Upper Extremity (MSK) — Oral practice
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Transcript
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Checklist
Upper Extremity
INSPECTION Anteriorly & Posteriorly (Verbalize)
- Abnormal positioning
- Deformity
- Swelling
- Fasiculations
- Muscular atrophy
Shoulder
Palpation Bilaterally
- Sternoclavicular joint
- Clavicle
- Acromioclavicular joint
- Coracoid process Ibeneath davide and anteriorto acromion)
- Greater tubercle 12 inch above IM inj site)
- Biceps tendon at bicipital groove (2 inch above armpitt
- Flexion extension AbductionAdduction InternalRotation External Rotation
- Subacromial & subdeltoid bursae Jabove greatertuberde-tip of shoulder) liftpatient's elbow posteriorly
- -underacromionunder supraunder infra "2Findspireof scapula
- Shoulder muscles (SITS-supraspinatus, infraspinatus, teres minor, subscapularis) .R seo pll af rain tege dr es lta ob idov ae nt do find subscapularis
- Verbalize: palpating for soft tissue, bony or joint tenderness, warmth, swelling, crepitus, and masses - -
ASSESSES: Active ROM (AROM) & Passive ROM Bilaterally
- Flexion/Extension Raise arm forward over head/pull arm backwards
- Abduction/Adduction pull arm toside
- Internal/External Rotation Hold elbow steady and "show me how bigfish was"(external)
SHOULDER Special Tests
- Empty Can test (supraspinatus)- patient elevates arms to 90 degrees and internally rotates the arms with the thumbs pointed down. Ask patient to resist as you apply downward pressure to the forearms
- Infraspinatus test- Patient holds arm at their side with elbow flexed to 90 degrees and then externally rotates shoulder against resistance
- Subscapularis test-patient holds arm at their side with elbow flexed to 90 degrees and then internally rotates shoulder against resistance
- Crossed body adduction test (acromioclavicular joint)- Adduct the patient's arm across the chest.
- Neer test (subacromial impingement)-Forward flex patient’s arm while depressing scapula or acromion -
- Hawkins test (subacromial impingement)-Abduct patient’s shoulder to 90 degrees with elbow flexed at 90 degrees and internally rotate shoulder -
Elbow
Palpation Bilaterally
- Olecranon process
- Radial head
- Biceps brachii tendon
- Medial epicondyle
- Lateral epicondyle
- Verbalize: palpating for soft tissue, bony or joint tenderness, warmth, swelling, crepitus, and masses or nodules
ASSESSES: Active ROM (AROM) & Passive ROM Bilaterally
- Forearm Supination /Pronation esupinationpronation
Special Tests
- Forearm Supination/Pronation against resistance medial epicondylitis lateral epicondylitis
Wrist, Hands, Fingers, Thumb
Palpation Bilaterally
- Distal Radius
- Distal ulna
- Anatomic snuffbox
- Carpals
- Metacarpals
- MP Joint
- PIP Joint
- DIP Joint
- Palm Verbalize: palpating for thickening and contractures.
- Verbalize: Palpating for soft tissue, bony or joint tenderness, warmth, swelling, bogginess, crepitus, and masses
- ASSESSES: Active ROM (AROM) & Passive ROM "copymy movements" Bilaterally Wrist Flexion /Extension
- Wrist Ulnar/Radial Deviation
- Finger Flexion/Extension
- Finger Abduction /Adduction
- Thumb Flexion/Extension
- Thumb Adduction/Abduction
- Thumb Opposition
Special Tests
Steps
- Tinel sign (for Carpal tunnel syndrome)-Examiner taps volar aspect of wrist between thenar and hypothenar proximal eminences
- Phalen test (for Carpal tunnel syndrome)-Patient holds wrists fully flexed with dorsal surfaces held together for 1 minute
- Hand grip stength- Ask the patient to grasp your second and third fingers as tightly as possible. ulnarnerve test
- Thumb tenosynovitis (Finkelstein) test- Patient grasps the thumb against the pam and then moves the wrist toward the midline in ulnar deviation. Complete bilaterally for campison. Positive sign- pain with ulnar deviation
- Thumb Abduction test - patient abducts thumb against resistance Carpal Tunnel
- Consider whether a neurological examination is necessary when completing a musculosketal examination.
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