Upper Extremity Abnormalities

Front 1

When inspecting always compare....

Back 1

bilaterally

Front 2

When examining nodules, what are the two parameters?
Tender, non-tender, enlarged

Back 2

Tender or nontender,
Tender, Non-tender, enlarged.

Front 3

What provides the diagnosis "usually"

Back 3

anatomical location will tell you if it involves bone, muscle, bursa, tendon, or ligament.

Front 4

What can cause a loss of contour of a normally rounded shoulder?

Back 4

Dislocation

Front 5

Atrophy of the shoulder can be a result of

Back 5

Chronic dislocations
rotator cuff tear (supra/infraspinatus)

Front 6

What is a "proximal humerus deformity with lots of soft tissue swelling consistent with a fracture of the humerus?"

Back 6

Biceps rupture

Front 7

Winged scapula

Back 7

paralysis of the Serratus anterior from the injury to the LOng thoracic nerve

Front 8

What is the most common cause of shoulder pain in soft tissue?

Back 8

Tendonitis/bursitis at the insertion of the supraspinatus tendon.

Front 9

What are the muscles of the rotator cuff?

Back 9

SITS
supraspinatus is the most important it pulls in and abducts

Front 10

Where is the supraspinatus mm?

Back 10

above the spine of the scapula

Front 11

Tell me about the infraspinatus

Back 11

a rotator cuff muscle
inferior to teres, inserts on greater tubercle for external rotation

Front 12

tell me about subscapularis

Back 12

inserts on lessertubercle for internal rotation

Front 13

What causes pain when arms are elevated overhead?

Back 13

Impingement sysndrome (rotator cuff tendonitis)
pain when arms are elevated
overhead, localized tenderness

Front 14

abduction severely impaired

Back 14

Rotator cuff tear: abduction severely impaired
 efforts to abduct produces shoulder shrugging

Front 15

Guarding of extremity

Back 15

arm held close to body to prevent movement
not 14
 specific; seen with different pathologies

Front 16

Describe impingement syndrome

Back 16

Shoulder pain
caused by
impingement of the
acromion, coracoacromial
ligament,
AC joint, and
coracoid process
on the underlying
bursa, biceps
tendon, and rotator
15
,
cuff.

Front 17

Pt. unable to fully
abduct the arm

Back 17

Supraspinatus
tendon rupture

Front 18

The “Drop Arm” sign

Back 18

Test for rotator cuff tear.
Ask patient to hold arm out to side at 90º
of abduction.
Then have pt slowly lower arm to side.
Drop test is positive if patient is unable to
hold arm out to side or if it drops suddenly.
Be aware that the deltoid muscle controls
90-120 º abduction
18
movement between 90 abduction.

Front 19

Shoulder Tenderness

Back 19

Unilateral or bilateral
Worse with ROM?
 Reduced ROM with “frozen shoulder”
Associated findings - erythema, warmth
 Bursitis
 Clavicle or humerus fracture
 Dislocation, acute or chronic

Front 20

Frozen Shoulder

Back 20

Adhesive capsulitis”
Diffuse, dull, aching pain
Progressive restriction of
ROM
Usually no localized
tenderness
Usually unilateral
Patients age 50 - 70
21
Course is chronic

Front 21

Subacromial Bursitis

Back 21

Inflammation of
the subacromial
bursa, with pain
on abduction.
Subacromial
tenderness
present. Pain
may radiate to
the 22
forearm and
hand.

Front 22

Bicipital Tenosynovitis
(Tendonitis)

Back 22

Occurs after excessive use of the biceps.
Pain at bicipital groove in proximal
humerus.
Shoulder motion may be limited.
Yergason’s sign: flex elbow to 90º,
pronate forearm, grasp pt’s hand and ask
him to supinate against your resistance.
Pain at anteromedial shoulder is positive
sign.

Front 23

Yergason’s sign:

Back 23

Yergason’s sign: flex elbow to 90º,
pronate forearm, grasp pt’s hand and ask
him to supinate against your resistance.
Pain at anteromedial shoulder is positive
sign.

Front 24

Biceps Rupture

Back 24

Biceps tendon may
rupture from its
origin or insertion.
 Origin more common
Biceps muscle then
shortens and
becomes spherical.

Front 25

Elbow limitations indicative of

Back 25

Limitations may be indicative of an acute
process, such as a radial head fracture
May be chronic from previous fracture
26
that did not heal properly

Front 26

Elbow Swelling or pain

Back 26

Swelling or Pain
 Epicondylitis
 Olecranon bursitis
 Arthritis
 Acute trauma (Nursemaid’s elbow)

Front 27

Nodules

Back 27

Subcutaneous nodules along extensor surface of
ulna, usually firm and non-tender
Usually due to rheumatoid arthritis; occasionally gout.
 Usually distal to olecranon bursa

Front 28

elbow tenderness worsens with extension of wrist against resistance

Back 28

Tenderness
 Lateral epicondyle (tennis elbow)
Pain worsens with extension of wrist
against resistance

Front 29

elbow tenderness worsens with flexion of wrist against resistance

Back 29

Medial epicondyle (pitcher’s or golfer’s
elbow)
Pain worsens with flexion of wrist against
resistance

Front 30

Olecranon bursitis

Back 30

Inflammation of the
bursa with fluid
accumulation.
May be due to local
irritation, trauma, or
infection.
Pain suggests
trauma or infection

Front 31

Nursemaid's elbow

Back 31

Pediatric problem, most common in 2-6
year range
Due to subluxation (partial dislocation) of
radial head
History of pulling arm or falling on arm
Child guards extremity and limits ROM
 holds elbow slightly flexed, forearm pronated
May complain of wrist or forearm pain

Front 32

two types of subcutaneous nodules

Back 32

Gouty tophi
RA nodules (soft)

Front 33

Wrist abnormality pearl:

Back 33

Pearl: always assess distal circulation

Front 34

Colles’ Fracture (distal radius & ulna)

Back 34

Dinner fork deformity

Front 35

Allen Test for Arterial Patency

Back 35

To assure patency of
ulnar artery before
doing radial artery
puncture.
Make fist.
Occlude radial and
ulnar arteries.
Release pressure
over ulnar artery.
Palm should flush
within 3-5 seconds.

Front 36

Carpal Tunnel Syndrome

Back 36

Caused by compression (entrapment) of the
median nerve in the wrist.
Results in compression neuropathy with pain
and paresthesias of fingers; thenar atrophy.

Front 37

Tinel’s Sign

Back 37

Percuss over the
median nerve to test
Tinel’s sign.
Tingling sensation in
the distribution of the
median nerve is a
positive sign
 Suggestive of carpal
tunnel syndrome

Front 38

Phalen’s Test

Back 38

Phalen’s test hold in
flexed position for 30-
60 seconds.
Positive test results in
paresthesias in the
distribution of the
median nerve.
 Consistent with carpal
tunnel syndrome

Front 39

Thenar Atrophy

Back 39

seen in CTS

Front 40

Tenosynovitis of the Wrist

Back 40

Tenosynovitis of the Wrist
(deQuervain’s Tenosynovitis)
Irritation or swelling of the
extensor tendons of the
thumb.
Sx’s: pain over the radial
styloid, worsened by
attempts to move the
thumb or make a fist.

Front 41

Finkelstiens

Back 41

Reverse hitchiker masturbation (according to John Shih)

Front 42

SScaphoid (Navicular) Fracture

Back 42

Tenderness of anatomical “snuff box”

Front 43

Radial deviation

Back 43

Radial deviation - most common at wrist and
DIP joints; associated with OA

Front 44

Ulnar deviation

Back 44

most common at wrist, MCP
and PIP joints; associated with RA

Front 45

Swan neck

Back 45

hyperextension of PIP joints
with fixed flexion of DIP; RA

Front 46

Boutonnière

Back 46

persistent flexion of PIP joint
with hyperextension of DIP joint

Front 47

Heberden’s nodes

Back 47

Heberden’s nodes - osteoarthritis (OA)
 NOT characteristic of rheumatoid arthritis
 dorsolateral aspects of DIP joints
 usually hard and painless
 usually associated with other arthritic changes

Front 48

Bouchard’s nodes –

Back 48

Bouchard’s nodes – RA and/or OA
 similar nodes at PIP joints, less common in OA

Front 49

Rheumatoid nodules

Back 49

common on dorsum of hand

Front 50

RA findings

Back 50

MCP and PIP Swelling is typical
 Ulnar deviation of MCP is common

Front 51

OA findings

Back 51

OA
 DIP swelling/nodules (Heberden’s nodes)
 May also have PIP swelling (Bouchard’s)

Front 52

Ganglion Cysts

Back 52

Round, nontender
swellings
located along
tendon sheaths
or joint capsules
 Flexion of wrist
tends to make
more prominent

Front 53

Trigger Finger

Back 53

Nodule develops in
flexor tendon,
which results in a
jerky, “triggering”
effect with
extension.

Front 54

Dupuytren’s Contracture

Back 54

Scar tissue
developing in the
flexor tendons of
the hand, esp. the
4th and 5th fingers.
Results in a
thickened fibrotic
cord with flexion
contracture of
fingers. Etiology

Front 55

Septic Tenosynovitis

Back 55

Infection in the space
between the two layers of
synovium which cover
the flexor tendons of the
fingers and thumb.
Usually occurs after a
puncture wound.
Swelling, tenderness and
reduced ROM.

Front 56

Causes of metacarpat tenderness

Back 56

Dislocation
Classic fractures
 Boxer’s - 5th metacarpal
 Bennett’s - base of first metacarpal
Hyperextension injuries

Front 57

Innervation of the hand

Back 57