Physical Examination 210: Upper Extremity

The examination of the upper extremity from the biceps tendon to the wrist as a chiropractor performs and documents it: the consultation and history and the purposes of the examination; the upper extremity deep tendon reflexes — biceps, brachioradialis and triceps — on the NINDS 0–5 scale; long head of biceps tendinopathy with the Uppercut, Speed's, Yergason's, Ludington's and Lippman's tests; distal biceps tendon rupture with the Popeye and reverse Popeye signs and the Hook test; medial elbow instability of the ulnar collateral ligament with valgus stress, moving valgus stress and the milking maneuvers; posterolateral rotatory instability with the posterolateral rotary drawer, chair push-up, prone push-up, table-top relocation and varus stress tests; lateral epicondylitis with Mill's, Cozen's, Maudsley's and Chair tests; medial epicondylitis; intersection syndrome; De Quervain tenosynovitis with Eichhoff's and Finkelstein's tests; and the clinical integration of findings into diagnosis, prognosis, patient education, activity modification, rehabilitation and return to sport.

Donald Ozello, DC, CCN, CCSM — sports chiropractor, founder of Championship Chiropractic in Las Vegas and CCEDseminars faculty for the Sports Injuries, Rehabilitation and Adjusting & Manual Therapy series — teaches the 2-hour course. It is written for Doctors of Chiropractic who want a repeatable, documentable arm examination: the reflex grades that belong in the chart, each condition's clinical picture, and the named tests that confirm or exclude it.

By where it hurts, what provokes it and which tests reproduce it, which is what the course teaches condition by condition. Tennis elbow (lateral epicondylitis) is an overuse condition that declares itself as tenderness at the outside of the elbow, grip weakness and pain with resisted wrist extension, and the Mill's, Cozen's, Maudsley's and Chair tests confirm it; golfer's or climber's elbow (medial epicondylitis) is the mirror image on the inside of the elbow with its own test. A ligament problem is different: the ulnar collateral ligament on the inside of the elbow, strained by repetitive valgus stress in throwing athletes, shows itself on the valgus stress test, the moving valgus stress test and the milking maneuvers, while instability on the outside — posterolateral rotatory instability — shows itself on the posterolateral rotary drawer, chair push-up, prone push-up and table-top relocation tests. Higher up, the biceps tendon has its own set: the Uppercut, Speed's, Yergason's, Ludington's and Lippman's tests for tendinopathy of the long head, and the Hook test and the Popeye signs for a rupture at the elbow. On the thumb side of the wrist, De Quervain tenosynovitis of the first dorsal compartment is confirmed with Eichhoff's and Finkelstein's tests, and intersection syndrome, where the first and second dorsal compartments cross, is separated from it by its location, crepitus and swelling. The pattern across history, palpation and the tests makes the call.

Physical Examination 210 is online and on-demand: you start immediately after checkout and work at your own pace. When you pass the post-course assessment your completion is recorded electronically and your certificate is issued right away. CCEDseminars is PACE Provider #34015544 and the course is co-sponsored by Texas Chiropractic College; completions are reported to CE Broker for the states served. Approved states are listed at the bottom of this page, and confirming your own board's requirements remains your responsibility.

Dr. Ozello's Physical Examination 209: Shoulder Complex is the other half of the upper quarter — 209 is the shoulder, 210 is the arm from the biceps tendon to the wrist — and his 205: Cervical Spine clears the neck first; the three together are 6 CE hours, where the automatic 10% multi-course discount starts ($108 instead of $120). His Adjusting & Manual Therapy 205: Upper Extremity Techniques is the treatment half of this course. Dr. O'Hara's Physical Examination 202: Neck and Upper Extremities approaches the same region from the injury-pattern and imaging side, and many clinicians take both. New Physical Examination titles are released as faculty complete them; the current list with pricing lives on the category page.