Upper Extremity Evaluation - Exam 2
The blood supply to the shoulder joint is derived from the: a. axillary artery b. brachial artery c. brachialcephalic artery d. subclavian artery
Answer: A, axillary artery
The true function of the rotator cuff is: a. center the head of the humerus in the glenoid fossa b. allow the humerus to rotate without restriction c. abduct the humerus d. support the scapula
Answer: A, center the head of the humerus in the glenoid fossa
The differential diagnosis in the examination of the shoulder region would be used to eliminate problems in what area? a. cervical spine b. thoracic spine c. wrist d. head
Answer: A, cervical spine
An examiner indentifying a particular structure or texture by feeling an object with the eyes closed is relying on a. cortical sensation b. primary sensation c. sensory discrimination d. proprioception
Answer: A, cortical sensation
Which of the following tests does not indicate that the subclavian artery is being compressed? a. impingement syndrome test b. adson sign test c. halstead test d. military brace test
Answer: A, impingement syndrome test
If the lower extremity is designed for stability, then the upper extremity is designed for a. mobility b. rotation c. gliding d. sliding
Answer: A, mobility
Which of the following tests is used to determine inferior glenohumeral instability? a. sulcus test b. surprise test c. adson test d. jobe relocation test
Answer: A, sulcus test
The biceps tension test primarily assess injury to what structure? a. short head of the biceps brachii b. glenoid labrum c. long head of the biceps brachii d. supraspinatus
Answer: B, Glenoid Labrum
This complication of a shoulder dislocation is caused by compression of the cancellous bone against the anterior glenoid rim creating a divot in the humeral head a. bankhart lesion b. hill-sachs lesion c. SLAP lesion d. rotator cuff tear e. all of the above
Answer: B, Hill-Sachs Lesion
The scapula serves as the base or platform for which muscle(s) a. rhomboids b. rotator cuff c. levator scapulae d. serratus anterior
Answer: B, rotator cuff
Identify one other muscle that attaches to the coracoid process along with the subclavius and pectoralis major a. long head of the biceps brachii b. short head of the biceps brachii c. pectineus d. subscapularis
Answer: B, short head of the biceps brachii
The brachial plexus is derived from what spinal nerve segments? a. C4-T1 b. C6-T1 c. C5-T1 d. C6-T2
Answer: C, C5-T1
Which of the following special tests is the best one to use to identify a SLAP lesion? a. Gerber lift off b. Speed's test c. O'Brien d. Clunk e. Feagin
Answer: C, O'Brien
This complication of a shoulder dislocation causes a defect in the superior labrum that begins posteriorly and extends anteriorly impacting the attachment of the long head of the biceps on the labrum a. bankhart lesion b. hill-sachs lesion c. SLAP lesion d. rotator cuff tear e. all of the above
Answer: C, SLAP lesion
Which of the following best defines Sprengel's Deformity? a. posteriorly dislocated sternoclavicular joint b. atrophy of the deltoid muscle c. a congenitally undescended scapula d. atrophy of the upper trapezius muscle e. an exostosis at the acromioclavicular joint
Answer: C, a congenitally undescended scapula
During a brachial plexus injury, muscular weakness is evident in the: a. internal rotators and deltoid b. external rotators and deltoid c. external rotators, deltoid, and biceps brachii d. internal rotators, deltoid, biceps brachii
Answer: C, external rotators, deltoid, and biceps brachii
A quarterback sustains a direct blow to his throwing arm during practice. Two days later he still has slight pain when moving his arm through a full ROM. The athlete should be allowed to return to play: a. immediately b. immediately, with the arm protected with tape c. only when ROM is pain free d. only after a custom-fitted brace is made
Answer: C, only when ROM is pain free
In a patient with a Grade II AC sprain, which of the following motions will most likely cause the most significant increase in pain? a. shoulder flexion b. shoulder extension c. shoulder horizontal adduction/flexion d. shoulder horizontal abduction/extension
Answer: C, shoulder horizontal adduction/flexion
The most important and most commonly injured bursa around the shoulder joint is the: a. subcoracoid bursa b. subclavicular bursa c. subacromial bursa d. subbicipital bursa
Answer: C, subacromial bursa
The greatest number of proximal humeral fractures occurs at the: a. epiphyseal plate at proximal humerus b. shaft c. surgical neck d. tuberosities
Answer: C, surgical neck
The prime mover(s) for both scapular elevation and cervical extension are: a. the levator scapulae b. the latissimus dorsi c. the superior fibers of the trapezius d. the sternocleidomastoid e. a and c above
Answer: E, a and c above (levator scapulae and superior fibers of the trapezius)
Diagnostic accuracy statistics for special tests are calculated based on the resultant number of a. true positives b. false positives c. true negatives d. false negatives e. all of the above f. none of the above
Answer: E, all of the above
According to the article shown in class and posted on BB entitled "Evidence approach to shoulder diagnostic testing", which of the below tests had the highest specificity rating for the diagnosis of biceps tendinopathy? a. Speed's b. Yergason's c. Ludingtons d. All tests had comparable ratings
Answer: a, speeds
Damage to the subclavian artery and subclavian vein, the esophagus, and the trachea may accompany which of the following shoulder injuries? a. posterior glenohumeral dislocation b. third degree posterior sternoclavicular sprain c. third degree anterior sternoclavicular sprain d. clavicle fracture that is displaced posteriorlly e. b and d above
Answer: b & d, third degree posterior sternoclavicular sprain and clavicle fracture that is displaced posteriorly
The scapula fossa that articulates with the humerus is deepened by an additional structure called the: a. articulating disk b. glenoid labrum c. ligamentum teres d. zona orbicularis
Answer: b, glenoid labrum
When palpating the rotator cuff, from anterior to posterior, what order do the muscles insert on the head of the humerus? a. infraspinatus, supraspinatus, subscapularis, teres minor b. subscapularis, teres minor, infraspinatus, supraspinatus c. subscapularis, supraspinatus, infraspinatus, teres minor d. subscapularis, infraspinatus, supraspinatus, teres minor
Answer: c, subscapularis, supraspinatus, infraspinatus, teres minor
In shoulder impingement syndrome, which of the following is NOT the cause of the primary form of impingement: a. anatomical structure of the acromion b. degenerative changes to the bony surfaces c. scarring and weakness in the avascular zone of the supraspinatus tendon d. glenohumeral instability e. all of the above are not causes of primary form of shoulder impingement
Answer: d, glenohumeral instability
Which of the following joints is commonly referred to as the "shoulder joint proper"? a. sternoclavicular joint b. scapulothoracic joint c. acromioclavicular joint d. glenohumeral joint e. none of the above
Answer: d, glenohumeral joint
Contusions to the distal end of the clavicle called ____ _____ could be initially diagnosed as an acromioclavicular sprain a. glass arms b. bicipital arms c. frozen shoulders d. shoulder pointers
Answer: d, shoulder pointers
These structures can be involved with shoulder impingement syndrome? a. glenohumeral joint capsule b. humeral head c. supraspinatus tendon d. long head of the biceps e. all of the above
Answer: e, all of the above
When performing the observation portion of your assessment for the shoulder which of the following must you look for? a. scapular winging b. position and appearance of the clavicle c. muscle symmetry d. elevation or depression of the shoulder tips e. all of the above
Answer: e, all of the above
According to the article shown in class and posted on BB entitled "Evidence approach to shoulder diagnostic testing", both Hawkins Kennedy and Neer's test has a. high specificity b. high sensitivity c. low specificity d. low sensitivity e. b and c f. a and d
Answer: e, b and c (high sensitivity and low specificity)
To treat an athlete who has acute symptoms associated with shoulder impingement, the team physician will likely initially recommend: a. a partial acromionectomy b. steroid injections into the rotator cuff c. oral anti-inflammatory medications d. overhead activities to promote strengthening e. decrease all activities above the 90 degree horizontal plane
Answer: e, decrease all activities above the 90 degree horizontal plane
T/F Decreased muscle tone, sensory loss, and diminished or absent pulse are indicative of an upper motor neuron lesion.
False
T/F For most EEG and Nerve Conduction Study tests, the patient is required to fast 8-12 hours prior to these tests being conducted
False
T/F Most shoulder dislocations occur when the arm is abducted and internally rotated
False
T/F The acromioclavicular joint is a strong joint reinforced by several key ligaments
False
T/F The prime mover for the first 20-30 degrees of shoulder abduction is the infraspinatus muscle
False
T/F When assessing range of motion, you would expect the non-dominant arm to have less range than the dominant arm
False
T/F A tear or detachment of the glenoid labrum on the posterior lateral aspect of the humeral head is called a Bankart Lesion
False, a bankart lesion is a permanent anterior defect of the labrum
T/F One of the prime movers for shoulder medial rotation is the teres minor muscle
False, the prime mover for shoulder medial rotation is the subscapularis
T/F The glenoid labrum and the rotator cuff enhance the overall stability of the acromioclavicular joint.
False, the rotator cuff enhances stability for the Glenohumeral joint. The glenoid labrum deepens and the glenoid fossa to enhance stability
Physicians generally agree that a first-time dislocation of the shoulder may be associated with a fracture or other complications, and therefore individuals with this injury should be referred to the emergency room for x-ray and reduction
True
T/F A clonus test determines whether the central nervous system is functioning properly. A positive test produces a hyperactive stretch reflex and is characterized by rhythmic muscle contractions
True
T/F A posterior sternoclavicular dislocaiton poses a greater threat to the athlete than an anterior sternoclavicular dislocation, and thus needs to be recognized immediately by the athletic trainer
True
T/F According to data provided by one of classmates, both the Gerber lift off and belly press tests would be good tests to rule in pathology for which they are intended to assess, but not that great in ruling out this same pathology
True
T/F According to data provided by one of your classmates, the Yergason test had higher specificity values than sensitivity values
True
T/F An acromioclavicular sprain can be induced by a direct blow to the tip of the shoulder, pushing the acromion process downward or by a fall on an outstretched hand
True
T/F During a neurological examination, unilateral symptoms typically indicate a nerve root or peripheral nerve lesion (lower motor neuron)
True
T/F Full abduction of the arm to 170-180 degrees depends on unrestrained movement of the scapula and external rotation of the humerus
True
T/F Of the injuries discussed thus far in both orthopedic assessment classes, the likelihood of Nerve Conduction Study tests being ordered by the physician you referred your patient to would outweigh the number of EEG testes ordered
True
T/F Tendonitis of the long head of the biceps brachii muscle is common among athletes who execute an overhead throwing movement as a part of their sporting event
True
T/F The rotator cuff muscle most commonly injured is the supraspinatus
True
T/F Thoracic Outlet compression syndrome is often attributed to a cervical rib anomaly, originating from a cervical vertebra and the thoracic rib
True
T/F Thoracic outlet syndrome is a condition in which nerves and/or vessels become compressed in the root of the neck or axilla.
True
T/F To have full mobility of the upper extremity, the motions of the shoulder joint and scapula must be unrestricted and occur in a combined and coordinated fashion
True
T/F Any grade of acromioclavicular sprain may generally impact the ROM of the shoulder
True, pain associated with an AC sprain may inhibit abduction above 120 and horizontal adduction in the first degree. In the second degree patients would have trouble moving above horizontal. The third degree, there would be an unwillingness to move the arm.
T/F The shoulder complex is susceptible to injury because of its mobility and inherent instability
True, the mobility of the shoulder joint is high to allow for range of motion to occur in all pla
T/F According to data in the textbook and also provided by one of your classmates, the Surprise (Anterior Release) test has higher sensitivity and specificity values than other special tests for anterior glenohumeral instability
True, the sensitivity is .81 and the specificity is .86. SN for anterior drawer is .28 and SP .78. The SN for Apprehension is .65 while SP is .95
T/F The sternoclavicular joint is the only bone-to-bone joint that holds the shoulder complex to the thorax
True, there are no other bone to bone joints that hold the shoulder complex to the thorax
T/F Anterior instabilities account for ~95% of all chronic instabilities of the glenohumeral joint
True, through sports with overhead throwing the anterior capsule can become weakened which results in a laxity that increases anterior instability.