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54 Cards in this Set
- Front
- Back
Rotator cuff muscles and actions
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supraspinatous - abducts the arm
infraspinatous - externally rotate teres minor - externally rotate subscapularis - internally rotate Up, Out, In |
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Brachial plexus bascis
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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.
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Lymphatics
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The right upper extremity lymphatics drain into the right lymphatic duct. The left upper extremity lymphatics drain into the thoracic duct.
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Biceps reflex tests
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C5
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Brachioradialis reflex tests
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C6
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Triceps reflex tests
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C7
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Testing DTR
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4/4 Brisk response with maintained clonus
3/4 Brisk response 2/4 normal 1/4 decreased but present response 0/4 no response |
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Muscle strength
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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 |
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Apley's Scratch Test
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Tests ROM
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Adson's test
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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.
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Roos Test
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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.
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Drop Arm test
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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.
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Speed's test
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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.
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Yergason's Test
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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.
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Brachial plexus injury
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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.
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Winging of the scapula
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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.
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Thoracic outlet syndrome
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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.
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Supraspinatous tendonitis
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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.
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Rotator cuff tear
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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.
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Adhesive capsulitis (frozen shoulder)
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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.
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Shoulder dislocation (subluxation)
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Humeral dislocated inferioanteriorly from glenoi. May result in axillary nerve damage, resulting in deltoid muscle paralysis.
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Bicipital tenosynovitis
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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.
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Lateral epicondyle
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extensors of wrist and hand, all innervated by the radial nerve.
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Medial epicondyle
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flexors of wrist and hand - all innervated by the median nerve.
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Primary extensor of the forearm
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triceps
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primary flexor of the forearm
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brachialis
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Supinators of the forearm
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Biceps (musculocutaneous nerve) and supinator (innervated by radial nerve)
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Pronators of the forearm
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pronator teres and pronator quadratus, both are innervated by the median nerve.
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Carrying angle
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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.
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Radial head movement
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When the frearm is pronated, the radial head glides posteriorly. When supinated, the radial head glides anteriorly.
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Anterior radial head
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Radial head is stuck anteriorly and easily supinates but is restricted in pronation.
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Adduction of the ulna
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The ulna is easily adducted, with restriction in abduction. Since the ulna is adduction, the wrist is abducted.
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Lateral epicondylitis
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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.
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Medial epicondylitis
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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.
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Tinel's
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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.
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Phalen's
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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.
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Prayer (reverse phalen's)
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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.
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Allen's test
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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.
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Finkelstein
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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.
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Carpal tunnel syndrome
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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.
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Drop Wrist deformity
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Paralysis of extensor muscles. Patient is unable to extend the wrist, and so wrist tends to 'drop' into flexion.
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Interossei and lumbricals
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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)
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Lumbricals
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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.
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Intrinsic muscles of the hand
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Thenar muscles, hypothenar muscles, interossei, and lumbricals
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Thenar muscles
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Thenar = Thumb, include the abductor pollicis brevis, flexor pollicis brevis, and opponens pollicis.
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Nerve supply to hands: Radial nerve
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Cutaneous sensory innervation, supplies NO intrinsic hand muscles
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Nerve supply to hands: median nerve
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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.
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Nerve supply to hands: Ulnar nerve
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Provides cutaneous snesory innervation to a portion of the hand and innervates all muscles of the hand except those innervated by the median nerve.
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Swan neck deformity
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Flexion contracture of the MCP and DIP with extension contracture of PIP. Often associated with rheumatoid arthritis.
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Boutonniere deformity
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Extension contracture of the MCP and DIP with flexion contracture of the PIP. Associated with rheumatoid arthritis. Due to hood rupture.
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Claw Hand
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Flexion of PIPS and DIPS with extension of the MCPs due to intrinsic muscle activity loss. Due to ulnar nerve damage.
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Ape Hand
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Thenar atrophy with unopposable thumb. Median nerve damage.
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Dupuytren's contracture
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Flexion contracture of the MCP and PIP with often contracture of the last two fingers. Palmar fascia contracture.
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Bishop's deformity (Hand of Benediction)
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Paralysis of lumbricals 1 and 2 due to median nerve damage.
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