to insure there is no nerve or blood vessel damage prior to reducing a dislocated shoulder?

Order an X-ray

Jill, 54 year old female, comes in complaining of left shoulder pain, especially with movement. Pertinent history of shoulder dislocations. No shoulder deformities present at this time b/l. While examining, you bring her arm across the chest and she yells at you to never do that again. What would you most likely suspect?

Acromioclavicular arthritis

Jill, 54 year old female, history of significant shoulder dislocations and acromioclavicular arthritis. How should you treat?

NSAIDs and PT

What are the 2 principle characteristics of Adhesive capsulitis (frozen shoulder)?

Pain and contracture

Can you use radiographic findings to diagnose adhesive capsulitis?

NO, it's a clinical diagnosis

Calcific tendonitis is usually involved with which tendon?

Supraspinatus tendon

What is a give-away (radiographic) diagnosis of calcific tendonitis?

X-ray - may show calcium deposits

True or false: symptoms of calcific tendonitis may resolve spontaneously

true

Sensation of catching with specific movements is a characteristic of which UE condition?

Labral tear

What is the hallmark of bicipital tendonitis?

reproduceable pain during resistance to forearm supination

What X-ray order would you give for pt with AC dislocation?

AP X-ray with and without weights

What is the most common type of UE fracture?

Clavicular fracture

What action do Biceps and brachioradialis do?

Flexion

What is the action of Triceps?

Extension

What is the action of pronator teres?

Pronates

What is the action of supinator?

Supinates

Which nerve runs posterior between medial epicondyle and olecranon?

Ulna

Which nerve is medial to the brachial artery?

Median nerve

Which nerve runs on lateral elbow?

Radial

What is the name of this test: Pain over lateral epicondyle region with wrist extension against resistance?

Tennis elbow test

Tennis elbow test is an assesment for what condition?

Lateral epicondylitis (Tennis elbow)

Wrist flexion against resistance causing ulnar neuropraxia would make you suspect which condition?

Medial epicondylitis (Golfer's elbow)

What are the two systemic diseases would you want to rule out when diagnosing olecronon bursitis?

RA and gout

Fat pad sign on x-ray is often associated with what kind of fracture?

Radial head fx

Injury to brachial artery causing ischemic necrosis of flexor muscles of the forearm giving a claw like deformity - what condition?

Volkmann's ischemic contracture

Pressure on what nerve can cause Cubital Tunnel syndrome?

Ulnar nerve

Paresthesia and pain in which digits is associated with Cubital tunnel syndrome?

4th and 5th

(also in elbow, forearm, and hand)

What special test/sign can you use to dx cubital tunnel syndrome (ulna nerve entrapment)?

Tinel sign

Sally, 3 year old female, comes in with forearm pain. You find radial dislocation (radius slipped under annular ligament). What's your most likely dx?

Nursemaid's elbow

Which fracture is a a fx of radius with dislocation distal radioulnar joint?

Galezzi fx

Whats the name of the fracture of the proximal third of the ulna with dislocation of the head of the radius?

Monteggia fx

A salter-Harris fracture is a fracture that involves the epiphyseal plate: which type is the most common type and is through growth plate and metaphysis?

Type 2

A salter-Harris fracture is a fracture that involves the epiphyseal plate: which type is through growth plate and epiphysis?

Type 3

Just kind of know what it's associated with- Volar (flexion) =

Smith's fx

Also just know this one - Dorsal (extension)=

Colle's fx

Which fracture is often a mechanism of falling on extended hand and would have a dinner fork deformity?

Colle's

What is the most common metacarpal bone (5th) fracture often caused by "missed punch"?

Boxer's fracture

What nodes are often seen in osteoarthritis?

Heberden's

What kind of arthritis is characterized by ulnar deviation of metacarophalangeal joints and swan neck deformity of fingers?

Rheumatoid