Handbook of Upper Extremity Examination: A Practical Guide

Description

In addition to complementary radiographic imaging, the physical exam is an essential diagnostic element for the orthopedic surgeon. As such, learning to perform this exam thoroughly is of utmost importance to medical students, residents and interns on an orthopedic rotation and in later practice.  This practical text succinctly presents all of the necessary information regarding the physical examination of the upper extremity. The hand, wrist, elbow and shoulder are discussed in dedicated thematic sections, with each section comprised of three main chapters. The initial chapter describes the musculoskeletal anatomy and function of the joint, presenting the tests themselves along with the rationale for performing them. The second chapter presents the systematic examinations carried out in every case, and the third chapter describes examinations for specific conditions relating to the joint, including tendinopathies, osteoarthritis, neurological conditions, deformities, and more. Plentiful bullet points and color images throughout the text describe and illustrate each test and physical sign. Convenient and user-friendly, Handbook of Upper Extremity Examination is a valuable, portable guide to this all-important diagnostic tool for students and practitioners alike. Acknowledgements Introduction Contents About the Author Part I: The Hand 1: Introduction to the Hand 1.1 Some Interesting and Useful Facts 2: Anatomy and Function of the Hand 2.1 Bones and Joints 2.1.1 The Carpals, Metacarpals and Phalanges 2.1.1.1 Carpus 2.1.1.2 Scaphoid Instability Patterns 2.1.1.3 Lunate 2.1.1.4 Trapezium 2.1.1.5 Metacarpus 2.1.1.6 Phalanges 2.1.1.7 Sesamoid Bones 2.1.2 Surface Anatomy 2.2 Muscles and Tendons 2.2.1 Extrinsic Muscles 2.2.2.1 Flexor Muscles 2.2.2 How to Differentiate Between the Action of FDP and FDS 2.2.2.1 Flexor Digitorum Profundus 2.2.2.2 Flexor Digitorum Superficialis 2.2.2.3 Extensor Muscles 2.2.3 Intrinsic Muscles 2.2.4 An Additional Note on Testing Opposition of the Thumb 2.3 Nerve Supply of the Hand 2.3.1 Median Nerve 2.3.2 Ulnar Nerve 2.3.3 Radial Nerve 2.4 Testing for Motor Function of the Three Nerves That Supply the Hand 2.4.1 Median Nerve 2.4.2 Ulnar Nerve 2.4.3 Radial Nerve 2.5 Important Considerations in Carrying Out the Tests 2.5.1 Median Nerve 2.5.2 Ulnar Nerve 2.5.5.1 Abduction of the Fingers 2.5.5.2 Adduction of the Fingers 2.5.5.3 Adduction of the Thumb 2.5.3 Radial Nerve 2.5.5.1 Extension of the Wrist 2.5.5.2 Extension of the Fingers 2.5.5.3 Extension of the Thumb 2.6 Testing for Sensory Function of the Three Nerves That Supply the Hand 2.6.1 Testing for Vascular Function 3: A Systematic Examination of the Hand 3.1 Inspection 3.2 Range of Movement 3.3 Motor Power 3.3.1 Extrinsic 3.3.2 Intrinsic 3.4 Sensory Testing 3.5 Arterial Supply 3.5.1 Screening Tests for Motor and Sensory Function of the Hand in Less Than 20 Seconds 4: Examination for Specific Conditions of the Hand 4.1 Neurological 4.1.1 Carpal Tunnel Syndrome 4.1.2 Note: High Versus Low Median Nerve Lesions 4.1.3 Cubital Tunnel Syndrome 4.1.4 Radial Tunnel Syndrome 4.1.5 Ulnar Claw Hand 4.1.5.1 An Explanation of the Deformity The Difference Between Balanced and Unbalanced Paralysis Intrinsic Muscle Function 4.1.5.2 Explanation of the Ulnar Claw Hand Deformity 4.1.5.3 Summary The Ulnar Paradox 4.2 Tendinopathies 4.2.1 DeQuervain’s Tenosynovitis 4.2.2 Lateral Epicondylitis (Tennis Elbow) 4.2.3 Trigger Thumb and Trigger Finger 4.3 Deformities 4.3.1 Dupuytren’s Contracture/Disease 4.3.2 Boutonniere Deformity 4.3.3 Swan Neck Deformity 4.3.4 Mallet Finger 4.3.5 Instabilities 4.3.5.1 Scapholunate Instability: Watson Test 4.3.5.2 Ulnar Collateral Ligament of the Thumb (Gamekeeper’s Thumb) 4.4 Miscellaneous Tests and Signs 4.4.1 Bunnell Test for Intrinsic Tightness 4.4.2 Grind Test for OA of Base of Thumb 4.4.3 ‘OK’ Sign (Anterior Interosseous Nerve Syndrome) 4.4.4 Benediction Sign Part II: The Wrist 5: Anatomy and Function of the Wrist 5.1 The Distal Radioulnar Joint 5.2 The Radiocarpal Joint 5.3 The Midcarpal Joint 5.4 Grip Strength 5.4.1 Note: Acnestis 6: A Systematic Examination of the Wrist 6.1 Inspection and Palpation 6.2 Range of Movement 6.3 Testing for Motor Power 6.3.1 Muscles Involved 6.4 Radial Deviation (Abduction) 6.5 Ulnar Deviation (Adduction) 7: Examination for Specific Conditions of the Wrist 7.1 Instabilities – Classification 7.2 A: Carpal Instabilities 7.3 B: Distal Radioulnar Joint Instability 7.4 C: Longitudinal Instability 7.4.1 Watson (Scaphoid Shift) Test 7.5 Tendinopathies 7.5.1 A: DeQuervain’s Tenosynovitis 7.5.5.1 *Finkelstein’s Test 7.5.2 B: Intersection Syndrome 7.5.3 C: Extensor Tenosynovitis 7.5.4 D: Flexor Tendinitis 7.6 Osteoarthritis 7.7 Carpal Tunnel Syndrome 7.7.1 Symptoms 7.7.2 Physical Signs 7.8 Triangular Fibrocartilage Complex (TFCC) Disorders 7.9 Kienbock’s Disease Part III: The Elbow 8: Anatomy and Function of the Elbow 9: A Systematic Examination of the Elbow and Forearm 9.1 Inspection and Palpation 9.2 Range of Movement 9.2.1 Pronation Versus Supination 9.3 Testing for Motor Power 9.3.1 Muscles Involved 9.4 Sensory Testing 9.4.1 †Pronation Versus Supination 9.4.2 Triceps Function – An Instructive Case 9.4.2.1 *Eccentric Contraction 9.4.2.2 #Answer to Triceps Function Question 10: Examination for Specific Conditions of the Elbow 10.1 Lateral Epicondylitis (Tennis Elbow) 10.1.1 Symptoms 10.1.2 Signs 10.2 Medial Epicondylitis (Golfer’s Elbow) 10.2.1 Symptoms 10.2.2 Signs 10.3 Ulnar Nerve Lesions 10.4 Arthritis 10.4.1 A: Inflammatory 10.4.1.1 Gout and Pseudogout 10.4.1.2 Rheumatoid Arthritis 10.4.2 B: Osteoarthritis 10.4.2.1 Signs 10.5 Avulsion of the Distal Tendon of Biceps 10.5.1 Symptoms 10.5.2 Signs 10.6 Cubitus Valgus and Varus 10.6.1 Cubitus Valgus 10.6.2 Cubitus Varus 10.7 Miscellaneous 10.7.1 Olecranon Bursitis 10.7.2 Osteochondritis Dissecans 10.7.3 Loose Bodies in the Elbow Part IV: The Shoulder 11: Anatomy and Function of the Shoulder 11.1 The Joints of the Shoulder Girdle 11.1.1 A: The Glenohumeral Joint 11.1.2 B: Acromioclavicular Joint 11.1.3 C: Sternoclavicular Joint 11.1.4 D: Scapulothoracic Articulation 11.2 The Rotator Cuff 11.3 Shoulder Stability 11.3.1 Static Stabilisers 11.3.2 Dynamic Stabilisers 12: A Systematic Examination of the Shoulder 12.1 Inspection and Palpation 12.2 Range of Motion 12.3 Testing Motor Power 12.3.1 Rotator Cuff Muscles 12.3.2 Infraspinatus (External Rotator of Humerus) 12.3.3 Subscapularis (Internal Rotator of Humerus) 12.3.4 Teres Major (Shoulder Adduction – Limited Clinical Application) 12.4 Muscles Involved in Movements of the Shoulder 12.4.1 Flexion 12.4.2 Extension 12.4.3 Abduction 12.4.4 Adduction 12.4.5 External Rotation 12.4.6 Internal Rotation 12.5 Sensory Testing 13: Examination for Specific Conditions of the Shoulder 13.1 Note: Checklist 13.2 Rotator Cuff Lesions 13.3 Glenohumeral Instability 13.4 Special Tests 13.4.1 Anterior Instability 13.4.2 Posterior Instability 13.4.3 Inferior Instability 13.4.4 Multidirectional Instability 13.5 Labral Tears 13.5.1 Bankart Lesion 13.5.2 SLAP Tear 13.5.3 Posterior Labral Tears (Reverse Bankart Tear) 13.5.4 O’Brien’s Test 13.6 Biceps Tendon 13.6.1 Tendinitis 13.6.2 Rupture 13.6.3 Biceps Instability 13.6.3.1 Speed’s Test 13.6.3.2 Yergason’s Test 13.7 Impingement 13.8 Adhesive Capsulitis (Frozen Shoulder) 13.9 Acromioclavicular Joint (ACJ) 13.10 Sternoclavicular Joint (SCJ) 13.11 Neurological Conditions 13.11.1 A: Lesions of the Posterior Branch of the Axillary Nerve 13.11.2 B: Supraclavicular Nerve Injury (Sensory Only) 13.12 Scapular Winging 13.13 Checklist for Examination of the Shoulder Appendix Range of Motion – Upper Extremities AMA Table References Suggested Reading Index