Omm Upper Extremity

Front 1

only bone connecting upper extremity and axial spine

Back 1

clavicle

Front 2

four joints of the shoulder

Back 2

scapulothoracic
acromioclavicular
sternoclavicular
glenohumeral

Front 3

muscles of the rotator cuff

Back 3

SITS:
supraspinatus- abduction of the arm
infraspinatus- external rotation of arm
teres minor- external rotation of arm
subscapularis- internal rotation of the arm

Front 4

primary flexor

Back 4

deltoid (anterior)

Front 5

primary abductor

Back 5

deltoid (middle)

Front 6

primary extensors

Back 6

latissimus dorsi, teres major, deltoid (posterior)

Front 7

primary adductors

Back 7

pectoralis major, latissimus dorsi

Front 8

primary external rotators

Back 8

infraspinatus, teres minor

Front 9

primary internal rotator

Back 9

subscapularis

Front 10

subclavian artery passes between which two muscles

Back 10

anterior and middle scalenes

Front 11

subclavian vein passes where with respect to scalenes

Back 11

anterior to the anterior scalene

Front 12

where does subclavian artery become axillary artery

Back 12

lateral border of the first rib

Front 13

where does axillary artery become brachial artery

Back 13

inferior border of teres minor

Front 14

first major branch of the brachial artery and what does it accompany and where

Back 14

profunda brachial artery; radial nerve; posterior course of radial groove

Front 15

where does brachial artery bifurcate into ulnar and radial arteries

Back 15

bicipital aponeurosis

Front 16

radial artery travels where and supplies what

Back 16

courses lateral aspect of forearm; supplies elbow, wrist, dorsal aspect of hand, forms most of the deep palmar arterial arch

Front 17

ulnar artery course and supplies what

Back 17

courses medial aspect of forearm; supplies elbow, wrist, dorsal aspect of hand and forming superficial palmar arterial arch

Front 18

Lymphatic drainage of RUE

Back 18

right (minor) duct

Front 19

Lymphatic drainage of LUE

Back 19

left (main) duct

Front 20

three treatments to relieve lymph congestion in UE

Back 20

1.) open thoracic outlet
2.) redome diaphragm
3.) posterior axillary fold technique

Front 21

describe motion at shoulder joint

Back 21

180 degrees with active motion; 120 due to glenohumeral motion and 60 degrees due to scapulothroacic motion
- for ever 3 degrees of abduction, 2 degrees are from GH joint, 1 degree is from ST joint

Front 22

most common somatic dysfunction of the shoulder

Back 22

restriction in internal and external rotation

Front 23

second most common and then lead most common somatic dysfunction of shoulder

Back 23

restriction in abduction

restriction in extension

Front 24

most common SD found at sternovlavicular joint

Back 24

clavicle, anterior and superior on sternum

Front 25

findings of a clavicle anterior and superior on sternum

Back 25

resists posterior glide at sternum
superior glive present with shoulder depression
interior glide restricted with shoulder elevation
anterior glibe present with shoulder reetraction
posterior glide restricted with shoulder protraction
decreased motion of clavicle around transverse axis

Front 26

most common SD found at AC joint

Back 26

clavicle, superior and lateral on acromion

Front 27

AC joint stabilized by

Back 27

acromioclavicular ligament, coracoacromial ligament, coracoclavicular ligament

Front 28

findings of AC joint SD

Back 28

"step-off" seen at AC joint, clavicle will resist inferior glide at AC joint, tenderness at this joint

Front 29

3 spots of compression of neurovascular bundle (subclavian artery and vein; brachial plexus) in TOS

Back 29

1.) b/w anterior and middle scalenes
2.) b/w clavicle and third rib
3.) b/w pectoralis minor and upper ribs

Front 30

Four reasons that TOS might occur

Back 30

1.) cervical rib
2.) excessive tension of the anterior and middle scalenes
3.) somatic dysfunction of clavicle or upper ribs
4.) abnormal insertion of pec minor

Front 31

Location and quality of TOS pain

Back 31

- neck pain or radiating to arm
- ache or paresthesias

Front 32

Treatment of TOS

Back 32

OMT directed at C2-C7, T1, rib 1, thoracic inlet, clavicle, and scalenes
-exercises to strengthen trapezius and levator scapula

Front 33

Pathogenesis of supraspinatus tendinitis

Back 33

continuous impingement of greater tuberosity against the acromion as arm is flexed and internally rotated

Front 34

location of pain in supraspinatus tendinitis

Back 34

tenderness at tip of acromion

Front 35

signs and symptoms of supraspinatus tendinitis

Back 35

gradual onset; exacerbated by abduction, especially from 60-120; "painful arc"

Front 36

clinical manifestation of supraspinatus tendinitis

Back 36

may lead to calcification

Front 37

treatment of supraspinatus tendinitis

Back 37

Rest, ice, NSAIDS (acute)
sling/injection of lidocaine or steroids
OMT: directed at the shoulder complex, upper thoracic and ribs to free up motion and loosen fascia of the shoulder girdle to expedite the healing process

Front 38

Pathogenesis of bicipital tenosynovitis

Back 38

inflammation of tendon and sheath of long head of biceps due to overuse
-adhesions bind the tendon to the bicipital groove
-may be from subluxation of bicipital tendon out of the bicipital groove

Front 39

Location of pain in bicipital tenosynovitis

Back 39

anterior portion of the shoulder which radiates to the biceps

Front 40

signs and symptoms of bicipital tenosynovitis

Back 40

tenderness over bicipital groove; pain aggravated by resisted flexion or supination of the forearm

Front 41

treatment of bicipital tendosynovitis

Back 41

rest and ice; severe: injection of lidocaine or steroids
OMT- freeing up any restrictions in glenohumeral area and myofascial release

Front 42

Rotator cuff tear definition

Back 42

-tear at the insertion of one of the rotator cuff tendons; usually supraspinatus
- minor teras are common
- complete tear can occur resulting in retraction of affected muscle with sharp shoulder pain

Front 43

location and quality of pain with rotator cuff tear

Back 43

tenderness just below tip of acromion; transient sharp pain in the shoulder followed by a steady ache

Front 44

signs and symptoms of rotator cuff tear

Back 44

supraspinatus tears: weakness in active abduction with positive drop arm test
- atrophy is common
- pain is common for months esp at night

Front 45

treatment of rotator cuff tears

Back 45

rest, ice, NSAIDS
OMT: freeing up restrictions in glenohumeral area and treating clavicle, upper thoracic, and ribs for somatic dysfunction
*surgery for complete avulsion*

Front 46

Adhesive capsulitis definition

Back 46

common- pain and restriction of shoulder motion that increasingly gets worse over the course of one yar

Front 47

signs and symptoms of adhesive capsulitis

Back 47

decreased ROM, active and passive movements
-abduction, internal and external range of motion most often effected
-extension preserved
-pain present at the end of the range of motion

Front 48

epidemiology, etiology, and location of pain in adhesive capsulitis

Back 48

pts over 40, caused by prolonged immobility of shoulder, tenderness at anterior portion of shoulder

Front 49

treatment of adhesive capsulitis

Back 49

*prevention*
- early mobilization following shoulder injury
- injection of NSAIDS or corticosteroids
-OMT: Spencer techniques- improving motion and lysing adhesions

Front 50

Shoulder dislocation

Back 50

common in athletes- trauma
-humeral dislocation occurs anteriorly and inferiorly
-recurrence common
- injury to axillary nerve can occur

Front 51

winging of the scapula

Back 51

weakness of anterior serratus muscle due to long thoracic nerve injury

Front 52

most common type of brachial plexus injury

Back 52

Erb-Duchenne's palsy

Front 53

Erb's palsy

Back 53

upper arm paralysis caused by injury to C5/C6 usually during childbirth

Front 54

result of Erb's palsy

Back 54

paralysis of deltoid, external rotators, biceps, brachioradialis, supinator muscles

Front 55

Klumpke's palsy

Back 55

injury to C8 and T1
-paralysis of intrinsic muscles of the hand

Front 56

Radial nerve injury

Back 56

**most common nerve injured in the UE due to direct trauam
- crutch palsy: direct pressure in axilla
- humeral fractures: injured while traveling through spinal groove
- saturday night palsy: compression against the humerus
*result in wrist drop

Front 57

primary flexors of the wrist and hand original where and are innervated by what

Back 57

originate on or near the medial epicondyle; most innervated by the median nerve
**(exception: flexor carpi ulnaris-ulnar nerve)

Front 58

primary extensors of the wrist and hand

Back 58

originate at lateral epicondyle of humerus; all innervated by radial nerve

Front 59

primary supinators of the forearm

Back 59

biceps- musculocutaneous nerve
supinator- radial nerve

Front 60

primary pronators of forearm

Back 60

pronator teres and pronator quadratus- median nerve

Front 61

Muscles in thenar eminence innervation

Back 61

median (except for adductor pollicis brevis-ulnar)

Front 62

muscles in hypothenar eminence and interossi innervation

Back 62

ulnar nerve

Front 63

lumbrical innervation

Back 63

first and second- median
third and fourth-ulnar

Front 64

flexor digitorum profundus attaches to what joint

Back 64

DIPs (deep flexor)

Front 65

normal carrying angle in men/women

Back 65

5 degrees-male
10-12 degrees-female

Front 66

carrying angle of greater than 15 degrees

Back 66

cubitus valgus
-abduction of the ulna if somatic dysfunction is present

Front 67

carrying angle of less than 3 degrees

Back 67

cubitis varus
-adduction of the ulna if SD present

Front 68

parallelogram effect

Back 68

increase in carrying angle will cause an adduction of the wrist
- decrease in carrying angle will cause abduction of wrist

Front 69

motions that will cause radius to be fulled proximally and therefore abduct the wrist

Back 69

adduction of ulna, lateral glide of the olecranon (proximal ulna)

Front 70

radial head motion

Back 70

anteriorly with supination

posteriorly with pronation

Front 71

findings in an abducted ulna

Back 71

-increased carrying angle
- olecranon process restricted in lateral glide
- radial head compressed against lateral humeral condyle
- wrist/hand adducted

Front 72

findings in adducted ulna

Back 72

-decreased carrying angle
-olecranon restricted in medial glide
-radial head distracted from materal condyle
-distal ulna restricted in lateral glide
-wrist/hand abducted

Front 73

posterior radial head etiology

Back 73

falling forward on a pronated forearm

Front 74

posterior radial head effect

Back 74

restricted supination of forearm; restricted anterior glide of radial head

Front 75

anterior radial head etiology

Back 75

falling backward on a supinated forearm

Front 76

anterior radial head effect

Back 76

restricted pronation of forearm
restricted posterior glide of radial head

Front 77

Carpal Tunnel Syndrome and quality of pain

Back 77

entrapment of median nerve at wrist
- paresthesias on thumb and first 2.5 digits

Front 78

signs and symptoms of CTS

Back 78

weakness and atrophy appear late
- symptoms reproduced with Tinel's Phalen, and prayer tests
-Nerve conduction= gold standard

Front 79

treatment of CTS

Back 79

splints, NSAIDs, steroid injections

Front 80

OMM for CTS

Back 80

-treat rib and upper thoracic SDs to decrease sympathetic tone in UE
- treat cervical SD and myofascial restrictions to enhance brachial plexus function and remove sites of added compression
- treat with direct release techniques to increase space

Front 81

Lateral epicondylitis

Back 81

strain of extensor muscles of forearm near lateral epicondyle

Front 82

pathogenesis of tennis elbow

Back 82

overuse of forearm extensors and supinators; aggravating activities: hitting a ball in racquet sports with improper techniques and turning a screwdriver

Front 83

treatment of tennis elbow

Back 83

NSAIDs, rest, ice
OMM: directed toward correcting cervical or upper thoracic dysfunctions
- counterstrain to affected muscles (extensors) and myofascial release to decrease fascial restrictions

Front 84

Medial epicondylitis

Back 84

strain of flexor muscles of the forearm near the medial epicondyle; from overuse of forearm flexors or pronators

Front 85

Swan-neck deformity

Back 85

-flexion contracture at MCP and DIP
-extension contracture of PIP
-results from contracture of intrinsic muscle of hand (assd with RA)

Front 86

Boutonniere deformity

Back 86

-extension contracture at MCP and DIP
-flexion contracture at PIP
-results from rupture of the hood of the extensor tendon at PIP (assd w RA)

Front 87

claw hand

Back 87

-extension of MCP
- flexion of PIP and DIP
-from median and ulnar injury

Front 88

ape hand

Back 88

-similar to claw but also has wasting of thenar eminence; thumb adducted

Front 89

bishops deformity

Back 89

contracture of last two digits with atrophy of hypothenar eminence due to ulnar nerve damage

Front 90

Dupuytren's contracture

Back 90

flexion contracture of MCP and PIP seen with contracture of the last two digits
- contracture of the palmar fascia