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MSK Week 2 > 2.2.2. SG Physical Exam > Flashcards

2.2.2. SG Physical Exam Flashcards

1
Q

5 key aspects of the history

A
  1. Overuse versus Traumatic mechanism of Injury
  2. Insidious versus acute onset of pain
  3. Presence or absence of swelling
  4. Past history or previous injury or surgery
  5. Presence of systemic symptoms like fever, weight loss, fatigue, night sweats, etc.
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2
Q

Inspection Steps

A

Begins with patient walking in. Look for changes in gait, arm swing, seating, and other observations can provide clues
Make sure to actually observe the skin of the patient
Also check to see if the joint appears swollen, which is often caused by joint effusion

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3
Q

What are joint effusions?

A

Joint effusions are collections of fluid inside the joint capsule, which is like the plastic bag around the joint. Can vary from obvious redness to swelling to far more subtle

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4
Q

First step of palpation exam

A

Wash hands

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5
Q

Last step of palpation exam

A

Wash hands

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6
Q

Two things you need to do when doing palpation portion of exam

A
  1. Need to know the anatomy

2. Check temperature

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7
Q

What is the warm cold warm test?

A
  1. Place back of hand on thigh (warm)
  2. Place back of hand on kneecap or just medially (cold)
  3. Place back of hand on lateral calf (warm)
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8
Q

What does Warm-Cold-Warm mean for the Warm cold warm test?

A

Warm-Cold-Warm means no irritation or inflammation in the joint

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9
Q

What does Warm-Warm-Warm mean for the Warm cold warm test?

A

Warm-warm-warm means something is irritating the joint. Not normal, could be chronic or acute

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10
Q

What does Warm-Hot-Warm mean for the Warm cold warm test?

A

Warm-hot-warm almost always means joint infection, accompanied by swelling, redness

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11
Q

Two types of ROM

A

Active vs. Passive

Active is how much they can do on their own, passive is how much you can do for them

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12
Q

What are we looking for with active ROM testing?

A

Ask patient to describe any pain during that motion, watch for catching and locking and look for any changes bilaterally (usually the same on both sides)

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13
Q

Two considerations for the strength-neurological testing

A
  1. Place limb so that the muscle being tested is activated or contracted and then put force on it with the patient resisting in the opposite way
  2. When testing nerve innervations, use muscles that are weaker to test if there really is a problem, don’t use muscles that even at a “weak” state are still very strong
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14
Q

Steps to the Physical Exam

A 
Inspection
Palpation
ROM
Strength
Special Tests
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15
Q

First thing you do when a patient complains of back pain

A

Check the spine

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16
Q

How does cervical innervation differ from lumbar/thoracic vertebrae?

A

Cervical nerve roots named for the vertebrae below

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17
Q

Where does the C5 nerve root exit out of?

A

Between the C4 and C5 vertebrae

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18
Q

C5 nerve Motor

A

Deltoid, Biceps

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19
Q

C5 nerve Reflex

A

Biceps

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20
Q

C5 nerve Sensation

A

Lateral Arm

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21
Q

C6 nerve motor

A

Wrist Extensors, biceps

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22
Q

C6 nerve reflex

A

Brachioradialis

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23
Q

C6 nerve sensation

A

Thumb/index finger

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24
Q

C7 nerve motor

A

Triceps, wrist flexors

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25
Q

C7 nerve reflex

A

Triceps

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26
Q

C7 nerve sensation

A

Long finger

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27
Q

C8 nerve motor

A

Finger Flexors

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28
Q

C8 nerve reflex

A

None

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29
Q

C8 nerve sensation

A

Ulnar forearm, palmar pinky

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30
Q

T1 nerve motor

A

Finger Abduction

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31
Q

T1 nerve reflex

A

None

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32
Q

T1 nerve sensation

A

Medial elbow

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33
Q

Nickname for the nerve C5

A

Blocker

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34
Q

Nickname for the nerve C6

A

Beggar

35
Q

Nickname for the nerve C7

A

Kisser

36
Q

Nickname for the nerve C8

A

Grabber

37
Q

Nickname for the nerve T1

A

Spock

38
Q

Examination of Cervical Thoracic Spine - Inspection

A
  1. Loss of cervical lordosis
  2. Thoracic Kyphosis
  3. Skin changes (rash erythema, etc)
39
Q

Examination of Cervical Thoracic Spine - Palpation

A

Spinous processes
Trapezius muscles
SCM muscles

40
Q

Examination of Cervical Thoracic Spine - ROM

A

Cervical Flexion
Cervical Extension
Rotation, left and right
Lateral bending left and right

41
Q

Examination of Cervical Thoracic Spine - Strength/Neurovascular

A

C5 - T1

42
Q

Examination of Cervical Thoracic Spine - Special Tests

A

Spurling’s Maneuver

43
Q

Sperling’s Maneuver

A
  1. Have patient laterally bend and rotate to affected side
  2. Apply slight axial loading pressure to top of head
  3. If not painful, have patient repeat the lateral bending and rotation but add the extension as well. Instruct patient to try and look in the back pocket of your jeans
  4. Again apply slight axial loading pressure
  5. If the patient experiences pain in the contralateral (opposite side) of the neck or upper extremity, then they have a “Reverse Spurling Sign” caused by the distraction of a cervical nerve root
44
Q

Caudal equina syndrome

A

Compression of the terminal nerve roots in the spine

45
Q

Inspection for L Spine

A

Lumbar lordosis
Thoracic Kyphosis
Scoliosis (More than 10 degrees of curvature)
Skin changes (rash, erythema, etc)

46
Q

Palpation part of L Spine exam

A

Spinous processes
Paraspinous muscles
Sacroiliac joints (SI joints)

47
Q

ROM portion of L spine exam

A

Spine Flexion

Spine Extension

48
Q

What stress does spine flexion cause?

A

Spine flexion causes anterior compression between vertebral bodies which causes nucleus pulposus, the goo inside of the intervertebral discs, to get pushed posteriorly. Normal discs don’t do this, but a herniated or ruptured one will, and it will press on the nerve roots with this bulge causing pain

49
Q

Complaint common to flexion abnormalities

A

Unbearable to bend over and tie my shoes

50
Q

What stress does spine etension cause

A

Compresses posterior elements of the spine
Normal posterior elements leave enough room between them for the nerve roots to get out unscathed, but abnormal elements like fractures, arthritis or congenital stenosis can, under extension, cause nerve root compression

51
Q

Complaint common to extension abnormalities

A

Patient will want to be bent forward

52
Q

Palpation portion of L spine exam

A

Need to distinguish boney vs. non-bony pain (spinous processes vs. paraspinal muscles). Bony means xray, nonbony needs time and fitness

53
Q

What do we order and what are we worried about with someone who has history of cancer

A

Recurrent cancer, order xrays of the spine

54
Q

What do we order and what are we worried about with someone who has unrelenting nocturnal pain

A

Cancer or osteoid osteoma. Order xrays for the cancer and CT for the osteoid

55
Q

What do we order and what are we worried about with someone who has unclear injury mechanism

A

Cancer or an infection. Xrays for the cancer and labs for the infection

56
Q

What do we order and what are we worried about with someone who has constitutional changes like fever, weight loss or night sweats?

A

Cancer, infection, or rheumatologic disease. Xrays for cancer, labs for the others

57
Q

What do we order and what are we worried about with someone who is over the age of 50?

A

Cancer, do xrays

58
Q

What do we order and what are we worried about with someone who is younger than 18?

A

Infection, stressfracture, discitis. Labs for infection, Xrays for others

59
Q

What do we order and what are we worried about with someone who has a history of trauma

A

Fracture or Nerve root compression, just need xrays

60
Q

What do we order and what are we worried about with someone who has numbness or sensation change in dermatomal distribution?

A

Cauda Equina Syndrome. Get that person an MRI within 2 hours and neurosurgery TODAY

61
Q

During the exam, if a patient has neurological deficits, what are we worried about?

A

Nerve root compression. Do Xrays and follow closely for exam progression

62
Q

During the exam, if a patient has saddle sensation changes in the groin or upper thigh, what are we worried about?

A

Cauda Equina - MRI within 2 hours and neurosurgery TODAY

63
Q

L4 Motor

A

Tibialis Anterior

64
Q

L4 Reflex

A

Quads

65
Q

L4 Sensation

A

Medial Foot ankle

66
Q

L5 Motor

A

Hallucis longus

67
Q

L5 Reflex

A

None

68
Q

L5 Sensation

A

Dorsal ankle/foot

69
Q

S-1 Motor

A

Peroneals

70
Q

S1 Reflex

A

Achilles

71
Q

S1 Sensation

A

Lateral foot/ankle

72
Q

Strength tests for lower spine

A

Ankle inversion and dorsiflexion for L4

Great toe dorsiflexion for L5

Ankle Eversion for S1

73
Q

Reflex tests for lower spine

A

Patellar reflex for L4

Achilles reflex for S1

74
Q

Sensation tests for lower spine

A

Medial Leg/ankle for L4

Dorsum of foot for L5

Lateral leg/ankle for S1

75
Q

Special Tests for the lower spine

A

Straight leg raise
Patrick’s Faber Test
Single Leg Stork

76
Q

Straight leg raise

A
  1. Passively elevates patients leg with knee locked
    2a. Pain radiating into the leg at 30 degrees or less suggests neural tension
    2b. Pain in the calf at less than 30 degrees also is suggestive of neural tension
77
Q

Patrick’s FABER Test

A

Flexion, ABduction, External Rotation - Looking for pain at SI joint or pain in hip

78
Q

Single Leg Stork Test

A
  1. Patient stands on one leg and extends spine (leans back)
  2. Pain in lumbar region on stance suggests spondylolysis
  3. Repeat on opposite leg
79
Q

Spondylolysis

A

Stress fracture of pars intraarticularis

80
Q

Lumbago

A

Low back pain

81
Q

S1, 2 - “buckle my shoe”

A

Achilles reflex

82
Q

L3, 4 - “kick the door”

A

Patellar reflex

83
Q

C5, 6 - “pick up sticks”

A

Biceps reflex

84
Q

C7, 8 - “lay them straight”

A

Triceps reflex

MSK Week 2 (28 decks)

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