AA2 Final Flashcards
When grading/documenting dermatomes and you give the patient a 0, what does this mean?
The sensation is absent
When grading/documenting dermatomes and you give the patient a 1, what does this mean?
The sensation is diminished
When grading/documenting dermatomes and you give the patient a 2, what does this mean?
The sensation is normal
When grading/documenting dermatomes and you give the patient NT, what does this mean?
It was Not Tested
What is the sensory distribution of L1 Dermatome?
Anterior Pelvis/Thigh
What is the sensory distribution of L2 Dermatome?
Upper Medial Thigh
What is the sensory distribution of L3 Dermatome?
Medial Knee
What is the sensory distribution of L4 Dermatome?
Medial Malleolus/Medial Lower Leg
What is the sensory distribution of L5 Dermatome?
Dorsal Midline of foot/Dorsal webspace of toes 2 and 4
What is the sensory distribution of S1 Dermatome?
Lateral Malleolus
What is the sensory distribution of S2 Dermatome?
Plantar heel/Posterior Medial knee
What is the sensory distribution of S3/S4 Dermatome?
Questioning about saddle paresthesia
For Myotomes, If you are checking Hip Flexion, and Psoas Major, Iliacus, and Pectineus muscles, which spinal nerve(s) are you testing?
L1/L2
For Myotomes, if you are checking Knee Extension, and Quad. muscles, which spinal nerve(s) are you testing?
L3
For Myotomes, if you are checking Ankle Dorsiflexion and Tibialis Anterior, which spinal nerve(s) are you testing?
L4
For Myotomes, if you are checking Hallux Extension and Extensor Hallucis Longus, which spinal nerve(s) are you testing?
L5
For Myotomes, if you are checking Ankle Eversion/Plantarflextion and Gastrocnemius-Soleus, and Fibularis Longus and Brevis, which spinal nerve(s) are you testing?
S1
For Myotomes, if you are checking Knee Flexion and the Hamstings, which spinal nerve(s) are you testing?
S2
What spinal nerve(s) are tested in a Patellar Tendon DTR? What action are you looking for?
Testing L3 and L4
- Looking knee extension
(Patient is seated)
What spinal nerve(s) are tested in Achilles Tendon DTR? What action are you looking for?
Testing L5 and S1
- Looking for Ankle Platarflexion
(Patient can be seated or prone)
What spinal nerve(s) are tested in Bicep femoris Tendon? What action are you looking for?
Testing S2
- Looking for Knee Flexion
(Patient is prone)
What is the Clonus Stretch Test?
A quick stretch that is applied to the ankle plantarflexors, if the stretch reflex is triggered excessively, clonus occurs.
(One-Two or Three beats of clonus may be considered normal in presence of symmetrical findings and otherwise normal examination)
What is the Babinski Reflex?
Its a reflex that is inhibited with involuntary control of the toes.
- The test consist of a quick stimulus/stroke of the lateral foot towards the toes. If the Babinski is present, the hallux will extend while the smaller toes flex.
What is the Normal ROM for Knee Flexion? What is the endfeel?
Normal ROM = 135 - 150°
Soft End-Feel
When measuring for Knee Flexion, what is the Axis, Stationary and Moving arm?
Axis: Lateral Epicondyle of femur
Stationary Arm: Lateral midline of femur towards greater trochanter
Moving Arm: Lateral midline of fibula, in line with fibular head and lateral malleolus
Patient is in supine position w/ towel under ankle
What is the Normal ROM for Knee Extension? What is the End-Feel?
Normal ROM = 0°
(Can range from -2 to 5°)
Firm Capsular End-Feel
When measuring for Knee Extension, what is the Axis, Stationary and Moving arm?
(Same as Flexion)
Axis: Lateral Epicondyle of femur
Stationary Arm: Lateral midline of femur towards greater trochanter
Moving Arm: Lateral midline of fibula, in line with fibular head and lateral malleolus
Patient is in supine position w/ towel under ankle
What is the procedure for Knee Flexion (All Hamstrings) MMT?
Patient is prone, ask patient to flex leg and ask them to hold knee in 45°of knee flexion and add resistance (“Don’t let me break you”)
What is the procedure for Knee Flexion (Medial Hamstring Test) MMT?
Patient is prone, ask patient to flex leg and ask them to hold at 45° of knee flexion and their leg is in internal rotation (Toes point in). Add resistance down and outward
What is the procedure for Knee Flexion (Bicep Femoris) MMT?
Patient is prone, ask patient to flex leg and ask them to hold at 45° of knee flexion and their leg is in external rotation (Toes point out). Add resistance down and inward
What do you do under a grade 3 for Knee Flexion MMT?
- Grade 2: Patient is in sidelying and testing limb is supported by therapist, instruct patient to flex their knee
- Pt. is able to complete available ROM in sidelying with gravity min.
Grade 1 and 0:
Patient is prone, knee is partially flexed and the ankle is supported by therapist
G1: Tendons become prominent, bit no visible movement
G0: No contraction and tendons do not stand out
What is the procedure for Knee Extension (Quads) MMT?
Patient is in short-sitting with a towel rolled under the distal thigh, ask the patient to extend their knee, then apply resistance
What do you do below grade 3 for Knee Extension MMT?
Pt. is in sidelying and the knee is in about 90°of flexion, the therapist should support the limb, and ask the patient to straighten their knee
Grade 2: They complete the available ROM
Grade 1 and 0:
- Patient is in supine and therapist is palpating the quad tendon.
- Instruct patient to “push back of knee down into table or tighten your kneecap”
G1: No joint movement, but contraction can be palpated through the tendon
G0: No contraction or movement
What is the procedure for Rectus Femoris MLT or Ely’s Test? What is considered normal?
Patient is prone and the therapist passively flexes the knee and looks for compensation at the pelvis.
- Normal test is the knee passing 90°without compensation and feel the firm end-feel
What is the Normal ROM of Ankle Dorsiflexion? What is the End-Feel?
Normal - 10-25°
Firm Capsular End-Feel
When measuring Ankle Dorsiflexion what is the Axis, Stationary and Moving arm?
Axis: Lateral Malleolus
Stationary Arm: In line with the fibular head
Moving Arm: Parallel with the 5th metatarsal
PT. is supine, put gastroc in slack with pillows, foot off table, and stabilize distal tibia/fibula joint
What is the Normal ROM of Ankle Plantarflexion? What is the End-Feel?
Normal = 40-65°
Firm Capsular End-Feel
When measuring Ankle Plantarflexion what is the Axis, Stationary and Moving arm?
Axis: Lateral Malleolus
Stationary Arm: In line with the fibular head
Moving Arm: Parallel with the 5th metatarsal
Pt. is supine, towel/pillow under distal tib/fib joint, foot off table
What is the Normal ROM of Ankle/Foot Supination? What is the End-Feel?
Normal = 30-50°
Firm Capsular End-Feel
When measuring Ankle/Foot Supination, what is the Axis, Stationary and Moving arm?
Axis: Anterior aspect of Talocrural Joint
Stationary Arm: Anterior Midline of tibia, in line with Tibial Crest
Moving Arm: Anterior Midline of second Metatarsal
Pt. is supine, towel under distal tib/fib joint, move distal segment and moving arm into inversion
What is the Normal ROM of Ankle/Foot Pronation? What is the End-Feel?
Normal = 5 to 30°
Firm Capsular End-Feel (can be a hard end-feel)
When measuring Ankle/Foot Pronation, what is the Axis, Stationary and Moving arm?
Axis: Anterior Aspect of Talocrural Joint
Stationary Arm: Anterior Midline of tibia, in line with the tibial crest
Moving Arm: Anterior Midline of second Metatarsal
Pt. is supine, towel under distal tib/fib joint, move distal segment and moving arm into eversion
What is the Normal ROM of Ankle Subtalar Inversion? What is the End-Feel?
There is no normal ROM
Firm Capsular End-Feel
When measuring Ankle Subtalar Inversion, what is the Axis, Stationary and Moving arm?
Axis: Over Calcaneal Tendon in line with Malleoli
Stationary Arm: Bisects the posterior calf/middle lower leg
Moving Arm: Posterior Midline of Calcaneus
Pt. is prone, foot is off table, Find subtalar neutral, cup calcaneus and move into inversion
What is the Normal ROM of Ankle Subtalar Inversion? What is the End-Feel?
There is no normal ROM
Firm Capsular End-Feel
When measuring Ankle Subtalar Eversion, what is the Axis, Stationary and Moving arm?
Axis: Over Calcaneal Tendon in line with Malleoli
Stationary Arm: Bisects the posterior calf/middle lower leg
Moving Arm: Posterior Midline of Calcaneus
Pt. is prone, foot is off table, Find subtalar neutral, cup calcaneus and move into Eversion
What is the Normal ROM of First MTP Flexion? What is the End-Feel?
Normal = 30-45°
Firm Capsular End-Feel
When measuring First MTP Flexion, what is the Axis, Stationary and Moving arm?
Axis: Medial Aspect of 1st MTP joint
Stationary Arm: Medial Midline of 1st Metatarsal
Moving Arm: Medial Midline of Proximal Phalanx of Great toe
Pt. is supine, find subtalar neural
What is the Normal ROM of First MTP Extension? What is the End-Feel?
Normal ROM = 80 to 95°
Firm Capsular End-Feel
When measuring First MTP Extensions, what is the Axis, Stationary and Moving arm?
Axis: Medial Aspect of 1st MTP joint
Stationary Arm: Medial Midline of 1st Metatarsal
Moving Arm: Medial Midline of Proximal Phalanx of Great toe
Pt. is supine, find subtalar neural
What is the procedure for Ankle Plantar Flexion (Gastroc and Soleus) MMT?
And grades 5-3?
The Patient stands on one leg and does “Heel Raises” repeatedly
G5: Pt. completes 25 heel raises through full ROM without rest
G4: Pt. completes 2 to 24 heel raises
G3: Able to hold up BW, unable to raise BW more than one time
What do you do below grade 3 for Ankle Plantar Flexion (Gastroc and Soleus)?
Pt. is prone with feet off the table and plantar flexes ankle against manual resistance
G2: Holds test position against Max. manual resistance, (Doesn’t break)
G1: Pt. moves through partial ROM without resistance and palpate gastroc for contraction
G0: No contraction or movement
What is the procedure for Ankle Dorsiflexion and Inversion (Tibialis Anterior) MMT?
Pt. can be supine or sitting (Book recommends supine). Pt. then dorsiflexes and inverts foot and therapist applies resistance into plantarflexion and eversion.
What do you do below grade 3 for Foot Dorsiflexion and Inversion (Tib. Anterior)?
Pt. is still in supine position
G2: Completes partial ROM
G1: Therapist will detect contraction or the tendon will stand out, no joint movement
G0: No contraction or movement
What is the procedure for Foot Inversion (Tibialis Posterior) MMT?
Patient is sitting, ask the patient to move the foot down and in. Therapist applies resistance into eversion.
What do you do below Grade 3 for Foot Inversion (Tibialis Posterior)?
G2: Pt. is in same position and only performs partial ROM.
Pt. is either in sitting (same position )or supine
G1: The Tibialis Posterior will stand out if there is contraction in the muscle but no movement will occur
G0: No movement or contraction
What is the procedure for Foot Eversion and Plantarflexion (Fibularis Longus and Brevis) MMT?
Pt. is sitting with the ankle in neutral position. (Test can also be in supine). Ask the patient to move their foot down and out. Therapist applies resistance into inversion and slight dorsiflexion.
What do you do below Grade 3 for Foot Eversion and Plantarflexion (Fibularis Longus and Brevis)?
G2: Pt. is in same position and only performs partial ROM
Pt. is either in sitting (same position )or supine
G1: Both Fibularis longus and brevis will stand out with contraction but no movement will occur
G0: No movement or contraction
What is the procedure for Hallux and Toe MP Flexion (Lumbricals and Flexor Hallicus Brevis)?
Pt. is in supine (Can be sitting also), ask the pt. to bend their great toe, therapist applies resistance into extension. After ask the Pt. to bend their toes, then therapist applies resistance into extension.
(These are done separately, but have the same grading)
What do you do below Grade 3 for Hallux and Toe MP Flexion (Lumbricals and Flexor Hallicus Brevis)?
Patient is in the same position throughout the whole test.
G2: Pt. completes partial ROM
G1: Therapist palpates for contraction but no movement
G0: No movement or contraction
What is the procedure for Hallux and Toe DIP and PIP Flexion (Flexor Digitorum Longus and Brevis, and Flexor Hallucis Longus)?
Pt. is sitting (Can be supine also), ask Pt. to curl toes, then place fingers under PIP and DIP of toes then ask to curl the IP of big toe, Then apply resistance going into extension. (Resistance will be minimal)
(These are done separately, but have the same grading)
What do you do below Grade 3 for Hallux and Toe DIP and PIP Flexion (Flexor Digitorum Longus and Brevis, and Flexor Hallucis Longus)?
Patient is in the same position throughout the whole test.
G2: Completes partial ROM
G1: Therapist palpates for contraction but no movement
G0: No movement or contraction
What is the procedure for Hallux and Toe MP and IP Extension (Extensor Digitorum Longus/Brevis, Extensor Hallicus Longus)?
Pt. is sitting (Can be supine also), ask Pt. to straighten the big toe, then extend the other toes. Therapist will apply resistance in flexion.
(These are done separately, but have same grading)
What do you do below Grade 3 for Hallux and Toe MP and IP Extension (Extensor Digitorum Longus/Brevis, Extensor Hallicus Longus)?
Patient is in the same position throughout the whole test.
G2: Completes partial ROM
G1: Therapist palpates for contraction but no movement
G0: No movement or contraction
When the opposing muscle is stretched to a point where it can no longer lengthen and allow further movement, what type of insufficiency?
Passive Insufficiency
Occurs when the muscle produces simultaneous movement at all the joints it crosses and reaches such a shortened position that it no longer has the ability to develop effective tension, is what type of insufficiency?
Active Insufficiency
What is Standard Deviation (SEM)?
Amount of error one consider measurement error
What is minimal detectable change (MDC)?
The minimum amount of change that is not considered measurement error
What is Reliability?
The consistency of measurements
It will produce similar results across various conditions including different testers and different environments
- Intra-rater: Examiner is able to reproduce his findings overtime
- Inter-rater: Two or more examiners can reproduce their results overtime
What is Validity?
Each time a test/measure is performed we must understand how the result of the test compare with the truth
What happens if a test is high in sensitivity?
Test with high sensitivity when negative Rules Out condition. Rarely misses true positives
SNOUT
(S)ensitivity (N)egative finding rules (OUT)
What happens if a test is high in Specificity?
Test with high specificity when positive Rules In a condition. Rarely misses true negative
SPIN
(S)pecific (P)ositive finding rules (IN)
