MSK UE & Gait

ROM of Shoulder

ROM of Shoulder

• Flexion (150⁰) 

• Extension (40⁰)

• Internal rotation (70⁰)

• External rotation (80⁰) 

• ABduction (150⁰)

• ADduction (30⁰)

ROM of elbow

• Flexion (150⁰)

• Extension (0-5⁰)

• Pronation (80⁰)

• Supination (80⁰)

ROM of wrist

• Flexion (80⁰)

• Extension (70⁰)

• Radial deviation (20⁰)

• Ulnar deviation (30⁰)

ROM of fingers

• ADduction 

• ABduction 

• Thumb and small finger opposition

Bony structures and soft tissues of shoulder for palpation

• Bony structures (clavicle, scapula, humerus)

• Joints/articulation: acromioclavicular joint

• Soft tissue

  • Tendons

  • muscles

  • rotator cuff

  • bursae

Sensation testing for shoulder

supraclavicular nerve (C3-C4)

axillary nerve (C5-C6)

Scapular winging

Identify underlying neuromuscular pathology of serratus anterior 

Drop arm test

Identify rotator cuff (supraspinatus) tear

Hawkins test

Identify possible subacromial impingement syndrome

Neer test

Identify possible subacromial impingement syndrome

Yergason test

Evaluate for biceps tendonitis or SLAP tear 

Apprehension test

• Tests for Anterior Shoulder Instability 

• Testing for chronic or ongoing shoulder dislocation

Sensation testing for elbow

Sensation

• Lateral antebrachial cutaneous nerve (C5- C6) 

  • Branch of musculocutaneous nerve 

• Medial antebrachial cutaneous nerve (C8- T1) 

• Posterior antebrachial cutaneous nerve (C5- C6)

Tennis elbow test

Lateral epicondylitis

• Positive test is pain at the lateral epicondyle.

Golfer’s elbow test

medial epicondylitis

Positive test is pain at the medial epicondyle

Tinel sign: elbow

Cubital tunnel syndrome (ulnar nerve irritation) 

Positive sign is a tingling sensation in the pinky and ring finger

Sensation of wrist, hand & fingers

• C6 – test at thumb web space dorsal side of hand 

• C7 – test at long finger pad tip 

• C8 – test at little finger pad tip

Tinel sign: wrist

Carpal tunnel syndrome

• Positive sign is a tingling sensation in the distribution of the median nerve

Allen test

Done prior to arterial line/ABG (arterial blood gas) to confirm collateral circulation 

Finkelstein test

De Quervain’s Tenosynovitis 

• Maneuver designed to elicit pain from the 1st dorsal compartment

Phalen’s test

Carpal Tunnel Syndrome 

• tingling/pain in median nerve distribution

• A positive test is tingling and/or pain in the median nerve distribution

Adson test

Musculoskeletal disorder: Thoracic outlet syndrome 

Deep tendon reflexes of upper extremity

• Bicep (C5, C6)

• Brachioradialis (C5, C6)

• Triceps (C6, C7)

• Long finger flexors (C8, T1)

Carrying angle of the elbow

When arms are held out at your sides and your palms are facing forward, forearm and hands should normally point about 5 to 15 degrees away from your body

Primary extensors

Latissimus dorsi

teres major

posterior portion of the deltoid

Latissimus dorsi

Innervation: thoracodorsal nerve (C6, C7, C8)

primary extensor & aDductor

Teres major

Innervation: lower subscapular nerve (C5, C6)

Posterior portion of the deltoid

Innervation: axillary nerve (C5, C6)

Primary flexors

Anterior portion of deltoid

Coracobrachialis

Anterior portion of the deltoid

Innervation: axillary nerve (C5)

Coracobrachialis

Innervation: musculocutaneous nerve (C5, C6)

ABductors

Middle portion of the deltoid

Suprasinatus

Middle portion of the deltoid

Innervation: axillary nerve (C5, C6)

Supraspinatus

Innervation: suprascapular nerve (C5, C6)

ADductors

Pectoralis major

Latissimus dorsi

Pectoralis major

Innervation: medial and lateral anterior thoracic nerve (C5, C6, C8, T1)

Shoulder sensation testing

Supraclavicular nerve (C3-C4) and axillary nerve (C5-C6)

Elbow sensation testing

Lateral antebrachial cutaneous nerve (C5-C6)

Medial antebrachial cutaneous nerve (C8-T1)

Posterior antebrachial cutaneous nerve (C5-C6)

Biceps reflex (C5-C6)

Triceps reflex (C6-C7)

Wrist, hand, fingers sensation

Thumb web space dorsal side of hand (C6)

Long finger pad tip (C7)

Little finger pad tip (C8)

Brachioradialis reflex (C6)

Stance phase

60% of normal cycle = Foot strike, foot flat, mid-stance, toe off

Swing phase

40% of normal cycle = acceleration, mid-swing, deceleration

Gait Width and Step Length

• Observe patient’s gait width - how far apart the feet are as steps are taken  

  • Normal width is approx. 2-4 inches  

  • Wide-based waddling gaits

• Observe step length with each step  

  • Normal length is approx 15 inches

  • Short-shuffling gaits

Gait abnormalities

• abnormal posture 

• decreased or otherwise altered speed of ambulation 

• disordered balance 

• tripping, stumbling or frequent falls

Spastic hemiparesis

stiffness and weakness on one side, awkward and jerky gait

Spastic diplegia

cerebral palsy, causes muscle stiffness in both legs (hypertonia)

Steppage/ drop foot

walking with a high step, hard to lift food (looks like they’re climbing stairs), foot slaps ground with each step

Ataxia- cerebellar/ sensory

coordination issue, causes increased step width, wide base, and irregularity of steps (slower and shorter strides)

Dystonia

leg and foot points downward and inward, toe curling, involuntary muscle contractions, which causes slow movements and muscle cramps

Abductor lurch (Trendelenburg)

uneven pelvic tilt when walking, one gluteus medius muscle significantly weaker and causes whole pelvis to tilt down on opposite

Extensor lurch

uneven pelvic tilt, person appears to be leaning backwards while walking (center of gravity off), weakness on gluteus maximus, heel strikes ground on weaker side

Flat foot

Overpronation (feet rolling inward excessively), feet pointing outward, can over stain muscles involved in foot arch support

Antalgic

Caused by pain, person is trying to take the weight off the painful side, not put pressure on hurting foot/leg (ex. limp due to injury, arthritis, etc.)