307 Exam 5 Mod 9-10 Flashcards
When a skeletal muscle contracts to cause a movement, the relatively stationary end of attachment of the muscle is termed what?
The insertion.
What are the articulate structures?
Joint capsule, synovium, synovial fluid, articulate cartilage, infra-articulate ligaments, juxta-articulate bone.
What are the extra-articulate structures?
Periarticular ligaments, tendons, bursar, muscle, fascia, bone, nerves, overlying skin
What do ligaments connect?
Bone to bone
What do tendons do?
Muscle to bone connection
What is cartilage?
Collagen matrix, facilitates smooth painless movement of joint.
What is bursae ?
Pouches of synovial fluid.
Cushions movement of tendons and muscles over bone/other joint structures.
What are synovial joints?
Freely moveable
Covered by articulate cartilage
Has a synovial cavity and a joint capsule
What type of joints are the knee and shoulders?
Synovial joints
What type of joints are in the vertebral column?
Cartilaginous joints
What type of joints are the suture of the skull?
Fibrous joints
What are 3 structure types of synovial joints? And examples of them
Spheroidal (ball and socket)
- shoulder and hip
Hinge - interphalangeal (fingers);foot; elbow.
Condylar- knee, Tmj joint
Where would you find bursae
In areas where tendons or muscles run against bone, ligament, or other tendons or muscles.
The leading cause of complaints in heath care visits are related to what?
Musculoskeletal complaints
What equipment do you need for joint examination?
Tape measure
Goniometer
Skin marking pen
Weak thumb abduction and decreased sensation of index finger, 5th finger or dorsal web space between thumb and index would indicate what?
Possible carpal tunnel syndrome
What are myalgias?
Generalized “aches and pains” within muscles
What are arthralgias?
Generalized “aches and pains” within joint without evidence of arthritis
Lateral hip pain located near the greater tronchanter would suggest what?
Trochanteric bursitis
progressive, systemic joint pain suggests what?
Rheumatoid arthritis
Radiation of pain from low back into leg is seen in what?
Sciatica
Leg pain that resolves with rest and or lumbar forward flexion suggests what?
Spinal stenosis
Radicular pain (radiating along a dermatome) may be from what?
Spinal nerve compression, most commonly C7 or C6
Redness over a tender joint suggests what?
Septic (infection)
Gouty arthritis
Rheumatoid arthritis
What are fasciculations
Fine tremors of the muscles.
Fasciculations with atrophy and muscle weakness suggest what?
Disease of the peripheral motor unit
How would you assess muscle tone?
Feeling the muscle’s resistance to passive stretch.
What is hypotonia?
Decreased muscle tone.
What is paresis
Impaired strength or weakness
What is plegia?
Paralysis. Absence of strength.
What is hemiparesis?
Weakness of one half of the body
What is hemiplegia?
Paralysis of one half of the body
Scale for muscle grading is 0-5 where 0 is no contraction and 5 is normal muscle strength. T/f
True
If you are testing the muscle strength of a patient and they can actively move against gravity but not against resistance what is the score?
3
If joint trauma is present in a patient, what should you do before attempting movement for muscle testing?
Ask about an X-ray
Trauma that results in stretching or tearing of a ligament is called what?
Sprain
Stretching that results in the tearing of a tendon is called what?
STrain. (T= tendon)
What 3 ROM maneuvers are done for the TMJ?
Ask patient to demonstrate opening and closing, profusion and retraction, and lateral side to side motions.
Normally as the mouth opens wide, how many fingers can be inserted between incisors?
3 fingers is notmal
What is the glenohumeral joint?
Shoulder joint. Ball and socket. Where the arm goes into the shoulder
What is the shoulder girdle compromised of?
4 joints
-AC joint, Sternoclavicular joint, glenohumeral joint, scapulothoracic joint
3 large bones
- humerus, clavicle, scapula
3 principal muscle groups.
-Sits muscles (rotator cuff), axioscapular group (attaches trunk to scapula), and the axiohumeral group (attaches humerus to trunk)
If you had a patient standing and instructed them to “raise your arms in front of you and overhead” what movement are you examining?
And what muscles are working?
Flexion of the shoulder
Anterior deltoid, pec major, coracobrachialis, biceps brachii
When standing and arms are at your side, what is the shoulder movement that raises your arms behind you? And what principal muscles are used?
Shoulder hyperextension
Lats, teres major,post deltoid, triceps.
“Raise your arms out to the side and overhead”
What movement is happening in the shoulder?
Abduction
“Place one hand behind your back and touch your shoulder blade”
What shoulder movement is happening?
Internal rotation.
“Raise your arm to shoulder level, bend your elbow and rotate your forearm toward the ceiling”
What shoulder movement is happening?
External rotation
What is the special maneuver for examining the shoulders AC joint?
Sometimes called a crossover test, palpate and compare both joints for swelling or tenderness. Adduct the patients arm across the chest.
Pain with adduction is positive for a rotator cuff tear.
What does it indicate if there is pain during the Apley scratch test?
It suggests rotator cuff disorder or adhesive capsulitis
What does a positive result for the “drop arm” test indicate?
Rotator cuff tear if the patient cannot hold arm fully abducted at shoulder level.
Weakness during the “empty can test” is a positive test for what?
Supraspinatus rotator cuff tear
What is the pain provocation test?
Painful arc test.
Fully adduct the patients arm from 0-180 degrees.
Shoulder pain from 60-120 degrees is a positive test for subacromial impingement/rotator cuff tendinitis disorder.
What are the SITS muscles that form the rotator cuff
Supraspinatus
Infraspinatus
Teres minor
Subscapularis
What are the 4 regions of the brain
Cerebrum
Diencephalon
Brainstem
Cerebellum
What is the frontal lobe functions
Higher intellectual function
Speech production
Ipsilateral motor control (normal motor control pathway)
What is the parietal lobe responsible for
Primary somatic sensory area
(Detecting touch, proprioception, pain and temperature)
The occipital lobe is involved with what?
Vision and visual perception
The temporal lobe is involved with what?
Hearing
Memory
Speech perception
Brocas area is responsible for what?
Motor speech
What is the cerebellum involved with?
Coordination
The brainstem consists of what 3 parts
Midbrain
Pons
Medulla oblongata
What part of the brain affects the endocrine system and govern emotional behaviors like anger and sexual drive?
The hypothalamus
What is included in the Central nervous system
Brain and spinal cord
Most lumbar punctures are performed where to avoid injury to the spinal cord?
L3-L4 or L4-L5 intervetebral spaces
Where is the Cauda equina located?
L1-L2
The peripheral nervous system consists of what?
Cranial nerves and peripheral nerves.
What are the 3 principal motor pathways
Corticospinal tract
Basal ganglia system
Cerebella’s system
What motor pathway system controls voluntary movement and integrate skilled, complicated or delicate movements?
Corticospinal (pyramidal) tract
Damage to what motor pathway system would produce changes in muscle tone, disturbances in posture and gait, a slowness or lack of spontaneity and automatic movements (bradykinesia) and various involuntary movements?
Basal ganglia system
Sensory pathways help regulate what?
Internal autonomic functions like blood pressure, heart rate and respiration
What are the deep tendon reflexes and muscle stretch reflexes with their corresponding spinal segment?
Ankle. (Achilles)- sacral 1
Knee. (Patellar) - Lumbar 2,3,4
Supinator (brachioradialis) - Cervical 5,6
Biceps reflex. - cervical 5,6
Triceps reflex. - cervical 6,7
What are the cutaneous stimulation reflexes and their corresponding spinal segment?
Abdominal upper. - Thoracic 8,9,10
Abdominal lower. - thoracic 10,11,12
Cremasteric reflex - Lumbar 1,2
Plantar responses - Lumbar 5, sacral 1
Anal reflex - sacral 2,3,4
What are two of the most common neurological disorder symptoms?
Headache and dizziness
What is the Pound acronym and what is it for?
Pulsatile or throbbing
One day duration or 4-72 hrs untreated
Unilateral
Nausea or vomiting
Disabling
If 3/5 are present it is likely a migraine especially is preceded by aura or prodrome
What are reversible causes of restless leg syndrome?
Iron deficiency, renal disease, pregnancy
Tremors that can appear in patients with hyperthyroidism, anxiety or fatigue are called what?
Postural (action) tremors
Slow, fine, pull rolling tremors that can be seen with patients that have Parkinson’s disease are Called what?
Resting (static) tremors
Tremors that can occurs in patients with multiple sclerosis are called what?
Intention tremors
Dystonia and athetosis movements are similar in that they are slow, twisted and writhing. How are they different
Dystonia movements appear in larger body parts such as the neck or trunk
Athetosis appears in distal extremities and the face muscles.
5 Important areas of examination within a neurological screening are
Mental status
Cranial nerves
Sensory system
Motor system
Reflexes.
If findings are abnormal with the neurological screening you should group them into pattern of what?
Central or peripheral disorders
Glasgow coma scale scores less than 10 are concerning for severe brain injury? T/f
False.
Scores of 3-8 considered coma
15= fully functioning
3= lowest possible score. No response in any area
Glasgow coma scale assesses what 3 activities?
Opens eyes-
Motor response
Verbal response
Which assessment would need to be performed to assess the patients position sense and coordination of movement?
Heel to shin
What does Romberg test assess?
Position sense, cerebella’s function, balance and coordination
What is a positive babinski test
Flaring if toes when some of foot is stroked
What is abduction of upper extremity entail?
Asking patient to move upper extremity away from the body 180 degrees
What cranial nerve is olfactory?
1
What is graphetesia
Sensation of touch or tactile stimulation
When assessing the pronator drift how many seconds do you observe the patients arm for a change in position while the patient has their eyes closed
20-30 seconds
What deep tendon reflexes involve stretching biceps to access C5&C6?
Biceps reflex
Assessment of the shoulder includes which of the following 4 motions?
Flexion, extension, internal and external rotation
What assessment techniques are done during a vertebral assessment
Inspection and palpation
What test asks the patient to flex wrists and press them together for 1 minute
Phalens
What is ataxia?
An unsteady gate. Can be compensating for injury or pain or indicating a cerebella’s function problem
