Handbook Of Omt Review Chapter 6

Front 1

Rotator cuff muscles and actions

Back 1

supraspinatous - abducts the arm
infraspinatous - externally rotate
teres minor - externally rotate
subscapularis - internally rotate
Up, Out, In

Front 2

Brachial plexus bascis

Back 2

Comrpised of C5-T1 nerve roots. Responsible for innervation of the upper extremity. Nerve roots C5 and C6 join to form the upper runk. C8 and T1 join to form the lower trunk. C7 remains independent, forming the middle trunk itself. Eventually the upper trunk and lower trunk divide and contribute to the middle trunk to form the posterior cord. The terms medial, later, and posterior, are used to denote the cord's location in relation to the axillary artery.

Front 3

Lymphatics

Back 3

The right upper extremity lymphatics drain into the right lymphatic duct. The left upper extremity lymphatics drain into the thoracic duct.

Front 4

Biceps reflex tests

Back 4

C5

Front 5

Brachioradialis reflex tests

Back 5

C6

Front 6

Triceps reflex tests

Back 6

C7

Front 7

Testing DTR

Back 7

4/4 Brisk response with maintained clonus
3/4 Brisk response
2/4 normal
1/4 decreased but present response
0/4 no response

Front 8

Muscle strength

Back 8

5 normal
4 movement against gravity with some resistance
3 movement against gravity but not against resistance
2 movement without gravity
1 some evidence of a contraction but no movement
0 no evidence of any contraction

Front 9

Apley's Scratch Test

Back 9

Tests ROM

Front 10

Adson's test

Back 10

Evaluates thoracic outlet syndrome. Patient extends elbow and arm, and slightly abducts arm, with a deep inhalation, turns head in ipsilateral direction. A + test is very decreased or absent radial pulse.

Front 11

Roos Test

Back 11

Evaulates thoracic outlet syndrome. Patient abducts both arms to 90 degree, externally rotates the arms, then flexes the elbows to 90 degrees. The patient repetitively forms a first and releases it while maintaining the entire arm/foremarm position for 3 minutes. A + test would be much sensation of heaviness or weakness in an arm, or paresthsias of the hand.

Front 12

Drop Arm test

Back 12

Evaluates rotator cuff tears. patient abducts their arm to 90 degrees, then slowly and steadily lowers the arm to his/her side. A + test is the inability to smoothly lower arm.

Front 13

Speed's test

Back 13

Evaluates the biceps tendon. Patient extends their elbow and supinates forearm. Clinician resists them trying to flex the arm at the shoulder. A + test is tenderness in the biceipital groove.

Front 14

Yergason's Test

Back 14

Evaluates the stability of biceps tendon in bicipital groove. Patient flexes elbow to 90 degrees. The clinician holds the patients wrist with one hand and the patient's elbow with their other hand. The clinican resists the patient's flexive forces and resists patient trying to supinate.

Front 15

Brachial plexus injury

Back 15

Injury to the brachail plexus, could be due to trauma. Erb-Duchenne is due to injury to C5-6 nerve roots, resulting in upper arm paralysis. Klumpke's palsy is injury to C8-T1 nerve roots, resulting in paralysis of intrinsic muscles of the hand.

Front 16

Winging of the scapula

Back 16

While patient pushes anteriorly, the scapula protrudes posteriorly. Due to the long thoracic nerve injury. Results in weakness or paralysis of the serratus anterior muscle.

Front 17

Thoracic outlet syndrome

Back 17

An ache and/or paresthesias of the neck and/or arm secondary to the compression of the neurovascular bundle of the shoulder. Could be due to cervical rib, spasm or hypertonicity of the anterior or middle scalenes; anomaly in pectoralis minor insertion; or, somatic dysfunction of clavicles or upper ribs. Risk factors include poor posture and large, heavy breasts. Compression of the neurovascular bundle may occur between the anterior and middle scalenes, and/or the clavicle and 1st rib, and/or the pectoralis minor and the upper ribs. +Adon's, Roos, and usually Apley's scratch.

Front 18

Supraspinatous tendonitis

Back 18

When the arm is flexed and internally rotated there is impingement between the acromion and greater tuberosity. Superior acromion is tender. Pain is exacerbated by abduction of the arm beyond 60 degrees, with relief increasing as the arm reachers 180 degrees. This is known as painful arc syndrome. + drop arm test.

Front 19

Rotator cuff tear

Back 19

A tear in one of the tendons of the rotator cuff, usually the supraspinatous. Tenderness just inferior to the tip of the acromion. +weakness in abduction and + drop arm test. Complete avulsions result in muscle retraction and must be reated surgically.

Front 20

Adhesive capsulitis (frozen shoulder)

Back 20

Restricted ROM of shoulder with pain, all worsening gradually over time. Prolonged immobility or guarding of the shoulde,r usually secondayr to trauma, thoracic outlet, etc. Tenderness just anterior to the shoulder; more commin in patients older than 40. TX is prevention.

Front 21

Shoulder dislocation (subluxation)

Back 21

Humeral dislocated inferioanteriorly from glenoi. May result in axillary nerve damage, resulting in deltoid muscle paralysis.

Front 22

Bicipital tenosynovitis

Back 22

Inflammation of the tendon of the long head of the biceps, along with its sheath. Inflammation leads to development of adhesions that bind the tendon to its sheath. Pain at anterior shoulder. May get radiation down arm.

Front 23

Lateral epicondyle

Back 23

extensors of wrist and hand, all innervated by the radial nerve.

Front 24

Medial epicondyle

Back 24

flexors of wrist and hand - all innervated by the median nerve.

Front 25

Primary extensor of the forearm

Back 25

triceps

Front 26

primary flexor of the forearm

Back 26

brachialis

Front 27

Supinators of the forearm

Back 27

Biceps (musculocutaneous nerve) and supinator (innervated by radial nerve)

Front 28

Pronators of the forearm

Back 28

pronator teres and pronator quadratus, both are innervated by the median nerve.

Front 29

Carrying angle

Back 29

Determined by the degree of abduction of the forearm with respect to the arm, specifically the degree of abduction of the ulna with respect to the humerus. Female carrying angle: 10-12 degrees, men 5 degrees. Anything greater is termed cubitus valgus. If less, cubitus varus. The carrying angle has the opposite effect on the wrist.

Front 30

Radial head movement

Back 30

When the frearm is pronated, the radial head glides posteriorly. When supinated, the radial head glides anteriorly.

Front 31

Anterior radial head

Back 31

Radial head is stuck anteriorly and easily supinates but is restricted in pronation.

Front 32

Adduction of the ulna

Back 32

The ulna is easily adducted, with restriction in abduction. Since the ulna is adduction, the wrist is abducted.

Front 33

Lateral epicondylitis

Back 33

The extensor muscles are strained at their attachment to the lateral epicondyle. This often results form repeitive strain injury, often involving frequent supination or forceful extension of the wrist with pronation. The patient usually has tenderness over just distal to the lateral epicondyle that tends to worsen with resisted supination, the pain may also radiate along the lateral aspect of the upper extremity.

Front 34

Medial epicondylitis

Back 34

results from strain of the flexors as they attach to the medial epicondyle, resulting in tenderness of the medial epicondyle +/- radiaitng pain over the medial upper extremity. Again, this is usually a result of repeitive strain, especially with strenuous pronation or very forceful flexion of the wrist in combination with supination.

Front 35

Tinel's

Back 35

Carpal tunnel syndrome. Clinician taps over the volar aspect of a patient's transver carpal ligmanet. + test is paresthesias of thumb and first 2 and 1/2 fingers.

Front 36

Phalen's

Back 36

Carpal tunnle syndrome: patient's wrist is passively but maximally flexed by clinician, and is held in this position for one minute. + test = paresthesias of the thumb and first 2.5 digits.

Front 37

Prayer (reverse phalen's)

Back 37

Carpal tunnel syndrome. Patient grasps clinicans hand, pal to pal, and patient's hand is passively moved into full extension while the clinician places direct pressure onto the carpal tunnel for one minute.

Front 38

Allen's test

Back 38

Radial artery and ulner artery patency/blood flow. Clincian occludes the ulnar and radial arteries and patient opens and closes hands several times. The clinician releases one of the arteries and watches for flushing. The test is failed if the hand does not flush or flushes slowly.

Front 39

Finkelstein

Back 39

Tenosynovitis of the abductor pollicis longus and extensor pollicis brevis. Patient makes a tight fist with thumb tucked into first. The clincian induces adduction of the wrist. + test = pain over the tendons at the wrist.

Front 40

Carpal tunnel syndrome

Back 40

Median nerve entrapment between the longitudinal tendons of the hand and the flexor retinaculum. Patients have paresthesias of the palmar surface of the thumb and first 2.5 digits. + tests = phalens, prayer, and tinels.

Front 41

Drop Wrist deformity

Back 41

Paralysis of extensor muscles. Patient is unable to extend the wrist, and so wrist tends to 'drop' into flexion.

Front 42

Interossei and lumbricals

Back 42

The interossei and lumbricals of the hand are supplied by C8 and T1 nerve roots. There are seven interossei; three palmar and four dorsal. The dorsal interossei abduct the fingers (DAB) and the palmar interossei adduct the fingers (PAD)

Front 43

Lumbricals

Back 43

There are four lumbricals, one for each finger except the thumb. They flex the digits at the metacarpal-phalangeal joints and extend the proximal and distal interphalangeal joints.

Front 44

Intrinsic muscles of the hand

Back 44

Thenar muscles, hypothenar muscles, interossei, and lumbricals

Front 45

Thenar muscles

Back 45

Thenar = Thumb, include the abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis.

Front 46

Nerve supply to hands: Radial nerve

Back 46

Cutaneous sensory innervation, supplies NO intrinsic hand muscles

Front 47

Nerve supply to hands: median nerve

Back 47

innervates lumbricals 1 and 2, provides cutaneous sensory innervation to a portion of the hand. The recurrent branch innervates the abductor pollicis brevis, the flexor pollicis brevis, and opponens pollicis.

Front 48

Nerve supply to hands: Ulnar nerve

Back 48

Provides cutaneous snesory innervation to a portion of the hand and innervates all muscles of the hand except those innervated by the median nerve.

Front 49

Swan neck deformity

Back 49

Flexion contracture of the MCP and DIP with extension contracture of PIP. Often associated with rheumatoid arthritis.

Front 50

Boutonniere deformity

Back 50

Extension contracture of the MCP and DIP with flexion contracture of the PIP. Associated with rheumatoid arthritis. Due to hood rupture.

Front 51

Claw Hand

Back 51

Flexion of PIPS and DIPS with extension of the MCPs due to intrinsic muscle activity loss. Due to ulnar nerve damage.

Front 52

Ape Hand

Back 52

Thenar atrophy with unopposable thumb. Median nerve damage.

Front 53

Dupuytren's contracture

Back 53

Flexion contracture of the MCP and PIP with often contracture of the last two fingers. Palmar fascia contracture.

Front 54

Bishop's deformity (Hand of Benediction)

Back 54

Paralysis of lumbricals 1 and 2 due to median nerve damage.