Upper Extremity Somatic Dysfunction

Front 1

Describe motion of scapula

Back 1

** there is a 2:1 ratio of motion during abduction of the arm between the glenohumeral joint and the scapulothoracic joint

- For every three degrees of abuduction

--> 2 degrees happen in glenohumeral joint

--> 1 degree happens at scapulothoracic articulation

Protraction/abduction

retraction/ adduction

elevation

depression

downward rotation/upward rotation

motion combinations

Front 2

Describe motion of clavicle in sternoclavicular joint

Back 2

-Flexion/extension horizontal plane

-abduction/adduction frontal plane

-rotation around longitudinal axis

-true synovial joint with meniscus

Front 3

Describe motion of glenohumeral joint

Back 3

-abduction/adduction in frontal plane

-forward flexion/extension in horizontal plane

-internal/ external rotation in plane of scapula

Front 4

Describe motion of ulnohumeral joint

Back 4

- carrrying angle 5-15 degrees,normal angulation, exceeding 15 degree called cubital valgus- excess of abduction in joint glide

- normal joint glide allows for abduction and adduction at elbow

-Flexion-150-160

Extension 0

10 degrees of hyperextension may be normal in some individuals

Front 5

Describe motion of radioulnar joint

Back 5

--interosseous membrane-usually retains strain pattern long after a fracture or dislocation is healed

-- allows freedom of rotational motion between radius and ulna

-distal radioulnar joint- alows lateral/medial gliding motion at wrist at ulnar knotch

-Paralellogram mechanics- when elbow moves into abduction, the wrist compensates by moving iinto opposite direction (ulnar deviation) and vice versa

Front 6

Describe motion of radiocarpal joint

Back 6

-radius is primarily a wrist bone

-composed of radius , three carpal bones and attached cartilage

2 major axis of rotation-

Transverse- flexion and extension

Anteroposterior axis-

allows abduction and addcution

Front 7

Describe motion of intercarpal joints

Back 7

- concave and saddle shaped joints that allow circumduction

Front 8

Restriction in scapular rotation

Back 8

shoulder girdle problem

Front 9

Restriction in humeral abduction

Back 9

glenohumeral problem

Front 10

Scapular rotation defined by motion of

Back 10

acromion process

Front 11

Describe the motion of the clavicle in the acromioclavicular joint

Back 11

-elevation with shoulder abduction

-depression with shoulder adduction

-posterior glide with shoulder flexion

-anterior glide with shoulder extension

-rotation around longitudinal axis

-true synovial joint

Front 12

Radiohumeral joint

Back 12

-radius glides anterior with elbow flexion and posterior with elbow extension

-proximal radius glides anterior, externally rotates during supination and glides posteriorly, internally rotates during pronation.

-Radial head in anchored by annular ligament that allows rotation

Front 13

Extreme elbow entension induces

Back 13

anterior radial head somatic dysfunction

Front 14

Extreme elbow flexion induces

Back 14

posterior radial head somatic dysfunction

Front 15

Elbow abduction and adduction are ______ motions

Back 15

gliding

Front 16

The carrying angle of the elbow is

Back 16

5-15 degrees and usually does not change during flexion and extension

Front 17

Ulnohumeral Abduction:

Back 17

increases carrying angle

Front 18

Ulnohumeral adduction:

Back 18

decreases carrying angle

Front 19

What type of dysfunction is often caused by fall onto an outstretched hand

Back 19

posterior radial head somatic dysfunction

- restricts supination

-radial head does not generally glide anteriorly

- present with wrist pain or elbow pain especially with supination

Front 20

What type of dysfunction is often caused by a fall when the patient extends arm behind himself with hand facing away from him on landing?

Back 20

anterior radial head somatic dysfucntion

- radial head does not glide posteriorly

- restricts pronation

- patient presents with wrist pain in pronation

Front 21

Common somatic dysfunction of ulnohumeral joint

--> Ulnar abduction

--> Ulnar adduction

Back 21

-restricted adduction (lateral glide)

-patient may present with pain or restriction at endpoint of flexion

-increases the carrying angle

-restricted adduction

-patient may present with pain or restriction at endpoint extension

-decrease carrying angle

Front 22

Radial head somatic dysfunction

Back 22

-posterior head somatic dysfunction

-when radius is pronated the radial head will be posterior

Front 23

A sprain, strain, or fracture of the forearm, wrist, or elbow can also strain

Back 23

interosseous membrane

--> this can persist long after injury heals

--> palpation of interosseous membrane will reveal increased tension or tenderness

Front 24

Wrist in extension

Back 24

normal motion that widens the carpal tunnel

Front 25

Wrist in flexion

Back 25

normal motion narrows the carpal tunnel

Front 26

Flexion somatic dysfunction in wrist

Back 26

repetitive use in flexed position

-causes persistent narrowing of carpal tunnel and increased tone of flexor retinaculum

-Planlens and Tinels test for median nerve damage

Front 27

Active range of motion of radiocarpal joint

Back 27

Flexion 80-90

Extension 70

Abduction( radial deviation) 20

Adduction ( ulnar deviation) 30-50

circumduction- all of above

Front 28

Somatic dysfucntion of the wristmay not be related to gross motions but to the slight gliding motion of

Back 28

carpal bones on radius

Front 29

What do the carpal bones do during extension

Back 29

anteriorly

Front 30

What do the carpal boones do during flexion

Back 30

glide posteriorly

Front 31

If a wrist extends but is restricted in its full flexion than it is and

Back 31

extension somatic dysfunction of wrist

Front 32

If a wrist abducts but is restricted in addcution

Back 32

then it is and abduction somatic dysfucntion of the wrist

Front 33

The most common somatic dysfunction of the wrist is

Back 33

extension wrist

Front 34

Counterstrain tender points in the wrist may be found in the

Back 34

muscle bellies or tendons

Front 35

The carpal bones have no

Back 35

voluntary motion

-involuntary glide between bones with active hand movement

-somatic dysfunction occurs with compressive injury

Front 36

Carpometacarpal joints

Back 36

-Main somatic dysfunction is dorsal glide with restrcition ventral glide

-

Front 37

Thumb

Back 37

- has saddle joint that permits angular movements in almost any plane with the excepetion of limited axial rotation

-more likely to have strain or sprain

Front 38

metacarpophalangeal joints

interphalangeal joints

Back 38

6 gliding motions

anteroposterior

mediolateral

internal-external rotational

Front 39

Lateral epicondylitis

Back 39

--> pain over common extensor origin about 1cm distal to lateral epicondyle

--> maximal pain on tendon

--> tissue degeneration

--> pain is reprodcued with resisted extension at the wrist

Front 40

De Quervian tenosynovitis

Back 40

swelling of sheath that surrounds the abductor pollicis longus and extensor pollicis brevis at the wrist

- inflammation thickens the tendon sheath and constricts tendon causing a triggering phenomena as the patient moves thumb

-crepitus revealed

Front 41

Compression of nerves of forearm

Back 41

ulnar nerve(cubital tunnel syndrome)

medial nerve compression at elbow

posterior interosseous nerve compression

pronator syndrome- musclular compressionof median nerve in forearm

Radial tunnel syndrome

Front 42

Somatic dysfunction may be secondary to

Back 42

viscerosomatic reflex

Front 43

Diaphragm

Back 43

trapezius area

Front 44

myocardial pathology

Back 44

left axilla and inside left arm

Front 45

gallbladder irritation can refer to pain in

Back 45

acromioclavicluar and scapular

Front 46

Radial head counterstrain tenderpoint

Back 46

most important for elbow