17 Questions
Which test is used to evaluate biceps tendon pathology?
Pronation resistance test
Which of the following is NOT a typical clinical feature of carpal tunnel syndrome?
Pain or numbness in the small finger
Which test is used to assess for De Quervain's tenosynovitis?
Finkelstein's test
What is a common clinical feature of trigger finger?
Flexed finger that 'catches' and opens with a painful 'pop'
Which test is used to evaluate shoulder instability?
Speed's test
What should be inspected during a wrist and hand evaluation?
Smoothness of motion, surface contour, alignment, and bony deformities
What is the MOST important first step in evaluating a patient with shoulder pain?
Performing a detailed history and physical examination
Which of the following is a key component of the cervical spine evaluation for a patient with shoulder pain?
Assessing range of motion with caution, as it is often limited by pain
A patient presents with shoulder pain and reports a history of shoulder instability. Which of the following special tests would be MOST appropriate to perform?
Apprehension test
Which of the following is a common misconception in the evaluation of a patient with shoulder pain?
I can perform a complete physical examination without touching the patient
A patient presents with gradual-onset shoulder pain without a history of injury. Which of the following is the MOST likely diagnosis?
Adhesive capsulitis
What is a common symptom of acute rotator cuff injury?
Minimal or NO motor strength
Which test is used to assess the overall shoulder rotation?
Apley scratch test
Which condition is characterized by pain deep in the glenohumeral joint while the forearm is pronated?
SLAP tear
What type of athletes are more prone to experiencing a SLAP tear injury?
Throwing athletes
Which test involves the elbow being flexed to 90 degrees with the forearm pronated?
Yergason's test
Which condition is characterized by an unstable feeling in the shoulder during certain movements?
Shoulder subluxation
Study Notes
Upper Extremity Evaluation
- Idealism vs. Realism: the difference between the ideal and real-world approaches to musculoskeletal care
- Importance of taking a detailed history, performing a complete physical exam, and making an accurate diagnosis
Neck and Cervical Spine Evaluation
- Location and characteristics of pain (injury, acute or gradual onset, associated symptoms)
- Inspection: head position, stiffness
- Palpation: spinous process, paraspinal muscles
- Range of motion: use caution, often limited by pain
- Neuro evaluation: Spurling compression test (foraminal compression test)
Shoulder Evaluation
- "Red flags": injury with fracture, septic bursa or joint, acute rotator cuff injury, fever, chills, severe pain
- Inspection: swelling, deformity, muscle atrophy, fasciculations, or abnormal positioning
- Palpation: bony landmarks, areas of tenderness
- Range of motion: flexion, extension, abduction, adduction, internal and external rotation
- Maneuvers: acromioclavicular joint, subacromial and subdeltoid bursae, overall shoulder rotation (Apley scratch test)
Shoulder Anatomy
- Humeral head, glenoid, scapula (golf ball on a tee)
- Rotator cuff: compressor cuff, glenoid labrum
- Shoulder pain cycle: instability, weakness
Shoulder Problems
- "Tendonitis" and "bursitis"
- Impingement: overhead pain, Hawkins, Neers, crossover tests
- Instability: dislocation, subluxation, repetitive activity, apprehension, relocation
- Weakness: painful vs. non-painful, abduction, internal rotation/external rotation
- SLAP/Labrum: superior labrum anterior to posterior, occurs in throwing athletes, O'Brien's test
Biceps Tendon
- Yergason's test: elbow flexed to 90 degrees, forearm pronated, pain in bicipital groove
- Speed's test: patient attempts to forward elevate shoulder against resistance, elbow extended, forearm supinated
Wrist and Hand Evaluation
- Inspection: smoothness of motion, surface contour, alignment of wrist and fingers, bony deformities
- Palpation: distal radius and ulna, carpal bones, MCP, PIP, and DIP joints
- Range of motion: wrist (flexion, extension, ulnar/radial deviation), fingers (flexion, extension, abduction, adduction), thumb (flexion, extension, abduction, adduction, opposition)
- Test hand grip strength, sensation on palmar and dorsal surfaces
Carpal Tunnel Evaluation
- Clinical features: pain or numbness in fingers, night pain, loss of sensation in median nerve distribution
- Assess: weak abduction of the thumb, carpal tunnel compression test, Tinel's sign, Phalen's sign
DeQuervain's Teno-synovitis
- Clinical features: moving the thumb, forming a fist, grasping, turning the wrist, lifting
- Assess: tenderness over thumb tendons, APL, EPB, Finkelstein's test
Trigger Finger
- Clinical features: flexed finger, "catches", opens with painful "pop"
- Assess: palpate lump in midpalm over A1 pulley, finger triggers on exam
- Treatment: splint in extension, inject, surgery
Test your knowledge on assessing shoulder injuries including fractures, septic bursa or joint issues, acute rotator cuff injuries, and high-risk injuries. Learn about important signs such as fever, chills, severe pain, and muscle weakness. Explore evaluation techniques like inspecting for swelling, palpating bony landmarks, and checking range of motion.
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