Handbook of Upper Extremity Examination: A Practical Guide

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