BIRD SHIT Flashcards
What is examination?
Patient history and tests and measures.
What is evaluation?
Synthesizing of data; diagnosis and prognosis.
What is the difference between open ended and closed ended questions?
Open ended questions will have open and broad responses; closed ended questions will have short responses (‘yes’ or ‘no’).
What does aching indicate?
Muscular pain.
What does burning indicate?
Neural or muscular pain.
What do shooting, lightning, or electrical pain indicate?
Nerve root irritation.
What does coldness in pain suggest?
Pain may be due to lack of blood flow.
What does hotness in pain suggest?
Localized inflammation or infection pain.
What do clicking, snapping, or popping sounds indicate?
Ligament/tendon dysfunction.
What does joint locking indicate?
Cartilage tear, loose body, joint malalignment.
What does global weakness/fatigue/no clear pattern suggest?
Cardiovascular dysfunction.
What does whole body pain indicate?
Central somatization, chronic pain.
What does joint pain/stiffness worse in the morning indicate?
Inflammatory pain.
What does joint pain less in the morning and worse with activity indicate?
Degenerative pain.
What does back pain worse in the morning, better after a few hours, and worse again in the evening suggest?
Disc pathology.
What does constant, intense pain, worse in the evening, waking the patient from sleep without relief indicate?
RED FLAG MALIGNANCY.
What are red flags requiring immediate attention?
Anginal pain not relieved in 10-20 minutes; client with angina who has nausea, vomiting, or profuse sweating; confused and lethargic diabetic with changes in mental alertness and function; onset of incontinence or saddle anesthesia; anaphylactic shock symptoms (hives, asthma, tachycardia, hypotension, anxiety, nausea, vomiting).
What are ordinal measures?
Outcome measured in ranked order; points are based on self-reported performance; points summarized for a total score; number refers to something (fair, poor, good).
What is an interval measure?
Numbers quantify what the patient describes, but do not include 0 (e.g., girth measurements).
What is ratio data?
Numbers quantify what the patient is describing, includes 0 (e.g., ‘how often do you go to the gym’).
What is a floor effect?
Data skewed because activities are too hard.
What is a ceiling effect?
Results from the Berg balance scale would lead to this effect.
What is the gold standard of balance?
Berg balance scale.
When would you NOT use the Berg balance test?
It does not evaluate walking; does not need to be used for patients after stroke.
What does a higher score on the QuickDASH indicate?
Greater disability.
What does a higher score on the LEFS indicate?
Less disability.
What does a low score on the UEFS indicate?
Good outcome.
What is the gold standard for low back pain?
Oswestry Disability Index (ODI); score 0-50: low = no disability, high = completely disabled.
What do you want when using the NDI?
Less points.
What is anesthesia?
Complete loss of sensation.
What is hypothesia?
Abnormally decreased sensitivity to stimulation.
What is hyperesthesia?
Abnormally increased sensitivity to stimulation.
What is hypalgesia?
Diminished sensitivity to pain.
What is hyperalgesia?
Increased sensitivity to pain.
What is asterognosis?
Inability to recognize familiar objects by sense of touch.
What is atopognosis?
Inability to correctly locate sensation.
What is baragnosis?
Inability to distinguish between different weights.
What is paresthesia?
Abnormal tactile sensation often described as creeping, burning, tingling, or numbness.
What is dyesthesia?
Impaired sensation, especially touch.
What is paralysis?
Loss of impairment in body part due to lesion in neural or muscular systems; may also include impairment of sensory.
What is hemiparaplegia?
Paralysis of the lower half of one side of the body.
What is hemiparesis?
Muscular weakness or partial paralysis restricted to one side of the body.
What is hemiparesthesia?
Numbness of one side of the body.
What is hemiplegia?
Paralysis of one side of the body.
What is paraperesis?
Partial paralysis affecting lower limbs.
What is paraplegia?
Paralysis from the waist down.
What is tetraplegia (quadriplegia)?
Paralysis of all four limbs.
What is triplegia?
Paralysis of three extremities.
What is diplegia?
Paralysis in either both upper extremities or lower extremities.
What is coordination testing done to test?
Cerebellar dysfunction.
What are global signs of cerebellar dysfunction?
Ataxia, tremors, hypotonia, dysarthria, eye deviations.
What is ataxia?
Lack of control of body movements, decreased movement coordination.
What is dysmetria?
Error in trajectory due to abnormal range, rate, and/or force of motion; inability to touch target with hand or foot.
What does dysdiadochokinesia test for?
Impaired ability to perform rapid alternating movements.
What are upper extremity coordination tests?
Rapid alternating movement, finger opposition, finger to nose (eyes closed variation and open variation).
What does finger to nose with eyes open and closed test?
Dysmetria and intention tremors.
What are lower extremity coordination tests?
Rapid alternating movements, heel to shin, toe tapping.
What should you see when testing cranial nerves II and III?
Bilateral constriction followed by dilation of the eye not receiving the light.
What does the trochlear nerve innervate?
Superior oblique (moves eyeball down and in).
What does the abducens innervate?
Lateral rectus.
What are signs of oculomotor palsy?
Dilated pupil, drooping eyelid, eye drifting lateral and down.
Will oculomotor palsy present as ipsilateral or contralateral?
Ipsilateral.
How do you test the motor function of cranial nerve V?
Palpate masseter and temporalis as patient clenches jaw.
How do you test the sensory function of cranial nerve V?
Light touch assessment.
How do you test the reflex of cranial nerve V?
Reflex hammer to jaw (light tap on finger), should expect light jaw protrusion.
How do you test the sensory function of cranial nerve VII?
Test sweet, sour, or salt on patient’s tongue.
How do you test the motor function of cranial nerve VII?
Have patient raise eyebrows, close eyes, smile/frown, puff out cheeks.
What is Bell’s palsy?
Peripheral face nerve impairment; motor: ipsilateral paralysis of half of face; loss of taste on anterior 2/3 of tongue on affected side; loss of tear production and reduction of saliva.
How will the uvula deviate in a cranial nerve X issue?
Contralateral.
How will the tongue deviate if there is a lesion to cranial nerve XII?
Ipsilateral.
What are the symptoms of foraminal stenosis?
Patient presents with relieved pain with foraminal opening, pain increased with foraminal closing, and has unilateral radiating symptoms.
What questions should you ask someone if you suspect foraminal stenosis?
‘Does the pain go down to the arm?’ Ask about arm weakness.
What should be tested when examining someone with foraminal stenosis?
NDI, grip strength dynamometer, and cervical flexor endurance test.
What tests and measures are looked at to examine foraminal stenosis?
Reflex testing, cervical AROM, cervical MMT.
What needs to be included in the subjective interview when doing an exam on someone for central stenosis?
Cervical AROM, myotome screen, reflexes, UE sensation testing, cervical MMT.
What should be included in the subjective interview for lumbar degenerative disc disease (DDD)?
‘What activities are difficult? What cannot be performed?’ 24-hour behavior, AM? Previous lumbar surgeries, ‘Any leg symptoms?’
What should be performed when examining lumbar DDD?
ODI, modified plank, 5 STS, and functional lifting index (FLI).
What tests and measures should be performed when examining lumbar DDD?
Posture, gait, thoracolumbar AROM, trunk and hip MMT, and LE neurosensory screen.
What does lumbar spine disc pathology present with?
Unilateral motor and sensory pending severity in addition to positive reproduction with Valsalva/WB.
What needs to be discussed in the subjective interview when examining for lumbar disc pathology?
‘Do you have any areas in the leg with less sensation?’ ‘Any loss of strength in lower leg?’
What functional outcomes should be performed to test for lumbar pathology?
ODI, 5 STS, lumbar performance index, heel/toe walking.
What is the difference between spondylolysis and spondylolisthesis?
Spondylolysis: stress fracture of the pars interarticularis (scotty dog); Spondylolisthesis: vertebral sliding (step-off).
What is lumbar spinal stenosis?
Hypertrophy of ligamentum flavum.
What subjective information is needed for lumbar spinal stenosis?
Walking tolerance, standing tolerance, medications, relief with position.
What tests are used for lumbar spinal stenosis?
6-minute walk test, timed treadmill test, treadmill incline test.
What is hypermobility?
Patient presents with pain directly at SIJ, can radiate down posterior limb to posterior knee.
What is the arc format?
Combining extension and flexion measurements; extension - 0° - flexion.
What is the end feel of elbow extension?
Hard, bone to bone.
What is the end feel of wrist flexion?
Firm, tissue stretch.
What is the end feel of elbow or knee flexion?
Soft.
What is the end feel if there is pain present?
Empty (abnormal).
What is a grade 5 muscle strength?
Complete full ROM against gravity with max resistance.
What is a grade 4 muscle strength?
Complete full ROM against gravity, moderate resistance.
What is a grade 3+ muscle strength?
Complete full ROM against gravity, minimum resistance.
What is a grade 3 muscle strength?
Complete ROM against gravity, no resistance.
What is a grade 3- muscle strength?
> 50% ROM against gravity but full in gravity reduced.
What is a grade 2+ muscle strength?
<50% ROM against gravity, but full in gravity reduced.
What is a grade 2 muscle strength?
Full ROM with gravity eliminated or ‘minimized.’
What is a grade 2- muscle strength?
Completes partial ROM with gravity eliminated.
What is a grade 1 muscle strength?
Palpable contraction.
If a patient can move its full range against gravity, what do they already get?
A grade of 3.
If a patient cannot get full ROM against gravity, what is the highest they can get?
A grade of 3-.
What does AROM give an idea of?
Contractile tissue integrity; may give idea if inert tissues are stretched or pinched.
What does PROM indicate?
Integrity of joint surfaces; extensibility of capsule, ligaments, muscles, fascia, and skin; end feels of joint.
What is normal cervical flexion?
40°.
Where do inclinometers need to be placed for cervical flexion and extension?
Top of skull and T1.
What is normal cervical extension?
50-70°.
What is normal cervical side bending?
22°.
What is normal cervical rotation?
50°: 70-90°.
What is normal thoracolumbar flexion?
60°.
What is normal thoracolumbar extension?
25°.
What are the landmarks for thoracolumbar flexion/extension?
T1 and S2.
What is normal thoracolumbar side bending?
35°.
What is normal thoracolumbar rotation?
45°.
What is a grade 5 trunk flexion?
Trunk flexion with arms behind head.
What is a grade 4 trunk flexion?
Trunk flexion with arms crossed.
What is a grade 3+ trunk flexion?
Trunk flexion with arms at side.
What is a grade 3 trunk flexion?
Trunk flexion with arms by side with scapula on plinth.
What is a grade 2 trunk flexion?
Head on plinth, arms at side.
What is a grade 5 angle between lower extremities and table?
0-30°.
What is a grade 4 angle between lower extremities and table?
30-60°.
What is a grade 3 angle between lower extremities and table?
60-75°.
What is a grade 2 angle between lower extremities and table?
> 75°.
What does a grade 1 indicate?
Patient cannot assume or maintain position but muscle contraction is palpable.
What muscles do you need to palpate before doing MMT of cervical flexion?
Scalenes and longus colli.
What muscle needs to be palpated for cervical lateral flexion?
SCM.
What needs to be palpated for trunk leg lowering?
Lumbar lordosis for flatness.
What needs to be palpated for trunk rotation?
EO.
What needs to be palpated for pelvic elevation?
QL.
What are the signs of a Labral Tear (Bankart Lesion) or SLAP lesion?
Patient reports FOOSH and heard pop, click, or clunk sound; arm feels heavy and like it is about to dislocate; pain with overhead reach, especially ABD/ER.
What can cause frozen shoulder (adhesive capsulitis)?
Middle-aged women, diabetes type 2, hypothyroidism.
What are the stages of frozen shoulder?
Freezing: losing ROM in shoulder, painful; Frozen: minimal ROM and less painful; Thawing: regaining ROM, pain varies.
What outcome measures should be performed when examining for adhesive capsulitis?
qDASH, UEFI, hand grip, wall overhead reach.
What tests and measures should be done to examine for adhesive capsulitis?
Clear spine, PROM and AROM of ER, ABD, IR, Flex, Apley scratch test, MMT, scap position and mobility.
What is normal shoulder flexion?
180°.
What is normal shoulder extension?
60°.
What is normal GH flexion?
120°.
What is normal GH extension?
20°.
What is normal shoulder abduction?
180°.
What is normal GH abduction?
100-130°.
What is normal shoulder internal rotation?
70°.
What is normal shoulder external rotation?
90°.
What is normal GH internal rotation?
50-60°.
What is normal GH external rotation?
90°.
What positon do you measure shoulder and GH internal rotation, external rotation, flexion, and abduction?
In supine.
When do you measure GH and shoulder extension?
In prone.
Where do you stabilize for shoulder measurements?
Trunk.
Where do you stabilize for GH measurements?
Trunk and scapula.
Where does the stationary arm of the goniometer need to be in shoulder and GH flexion and extension?
Parallel to midaxillary line of thorax.
Where does the stationary arm need to be in shoulder and GH abduction?
Parallel to midline of sternum.
Where is the axis of the goniometer in shoulder and GH flexion and extension?
Lateral aspect of greater tubercle.
Where is the axis of the goniometer in shoulder and GH abduction?
Anterior acromion.
Where is the axis of the goniometer in shoulder and GH internal/external rotation?
Olecranon process.
Where does the moving arm of the goniometer need to be in shoulder and GH flexion and extension?
Anterior midline of humerus.
Does the stationary arm need to be in shoulder and GH abduction?
Yes.
Where does the moving arm of the goniometer need to be in shoulder and GH flexion and extension?
Lateral epicondyle.
Where does the moving arm of the goniometer need to be in shoulder and GH abduction?
Anterior midline of humerus.
Where does the moving arm of the goniometer need to be in shoulder and GH internal/external rotation?
Midline of ulna.
What nerves go to the hand?
Ulnar nerve, radial nerve, median nerve.
What nerve is associated with wrist drop and ulnar deviation?
Radial nerve.
Measure atrophy muscles bilaterally.
What position will the hand be in if the radial nerve is affected?
Wrist drop.
What nerve is associated with ape hand?
Median nerve.
Thenar and hypothenar eminences.
What hand position will be shown if the median nerve is affected?
Ape hand.
What muscles will atrophy if the median nerve is affected?
Thenar and hypothenar muscles.
What nerve is associated with bishop’s hand/claw hand?
Ulnar nerve.
Lumbricals and interossei.
What hand positions may you see if the ulnar nerve is affected?
Bishop’s hand/claw hand.
What muscles are atrophied if the ulnar nerve is affected?
Lumbricals and interossei.
What nerve is being tested?
Median nerve.
What is done to test for median nerve injury?
Tinel’s test, Phalen’s test, Reverse Phalen’s test.
What is done to test the radial nerve?
Resisted supination.
What nerve can be entrapped at the nerve roots?
Ulnar nerve.
What nerve can be entrapped at the first rib?
Ulnar nerve.
What nerve can be entrapped at the cubital tunnel?
Ulnar nerve.
What nerve can be entrapped at the triangular space?
Radial nerve.
What nerve can be entrapped at the carpal tunnel?
Median nerve.
What is the diagnosis if a patient presents with pain with gripping or initiating wrist flexion and hears/feels crepitus during wrist flex/ext after repetitive wrist extension with radial deviation?
Tennis elbow.
What is the diagnosis if a patient has pain with gripping and initiating gripping or eccentric wrist extension, and hears or feels crepitus when flexing wrist or gripping with twist?
Golfer’s elbow.
What condition is associated with ulnar nerve entrapment and sustained positions?
Cubital tunnel syndrome (telephone elbow).
What condition is associated with repetitive, forceful valgus motion and possible catching and locking in joint?
Osteochondritis dissecans.
What condition is associated with sustained repeated wrist flexion or extension?
Carpal tunnel syndrome.
What needs to be asked in the subjective interview for carpal tunnel syndrome?
History of neck issues.
What is DeQuervain’s?
Tenosynovitis of the abductor pollicus longus (APL) and the extensor pollicis brevis (EPB).
What does the DeQuervain’s test assess?
Repetitive radial deviation.
