Test 4 ESHE 201

1. List and describe 3 major joints of the shoulder and identify the "true shoulder joint"

-The "true shoulder" joint is the Glenohumeral Joint. Is an enarthrodial, or ball-and-socket, joint in which the round head of the humerus articulates with the shallow glenoid cavity of the scapula. -Sternoclavicular Joint: The clavicle articulates with the manubrium of the sternum to form the sternoclavicular (SC) joint, the only direct connection between the upper extremity and the trunk. -Acromioclavicular Joint: Weak junction but is a gliding articulation of the lateral end of the clavicle with the acromion process. -Scapulothoracic Joint: The scapulothoracic joint is not a true joint; however, the movement of the scapula on the wall of the thoracic cage is critical to shoulder joint motion and attaches the scapula to the axial skeleton.

When observing for elbow problems, one of the things that you look for is carrying angle. What is a normal carrying angle?

5 - 15 degrees

With impingement syndrome there is often a painful arc of movement, usually with abduction. The angles of the painful movement are:

70 - 120 degrees

1. Define the gamekeeper's thumb

A sprain of the ulnar collateral ligament of the MCP joint of the thumb is common among athletes, especially skiers and football players. The mechanism of injury is usually a forceful abduction of the proximal phalanx, which is occasionally combined with hyperextension

Most glenohumeral dislocations occur when the shoulder is in what position?

Abduction, external rotation and extension

1. Understand the HOPS (important history, MOI, observation s/sx and special tests) and common treatments for the following: AC joint sprain (shoulder separation)

Acromioclavicular Sprain: Etiology: extremely vulnerable to sprains among active sports participants, especially in collision sports (at tip of the shoulder) Symptoms and signs: Grade 1: reflects point tenderness and discomfort during movement at the junction between the acromion process and the outer end of the clavicle. There is no disruption of the acromioclavicular joint, indicating only mild stretching of the acromioclavicular and coracoclavicular ligaments Grade 2: sprain indicates tearing or rupture of acromioclavicular ligaments, with associated stretching of the coracoclavicular ligament. Grade 3: involves complete rupture of the acromioclavicular and coracoclavicular ligaments Grade 4: sprain exhibits posterior separation of the clavicle, with complete disruption of the acromioclavicular ligament\ Grade 5: there is complete loss of both the acromioclavicular and the coracoclavicular ligaments, in addition to tearing of the trapezius and deltoid attachment to the clavicle and acromion. Grade 6: injury is very rare and involves the clavicle being displaced inferior to the coracoid behind the coracobrachialis tendon Management: application of cold and pressure to control local hemorrhage, (2) page 707stabilization of the joint by a sling and swathe bandage, and (3) referral to a physician for definitive diagnosis and treatment.25

What elbow ligament supports against varus force?

Annular Ligament

Most shoulder dislocations go in which direction?

Anterior

Which of the following muscles supinate the elbow?

Biceps brachii and Supinator

1. Chapter 22: Be able to label the bony, ligamentous, and muscular anatomy of the shoulder.

Bony anatomy of the shoulder: Clavicle, sternum, scapula, and humerus. Ligamentous anatomy of the shoulder: Sternoclavicular Joint Ligaments, Acromioclavicular Joint Ligaments, Glenohumeral Joint Ligaments. Muscular anatomy of the shoulder: Scapular Muscles: trapezius, rhomboids, and the serratus anterior and posterior

1. Chapter 24: Be able to label the bony, ligamentous, and muscular anatomy of the wrist and hand (as done in class)

Bony anatomy of the wrist: distal radius and ulna, with a proximal row of four and a distal row of four carpal bones that articulate with five metacarpals Ligamentous anatomy: Medial ligaments, lateral ligaments Muscular Anatomy: EXTENSOR CARPI RADIALIS LONGUS. EXTENSOR CARPI RADIALIS BREVIS. EXTENSOR CARPI ULNARIS. FLEXOR CARPI RADIALIS. FLEXOR CARPI ULNARIS. PALMARIS LONGUS.

Which of the following muscles flex the elbow?

Brachialis Biceps brachii Brachioradialis

Which of the following injuries occurs due to a FOOSH mechanism? Mark all that apply.

Colles' fracture maybe Elbow dislocation

Understand the HOPS (important history, MOI, observation s/sx and special tests) and common treatments for the following: GH joint dislocations (both acute and recurrent) rotator cuff impingement and rotator cuff strain.

Etiology: Glenohumeral Joint Sprain mechanism of this injury is similar to that which produces dislocations and strains. Anterior capsular sprains occur when the arm is forced into abduction Symptoms and signs: patient complains of pain during arm movement, especially when the sprain mechanism is reproduced. There may be decreased range of motion and pain during palpation. Management: Care after acute trauma to the shoulder joint requires the use of a cold pack for 24-48 hours, elastic or adhesive compression, rest, and immobilization by a sling. Massage may be needed.

Understand the HOPS (important history, MOI, observation s/sx and special tests) and common treatments for the following: SC joint sprain

Etiology: an injury to the joint where the clavicle (collarbone) meets the sternum (breastbone). Treatment: icing, inflammation and/or pain control with medications like ibuprofen and acetaminophen

1. Identify what the term FOOSH stands for

Falling on outstretched hand

A boxer's fracture is a fracture of which structure? Question options:

Fifth metacarpal

A "jersey finger" is a rupture of what tendon?

Flexor digitorum profundus

What structure serves as the roof of the carpal tunnel?

Flexor retinaculum

What grade of acromioclavicular joint sprain will have a complete tear of the acromioclavicular ligament and a moderate stretch to the coracoclavicular ligaments?

Grade IV

Which of the following best describes how rotator cuff strains and impingement syndrome are related?

Individuals with rotator cuff strain often have a long history of impingement syndrome.

Which of the following are treatment options for carpal tunnel syndrome?

NSAIDs corticosteriod injections rest and immobilization surgical decompression

1. Identify what each of these special tests test for and what is a positive test. a. Phalen's test b. Tinel's sign (wrist)

Phalens Test: Any symptoms of carpal tunnel syndrome are an indication for testing, using Tinel's sign and Phalen's test.1 In Phalen's test, the patient is instructed to flex both wrists as far as possible and press them together. This position is held for approximately 1 minute. If this test is positive, pain will be produced in the region of the carpal tunnel Tinels sign (wrist): produced by tapping over the transverse carpal ligament of the carpal tunnel, which causes tingling and parasthesia over the thumb, index finger, middle finger, and lateral half of the ring finger. This sensory distribution of the median nerve indicates the presence of carpal tunnel syndrome

Impingement syndrome is often associated with tightness if what joint capsule in the shoulder?

Posterior

1. Identify common methods for preventing shoulder injuries

Proper physical conditioning is important in preventing many shoulder injuries. Shoulder program should be directed toward general body development and the development of specific body areas for a given activity. Strengthening through a full range of motion of all the muscles involved in movement of the shoulder complex is essential

1. List several specific ways to prevent shoulder problems

Rest, don't overwork, train cautiously, warm-up. Also, wear proper equipment.

A jersey finger most often occurs in which finger?

Ring finger

1. Identify the structures associated with impingement syndrome

Shoulder impingement involves a mechanical compression of the supraspinatus tendon, the subacromial bursa, and the long head of the biceps tendon, all of which are located under the coracoacromial arch. This mechanical compression is due to a decrease in space under the coracoacromial arch. Repetitive compression eventually leads to irritation and inflammation of these structures. Impingement most often occurs in repetitive overhead activities.

A person with a scaphoid fracture will have severe pain in which area?

The anatomic snuff box

1. Define boxer's fracture and know how it commonly occurs.

The cause of metacarpal fractures is commonly a direct axial force or a compressive force, such as punching a wall or another person in anger. Typically occurs at the fifth metatarsal.

The most frequently fractured bone in the wrist is the:

scaphoid

The most commonly inflammed bursa in the shoulder is the:

subacromial bursa

1. Identify the rotator cuff muscles.

subscapularis, supraspinatus,infraspinatus, and teres minor muscles constitute the short rotator muscles,

The most commonly injured muscle in the rotator cuff is the:

supraspinatus muscle

1. Define carrying angle and identify cubital valgus and cubital varus

the elbow complex demonstrates a carrying angle that is an abducted position of the elbow in the anatomical position. Carrying angle for females 10-15 and for males 5-10 degrees. Cubitus valgus is a deformity in which the forearm is angled out away from the body when the arm is fully extended. Cubitus varus (gunstock deformity) is a malalignment of the distal humerus that results in a change of carrying angle from the physiologic valgus alignment (5-15 degrees) of the arm and forearm to varus malalignment

1. Identify the function of the Extensor digitorum profundus and know how to manually test for it.

the extensor digitorum communis extends medial four digits at the metacarpophalangeal joints and secondarily at the interphalangeal joints. It also acts to extend the wrist joint. You can test it by doing the Maudsley test

Parathesia associated with carpal tunnel typically occurs in which fingers?

thumb, index and middle

One of the primary mechanisms of injury for an acromioclavicular joint sprain is an impact to the:

tip of the shoulder

What nerve is commonly injured in the elbow?

ulnar

1. Identify how the humeral epicondyles and the olecranon process should look when the elbow is bent and straight*

The structural design of the elbow joint permits flexion and extension through the articulation of the trochlea with the trochlear notch of the ulna. Forearm pronation and supination are made possible because the head of the radius rotates against the capitulum freely without any bone limitations.

1. Identify the most commonly injured bursa in the shoulder.

The subacromial bursa.

A "gamekeepers thumb" is a sprain of the metacarpophalangeal joint (MCP) of the:

Thumb

The medial elbow ligament is treated with what common surgical technique?

Tommy John surgery

Which of the following are wrist carpals?

Trapezium Scaphoid Hamate Lunate

1. Identify the ligaments that support the AC joint

Trapezoid Ligament, Conoid Ligament, Acromioclavicular Ligament

1. Know the function of the Ulnar collateral ligament (UCL), the radiocollateral ligament (RCL) of the wrist

UCL of the wrist: critical for valgus stability of the elbow and is the primary elbow stabilizer. RCL of the wrist: It connects at the side of the scaphoid and prevents the wrist from bending too far to the side opposing the thumb.

1. Know the function of the Ulnar collateral ligament (UCL), the radiocollateral ligament (RCL) and the annular ligament.

UCL: help support it when performing certain motions, such as throwing. RCL: to provide stability against inner to outer stress on the elbow Annular Ligament: annular ligament stabilizes the radial head (stabilizes elbow joint).

UCL sprain Medial and lateral epicondylosis

UCL: instability, or looseness, of the elbow is the result of an injury to the ulnar collateral ligament Treatment: resting the elbow, ice application, medication and splinting. Lateral Epicondylosis: a common painful condition that affects the tendons that join the forearm muscles on the outside of the elbow (tennis elbow). Symptoms and Signs: pain over the attachment of the extensor carpi radialis brevis, at lateral epicondyle, and in the common extensor mass that is reproduced by resisted wrist extension. Weakness develops in the hand and wrist. Management: managing inflammation including extended rest, ice, NSAIDs, and deep friction massage.

The metacarpals and phalanges of the hand are numbered I - V. What is the number of the little finger?

V

1. Identify what each of these special test for and what is a positive test. a. Valgus stress test b. Tinel's sign (elbow) c. Cozen's Test (lateral epicondylitis test)

Valgus stress test: checks for sprain of the ulnar collateral ligament. Also, checks for sprain or instability of the radial collateral ligament. The athletic trainer grasps the patient's forearm with one hand and places the other hand over the lateral aspect of the elbow. The patient's elbow should be slightly flexed. Tinel's sign (elbow): designed to determine ulnar nerve compromise. Athletic trainer supports the patient's hand and forearm and with the other hand, taps the cubital notch between the olecranon process and medial epicondyle with a reflex hammer or the index finger. A positive Tinel's sign is when the patient complains of a tingling sensation along the forearm, hand, and fingers. Cozen's Test (lateral epicondylitis test): Keeping the patient's elbow flexed to 45 degrees, the clinician resists wrist extension (referred to as Cozen's test) and then flexion. Pain in lateral epicondyle when wrist extension is resisted indicates lateral epicondylitis. Pain in medial epicondyle when wrist flexion is resisted indicates medial epicondylitis

1. Identify the movement of the humeral head if the rotator cuff is damaged. *

With a poorly functioning (torn) rotator cuff, the humeral head can migrate upward within the joint because of an opposed action of the deltoid muscle.

Ulnar nerve injury (not in book)

You may lose sensation and have muscle weakness in your hand. Immobilize arm for treatment

1. Define Colles fracture and identify a picture of the injury.

a break in the radius close to the wrist (not in book)

1. Know the location of the anatomic snuff box (and its importance)

a triangular depression found on the lateral aspect of the dorsum of the hand. It is located at the level of the carpal bones and best seen when the thumb is abducted. Significant when there is pain with palpation within its boundaries.

1. Identify the ligament that support the SC joint

anterior sternoclavicular, posterior sternoclavicular, interclavicular, costoclavicular

A posterior disclocation of the clavicle at the sternoclavicular joint is rare but must be referred because it can:

be life threatening

What type of brace is commonly used with lateral epicondylitis?

counterforce brace

1. Identify key components of scapulothoracic rhythm

describes the movement of the scapula relative to the movement of the humerus throughout a full range of abduction. As the humerus elevates to 30 degrees, there is no movement of the scapula. This phase is referred to as the setting phase, during which a stable base is being established on the thoracic wall. After the setting phase, there is a 2:1 ratio of glenohumeral to scapulothoracic movement. Also, 180 degree is considered full elevation

What special test would be positive in an individual with a significant supraspinatus sprain (tear)?

empty can test

With a mallet finger, the athlete is not able to do what motion at the distal interphalangeal joint?

extend

Scaphoid Facture

fall on outstretched arm, pain in anatomical snuffbox

Shoulder impingement syndrome involves compression of all of the following structures EXCEPT the: long head of the biceps tendon subacromial bursa supraspinatus tendon glenoid labrum

glenoid labrum

An injury to the hook of which of the following bones can lead to numbness and tingling in the little and ring fingers?

hamate

Flexion and extension in the elbow occurs at which joint?

humeroulnar

Most elbow sprains are associated with what two mechanisms of injury?

hyperextension and valgus force

What is the technical name for "tennis elbow"?

lateral epicondylitis

The ulnar collateral ligament of the elbow is found on what side of the elbow?

medial

Carpal tunnel syndrome is associated with what nerve?

median

The part of the clavicle that is most commonly injured is the:

middle 1/3

Shoulder impingement syndrome often occurs due to repetitive:

overhead activities

carpal tunnel syndrome

painful condition resulting from compression of the median nerve within the carpal tunnel Symptoms and signs: The patient complains of pain, swelling, and difficulty moving the wrist. On examination, there is tenderness, swelling, and limited ROM. All patients having severe sprains should be referred to a physician for X-ray examination to determine possible fractures. A wrist sprain is often misdiagnosed as a scaphoid fracture. Management: Mild and moderate sprains should initially be given POLICE, splinting, and analgesics. It is desirable to have the patient start hand-strengthening exercises almost immediately after the injury has occurred. Taping for support can benefit healing and help prevent further injury

Which of the following best defines the term paresthesia?

pins and needles

Most elbow dislocations occur in which direction?

posterior

The annular ligament surrounds what structure?

radial head

Supination and pronation in the elbow occurs at which joint?

radioulnar

1. Chapter 23: Be able to label the bony, ligamentous, and muscular anatomy of the elbow, and forearm (as done in class)

-Bony Anatomy: humerus, the radius, and the ulna Ligamentous Anatomy: ulnar and radial collateral ligaments -Muscular Anatomy: biceps brachii, brachialis, and brachioradialis muscles -Forearm Anatomy: Two bones, the radius laterally and the ulna medially, form the forearm.

Jersey Finger

-Etiology: A rupture of the flexor digitorum profundus tendon from the distal phalanx because of the rapid extension of the finger while actively flexed. -Symptoms and signs: Because the tendon is no longer attached to the distal phalanx, the DIP joint cannot be flexed, and the finger is in an extended position. There is pain and point tenderness over the distal phalanx. -Management: If the tendon is not surgically repaired, the patient will never be able to flex the DIP joint, causing weakness in grip strength; otherwise, function will be relatively normal. If surgery is done, the course of rehabilitation requires about 12 weeks, and there is often poor gliding of the tendon with the possibility of rerupture.

Boutonniere Deformity

-Etiology: deformity is caused by a rupture of the extensor tendon dorsal to the middle phalanx. Trauma occurs to the tip of the finger, which forces the DIP joint into extension and the PIP joint into flexion. -Symptoms and signs: The patient complains of severe pain and an inability to extend the DIP joint. There is swelling, point tenderness, and an obvious deformity -Management: cold application followed by splinting of the PIP joint in extension. NOTE: If this condition is inadequately splinted, the classic boutonniere deformity will become permanent. Splinting is continued for 4-8 weeks.

Olecranon bursitis

-Etiology: lying between the end of the olecranon process and the skin, is the most frequently injured bursa in the elbow. Olecranon bursitis occurs from acute trauma or from septic infection that occasionally occurs following trauma. -Symptoms and Signs: With traumatic bursitis there is focal swelling on the posterior aspect of the elbow, often about the size of a golf ball with little or no significant pain except occasionally during flexion as the bursa gets stretched. Management: If the condition is acute, POLICE should be applied for at least 1 hour. P.O.L.I.C.E. stands for Protect, Optimal Load, Ice, Compress, Elevate.

elbow dislocation

-Etiology: occurs most often either by a fall on the outstretched hand with the elbow in a position of hyperextension or by a rotation while the elbow is in a flexed position. -Symptoms and signs: involve rupturing and tearing of most of the stabilizing ligamentous tissue, accompanied by profuse hemorrhage and swelling. There is severe pain and disability. -Management: apply cold and pressure immediately, then a sling, and to refer the patient to a physician for reduction. Only a physician should reduce an elbow dislocation. It should be reduced as soon as possible to prevent prolonged derangement of the soft tissue.

Mallet finger

-Etiology: sometimes called baseball finger or basketball finger. It is caused by a blow from an object that strikes the tip of an extended finger, forcing the distal phalanx into flexion that avulses the extensor tendon from its attachment of the dorsal surface of the distal phalanx. - Symptoms and signs: The patient complains of pain at the distal phalanx. X-ray examination may show a bony avulsion from the dorsal proximal distal phalanx. The patient is unable to extend the finger, carrying it at approximately a 30-degree angle. There is also point tenderness at the site of the injury, and the avulsed bone often can be palpated -Management: POLICE is used for the pain and swelling. If there is no fracture, the distal phalanx should immediately be splinted in a position of full extension for 6-8 weeks

1. Identify what each of these special tests, test for and what is a positive test. a. Hawkins-Kennedy Test b. AC joint compression test c. Drop Arm test d. Empty/full can test

-Hawkins-Kennedy Test:The Hawkins-Kennedy test involves horizontal adduction with forced internal rotation of the humerus, which produces impingement. A positive sign is indicated if the patient feels pain and reacts with a grimace -AC joint Compression Test: With the patient sitting, the glenohumeral joint is flexed to 90 degrees and horizontally adducted 15 degrees from the sagittal plane. The athletic trainer applies downward pressure over the distal forearm. if there is clicking within the glenohumeral joint, this may indicate an anteroposterior tear in the superior glenoid labrum, which is called a superior labrum anterior posterior (SLAP) lesion. -Drop Arm Test: The drop arm test is designed to determine tears of the rotator cuff, primarily of the supraspinatus muscle. The patient abducts the arm as far as possible and then slowly lowers it to 90 degrees. From this position the patient with a torn supraspinatus muscle will be unable to lower the arm farther with control. If the patient can hold the arm in a 90-degree position, pressure on the wrist will cause the arm to fall. -Empty Full Can Test: Full and empty can tests for supraspinatus muscle strength the patient brings the arm into 90 degrees of forward flexion and 30 degrees of horizontal abduction. For the full can test the arm is externally rotated as far as possible, thumb pointing upward. The athletic trainer then applies a downward pressure. In the empty can test the arm is internally rotated and the thumb points downward and downward pressure is applied. Weakness and pain can be detected in both of these positions although the full can position has been shown to have slightly better accuracy.

1. Identify the movements that take place at the humeroulnar joint and the radioulnar joint.

-Humeroulnar Joint: When the elbow is in flexion, the ulna slides forward until the coronoid process of the ulna stops in the floor of the coronoid fossa of the humerus. In extension, the ulna slides backward until the olecranon process of the ulna makes contact with the olecranon fossa of the humerus posteriorly. -Radioulnar joint: is the articulation of the lateral distal humerus and the capitulum. In flexion, the radius is in contact with the radial fossa of the distal humerus. The radio capitellar joint narrows with elbow valgus and forearm pronation. In full flexion, the radial head comes in contact with the radial fossa of the distal humerus.