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NMS 3
Midterm
| Question | Answer |
|---|---|
| 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 |
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trevpeters
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