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: Upper Extremities

Comprehensive OMT reference hub, interactive cheat sheets, and board review notes for COMLEX Level 1, 2-CE, and 3.

22 Review Modules Master OMT Practical Guide OMM Diagnostic Solver Autonomic & Chapman Map
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Key Takeaway

Understand elbow carrying angle rules: Cubitus valgus (>15°) causes medial ulnar deviation and lateral wrist adduction. Forearm pronation glides the radial head POSTERIORLY (FOOSH injury). Master thoracic outlet test maneuvers (Adson, Military Brace, Wright) and Spencer 7-step sequence.

1. Shoulder Complex Anatomy & Pathologies

The shoulder girdle comprises four joints: Glenohumeral (GH), Acromioclavicular (AC), Sternoclavicular (SC), and Scapulothoracic. Rotator cuff stability and clavicular motion are prime COMLEX targets.

Rotator Cuff Muscle (SITS)Primary ActionDiagnostic Clinical Test
SupraspinatusAbduction (first 0°–15°)Empty Can Test (Jobe Test) / Hawkins-Kennedy / Neer Test
InfraspinatusExternal RotationExternal Rotation Lag Sign
Teres MinorExternal Rotation & AdductionHornblower Sign
SubscapularisInternal RotationGerber Lift-Off Test / Belly Press Test

7-Step Spencer Technique for Adhesive Capsulitis

Frozen shoulder (Adhesive Capsulitis) presents with severe global loss of motion (External Rotation > Abduction > Internal Rotation). Treat using the Spencer Technique sequence:

  1. Step 1: Extension (Engage extension barrier with muscle energy).
  2. Step 2: Flexion (Engage flexion barrier with muscle energy).
  3. Step 3: Circumduction with Compression (Arm flexed 90°, small clockwise/counterclockwise circles).
  4. Step 4: Circumduction with Traction (Arm extended with axial traction).
  5. Step 5: Abduction / Lateral Traction (Abduct arm to barrier).
  6. Step 6: Internal Rotation (Hand behind back, push elbow anteriorly).
  7. Step 7: Lymphatic Pump / Joint Distraction (Pumping motion at GH joint).

2. Elbow & Radial Head Biomechanics

The humeroulnar joint determines the carrying angle, while the radiocapitellar joint dictates pronation/supination mechanics.

Parameter / DeformityCarrying AngleUlnar MotionWrist Motion Coupling
Cubitus Valgus ('Knock-elbow')Increased (> 15°)Medial Ulnar DeviationLateral Wrist Adduction
Cubitus Varus ('Gunstock')Decreased (< 5°)Lateral Ulnar DeviationMedial Wrist Abduction

Radial Head Mechanics & FOOSH Injury

RADIAL HEAD MECHANICS: - Forearm Pronation $\rightarrow$ Radial head glides POSTERIORLY. - Forearm Supination $\rightarrow$ Radial head glides ANTERIORLY. - FOOSH Injury (Fall On Outstretched Hand in Pronation): Forces the radial head POSTERIORLY. Patient presents with restricted supination and restricted anterior glide.

3. Thoracic Outlet Syndrome & Peripheral Entrapments

Entrapment SitePathology / Compressed StructureDiagnostic ManeuverClinical Presentation
Scalene TriangleBrachial plexus & Subclavian Artery between Anterior/Middle Scalenes.Adson Test: Extend neck, turn head TOWARD affected side, take deep breath $\rightarrow$ Radial pulse disappears.Paresthesias along C8–T1; arm fatigue; radial pulse dampening.
Costoclavicular SpaceCompression between 1st rib and clavicle.Military Brace Test: Depress and retract shoulders back and down.Shoulder heaviness when carrying heavy backpack.
Retro-Pectoralis MinorCompression beneath Pectoralis Minor insertion at coracoid process.Wright Test (Hyperabduction): Hyperabduct arm overhead.Paresthesias when working with arms overhead (painters, electricians).
Carpal TunnelMedian nerve under Flexor Retinaculum.Phalen Test (wrist flexion 60s) & Tinel Sign (percussion over wrist).Numbness in thumb, index, long fingers; thenar atrophy.
Cubital TunnelUlnar nerve at medial epicondyle.Elbow Flexion Test & Tinel Sign at elbow.Numbness in 4th/5th digits; weak grip; hypothenar atrophy.

4. COMLEX Practice Knowledge Check

Practice Drill
Q1: A 12-year-old boy falls on his hand with his arm pronated. Elbow exam shows marked pain over the anterior elbow. The right radial head resists anterior translation. What is the diagnosis?
Practice Drill
Q2: A patient has a carrying angle of 22°. What wrist dysfunction is associated with this condition?

Source

Based on the publicly available table of contents and topic organization of OMM Review: A Comprehensive Review of Osteopathic Medicine. All notes are original; no copyrighted text, figures, or full source material is included.