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NMS 3

Midterm

QuestionAnswer
Suprascapular Nerve C5,6 innervates what two muscles Supraspinatus Infraspinatus
Axillary (circumflex) Nerve C5,6 innervates Teres Minor
Upper and lower subscapularis nerve C5,6 innervates Subscapularis
Muscle that does lateral rotation, and stabilizes the humerus in glenoid Infraspinatus
Muscle that does lateral rotation, and extension of the humerus Teres Minor
Muscle that initiates abduction of the arm, and stabilizes the head of the humerus Supraspinatus
Muscle that does medial rotation and adduction of the humerus Subscapularis
3 muscles that insert at the greater tubercle of the humerus Supraspinatus Infraspiinatus Teres Minor
Muscle that inserts at the lesser tubercle of the humerus Subscapularis
Muscle that originates at the subscapular fossa of scapula Subscapularis
Muscle that originates at the upper lateral border of scapula Teres Minor
Originates at the supraspinous fossa of scapula Supraspinatus
Originates at the infraspinous fossa of scapula Infraspinatus
What are the 4 rotator cuff muscles Supraspinatus Infraspinatus Teres Minor Subscapularis
What are the additional two muscles that contribute to shoulder stability Deltoids Long head of Biceps
What are the 5 supplemental muscles of the shoulder Teres Major Latissimus dorsi Coracobrachialis Pectoralis Major Triceps
Impingement sydrome: In management or treatment of impingement syndrome, what is the order of the adjustment 1. Long axis distraction 2. Internal/External 3. Superior to Inferior
A common cause of traumatic instability of the shoulder is Past history of shoulder dislocation, or recurrent history
When evaluating for traumatic instability, what are the 3 glenoid labrum tests Crank O'Brien Clunk
T/F In non-traumatic shoulder instability, or looseness, the patient is usually asymptomatic True
Give 3 symptoms resulting from non-traumatic instability of the shoulder 1. Arm traction (sudden) with pain/weakness in entire arm and/or subluxation (arm support alleviates symptoms) 2. Overhead positions leads to fatigue rather than pain 3. Impingement development due to loose capsule
What is it called when there is inherent loosement in capsules of the shoulder "Born loose"
Where is the most common tear in the rotator cuff Supraspinatus
T/F Tennis elbow is more common in tennis players than anyone else False. More common in non-athletes
A person is diagnosed with lateral epicondylitis. What activities will cause pain? Resisted supination and extension Passive pronation and flexion Shaking hands Turning doorknob
What is the most common muscle involved in lateral epicondylitis Extensor carpi radialis brevis
What activities will cause pain with medial epicondylitis Resisted pronation and wrist flexion Passive supination and extension
A person is diagnosed with myositis ossificans. This is most commonly found in the lower brachialis or brachioradialis. What is the innervation of the brachioradialis Radial Nerve
What causes nursemaid's elbow The radial head is not fully developed and is entrapped. It presents as lateral elbow pain after swinging the child or jerking the child's elbow
What are the 2 flexors of the elbow Biceps and brachialis
What nerve innervates the 2 elbow flexors ( biceps and brachialis) Musculocutaneous nerve C5,6
What is the course of the Median Nerve -Enters forearm -Runs between the two heads of Pronator Teres -Lies deep to the biccipital aponeurosis - Anomaly is Ligament of Struthers
What is the course of the Ulnar Nerve -Passes through the ulnar sulcus -Continues through the 2 heads of the flexor carpi ulnaris
What is the course of the Radial nerve -Largest branch of the brachial plexus -Passes between the brachialis and brachioradialis just in front of the lateral epicondyle - Pierces the supinator
Where is Tunnel 1 located Radial border of the anatomical snuffbox
What 2 muscle tendons are located in Tunnel 1 Extensor Pollicis brevis Abductor pollicis longus
What is DeQuervain's disease, and where is it located -irritation of tendons; nonspecific stenosing tenosynovitis -Tunnel 1
Where is Tunnel 2 located Radial side of Lister's tubercle
What 2 muscle tendons are located in Tunnel 2 Extensor carpi radialis brevis Extensor carpi radialis longus
Where is Tunnel 3 located Ulnar border of snuff box and ulnar side of Lister's tubercle (tendon goes 45 degrees distal to tubercle)
What muscle tendon is found in Tunnel 3 Extensor pollicis longus
Where is Tunnel 4 located Center dorsum of wrist
What 2 muscle tendons are located in Tunnel 4 Extensor digitorum Extensor indices
What is Tunnel 4 common for Dorsal ganglions
Where is Tunnel 5 located Radial side of ulnar styloid
What muscle tendon is located in tunnel 5 Extensor digiti minimi
Where is Tunnel 6 located Ulnar side of ulnar styloid
What muscle tendon is located in Tunnel 6 Extensor carpi ulnaris
What nerve is compressed with Carpal Tunnel Median nerve
Where is the median nerve located in Carpal Tunnel Superficial to the flexor tendons
What happens with Carpal Tunnel Wrist flexion and finger flexion causes the Median nerve to be compressed by the flexor tendons
What is the Incidence ratio of Carpal Tunnel Female vs. Male 3-5: 1 Female over Male
What is located in the Tunnel of Guyon (Guyon Tunnel) Ulnar nerve and artery
Explain Dequervain's disease Nonspecific stenosing tenosynovitis of Tunnel 1 Occurs at radial styloid Caused from rubbing on styloid process More common in women
What is the most common, most frequent location of ganglions? Dorsal radial wrist
What are the symptoms of a ganglion -Few symptoms - firm cystic mass -usually painless - swelling, non-tender, not fixed to skin
What is Dupuytren's contracture Pulls the fingers in flexed position (usually the little finger and ring finger)
Since the median nerve is superficial to the flexor tendons, what happens wrist flexion and finger flexion causes the nerve to be compressed by the flexor tendons
What do you do to perform the sulcus sign test -Patient's hand is internally rotated in lap - Apply inferior traction/pull down by grasping at distal humerus/elbow
A positive sulcus sign test would be if a sulcus appears superior to humeral head/inferior to lateral acromian
What does a positive sulcus sign indicate Multidirectional instability
What do you do to perform the Subacromial Bursa test aka Dawburn's sign -Stand behind the patient, palpating the tender area anterolateral to acromion process - passively abduct arm to 90 degrees
A positive Subacromial Bursa test aka Dawburn's sign would be -painful area stays under Dr's hand OR it moves medially and is alleviated
Positive Subacromial Bursa test- If painful area stays under contact = Rotator cuff tear, stop test
Positive Subacromial Bursa test- if painful area is alleviated or moves medially = -Subacromial bursitis OR supraspinatus tendonitis= Postive Dawburns sign -follow with doing a drop arm test
What is Drop Arm test for -Distinguishes between subacromial bursitis and supraspinatus tendonitis - Further delineates a positive Dawburn's sign
How is a Drop Arm test done -Dr. passively abducts arm to 120-150 degrees - then patient actively lowers their arm to their side
What is a negative Drop Arm test and what does it indicate No pain, fluid motion= subacromial bursitis
What is a Positive 1 Drop arm test and what does it indicate -Arm drops quickly due to pain= supraspinatus tendonitis - do NOT continue with Codman's
What is a Positive 2 Drop arm test and what does it indicate -Arm drops in a cogwheel motion with no pain - deltoids are taking over - still possible supraspinatus tendonitis - go on to Codman's
What is a Positive 3 Drop arm test and what does it indicate -Patient supports motion with other hand - move onto Codman's
What is Codman's Drop Arm test Repeat same steps as normal Drop Arm test, but apply a downward force on the patient's arm
What is a positive Codman's Drop Arm test and what does it indicate Arm drops because of pain and/or patient cannot perform = suprapinatus tendonitis (or tear in rotator cuff complex)
What muscle does the Empty Can test evaluate Supraspinatus
How is the Empty Can test performed -Patient stands with elbow exended, arm at 90 degree abduction and neutral rotation -The shoulder is then moved 30 degrees in horizontal flexion and thumb pointed down -Dr. pushes down on arm
What would a positive Empty Can test be Pain or weakness when Dr. pushes down = weak or injured supraspinatus muscle or tendon
What muscle is tested with the Lift-Off test (Gerber's test) Subscapularis
How is Lift-Off test (Gerber's test) performed -Patient is seated or standing, and places hand behind back (shouldn't be painful) -Patient tries to move move hand posteriorly while doctor resists with finger - compare the other side
What would positive Lift-Off test (Gerber's test) be and what would it indicate -weakness or pain - indicates a weak or inured subscapularis muscle or tendon
Test that assesses for neurovascular compression of subclavian artery and brachial plexus caused by scalenes or cervical rib Adson's test
Tests positive for Thoracic Outlet Syndrome Adson's test Wright's test Costoclavicular test
Test that assesses for neurovascular compromise of axillary artery as seen in hyperabduction Wright's test
A patient presents with a positive Dawburn's sign and a negative Codman's and Drop Arm test. What is your diagnosis Subacromial bursitis
(M) Which test- Patient standing with elbow extended and shoulder 90 degrees flexion/10-15 degrees horizontal flexion; Position 1 is internally rotated, Position 2 is externally rotated O'Brien sign
(M) Which test- Patient is supine, shoulder in maximum flexion Crank Test
(M) Which test- Dr. passively/ forcefully elevates shoulder into flexion Neer's Test
(M) Which test- Patient supine, shoulder at 90 degrees abduction Clunk Test
(M) Which test- Dr. in front of the patient holding elbow, shoulder in 90 degree flexion Hawkins-Kennedy test
(M) Impingement test (2) Hawkins- Kennedy test Neer's test
(M) Labrum test (3) Crank test O'Brien test Clunk test
(M) Pain indicates impingement (2) Hawkins-Kennedy test Neer's test
(M) Pain indicates impingement of supraspinatus tendon (1) Hawkins-Kennedy test
(M) Positive is clicking with pain (1) Crank test
(M) Positive with pain in position 1 and alleviated in position 2 (1) O'Brien sign
(M) Deep shoulder pain indicating glenoid labrum (1) O'Brien sign
(M) Superficial or top of shoulder pain = AC injury (1) O'Brien sign
(M) Tests are as sensitive as MRI (3) Crank test O'Brien sign Clunk test
When palpating lateral elbow, which muscle attaches closest to the shoulder Brachioradialis
When performing an adjustment for abduction impingement of the shoulder, what is the order of the Dr's actions -Long axis distration -External rotation -S-I in abduction (standing, seated, or supine)
What 2 muscles are checked when testing resisted pronation of the elbow Pronator teres Pronator quadratus
What are the 3 tests for lateral epicondylitis Cozen's test- active Mill's test- passive Kaplan's test
How is Cozen's test performed -Patient clenches fist -dorsiflexes -maintains pronated position - Dr. applies resistance
What is a positive Cozen's test Reproduction of acute lancinating pain in the region of the lateral epicondyle
What is Cozen's test significant for Lateral epicondylitis or radiohumeral bursitis
How is Mill's test performed -Patients forearm, fingers, and wrist are passively flexed -forearm is pronated and extended
What is a positive Mill's test and what does it indicate elbow pain increases indicates lateral epicondylitis
How is Kaplan's test performed -Grip strength is assessed with dynamometer - then encircling the forearm firmly or with a strap placed 1-2 inches below the elbow joint line the grip is assessed again
What is a positive Kaplan's test If initial grip strength improves and lateral elbow pain diminished after placing the strap 1-2 inches below the elbow joint line
What does the Pinch Grip test check Checks anterior interosseous branch of Median Nerve
What is a positive Pinch Grip test Pad to pad instead of tip to tip
How is Finkelstein's test performed Patient makes fist with thumb inside and ulnar deviates
What is a Positive Finkelstein's test Pain over abductor pollicis longus, and extensor pollicis brevis tendons
What does a positive Finkelstein's test indicate Indicates tenosynovitis in the abductor pollicis longus, and extensor pollicis brevis
Created by: trevpeters