EXAMINATION of Upper Extremities

Week3 -MSK

Name of Student Date Completed: 9/27/2022

Setting the stage of the encounter

1. Greetings and introduction (introduces self with the name and as a medical
student)
2. Disinfects hands prior to shaking hands with patient
3. Verifies identifying data & determines how the patient wishes to be addressed/Asks the preferred pronoun
4. Ensures the patients’ privacy and comfort
5. Sets the agenda (explains what will happen during the encounter
6. Asks permission to proceed

Examination of the upper extremities

1. Inspection:
Inspect the shoulder, shoulder girdle, and scapulae. Inspect the elbow by supporting the forearm and flexing the elbow to 70 degrees. Identify the epicondyles and
olecranon process. Inspect the wrist and hands at rest and with movement.
Inspect each of the fingers. Inspect each region as you move down the upper extremity.

2. Palpate (shoulder):

• The sternoclavicular joint and the clavicle (anteriorly)

• Trace the bony spine of the scapulae to the acromion (posteriorly)

• The acromioclavicular joint

• The coracoid process

• The greater tubercle

• The biceps tendon in the intertubercular groove (hook index finger halfwaybetween the coracoid and greater tubercle anteriorly)

3. Check shoulder range of motion: flexion, extension, abduction, adduction,internal rotation, and external rotation.

4. Perform “drop-arm” sign (arm abducted to 90 degrees and then lowered slowly)

5. Crossover test (acromioclavicular joint)

6. Apley scratch test (overall shoulder rotation)

7. Perform Empty Can Test (supraspinatus strength – arms internally rotated as inemptying a can; push down on arms)

8. Test infraspinatus strength (arms at sides, elbows flexed to 90 degrees withthumbs up; resist external rotation)

9. Neer’s impingement sign (Scapula stabilized with one hand and patient’s armpassively raised)

10. Hawkin’s impingement sign (Flex shoulder and then elbow so palm is down. One of student’s hands on top of SP’s forearm & other hand under
SP’s arm followed by passive internal rotation.)
 EXAMINATION of Upper Extremities
Week3 -MSK
11. Palpate (elbow):
- The olecranon process
- Proximal radius (radial head)
- Over the epicondyles

12. Assess elbow/forearm: flexion, extension, supination, and pronation (observe 1st& provide resistance 2nd)

13. Palpate (wrist):

- Distal radius and ulna

- Groove of the wrist joint

- Anatomical snuffbox

14. Assess wrist: flexion, extension, radial deviation, ulnar deviation (observe
withoutresistance)

15. Perform “Finkelstein’s test” (actually Eichhoff’s test as presented in Bates)

16. Test Tinel’s sign (tapping median nerve in carpal tunnel)

17. Test Phalen’s sign (compression of the median nerve)

18. Palpate (fingers):

1. Carpal bones, metacarpals, and phalanges

2. Metacarpophalangeal joints
3. Proximal interphalangeal joints
4. Distal interphalangeal joints

19. Observe finger flexion, extension, abduction, and adduction

20. Observe thumb flexion, extension, abduction, adduction, and opposition

(observe1st& provide resistance 2nd)

21. Assess hand grip strength

Closing the encounter

1. Asked the patient “Does he/she has any questions? Concerns?”

2. Informs about what happens next

3. Demonstrated attentiveness via non- verbal body language
4. Used appropriate language and avoided medical jargon
5. Demonstrated professional behavior
6. Asked the patient “Does he/she has any questions? Concerns?”
Narrative Feedback (Comment on the overall performance – communication skills, examination skills, technique)

Name of Evaluator