Upper ExtremityUpper Extremity

Part 2: Muscle Testing for the Part 2: Muscle Testing for the Shoulder, Elbow, Wrist, and HandShoulder, Elbow, Wrist, and Hand

Group 3Group 3

Meggan McLeod- 0300906Meggan McLeod- 0300906 Carly Lepp- 0296317Carly Lepp- 0296317 Katie Ferrell- 0294961Katie Ferrell- 0294961 Shayne Young- 0220662Shayne Young- 0220662 Luke Luke

The ShoulderThe Shoulder

The Yergasen TestThe Yergasen Test

The Yergasen Test The Yergasen Test The Yergason test is used to test the stability of the biceps The Yergason test is used to test the stability of the biceps

tendon within the bicipital groove.tendon within the bicipital groove. The patient is instructed to fully flex at the elbowThe patient is instructed to fully flex at the elbow The clinician grasps the elbow in one hand while holding the The clinician grasps the elbow in one hand while holding the

wrist in the other hand. wrist in the other hand. The stability of the biceps tendon is tested by externally The stability of the biceps tendon is tested by externally

rotating the patients arm as the patient resists. The elbow is rotating the patients arm as the patient resists. The elbow is pulled downward to prevent medial rotation and supination.pulled downward to prevent medial rotation and supination.

If the biceps tendon is unstable it will pop out of the bicipital If the biceps tendon is unstable it will pop out of the bicipital groove and the patient will experience pain. If stable, the groove and the patient will experience pain. If stable, the tendon will remain in place.tendon will remain in place.

The biceps tendon can become unstable from injury sustained The biceps tendon can become unstable from injury sustained by repetitive overhead arm movement resulting in biceps by repetitive overhead arm movement resulting in biceps tendonitistendonitis

The Drop Arm TestThe Drop Arm Test

The Drop Arm TestThe Drop Arm Test

Patient sits or stands with affected arm passively abducted to Patient sits or stands with affected arm passively abducted to 90` and is instructed to slowly lower arm.90` and is instructed to slowly lower arm.

If a rotator cuff injury is present (especially one involving If a rotator cuff injury is present (especially one involving supraspinatus) patient will not be able to lower arm slowly and supraspinatus) patient will not be able to lower arm slowly and smoothly; arm will drop to patients side.smoothly; arm will drop to patients side.

Other signs of rotator cuff injury may include pain in the Other signs of rotator cuff injury may include pain in the lateral aspect of the shoulder, weakness in the shoulder, and lateral aspect of the shoulder, weakness in the shoulder, and marked decrease in active range of motion.marked decrease in active range of motion.

Muscles affected in rotator cuff injuries include teres minor, Muscles affected in rotator cuff injuries include teres minor, subscapularis, supraspintus and infraspinatus. subscapularis, supraspintus and infraspinatus.

Common causes of rotator cuff injuries may include falling, Common causes of rotator cuff injuries may include falling, lifting and repetitive arm activities, especially those done lifting and repetitive arm activities, especially those done overhead. overhead.

The Apprehension TestThe Apprehension Test

The Apprehension TestThe Apprehension Test The apprehension test involves abducting and externally rotating The apprehension test involves abducting and externally rotating

the patients arm to a position where it might easily dislocate. the patients arm to a position where it might easily dislocate. If the shoulder is ready to dislocate the patient will have a If the shoulder is ready to dislocate the patient will have a

noticeable look of apprehension or alarm on his face and will noticeable look of apprehension or alarm on his face and will resist further motion.resist further motion.

It is a test for chronic shoulder dislocation, which commonly It is a test for chronic shoulder dislocation, which commonly occurs because of glenohumeral joint instability. occurs because of glenohumeral joint instability.

Shoulder Dislocation occurs when the head of the humerus slips Shoulder Dislocation occurs when the head of the humerus slips out of the glenoid fossa of the scapula. out of the glenoid fossa of the scapula.

Symptoms of shoulder dislocation are pain in the shoulder, arm Symptoms of shoulder dislocation are pain in the shoulder, arm externally rotated and abducted. The muscles involved in externally rotated and abducted. The muscles involved in glenohumeral joint instability are the rotator cuff muscles which glenohumeral joint instability are the rotator cuff muscles which are the supraspinatus, infraspinatus, teres minor, and are the supraspinatus, infraspinatus, teres minor, and subscapularis. subscapularis.

May also result in a tear, detachment, or attenuation of the May also result in a tear, detachment, or attenuation of the glenoid labrum cartilage glenoid labrum cartilage

The ElbowThe Elbow

The Ligaments TestThe Ligaments Test

The Ligaments TestThe Ligaments Test The elbow ligament test is used to assess the stability of the medial (ulnar) The elbow ligament test is used to assess the stability of the medial (ulnar)

and lateral (radial) collateral ligaments.and lateral (radial) collateral ligaments. The test involves the clinician stabilizing the elbow with the left hand and The test involves the clinician stabilizing the elbow with the left hand and

grabbing the wrist with the right, while the arm is slightly flexed (the grabbing the wrist with the right, while the arm is slightly flexed (the patient can be either sitting or standing for this test)patient can be either sitting or standing for this test)

The clinician than administers a small amount of force laterally with the The clinician than administers a small amount of force laterally with the right hand, producing a valgus stress on the medial side of the elbow joint.right hand, producing a valgus stress on the medial side of the elbow joint.

While the elbow is stressed the clinician will palpate the ulnar collateral While the elbow is stressed the clinician will palpate the ulnar collateral ligament with the left hand to assess if there is any or no gapping between ligament with the left hand to assess if there is any or no gapping between the humerus and ulna.the humerus and ulna.

The hand that is holding the elbow joint not only acts as a fulcrum but also The hand that is holding the elbow joint not only acts as a fulcrum but also used to palpate the joint for gapping.used to palpate the joint for gapping.

Once the ulnar collateral ligament is assessed the clinician can switch Once the ulnar collateral ligament is assessed the clinician can switch hands and assess the stability of the radial collateral ligament in the same hands and assess the stability of the radial collateral ligament in the same fashion.fashion.

The muscles involved with the elbow ligament tests include the wrist The muscles involved with the elbow ligament tests include the wrist flexors and extensors.flexors and extensors.

This injury can occur from tennis, baseball, javelin, shot-put, discus any This injury can occur from tennis, baseball, javelin, shot-put, discus any movement that will put stress on these ligaments.movement that will put stress on these ligaments.

The Tinel Sign TestThe Tinel Sign Test

The Tinel Sign TestThe Tinel Sign Test The Tinel Sign test is designed to elicit tenderness over a neuroma within The Tinel Sign test is designed to elicit tenderness over a neuroma within

the ulnar nerve.the ulnar nerve. It is used to detect neuroma in the ulnar nerve at the site of the elbow.It is used to detect neuroma in the ulnar nerve at the site of the elbow. The test involves the clinician tapping between the medial epicondyle and The test involves the clinician tapping between the medial epicondyle and

the olecranon process with his/her index finger while the patient is sitting the olecranon process with his/her index finger while the patient is sitting on an examination table.on an examination table.

If neuroma is present the patient will experience a tingling sensation down If neuroma is present the patient will experience a tingling sensation down the forearm to the 4the forearm to the 4thth and 5 and 5thth phalanges. phalanges.

The muscles that could be affected by the neuroma of the ulnar nerve The muscles that could be affected by the neuroma of the ulnar nerve includes the flexor carpi ulnaris muscle, and in some cases the palmaris includes the flexor carpi ulnaris muscle, and in some cases the palmaris longus.longus.

The type of injury that may cause neuroma in the ulnar nerve could be The type of injury that may cause neuroma in the ulnar nerve could be trauma to the posterior aspect of the elbow which includes falling on the trauma to the posterior aspect of the elbow which includes falling on the medial/posterior elbow, etc.medial/posterior elbow, etc.

The EndThe End