Exam Upper Extremity · Abduction/adduction ! Flexion/extension . Range of Motion Screening ! Elbow...
Transcript of Exam Upper Extremity · Abduction/adduction ! Flexion/extension . Range of Motion Screening ! Elbow...
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Exam Upper Extremity RANCE MCCLAIN, DO, FACOFP, FAOASM
PROFESSOR & ASSOCIATE DEAN, CLINICAL SCIENCES
WILLIAM CAREY UNIVERSITY COLLEGE OF OSTEOPATHIC MEDICINE
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Learning Objectives
1. Obtain a focused history relevant to upper extremity
2. Apply principles of the quick orthopedic screen to the preparticipation examination of athletes
3. Understand common abnormalities identified in the upper extremities of athletes
4. Identify the appropriate specialized testing of the upper extremity
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History
! Most athletes have experienced a muscle, bone or joint injury
! Usually do not lead to chronic conditions or long-term adverse effects
! Questions on the PPE are designed to identify musculoskeletal (MS) problems that may have long term adverse effects
! Positive responses should be followed up with thorough examination of the area for physical limitations
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History
! Missed practice or game due to MS injury
! Fractures or dislocations
! Stress fracture
! Injury that required: X-rays, MRI, CT, surgery, injection, rehabilitation, physical therapy, brace, cast or crutches
! Do you regularly use a brace or assistive device
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History
! Other:
! Hand dominance
! Discomfort or pain
! Task associated problem or limitation
! Associated signs or symptoms
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Most common high school sports
Female
Track & Field (outdoor) 472,939
Basketball 433,120
Volleyball 420,208
Soccer 371,532
Softball (fast pitch) 362,488
Cross Country 214,369
Tennis 181,116
Swimming & Diving 163,992
Competitive Spirit Squads 116,508
Lacrosse 77,258
2012–2013
Sex and sport Participants
Male
Football (11-player) 1,086,627
Track & Field (outdoor) 580,672
Basketball 538,676
Baseball 474,791
Soccer 410,982
Wrestling 270,163
Cross Country 249,200
Tennis 157,247
Golf 152,584
Swimming & Diving 138,177
2012–2013
Sex and sport Participants
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Common upper extremity injuries
! Football – Glenohumeral instability, wrist and hand ligament damage
! Track and field – Shoulder and elbow (javelin), wrist (shot put)
! Basketball – Rotator cuff impingement, finger injuries
! Soccer – AC joint sprain
! Baseball – Medial elbow (Ulnar collateral ligament)
! Golf – Medial epicondylitis
! Tennis – Lateral epicondylitis
! Swimming – Rotator cuff impingement
! Lacrosse – Shoulder injuries
! Gymnastics – Glenohumeral instability, wrist and hand ligament damage
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Visual Examination
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Palpation
! Don’t forget you are osteopathic! Think TART
! Muscle tension or flaccidity
! Fascial strain patterning
! Muscle development
! Tenderness at key areas
! Peri-scapular tenderpoints
! Rotator cuff impingement
! Biceps tendon
! Medial and lateral elbow
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Range of Motion Screening
! Cervical motion
! Flexion/extension, rotation and sidebending
! Shoulder shrug
! Glenohumeral joint
! Internal/external rotation
! Abduction/adduction
! Flexion/extension
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Range of Motion Screening
! Elbow joint
! Flexion/extension
! Pronation/supination
! Wrist/Hand
! Open and close fist
! Circumduction hand
! With all ROM look at quality of motion in addition to quantity
! Any deficiencies need assessed with passive ROM evaluation and specialized testing
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Specialized testing
! Rotator Cuff strength/tear
! Empty can test/Full can test
! Lift off test
! Resisted external rotation
! Impingement
! Hawkins
! Neer
! Palpation of subacromial bursa and RTC insertion
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Empty can/full can test
ThePainSource.com
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Lift off test
quizlet.com
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Resisted external rotation
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Hawkins
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Neer
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Subacromial bursa/RTC tendon
http://www.vwmin.org/
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Specialized testing
! Glenohumeral Instability
! Load and shift test
! Sulcus sign
! Apprehension test
! Relocation test
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Load and shift test
vimeo.com
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Sulcus sign
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Apprehension test
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Relocation test
http://eikon.serveftp.net/
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Specialized testing
! AC joint
! Cross arm test
! Glenoid labrum pathology
! O’Brien’s test
! Biceps tendinitis
! Speed test
! Yergason’s test
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Cross arm test
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O’Brien’s test
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Speed test
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Yergason’s test
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Specialized testing
! Elbow Joint
! Varus/valgus stress test
! Medial and lateral epicondylitis
! Ulnar nerve entrapment
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Varus/valgus stress testing
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Medial and lateral epicondylitis
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Ulnar nerve entrapment
http://eikon.serveftp.net/
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Specialized testing
! Wrist and hand
! Tinel sign
! Phalen’s test
! Finkelstein’s test
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Tinel sign
http://www.geronguide.com/
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Phalen’s test
http://www.geronguide.com/
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Finkelstein’s test
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Clearance decisions
! Simplified criteria for return to play or clearance
! Normal kinematics
! Symptom free
! Strength >90% of opposite side
! Completion of sport-specific exercises without symptoms
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Thank You
Questions?