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Musculoskeletal Shoulder and Elbow
shoulder and elbow exam 1
50
Anatomy
Graduate
10/17/2011

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Cards

Term
O'briens test:
Definition
- SLAP tears
- arm flexed and adducted 10-15 degrees and internally rotated so thumb is pointing down> pt resists downward force> pain
- patient supinates hand so palm up> no pain
Term
Impingement occurs when the __ __ of the __ undersurface causes irritation to the underlying __ __ causing symptoms.
Definition
- anterior 1/3
- acromion
- cuff tendons
Term
with impingement there is less space for the rotator cuff to slide b/w the acromion and humerus
Definition
Term
A flat acromion is ideal. A __ or __ acromion may cause impengement symptoms.
Definition
curved or hooked
Term
dull generalized shoulder aching, worse at night, worse with overhead activity, hurts to sleep on, hurts to get things out of cabinet:
Definition
Impengement
Term
2 tests for Impingement:
Definition
Neer's Impingement sign
Hawkin's sign (better)
Term
Neer's test
Hawkin's test:
Definition
both test for impingement
Term
Impingement treatment:
Definition
- rest
- analgesics
- exercises: strengthening and stretching
- injection: cortisone may weaken tendon and lead to rupture so counsel pt on slow recovery
- surgery- excise and/or smooth acromion
Term
Pt says can't move there shoulder. So you check PROM, it is blocked. What are the 2 ddx now?
Definition
- arthritis
- frozen shoulder

Both of these block PROM
Term
Pt says can't move their shoulder, but you check PROM and it is good. What is the likely dx?
Definition
Rotator Cuff Tear (RCT)
Term
How do you differentiate b/w frozen shoulder and arthritis?
Definition
x-ray
Term
Patients with shoulder arthritis will have progressive pain and loss of __ and __ ROM. Their x-rays will show __ of __ __ and __.
Definition
- loss of active and passive ROM
- loss of joint space and osteophytes
Term
Thoracic outlet syndrome is __ or _ of the __ __ and/or __ __ over the __ _ or __ _ or __ __ __ and __ __ _ __ __.
Definition
- compression or pinching
- subclavian artery and/or brachial plexus
- first rib of clavicle rib
- behind the anterior scalene and in front of the middle scalene
Term
Thoracic outlet syndrome symptoms:
Definition
- arm ache
- numbness
- fatigue
- aching with overhead work
- numbness in ulnar nerve area (little, ring finger)
Term
Adson's test:
Definition
- Thoracic Outlet Syndrome: feel radial pulse at side, extend and abduct arm, ER, extend neck, turn ipsilateral, feel radial pulse diminish
Term
Dx of Thoracic outlet syndrom:
Definition
- symptoms, exam
- EMG/nerve conduction study
Term
Differential of Thoracic Outlet Syndrome:
Definition
- Pancoast tumor- upper lung tumor invading the 1st rib and brachial plexus- get chest xray
Term
Other ddx of shoulder pain:
Definition
- bone tumor
- myocardial ischemia
- gall bladder disease
- pancoast tumor
- carpal tunnel
- cervical disc
Term
MRI
Cuff tear/degeneration/tendonitis
SLAP/biceps tear
Bone disease
Definition
Term
Load and shift test:
Definition
laxity
Term
Sulcus sign:
Definition
laxity
Term
Anterior apprehension test:
Definition
- externally rotate and abduct arm and look for pt apprehension= +
Term
Anterior relocation test:
Definition
internally rotate and adduct> makes patient feel better
Term
Hill-Sachs lesion, also Hill-Sachs fracture, is a cortical depression in the posterior superior head of the humerus bone. It results from forceful impaction of the humeral head against the anteroinferior glenoid rim when the shoulder is dislocated anteriorly.
Definition
Term
With a distal humerus fracture, what nerve function must you check?
Definition
Radial nerve function
Term
Holstein-Lewis fracture:
Definition
- fracture of the distal 1/3 of the humerus resulting in entrapment of the radial nerve
Term
Tennis elbow is aka __ __. It is chronic degeneration of the __ __ __ __ tendon which inserts on the __. This happens with sports where you __ the wrist often. Have the patient put their __ finger __ and __ against ___.
Definition
- lateral epicondylitis
- extensor carpi radialis brevis
- elbow
- extend the wrist
- middle finger down and extend against resistance
Term
Tennis elbow physical exam:
Definition
Palpate maximum pain at lateral epicondyle
Resisted finger or wrist extension
May have weakness finger extension because of pain
Term
Tennis elbow tmt:
Definition
Rest
Activity modifications
Therapy
Counterforce bracing
Wrist splint
Injection (steroids or platelet rich blood)
Surgery: debride ECRB
Term
ERCB is on the __ elbow, while FCRB is on the __ elbow.
Definition
Lateral
Medial
Term
golfers can also get tennis elbow
Definition
Term
Medial epicondylitis is aka __ __ or __ __.
Definition
- baseball elbow
- golf elbow
Term
Lateral Epicondylitis hurts with wrist __, while Medial Epicondylitis hurts with wrist __.
Definition
- Lateral- extension
- Medial- flexion
Term
Medial epicondylitis is due to degeneration of __ __ or __ __ __.
Definition
- Pronator Teres or FCR (flexor carpi radialis)
Term
Pain with medial epicondylitis is worse with wrist __ and forearm ___.
Definition
- flexion
- pronation
Term
Rheumatoid arthritis:
Definition
eaten away bone
Term
Osteoarthritis:
Definition
degenerative bone disease, built new bone all deformed looking
Term
olecranon bursitis tmt:
Definition
Treatment
Rest and pressure bandage
Aspiration/injection
Surgery
Resect bursa
Term
Nerve Entrapment problems:
Definition
Typical Complaints
Pain (often not specific)
Impaired sensation – numbness
Impaired motor – weakness

Cubital Tunnel Syndrome
Radial Tunnel Syndrome
Term
What 3 places can the ulnar nerve be entrapped?
Definition
- Thoracic outlet
- Cubital tunnel- most common
- Guyon's canal
Term
Cubital tunnel:
Definition
Symptoms
Forearm/elbow pain - can radiate to shoulder
Numbness ring and little fingers
Findings
Tender ulnar nerve
+ Tinel’s sign (percussion nerve causes electric shock like sensation)
Decreased sensation ring and little fingers
Weakness intrinsic muscles
Atrophy of hand muscles
Term
Tests to run if suspect cubital tunnel:
Definition
- X-ray to r/o bony prominences
- EMG/nerve conduction studies to confirm at level of elbow- double crush
Term
Cubital tunnel tmt:
Definition
- prevent external pressure
- splint elbow in extension at night (pillow splint)
- surgery
Term
Radial tunnel syndrome:
Definition
Pain distal to joint and ECRB

No motor or sensory dysfunction

Consider in DDx of lateral epicondylitis
Term
Radial tunnel physical exam:
Definition
Tenderness to palpation along radial tunnel
Pain with resisted middle finger extension or resisted forearm supination with elbow extended
EMG usually not helpful
Term
Radial tunnel syndrome tmt:
Definition
Treatment
Rest and observation – may recover spontaneously (6-12 weeks)

Can consider injection

Surgery to decompress
Term
Posterior Interosseous Nerve (PIN):
Definition
Pain like radial tunnel plus weakness in PIN innervated muscles at same locations:
Supinator
ECU
APL
EPL
EPB
EMG more useful

Decompression of nonop fails
Term
With pronator syndrome there is __ nerve compression at the __. What are the symptoms?
Definition
- median nerve
- elbow

Symptoms:
- pain in volar proximal forearm with repetitive motion
- paresthesias in radial 3 1/2 digits
- rare to have weakness
Term
Pronator syndrome PE:
Definition
Resisted forearm pronation
Extreme elbow flexion
EMG unreliable
Term
Pronator syndrome: Nerve exploration and decompression often necessary
Definition
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