CP1 MMT Flashcards
1
Q
what muscle is primarily tested in shoulder flexion?
A
anterior deltoid
2
Q
what secondary muscles contribute to shoulder flexion?
A
- coracobrachialis
- supraspinatus
- biceps brachii
- trapezius (shoulder hiking)
- pectoralis major (if there is horizontal add)
3
Q
for grades 3 and up, how should a pt be positioned when tested shoulder flexion?
A
- short sitting
- arm flexed to 900
4
Q
for grades 0,1,2 how should a pt be positioned to test shoulder flexion?
A
- side lying
- palpate for anterior deltoid
5
Q
where do you stabilize when testing shoulder flexion (MMT)?
A
stabilize at shoulder
6
Q
where is resistance applied when performing shoulder flexion MMT?
A
distal humerus, downward direction
7
Q
what are some common substitutions pts may utilize during a shoulder flexion MMT?
A
- ER of arm
- shoulder hiking
- leaning trunk backwards
8
Q
what muscle(s) are primarily tested during shoulder extension MMT?
A
- posterior deltoid
- latissimus dosi
- teres major
9
Q
what secondary muscles contribute to shoulder extension?
A
long head of triceps brachii
10
Q
for grades 3 and up, how should a pt be positioned during shoulder extension MMT?
A
- prone
- face turned towards testing side
- palm facing up
- elbow remains extended and straight
11
Q
for grades 0,1,2 how should a pt be positioned for shoulder extension MMT?
A
- side lying
- palpate for posterior deltoid or teres major
12
Q
where do you stabilize when testing shoulder extension?
A
at the shoulder
13
Q
where is resistance applied when performing shoulder extension MMT?
A
distal humerus
14
Q
what muscle(s) are primarily tested during shoulder abduction MMT?
A
- middle deltoid
- supraspinatus
15
Q
for grades 3 and up how should a pt be positioned when performing shoulder abduction MMT?
A
- short sitting
- shoulder abducted 900
16
Q
for grades 0,1,2 how should a pt be positioned when performing shoulder abduction MMT?
A
- supine
- towel under arm to reduce friction on bed
17
Q
where should the tester stabilize when performing shoulder abduction MMT?
A
at the shoulder
18
Q
where is resistance applied when performing shoulder abduction MMT?
A
distal humerus
19
Q
what are some common substitutions that may occur when performing shoulder abduction MMT?
A
- trunk lateral flexion
- scapular/shoulder elevation
- using biceps brachii (arm will ER)
20
Q
what muscle(s) are primarily tested during shoulder horizontal abduction MMT?
A
- posterior deltoid
21
Q
for grades 3 and up how should the pt be positioned when peforming shoulder horizontal abduction MMT?
A
- prone facing arm being tested
- thumb down
- elbow at 900 (only for grade 3)
“lift your elbow to the ceiling, don’t let me push you down”
22
Q
for grades 0,1,2 how should the pt be positioned when performing horizontal shoulder abduction MMT?
A
- sitting
- arm supported on surface
“slide your arm backwards on the table”
23
Q
where should the tester stabilize when performing shoulder horizontal abduction MMT?
A
- shoulder/scapule = for grades 3 and up
- scapular for grade 0,1,2
24
Q
where is resitance applied when testing horizontal shoulder abduction?
A
above elbow/distal humerus
25
what is a common substituion that may be observed when testing shoulder horizontal abduction?
elbow may straigten out (long head of triceps will be used)
26
what muscle(s) are primarily tested during shoulder horizontal adduction MMT?
pectoralis major
27
for grades 3 and up, how should the pt be positioned during shoulder horizontal ADD MMT?
1. supine
2. arm pointed towards the ceiling
3. sligh elbow flexion
"bring your arm towards the middle, don't let me pull it back out"
28
how can you isolate the clavicular head of the pectoralis major during shoulder horizontal ADD MMT?
begin with the shoulder at 600 of ABD and tell the pt to move arm "up and in"
29
how can you isolate the sternal head of the pectoralis major during shoulder horizontal ADD MMT?
begin with the shoulder in 1200 of ABD and tell the pt to move arm "down and in"
30
where is resistance applied when performing a horizontal shoulder ADD MMT?
distal humerus/elbow
pull towards the therapist
31
what muscle(s) are primarily tested when performing shoulder ER MMT?
1. Infraspinatus
2. Teres Minor
32
for grades 3 and up how is the pt positioned during shoulder ER MMT?
1. prone, head turned towards testing side
2. hand hangin off side of table
3. PT supports under the arm
4. instruct pt to move forearm up and towards the ceiling and hold there
33
for grades 0,1,2 how is the pt positioned during shouder ER MMT?
Can do gravity minimized on table (towel under to reduce friction)
or
pt laying prone with arm off the table (instruct them to turn their palm out clockwise)
34
where do you stabilize when performing shoulder ER MMT?
distal humerus for support
35
where is resistance applied during shoulder ER MMT?
forearm in a downward direction
36
what muscle(s) are primarily tested during shoulder IR MMT?
1. Subscapularis
2. Teres Major
37
what secondary muscles contribute to shoulder internal rotation?
1. pectoralis major
2. latissimus dorsi
3. anterior deltoid
38
for grades 3 and up, how is the pt positioned during shoulder IR MMT?
1. prone
2. head facing towards testing side
3. start with hand hanging down and PT supporting arm
4. instruct pt to move forearm backwards and hold there
39
for grades 0,1,2 how is the pt positioned during shoulder IR MMT?
Gravity minimized = seated w/towel under arm
OR
laying prone with arm handing entirely off the table, instruct pt to turn their arm counter-clockwise
40
where do you stabilize when performing shoulder IR MMT?
distal humerus
41
where is resistance applied during shoulder IR MMT?
forearm in a downward direction
42
which shoulder MMTs do you **not** apply resistance at the distal humerus?
1. Shoulder IR
2. Shoulder ER
43
what motions/directions do you test when performing shoulder MMT?
1. Flexion
2. Extension
3. Abduction
4. Horizontal Abduction
5. Horizontal Adduction
6. Internal Rotation
7. External Rotation
44
what are the primary muscles for tested during elbow flexion MMT?
1. biceps brachii
2. brachioradialis
3. brachialis
45
for grade 3 and up, how should the pt be positioned during elbow flexion MMT?
1. sitting
2. elbow flexed past 900
3. for isolation:
* biceps = palm up (supinated)
* brachioradialis = thumb up (neutral)
* brachialis = palm down (pronation)
46
for grade 0,1,2 how should the pt be positioned during elbow flexion MMT?
can be lying supine or PT can support arm while pt is sitting
47
where should the PT stabilize during elbow flexion MMT?
at the shoulder
48
where is resistance applied during elbow flexion MMT?
to the forearm, out and downward force
49
what are the primary muscle(s) tested during elbow extension?
triceps brachii
50
for grades 3 and up, how should the pt be positioned during elbow extension MMT?
1. prone with arm off the table
2. entire arm is off, the shoulder/armpit is at the edge of the table
3. instrust pt to "straighten your arm, don't let me push it down"
51
what muscle(s) assit during elbow flexion?
1. pronator teres
2. all wrist flexors
52
what muscle(s) assit in elbow extension?
1. anconeus
2. some wrist extensors
53
for grades 0,1,2 how should the pt be positioned during elbow extension MMT?
1. sitting with shoulder abducted or flexted to 90
2. elbow at 90, instruct pt to extend the arm
54
where should the PT stabilize when performing elbow extension MMT?
distal humerus
55
where is resistance applied when performing elbow extension MMT?
forearm
56
what are some common substitutions observed when testing elbow extension?
pt may ER their shoulder
57
what are the primary muscle(s) tested during forearm supination MMT?
1. Biceps brachii
2. Supinator
58
for grades 3 and up, how should the pt be positioned during forearm supination MMT?
1. seated w/elbow at 90
2. forearm fully pronated
3. Instruct the pt to "turn palm up, don't let me push you back"
4. PT applies resistance to dorsum of forearm
59
for grades 0,1,2 how should the pt be positioned during forearm supination MMT?
1. seated with shoulder and elbow at 90
* elbow is supported by hand or table
2. forearm is in neutral
3. instruct the pt to "turn palm towards face"
60
where should the PT stabilize when performing forearm supination MMT?
at elbow
61
where is resistance applied when performing forearm supination MMT?
dorsal aspect of forearm
62
what are some common substitutions observed during forearm supination MMT?
shouler ER combined with horizontal ADD can indirectly cause the forearm to supinate
63
what muscle(s) are primarily tested during forearm pronation MMT?
1. pronator teres
2. pronator quadratus
64
for grades 3 and up, how should the pt be positioned during forearm pronation MMT?
1. seated with elbow flexed to 90
2. forearm fully supinated
3. Instruct the pt to "turn palm down and don't let me push it back"
4. PT applies resistance to anterior forearm
65
for grades 0,1,2 how should the pt be positioned during forearm pronation MMT?
1. seated with shoulder and elbow flexed to 90
* elbow supported by PT hands or by table
2. forearm in neutral rotation
66
where should the PT stabilize when performing forearm pronation MMT?
at elbow
67
where is resistance applied when performing forearm pronation MMT?
anterior forearm
68
what muscle(s) are primarily tested during wrist flexion MMT?
1. Flexor carpi ulnaris
2. Flexor carpi radialis
69
what muscle(s) are secondary/assit with wrist flexion?
1. palmaris longus
2. flexor digitorum profundus
3. flexor digitorum superficialis
4. flexor pollicis
5. Abductor pollicis
70
for grades 3 and up, how should the pt be positioned during wrist flexion MMT?
1. seated with forearm supinated on table
2. wrist in neutral for group flexion testing
* for FCU = flex + ulnar deviation (PT pulls into radial deviation)
* for FCR = flex + radial deviation (PT pulls into ulnar deviation)
71
T/F: when trying to isolate the flexor carpi ulnaris, instruct the pt to flex their wrist as well as radially deviate?
FALSE
flex + ulnar deviation
72
for grades 0,1,2 how should the pt be positioned during wrist flexion MMT?
1. seated with forearm in neutral pro/supination resting on table
* can use towel under arm
2. to target FCU or FCR, palpate accordingly
73
where should the PT stabilize when performing wrist flexion MMT?
1. group testing = forearm and wrist
2. FCU = hold under wrist so that your fingers wrap around to palpate the 5th metacarpal
3. FCR = hold the wrist so that your finger wrap around to palpate the 2nd and 3rd metacarpals
74
where is resistance applied when performing wrist flexion MMT?
1. group test = resistance applied to pt palm towards PT
2. FCU = pull into radial side
3. FCR = pull into ulnaris side
\*use 4 fingers on the palm
75
what muscle(s) are primarily testing during wrist extension MMT?
1. Extensor capri radialis longus
2. Extensor carpi radialis brevis
3. Extensor carpi ulnaris
76
for grades 3 and up, how should the pt be positioned during wrist extension MMT?
1. short sitting
2. forearm pronated and resting on table
77
for grades 0,1,2 how should the pt be positioned for wrist extension MMT?
1. short sitting
2. forearm in neutral rotation and resting on table
3. palpate for contraction
78
where should the PT stabilize when performing wrist extension MMT?
pt forearm
79
where is resistance applied during wrist extenstion MMT?
downward force applied to back of hand
80
to isolate the ECRL where shoul the PT palpate?
dorsum of 2nd MC
81
to isolate the ECRB where should the PT palpate?
dorsum of 3rd MC
82
to isolate the ECU where should the PT palpate?
dorsum of 5th MC and styolid process
83
what muscle(s) are primarily tested during MCP flexion +IP extension MMT?
1. palmar interossei (PADs and DABs)
2. Lumbricals
84
for grades 3 and up, how should the pt be positioned for MCP flexion + IP extension?
1. short sitting
2. forearm supinated and resting on table
3. Don't let IPs curls, should remain extended
4. Instruct the pt to "curl your hand towards your body while keeping your fingers as straight as you can"
85
for grades 0,1,2 how should the pt be positioned during MCP flexion + IP extension MMT?
1. short sitting
2. forearm in neutral rotation and resting on table
* thumb pointing up
86
where should the PT stabilize when performing MCP flexion + IP extension MMT?
stabilize with one hand gripping the metacarpals
87
where is resistance applied during MCP flexion + IP extension MMT?
proximal phalanx, down and out force
88
what muscle(s) are primarily tested during finger PIP and DIP flexion MMT?
1. PIP = flexor digitorum superficialis
2. DIP = flexor digitorum profundus
89
for grades 3 and up, how should the pt be positioned when performing finger PIP and DIP flexion MMT?
1. short sitting
2. forearm supinated and resting on table
3. isolate each finger to test IPs
* PIP = "bend middle joint of your finger"
* DIP = "bend tip of your finger"
90
for grades 0,1,2 how should the pt be positioned when performing finger PIP and DIP flexion MMT?
1. short sitting
2. fowarm in neutral and resting on table
3. palpate targeted muscle
91
T/F: this image depicts PIP flexion MMT?
FALSE, it depicts DIP flexion MMT
92
where should the PT stabilize when performing finger PIP and DIP flexion MMT?
1. PIP = stabilize other finger to keep them from flexion
2. DIP = stabilize at middle phalanx to prevent PIP flexion
93
where is resitance applied during finger PIP and DIP flexion MMT?
1. PIP = resistance is applied to middle phalanx
2. DIP = resistance is applied to distal phalanx
94
what muscle(s) are primarily tested during MCP extension?
1. Extensor digitorum
95
what muscle(s) assit in MCP extension?
1. extensor indicis
2. extensor digiti minimi
96
for grades 3 and up, how should the pt be positioned for MCP extension MMT?
1. short sitting
2. forearm pronated and resting on table
3. PT supporting wrist to keep this position
4. instruct the pt to "bend your knuckles as far back as you can"
97
for grades 0,1,2 how should the pt be positioned for MCP extension MMT?
1. short sitting
2. forearm in neutral
3. PT supporting wrist
98
where should the PT stabilize when performing MCP extension MMT?
at the wrist
99
where is resistance applied during MCP extension MMT?
applied to the back of proximal phalanx
100
what muscle(s) are primarily tested during finger ABDuction MMT?
Dorsal interossei (DABs)
101
how should the pt be positioned for finger ABDuction MMT?
1. short sitting
2. forearm in pronation and resting on table
3. fingers spread
4. Instruct the pt to "not let me push your fingers together"
102
T/F: finger abduction MMT can also be done in isolation?
TRUE
1. Abduction of ring finger toward little finger
2. Abduction of middle finger toward ring finger
3. Abduction of middle finger toward index finger
4. Abduction of index finger toward thumb
103
T/F: There is no specific gravity minized test for finger ABD?
TRUE
104
where should the PT stabilize when preforming finger ABD MMT?
at the wrist to keep it neutral
105
where is resistance applied during finger ABD MMT?
fingers pushed toward one another
106
what muscle(s) are primarily tested during finger ADD MMT?
Palmar Interossei (PADs)
107
how should the pt be positioned for finger ADD MMT?
1. short sitting
2. forearm in pronation and resting on table
3. finger together
4. Instruct pt to "not let me pull your fingers apart"
108
T/F: finger ADD MMT can also be done in isolation?
TRUE
1. Adduction of little finger toward ring finger,
2. Adduction of ring finger toward long finger,
3. Adduction of index finger toward long finger,
4. Adduction of thumb toward index finger
109
T/F: There is not specific gravity minimized test for finger ADD MMT?
TRUE
110
where should the PT stabilize when performing finger ADD MMT?
both hands used to pull fingers apart
if done in isolation, can stabilize the wrist
111
where is resistance applied during finger ADD MMT?
fingers pulled away from one another
112
what muscle(s) are primarily tested in thumb MCP and IP flexion?
flexor pollicis brevis
113
how should the pt be positioned when assessing thumb MCP and IP flexion MMT?
1. short sitting
2. forearm in supination and resting on table
114
how should you instruct a pt to move when assessing thumb MCP flexion MMT?
"Bring your thumb across your hand, touching your hand the whole time, don't let me push it back"
115
how should you instruct a pt to move their thumb when assess thumb IP flexion MMT?
"flex just your thumb joint, don't let me push it back"
116
where should the PT stabilize when performing thumb MCP and IP flexion MMT?
1. MCP = stabilize at the wrist
2. IP = stabilize at the MCP (proximal phalanx)
117
where is resistance applied when assessing thumb MCP and IP flexion MMT?
apply resistance into extension
118
what muscle(s) are primarily tested when performing thumb MCP and IP extension MMT?
extensor pollicis brevis
119
how should the pt be positioned when assessing thumb MCP and IP extension?
1. short sitting
2. forearm and wrist in neutral position and resting on table
120
how should you instruct a pt to move their thumb when assessing thumb MCP extension?
"lift your thumb to the ceiling, don't let me push it down"
121
how should you instruct a pt to move their thumb when assessing thumb IP extension?
"dont let me push the end of your thumb down"
122
where should the PT stabilize when performing thumb MCP and IP extension MMT?
1. MCP = stabilize at the wrist
2. IP = stabilize at the MCP (proximal phalanx)
123
where is resistance applied when assessing thumb MCP and IP extension?
1. MCP = resistance applied to back of proximal phalanx
2. IP = resistance applied to back of distal phalanx
124
what muscle(s) are primarily assessed during thumb abduction MMT?
1. abductor pollicis longus
2. abductor pollicis brevis
125
for grades 3 and up, how should the pt be positioned when assessing thumb abduction with MMT?
1. short sitting
2. forearm in supination and resting on the table
3. wrist in neutral
4. "move your thumb to the ceiling, don't let me push it down"
126
for grades 0,1,2 how should the pt be positioned when assessing thumb abduction with MMT?
1. short sitting
2. forearm in neutral (thumb pointed up) and resting on the table
3. instruct the pt to "move your thumb to the side"
127
where should the PT stabilize when performing thumb abduction MMT?
stabilize at the wrist
128
where is resistance applied when assessing thumb abduction with MMT?
downward force applied to lateral thumb
129
what muscle(s) is primarily assessed during thumb adduction MMT?
adductor pollicis
130
for grades 3 and up, how should the pt be positioned for thumb adduction MMT?
1. short sitting
2. forearm in pronation and resting on table
3. wrist in neutral
4. Instruct the pt to "move your thumb towards your other fingers, don't let me push it back down"
131
for grades 0,1,2 how should the pt be positioned when assessing thumb adduction with MMT?
1. short sitting
2. forearm in neutral (thumb up) and resting on table
3. Instruct the pt to "move your thumb back towards your fingers"
132
where should the PT stabilize when assessing thumb adduction with MMT?
stabilize at the wrist
133
where should resistance be applied when assessing thumb adduction with MMT?
downward force applied to medial thumb
134
what muscle(s) are primarily assessed when performing thumb opposition MMT?
1. Opponens pollicis
2. Opponens digiti minimi
135
how should the pt be positioned when assessing thumb opposition with MMT?
1. short sitting
2. forearm supinated and resting on table
3. Instruct the pt to "make an O with your fingers by toughing th tips of your thumb and pinky"
136
where should the PT stabilize during thumb opposition MMT?
no stabilization because you are using both hands
137
where should resistance be applied when assessing thumb opposition with MMT?
resistance applied to the thenar portion of the hand in an effort to pull the thumb and 5th digit apart
138
which MMT tests for the UE do not have a gravitiy minized position?
1. Thumb MCP flexion and extension
2. Thumb IP flexion and extension
3. Finger ADD
4. Finger ABD
5. Thumb opposition
139
how do differeniate between a 0,1,2 for tests that do not have a gravity minimized position?
check for full or partial ROM
140
what muscle(s) are primarily assessed with hip flexion MMT?
1. Iliacus
2. Psoas Major
141
what muscle(s) assist with hip flexion?
1. rectus femoris
2. sartorius
3. TFL
4. Pectineus
5. Adductor group
6. Gluteus Medius (anterior)
142
for grades 3 and up, how should the pt be positioned during hip flexion MMT?
1. sitting with legs off table
2. hands on table
3. instruct the pt to "lift your leg off the table, don't let me push you dont"
143
for grades 0,1,2 how should the pt be positioned during hip flexion MMT?
1. side lying
2. bottom leg bent, top leg straight
3. PT stabilizes top leg
4. Instruct the pt to "bring your knees toward your chest"
144
where does the PT stabilize during hip flexion MMT?
1. nowhere specific for grades 3 and up
2. at hop for 0,1,2
145
where should resistance be applied during hip flexion MMT?
distal femur
146
what muscle(s) are primarily assess with hip extension MMT?
1. Gluteus Maximus
2. Hamstrings
147
what muscle(s) assist with hip extension?
1. Adductor Magnus
2. Gluteus medius
148
for grades 3 and up, how should the pt be positioned during hip extension MMT?
1. pt in prone
2. therapist on the **side of testing leg**
3. Instruct pt to "lift leg as high as you can"
\*picture depicts wrong side for the therapist
149
for grades 0,1,2 how should the pt be positioned during hip extension MMT?
1. side lying
2. therapist supports lef with forearm and hand under knee
3. Instruct the pt to "move your leg back towards me"
150
What is a valid reason for utilizing a modified hip extension MMT?
hip flexor tightness
151
how should a pt be positioned for hip extension MMT if they have tight hip flexors?
1. pt leans chest onto table
2. therapist on side of testing leg
3. Instruct pt to "lift your foot off the floor as high as you can and hold it there"
4. apply resistance to distal femur
152
where does the PT stabilize during hip extension MMT?
at the pelvis for postural alignment
153
where should resistance be applied during hip extension MMT?
1. for normal exams = at the ankle
2. for modified test = distal femur
154
what muscle(s) primarily perform hip abduction?
1. Gluteus medius
2. Gluteus minimus
155
what muscle(s) assist with hip abduction?
1. Upper fibers of gluteus maximus
2. TFL
3. deep hip rotators
4. sartorius
156
for grades 3 and up, how should the pt be positioned during hip abduction MMT?
1. pt in side lying
2. bottom leg is bent
3. hips stacked
4. Instruct pt to "bring your fot to the ceiling"
* do not let hip roll as the leg lifts up
157
T/F: grades 4 and 5 have different lever arms?
TRUE
grade 5 = resistance applied at ankle
grade 4 = resistance applied to distal femur
158
for grades 0,1,2 how should a pt be positioned during hip abduction MMT?
1. supine
2. toes pointed to the ceiling
3. place a towel under foot
4. Instruct pt to "move your leg to the side"
159
where should the PT stabilize during hip abduction MMT?
at the pelvis, watch out for hip ER!
160
What would you expect a pt to be able to do if they recieve a 4 or 5 on hip abduction MMT?
they should be able to stand on one limb and keep their pelvis level?
161
what are common substitutions a pt may demonstrate during hip abduction MMT?
1. hip flexion with ER to recruit TFL
2. hip extension ro recruit gluteus maximus
3. may hip hike using quadratus lumborum and other trunk muscles
162
what muscle(s) primarily perform hip adduction?
1. adductor magnus
2. adductor brevis
3. adductor longus
4. pectineus
5. gracilis
163
what muscle(s) assist with hip adduction?
1. obturator externus
2. gluteus maximus
164
for grades 3 and up, how should the pt be positioned during hip adduction MMT?
1. side lying
2. PT is supporting upper leg
3. bottom leg is the one being tested
4. Instruct pt to "move the leg on the table up to your other leg and hold"
165
for grades 0,1,2 how should the pt be positioned during hip adduction MMT?
1. supine
2. toes pointed up to the ceiling
3. legs extended
4. start with tested leg abducted
5. Instruct pt to "move your leg into the other"
166
where should the PT stabilize during hip adduction MMT?
1. upper leg for grades 3 and up
2. pelvis in grades 0,1,2
167
where is resistance applied during hip adduction MMT?
1. distal portion of medial femur
168
what is a common substitution a pt may demonstrate during hip adduction MMT?
may attempt to recruit hip flexors = will appear as through trunk rotation is occuring from side lying
169
what MMT is done specifically to target the sartorius?
hip flexion, abduction, and ER with knee flexion
170
for grades 3 and up, how is the pt positioned when testing the sartorius with MMT?
1. sitting with legs off table
2. PT should place pt into the position
3. Can also instruct pt to "slide your hel up your other leg's shin, resist my push"
171
for grades 0,1,2 how should the pt be positioned when testing the sartorius with MMT?
same test as grades 3 and up only place the pt in supine
172
where should the PT stabiilze during sartorius MMT?
no stabilization, both hands used for resistance
173
where should resistance be applied when testing the sartorius with MMT?
1. one hand at ankle to move pt's foot laterally and straighten the knee
2. other hand at knee to move the hip into extension and adduction
174
what muscle(s) are primarily assessed with hip external rotation MMT?
1. Obturator Externus/Internus
2. Quadratus femoris
3. piriformis
4. gemellus superior/inferior
5. gluteus maximus
175
what muscle(s) assist with hip ER?
1. sartorius
2. biceps femoris long head
3. gluteus medius
4. psoas major
5. adductor magnus
6. adductor longus
7. popliteus
176
for grades 3 and up, how should a pt be positioned during hip ER MMT?
1. sitting
2. knees off the table
3. instruct pt to bring their foot inward
177
for grades 0,1,2 how should the pt be positioned during hip ER MMT?
1. supine
2. as pt to roll leg outward
3. can't truly palpate for a grade 1 or 2 since most primary movers are deep
178
how can you discern between a grade 1 and 2 and 0 for hip ER?
1. grade 2 = pt able to roll hip past midline voluntarily
2. grade 1 = no discernable movement, give a grade 1
3. no grade 0
179
where should the PT stabilize during hip ER MMT?
stabilize at the knee
180
where should resistance be applied during hip ER MMT?
medial ankle towards PT
181
what are some common subsitutions that may be observed during hip ER MMT?
1. hip hiking
2. hip abduction
3. recruting knee flexors
182
what muscles are primarily assessed with hip internal rotation MMT?
1. gluteus minimus
2. gluteus medius
3. TFL
183
what muscles assist with hip IR?
1. semitendinosus
2. semimembranosus
3. adductor magnus
4. adductor longus
184
for grades 3 and up, how should a pt be positioned during hip IR MMT?
1. sitting
2. knees off the table
3. leg positioned outward
4. Instruct pt to "keep your leg where it is, don't let me pull it in"
185
for grades 0,1,2 how should the pt be positioned during hip IR MMT?
1. supine
2. toes towards ceiling
3. legs extended
4. ask pt to roll leg inward
5. palpate muscles
186
where should the PT stabilize during hip IR MMT?
knee
187
where should resistance be applied during hip IR MMT?
lateral ankle towards PT
188
what muscles are primarily assessed during knee flexion MMT?
Hamstrings
189
what muscles assist with knee flexion?
1. Gracilis
2. TFL
3. Sartorius
4. Popliteus
5. Gastrocnemius
6. Plantaris
190
for grades 3 and up, how should the pt be positioned during knee flexion MMT?
1. prone
2. knee flexed between 45-90
3. Instruct pt to "keep your leg where it is, don't let me push it down"
191
for grades 0,1,2 how should the pt be positioned during knee flexion MMT?
1. side lying
2. PT supports top leg and ask pt to flex the knee
192
where should the PT stabilize during knee flexion MMT?
knee
193
where should resistance be applied during knee flexion MMT?
calf
194
How can a PT bias the medial hamstring?
internally rotating leg (toes pointed toward midline)
apply and downward and outward force
195
how can a PT bias the lateral hamstring?
externally rotating the leg (toes pointed laterally)
apply a downward and inward force
196
what are some common substitutions that may be observed during knee flexion MMT?
1. pt may utilize hip flexion to initiate
2. sartorius activation will cause hip and knee flexion and ER
3. if adduction observed, pt is using gracilis
4. may dorsiflex to use hamstring shortening to cause knee flexion
197
what muscles primarily extend the knee?
quadriceps
198
what muscles assist in knee extension?
TFL
199
for grades 3 and up, how should a pt be positioned during knee extension MMT?
1. sitting
2. knee off the table
3. good posture (not leaning back), keep hands on table
4. pt should not be in full extension
200
for grades 0,1,2 how should the pt be positioned during knee extension MMT?
1. side lying
2. PT supports top leg and starts off with it slightly flexed
3. Instruct pt to "try and extend your knee back out"
201
where should the PT stabilize during knee extension MMT?
under the knee
202
where should resistance be applied during knee extension MMT?
at the ankle
203
T/F: It is necessary to test hamstring length prior to this test?
TRUE
may impact ROM,
204
what is an alternative way to test knee extension?
chair stand test
205
how much strength is needed to rise up out a chair without arms??
strength equal to half the body weight
206
approximately how much force is transmitted through the knee during stair descent?
nearly 3x body weight
207
what muscles primarily plantarflex the ankle?
1. gastrocnemius
2. soleus
208
what muscles assist in plantarflexion of the ankle?
1. Tibialis posterior
2. Plantaris
3. Peroneus longus
4. Peroneus brevis
5. Flex digitorum longus
6. Flex hallucis longus
209
for grades 3 and up, how should a pt be positioned for plantarflexion MMT?
1. pt standing beside table
2. Instruct pt to perform as many heel raises as you can through full ROM
* grade 5 = 25
* grade 4 = 2-24
* grade 3 = 1 heel raise
210
for grades 0,1,2 how should the pt be positioned during ankle plantarflexion MMT?
1. prone
2. feet off table
3. Instruct pt to "point toes down like a ballet dancer"
211
where should the PT stabilize during ankle plantarflexion MMT?
1. no stabilization for grades 3 and up
2. support ankle for 0,1,2
212
where should resistance be applied during ankle plantarflexion MMT?
no resistance applied
213
T/F: the pt can place 1-2 fingers on the table for balance during ankle plantarflexion MMT?
TRUE
214
what determines that the test has ended during ankle plantarflexion (grades 3 and up)?
pt slows down
pt starts to only obtain 50% ROM
215
what muscle primarily dorsiflexes the ankle?
tibialis anterior
216
what muscles assist with ankle dorsiflexion?
1. peroenus teritius
2. extensor digitorum longus
3. extensor hallucis longus
217
for grades 3 and up, how should the pt be positioned during ankle dorsiflexion and inversion MMT?
1. seated
2. knee in 90 off the table
3. heel is resting on PT thigh
4. Instruct pt to "bring your foor up and in"
218
Alternative position for grades 3 and up in foot dorsiflexion and inversion MMT?
1. Supine
2. leg extended
3. toes pointed up
4. Instruct pt to "bring your foot up and in"
219
T/F: in the alternative supine position for foot dorsiflexion and inversion MMT, you must apply some resistance for grade 3
TRUE
to compensate for lack of gravity
220
for grades 0,1,2 how should the pt be positioned during foot dorsiflexion and inversion MMT?
no specific test
look for only partial ROM and use palpation
221
where should the PT stabilize during foot dorsiflexion and inversion MMT?
cup one hand around the dorsomedial aspect of the foot/ankle
222
where should resistance be applied during foot dorsiflexion and inversion MMT?
applied down and in toward PT
223
what muscles primarily invert the foot?
tibialis posterior
224
what muscles assist with foot inversion?
1. tibialis anterior
2. flexor digitorum longus
3. flexor hallucis longus
4. soleus
5. extensor hallucis longus
225
for grades 3 and up, how should the pt be positioned during foot inversion MMT?
1. sitting
2. knee of table
3. ankle in slight plantarflexion
4. Instruct pt to "turn your foot down and in"
226
for grades 0,1,2 how should the pt be positioned during foot inversion MMT?
no specific test
check for full vs partial ROM
palpate for activation
227
where should the PT stabilize during foot inversion MMT?
ankle, just above the malleoli
228
where should resistance be applied during foot inversion MMT?
applied to medial side of the foot at the level of the metatarsals
229
what is a common substitution that may be observed during foot inversion MMT?
toe flexion
230
what muscles primarily plantarflex and evert the foot?
1. Fibularis longus
2. **Fibularis brevis**
231
what muscles assist in foot eversion and plantarflexion?
1. extensor digitorum longus
2. fibularis tertius
3. gastrocnemius (plantarflexion)
232
for grades 3 and up, how should the pt be positioned during foot eversion and plantarflexion MMT?
1. sitting
2. pt everts and plantarflexes foot
3. instruct pt to "point your foot outward and down"
233
for grades 0,1,2 how should the pt be positioned during foot eversion and plantarflexion MMT?
no specific test (same position as before)
assess full vs partial ROM
use palpation
234
where should the PT stabilize during foot eversion and plantarflexion MMT?
stabilize at ankle just above malleoli
235
where should resistance applied during foot eversion and plantarflexion MMT?
applied to lateral foot trying to move to the foot toward midline and dorsiflexion
236
how do you palpate the fibularis longus?
place fingers on lateral upper leg just below the head of the fibula
237
what muscles primarily flex the hallux and toes MPs?
1. lumbricals
2. flexor hallucis brevis
238
what muscles assist with hallux and toe MP flexion?
1. PADs and DABs
2. flex digiti minimi
3. flex digitorium longus,
4. flex digitorum brevis,
5. flex hallucis longus,
6. abductor hallucis,
7. adductor hallucis
239
how should the pt be positioned for hallux and toe MP flexion?
1. sitting or supine
2. ankle in neutral
3. test foot rests on therapist's lap
240
how should the PT instruct the pt to move if they are testing the hallux MP flexion?
bend your big toe over my finger, don't let me straighten it
241
how should the PT instruct the pt to move if they are testing the toes MP flexion?
bend your toes over my finger, don't let me straighten them out
242
how should the pt be positioned for grades 0,1,2 during hallux and toe MP flexion MMT?
same as grades 3 and up
assess full vs partial ROM
palpation for contraction
243
where should the PT stabilize during hallux and toe MP flexion MMT?
metatarsals
244
where should resistance be applied during hallux and toe MP flexion MMT?
proximal phalanx
245
list the primary muscles for the following:
hallux IP flexion
DIP flexion
PIP flexion
1. hallux = flexor hallucis longus
2. DIP = flexor digitorum longus
3. PIP = flexor digitorum brevis
246
what assists in toe DIP flexion?
quadratus plantae
247
what assist in toe PIP flexion?
flexor digitorum longus
248
how should the pt be positioned for hallux and toe DIP and PIP flexion MMT?
1. sitting or supine
2. foot on therapist's lap
3. ankle neutral
249
how should the PT instruct the pt to move if they are testing the hallux IP flexion?
curl your big toe and hold it
250
how should the PT instruct the pt to move if they are testing toe DIP and PIP flexion?
curl your toes, hold it
251
how do you grade hallux and toe DIP and PIP flexion MMT?
* Grade 5: Completes against resistance
* Grade 4: mod resistance
* Grade 3: no resistance but can complete ROM
* Grade 2: completes partial range
* Grade 1: palpable contractile activity
252
where should the PT stabilize during hallux and toe DIP and PIP flexion MMT?
1. stabilize at the MP joint for the PIP
2. stabilize at the PIP for DIP
253
where should resistance be applied during hallux and toe DIP and PIP flexion MMT?
plantar aspect of middle and distal phalanx
254
what muscle primarily extends the hallux MP and IP joint?
extensor hallucis longus
255
what muscle primarily extends the toes MP and IP joints?
1. extensor digitorum longus
2. extensor digitorum brevis
256
how should the pt be positioned when testing the hallux and toe MP/IP extension with MMT?
1. sitting or supine
2. foot on therapist lap
3. Instruct the pt to "straighten your toes and hold it"
257
when you test the lateral toes MP and IP extension, where should you stabilize?
metatarsals
258
when you test the hallux MP and IP extension where should you stabilize?
metatarsal area with one hand
other hand stabilizes the foot at the heel
259
how do you grade hallux and toe MP/IP extension MMT?
* Grade 5: Completes extension against resistance
* Grade 4: mod/min resistance
* Grade 3: no resistance but can complete ROM
* Grade 2: completes partial range
* Grade 1: palpable contractile activity
260
T/F: most individuals cannot separate great toe extension from lateral toes?
TRUE
261
what are some self-reported measures tests?
1. Falls Efficay Scale (FES)
2. Activities-Specific Balance Confidence Scale (ABC)
3. Patient Specific Functional Scale (PSFS)
262
what is the FES?
16 item questionnaire
measures fear or concern of falling
263
what is the ABC?
similar to FES but expands to **daily acitivities**
measures an individual's confidence in his/her ability to perform daily activities w/o falling
264
what is the PSFS used for?
to quantify activity limitations and measure functional outcome for pts
265
name some gait/balance assessment tests
1. 6 minute walk test
2. Timed Up and Go (TUG) test
3. Berg Balance Scale
4. Functional Reach Test
5. Balance Evauation Systems Test (BESTest)
* full version
* MiniBest
* BreifBest
6. Tinetti Performance Oriented Mobility Assessment
266
describe the 6 min walk test
measures the distance covered in 6 minutes while walking at a comfortable pace
267
In what populations can the 6 min walk test be used?
1. Arthritis
2. MS
3. Parkinson's Disease
4. acquired brain injury
5. stroke
268
there are normative values for _______ and ________ in the 6 minute walk test
gender and age
269
describe the TUG Test
tests mobility, balance, walking ability, and fall risk
used mostly in the elderly
score decreases sig w/mobility impairments
270
In what populations can the TUG test be used?
1. Arthritis/Joint conditions
2. CP
3. MS
4. Parkinson's Disease
5. Neurological and vestibular conditions/disorders
271
what the Berg Balance scale?
objective measurement of static and dynamic balance abilities
14 functional tasks commonly performed in everyday life
272
In what populations can the Berg Balance scale be used?
1. Arthritis/Joint diseases
2. MS
3. Parkinson's Disease
4. Neurologic Conditions
5. Brain injuries/stroke
273
describe the functional reach test
quick screen of balance in elderly
max distance one can reach forward beyond arm's length while maintaining a fixed BOS in the standing position
274
scores \>\_\_\_\_\_ on the functional reach test indicated limited functional balance
7 inches
275
what is the BESTest?
balance test with 36 items grouped into 6 systems
276
what are the 6 systems included in the BESTest?
1. biomechanical constraints
2. stability limits/verticality
3. anticipatory postural adjustments
4. postural responses
5. sensory orientation
6. stability in gait
277
describe the MiniBest
shortened version of BESTest
has 4 scoring domains:
anticipatory
postural response
sensory orintation
gait balance
278
what is the BriefBest
abbreviated version designed to assese 6 different aspects contributing to postural control in standing and walking
279
describe the Tinetti Performance Oriented Mobility Assessment
used to measure gait and balance abilities
16 total items (9 balance and 7 gait)
280
what categories are involved in a mental status screen?
1. Appearance and behavior
2. attention and orientation
3. attention/memory
281
what is the Mini Mental State Exam?
widely known test of cognition
score of \>25 indicates cognitive impairment
celing effect w/mild impairments
282
categories included in the Mini-Mental State Exam
1. Orientation
2. Registration
3. Attention and Calculation
4. Recall
5. Language
283
T/F: the Mini-Mental State Exam is free
False it costs money to use
284
what is the Montreal Cognitive Assessment (MoCA)?
a rapid screen instrument for mild cognitive dysfunction
\>26 is considered normal
takes ~10 min to administer
285
what testing areas are included in the MoCA?
1. Visuospatial/Executive
2. Naming (animals)
3. Memory
4. Attention and Concentration
5. Abstraction
6. Delayed Recall
7. Orientation
286
what are ICD-10 codes used for?
medical and PT diagnoses of our patients
287
describe the ICD-10 code structure
1. category (first 3 characters)
2. etiology, anatomic site, severity (4th-6th characters)
288
how do you choose the correct ICD-10 code?
report specific diagnosis codes when they are supported by the available medical record doc and clinical knowledge of the patient's health condition
289
T/F: we want to choose a vague ICD-10 code?
TRUE, leaves us more wiggle room
signs, symptoms or unspecified codes are best
290
you code at the \_\_\_\_\_\_\_\_\_\_
level you can confirm
291
what codes are used for interventions?
CPT-4 codes
292
what does CPT stand for?
Current Procedural Terminology
293
T/F: CPT-4 codes are required to receive payment
TRUE
depends on insurance but mostly true
294
most CPT codes that are available to PTs are located in the \_\_\_\_\_\_\_
97000 series called Physical Medicine and Rehab
295
what is the 8 minute rule?
bill one unit for treatment greater than or equal to 8 minutes through and including 22 minutes
296
Units breakdown for CPT codes
* 8 -22 minutes = 1 unit
* 23-37 minutes = 2 units
* 38-52 minutes = 3 units
* 53 -67 minutes = 4 units
* 68-82 minutes = 5 units
297
T/F: most PT practices under bill and use the wrong codes?
TRUE
298
how does compensation work with CPT codes?
payment policy is determined by each individual payer and insurance
299
CPT 97110 Therapeutic Exercise
develop strength and endurance, ROM and flexibility
300
CPT 97530 Therapeutic Activities
direct (one-on-one) patient contact by the provider (use of dynamic activites to improve functional performance)
301
T/F: antropometry is a key component of nutritional staus assessment in children and adults?
TRUE
302
what are some methods for measuring antropometrics?
1. Body weight/height (BMI)
2. girth measurements (waist to hip ratio/limb girth)
3. skinfold calipers
4. hydrostatic weighing (gold standard)
5. Bod pod
6. electrical impedance
7. limb length
8. finger pressure (peripheral edema)
303
what is considered a normal BMI?
18.5 - 24.9
304
how is waist to hip ratio determined?
waist measurement taken at narrowest part of the torso (above the umbilicus and below the xiphoid process)
hip measurement taken at max circumference of the hip
305
name a limb circumference technique we did earlier this year
Figure-8 ankle measurement
306
describe the technique required for skinfold measurements
1. grasp skin firmly by thumb and index finger
2. place caliper 1 cm below hold
3. maintain grip while releasing caliper
4. wait 2 sec to read caliper to nearest 0.5 mm
5. take 2 measurements at each site, alternating sites
307
when should a 3rd skinfold measurement be taken?
if the 2 measurements differ by more than 1 mm
308
written goals should be used to determine what?
1. progress
2. allow for adjustment of clinical impression
3. prognosis, duration and frequency of the episode of care
4. conclucsion of care and intervention plan
309
Goal writing needs to be \_\_\_\_\_\_\_\_
1. patient/client centered
2. unbiased and objective
3. quantifiable/measurable
4. relates to a particular use or purpose and is therefore **functional**
5. has a time frame
310
what are 2 types of options of Daily notes?
1. S.O.A.P
2. S.I.R.P
311
what does SIRP stand for?
1. Status
2. Intervention
3. response
4. Plan
312
what are the elements of the Patient/Client Management Model?
1. Examination
2. Evauation
3. Diagnosis
4. Prognosis
5. Intervention
6. Outcomes
313
what occurs during the examination in the Patient/Client Management Model?
examine the pt. and collect data through the history, systems review, and tests and measures
314
what occurs during the evaluation in the patient/client management model?
evaluate the data and ID the problems
315
what occurs during the diagnosis portion of the patient/client management model?
determination of the diagnosis and prognosis
316
when is the POC implemented in the patient/client management model?
during Intervention
317
What is the HOAC?
a clinical decision making model that generates hypotheses and facilitates the use of science and evidence in practice to confirm or refute hypothesis
318
What does HOAC-II stand for?
Hypothesis-Oriented Algorithm for Clinicans II
319
how does the HOAC-II differ from the Patient/Client Management Model?
HOAC-II involves the patient in decision making and provides payers with better justification
320
In the HOAC-II model the problem is almost always a \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
functional deficit
321
how can patient problems be divided/subdivided in the HOAC?
1. Exisiting
2. Anticipated
3. Patient ID
4. non-patient identified
322
What are the steps in the HOAC-II?
1. Initial data collection
2. Generate patient identified problems (PIP) list
3. Exam strategy
4. Conduct exam and analyze data
5. Add Non-patient identified problems (NPIP) to problem list
6. Justification for hypothesis
7. Hypotheses about cuase
8. Refine Problem List
9. Goals
10. Establish testing critera
11. Establish predicitive criteria
12. Reassessment Plan
13. Plan and implement intervention
323
What is included in the hypotheses formed at the end of the HOAC?
determination of probable cause as well as magnitude of deficits
followed by subsequent quantifable steps that must be achieved to eliminate the identified problem
324
T/F: In PT, pathologies are often unchanged even though impairments or functional limitations are reduced or eliminated?
TRUE
325
Goals are written/expressed almost exclusively as \_\_\_\_\_\_\_\_\_\_
functional activities
326
All goals must represent \_\_\_\_\_\_\_\_
meaningul accomplishments
* functional task analysis
* short-term vs. long-term goals
327
define testing criteria
level of improvement in impairment needed to eliminate the problem
328
predictive criteria are related to \_\_\_\_\_\_\_\_
risk factors
329
Define tactics as it pertains to the HOAC
specific elements of intervention (frequency, duration, intensity)
330
What should goals be/include?
1. patient/client centered
2. unbiased and objectable
3. quantifiable/measurable
4. relates to a particular use or purpose and is therefore functional
5. have a time frame
331
what is the purpose of muscle length testing?
to determine the greatest extensibility of a muscle-tendon unit
332
how would you determine muscle length at a one joint muscle?
via goni measurement of PROM of motion opposite to action of muscle of interest
333
how would you measure muscle length in a two joint muscle?
lengthen the muscle across one joint and then asses ROM available at the second joint
334
how do you know when elbow extension is limited by a short bicep?
elbow extension will be limited when:
shoulder is postioned in full extension and the forearm is in full pronation
335
what else can limit elbow extension?
1. joint surfaces
2. shortening of the anterior capsule/collateral ligaments
3. other muscles such as brachialis/brachioradialis
336
what would indicate that something other than a short biceps is limiting elbow extension?
if elbow ext is limited regardless of shoulder position
337
describe the muscle length test for the biceps brachii
1. position pt. in supine at edge of table
2. flex the elbow fully, then move the shoulder into full ext while holding the forearm in pronation
3. test ends when resistance (should be firm end-feel) is felt
4. hold and measure w/goni
338
how do you know when elbow flexion is limited by the triceps brachii?
elbow flexion will be limited when the shoulder is positioned in full flexion
339
what else (other than the long head of triceps) can limit elbow flexion and how do you know?
abnormalities of joint surfaces
shortening of the posterior capsule
muscles that cross only the elbow (anconeus, M/L tricep)
elbow flexion will be limited regardless of shoulder position
340
describe the set up for muscle length testing of the triceps brachii
1. supine at edge of table
2. ext the elbow and move shoulder into full flexion w/00 of abduction
3. supinate the forearm
4. move the elbow into flexion until you feel resistance
341
describe how to measure the pectoralis major length
1. position pt in supine w/hands behind head
2. stabilize contralateral trunk/shoulder
3. measure the distance between the olecranon and the table
342
describe how to measure the pectoralis minor length
1. position the pt in supine with netural shoulder and elbow extended and palms facing up
2. measure the distance between the posterior acromion and the table
343
what is considered "tight" for the pectoralis minor length test?
a distance greater than 1 inch
differences compared to the contralateral side
344
what does the Thomas Test measure?
hip flexors muscle length
\*\*there are a lot of compensations
345
describe how to perform the Thomas Test
1. position the pt at the end edge of the table w/lower thighs, knees, and legs off the table
2. assist the pt into supine position by supporting pt's back and flex hips and knees
3. flex hips and knees enough to flatten low back and pelvis onto table
4. stabilize hip not being tested in flexion
5. extend hip being tested toward table (involved hip and knee should be relaxed)
346
Goni alignments for Thomas Test (for hip flexors)
1. Fulcrum = greater trochanter
2. Stationary = lateral midline of the pelvis
3. Moving = lateral midline of the femur (lateral epicondyle as ref)
347
what else can the Thomas Test be used to measure?
(other than hip flexors)
1. rectus femoris
2. abductor/adductors
3. sartorius tightness
\*use goni landmarks that test each of those ROMs
348
what are some possible abnormal findings during the Thomas Test?
1. unable to reach hip extension in testing position
2. Hip moves into ABD + ER + Knee flex
3. Hip moves into ABD + IR
4. Knee extends and is not flexed at 900
5. Hip moves into ADD
349
if you are unable to reach adequate hip extension in the testing position during the Thomas Test what may be the cause?
hip flexors may be shortened
350
What is most likely the cause of the hip moving into
ABD + ER + Knee flexion during the Thomas Test?
Sartorius may be shortened
351
What is most likely the cause of the Hip moving into
ABD + IR during the Thomas Test?
TFL may be shortened
352
What is most likely the cause of the knee extending out and not remaining at 900 during the Thomas Test?
Rectus femoris may be shortened
353
What is most likely the cause of the hip moving into ADD during the Thomas Test?
The adductors may be tight
(pectineus, adductor longus, adductor brevis)
354
Alternate name for the testing Hamstring muscle length?
SLR test
355
describe how to perform the SLR test
1. position the pt supine w/knee extended, hip in 00 flex, ext, ABD, ADD and rotation
2. stabilize knee being tested at 00
3. flex the hip by lifting the LE off the table while keeping the knee in 00 extension
356
what is considered a normal length for the SLR Test?
70-800 of hip flex w/knee extended
357
Describe how to test the distal hamstring length
1. position the pt in supine w/involved hip flexed to 900 and 0 of ABD/ADD/Rotation
2. uninvolved leg w/knee in 00 ext and hip in 00 everything
3. stabilize femur to prevent Rotation/ABD/ADD
4. Extend the knee to the end of RO
* stop the motion when resistance is felt and hip begins to move into extensino
358
what is the distal hamstring length test also called?
popliteal angle test
359
what are the main differences between the proximal and distal hamstring length?
1. goni placement
* prox =\> fulcrum over greater troch
* distal =\> fulcrum over lateral epicondyle of femur
2. knee angle
* prox =\> knee is full extended
* distal =\> knee starts off flexed
3. hip angle
* prox =\> hip starts at 00 flex
* distal =\> hip starts at 900 flex
360
describe how to perform the muscle length test for the rectus femoris
1. position the pt. prone w/feet off end of table
2. knees extended, hips in 00 everything
3. stabilize posterior hip to maintain neutral position
4. flex the knee towards buttocks
5. end ROM occurs when reistance is felt from ant thigh
361
what is another name for the rectus femoris muscle length test?
Ely Test
362
if knee flex is limited when the hip is in a flexed position and the pt is prone what is most likely the cause?
NOT from a short rectus
most likely from abnormalities of joint structure
or
short one joint knee extensor
363
What does the Ober Test examine?
length of TFL and IT band that ABD the hip
364
describe how to perform the Ober Test
1. position pt in side-lying near back edge of table w/involved leg on top
2. stabilize top iliac crest to stabilize the pelvis
* bottom hip and flexed knee stabilize trunk
3. support the involved leg by holding under med aspect of knee and lower leg
4. flex the hip and knee to 900
5. keep knee flexed and move the hip into ABD and Ext and then lower the hip into ADD and lower toward table
365
what does the IT band limit?
hip ADD
hip Ext, ER (a little)
Knee flexion (a little)
366
shortening of the IT band can contribute to what?
1. LBP
2. ITB friction syndrome
3. patellofemoral pain
367
goni alignment for the Ober Test
1. Fulcrum = over ASIS
2. Stationary = parallel to the opposite ASIS
3. Movement arm = ant midline of femur (patella as ref)
368
how is the modified Ober Test different from the standard Ober Test?
the knee is held in extension in the modified version
369
what does the modified Ober Test do?
evaluate the length of the hip abductors
370
How many ways are there to evaluate the muscle length of the Gastrocnemius?
2
371
describe how to perform the muscle length test for the Gastroc in supine
1. position pt in supine w/knee extended and foot in neutrl EV/IN
2. hold knee in full extension
3. dorsiflex the ankle to end ROM by pushing across plantar aspect of met heads
372
Goni alignment for Gastroc muscle length testing in supine
1. Fulcrum = over lateral aspect of lateral malleolus
2. Stationary = lateral midline of fibular, fibular head as ref
3. Moving = parallel to the lateral aspect of 5th met
373
T/F: if the gastroc is short it will limit ankle DF when the knee if flexed
FALSE - when the knee is extended it will limit ankle DF
374
If DF is limited regardless of what position the knee is in, what may be the cause?
abnormalities of ankle joint surfaces
shortening of the joint capsule
shortening of ligaments
shortening of the soleus
375
describe how to perform the muscle length test for the Gastroc in standing
1. maintain the knee in full ext
2. ensure heel remains in contact w/floor
3. pt DF ankle by leaning body foward
4. test ends when the individual feels tension in the post calf and knee, or if further DF causes the knee to flex and heel to lift of the floor
376
how much hip flexion is required for putting on socks?
120 of flexion
377
In order to walk on level surfaces how much function hip flexion is required?
0-300
378
in order to ascend stairs, how much hip flexion is required?
1-0-66
379
in order to descend stairs, how much hip flexion is required?
1-0-45
380
what are the primary muscles that perform capital extension?
1. rectus capitis Posterior Major/Minor
2. Longissimus Capitis
3. Obliquus Capitis Superior/Inferior
4. Semispinalis Capitis
5. Trapezius
6. Spinalis Capitis
381
for grades 3 and up, how should the pt be positioned when assessing capital extension with MMT?
1. Prone
2. Head off table
3. PT supports at chin with one hand
4. Instruct pt to "look at where the wall meets the floor"
382
for grades 0,1,2 how should the pt be positioned when assessing capital extension with MMT?
1. supine
2. head supported on table
3. place hands under base of skull to palpate muscles
4. Instruct pt to "look back at me without lifting your head from the table"
383
where should the PT stabilize during capital extension MMT?
one hand under chin (grades 3 and up) just in case head drops
384
where should resistance be applied during capital extension MMT?
towards the ground at the base of the head
385
what muscles are primarily assessed during cervical extension?
1. erector spinae cervical portion
2. semispinalis cervicis
3. splenius cervicis
4. Upper traps
386
what muscles are assisting in cervical extension?
1. Interspinalis cervicis
2. Intertransversarii cervicis
3. rotatores cervicis
4. Multifidi
5. levator scapulae
387
for grades 3 and up, how should the pt be positioned when assessing cervical extension with MMT?
1. Prone
2. head off the table (shoulders at the edge of table)
3. Pt supports under the chin with one hand and places other hand on the back of head
4. Instruct the pt to "push your head back into my hand without tilting your head"
* movement is like a chin tuck
388
what is the alterantive position for cervical extension grade 3?
in presence of trunk weakness, therapist holds upper trunk
389
for grades 0,1,2 how should the pt be positioned for cervical extension MMT?
1. supine
2. PT has hands under occiput
3. Instruct the pt to "push your head down into my hands"
* similar to a chin tuck motion
390
where should the PT stabilize during cervical extension MMT?
one hand under the chin for grades 4 and 5
at the upper trunk for grade 3
391
where should force be applied during cervical extension MMT?
towards the ground at the back of head
make sure the pt doesn't tilt the head back
392
what are the primary muscles tested during combined extension (cervical and capital)?
same muscles that performed cervical and capital extenstion
393
how should the pt be positioned for combined cervical and capital extension MMT?
1. prone
2. shoulders at the edge of table so head is off
3. arms by the sides
4. Instruct the pt to "lift your head and look at the wall/ceiling"
394
what is the alternative pt positioning for combined cervical and capital extension MMT?
for grade 3
involves stabilization of upper back if pt has trunk or hip extensor weakness?
395
how do you grade combined cervical and capital extension MMT?
No specific test/position for grades 0,1,2
check for full or partial ROM
Palpate
396
where should the PT stabilize during combined cervical and capital extension MMT?
PT has one hand under chin in case of head drop
upper trunk for alternative test
397
where should resistance be applied during combined cervical and capital extension MMT?
applied down and slightly out
398
what muscles are primarily assessed during capital flexion MMT?
1. rectus capitis anterior
2. rectus capitis lateralis
3. longus capitis
399
what muscles assist in capital flexion?
suprahyoid muscles
400
how should the pt be positioned during captial flexion MMT?
1. supine
2. head supported on table
3. Instruct the pt to "tuck your chin, don't lift your head from the table, don't let me lift your chin"
4. same position for all grades
401
where should the PT stabilize and apply resistance during capital flexion MMT?
no stabilization
both hands are used to counter flexion at the chin
402
what muscles are primarily assessed with cervical flexion MMT?
1. SCM
2. longus colli
3. anterior scalene
403
what muscles assist with cervical flexion?
suprahyoid muscles
middle and posterior scalene
404
for grades 3 and up, how should the pt be positioned during cervical flexion MMT?
1. supine
2. head supported on table
3. Instruct pt to "lift your head from the table keeping your shoulders down, don't let me push your head down"
405
for grades 0,1,2 how should the pt be positioned during cervical flexion MMT?
1. supine
2. head supported on table
3. Instruct pt to "roll your head to the left and then right"
4. palpate for contractility
406
where should the PT stabilize during cervical flexion MMT?
stabilize thorax to prevent lifting of shoulders
407
where should resistance be applied during cervical flexion MMT?
forehead with 2 fingers
408
what muscles are primarily assessed during combined capital and cervial flexion?
all capital and cervical flexors
409
how should the pt be positioned for combined capital and cervical flexion MMT?
1. supine
2. head supported on the table
3. Instruct pt to "bring your head up until your chin is toward your chest, do not raise your shoulders off the table"
410
how should combined capital and cervical flexion MMT be graded?
* Grade 5: Pt completes ROM Against strong resistance.
* Grade 4: Pt Completes ROM w/mod resistance
* Grade 3: Pt completes ROM w/no resistance.
* Grade 2: Partial ROM
* Grade 1: Palpate muscle but no motion.
411
where should the PT stabilize during combined capital and cervical flexion MMT?
stabilize thorax to prevent lifting of shoulders
412
where should resistance be applied during combined cervical and capital flexion
applied to the forehead down and out
413
how can you isolate the SCM with MMT?
1. same position as cervical flexion
2. instruct pt to "turn head to one side and then lift your head keeping it turned
3. for gravity minimized simply have them turn their head and palpate SCM
414
what muscles are primarily assessed with cervical rotation MMT?
1. SCM
2. semispinalis
3. longissimus capitis and cervicis
4. trapezius
5. scalenes
6. levator scapulae
7. obliquus capitis
8. rectus capitis
415
for grades 3 and up, how should the pt be positioned for cervical rotation MMT?
1. supine
2. head supported on table
3. start off facing L/R
4. Instruct pt to "turn your head and face the ceiling, don't let me push it back down
416
for grades 0,1,2 how should the pt be positioned for cervical rotation MMT?
1. sitting
2. head posture neutral
3. instruct pt to "turn your head as far R/L as you can"
417
where should the PT stabilize and apply resistance for cervical rotation MMT?
1. no specific stabilization
2. resistance applied to side of head above ear
418
T/F: for trunk extension, thoracic and lumbar extension can be separated for all grades?
FALSE
only for grades 5 and 4
419
what muscles will be involved in trunk extension? (both thoracic and lumbar)
1. Iliocostalis thoracis and lumborum
2. Longissimus thoracis
3. Spinalis thoracis
4. Semispinalis thoracis
5. Multifidus (multifidi)
6. Thoracic and lumbar rotatores
7. Intertransversarii Thoracis & Lumborum
8. Quadratus lumborum
420
for grades 4 and 5, how should the pt be positioned for lumbar extension MMT?
1. prone
2. hands behind head
3. Instruct pt to "raise your head, shoulders, and chest as high as you can"
4. observe for pt to clear umbilicus
421
where should the PT stabilize during lumbar extension grades 4 and 5 MMT?
at the ankles
OR
pelvis if they have hip extnesion weakness
422
where should the PT apply resistance for grades 5 and 4 lumbar extension MMT?
no resistance applied
pts own weight is used as resistance
423
T/F: test for hip and neck extension prior to trunk
TRUE
424
for grades 4 and 5, how should a pt be positioned for thoracic extension MMT?
1. prone
2. mid chest (nipple line) off table with hands behind head
3. Instruct pt to "raise your head, shoulders, and chest to table level
425
where should the PT apply resistance and stabilize during thoracic extension grades 4 and 5 MMT?
no resistance
stabilize at ankles
426
T/F: for grades 3, 2, 1, 0 thoracic and lumbar extension are tested together?
TRUE
427
for grades 3 and down, how should the pt be positioned for combined trunk extension MMT?
1. Prone
2. mid chest (nipple line) off table
3. arms by side
4. Instruct pt to "raise your head, and chest as high as you can"
* full ROM is grade 3
428
where should the PT stabilize and apply resistance during combined trunk extension MMT?
no resistance applied
stabilize at ankles
429
where should the PT palpate for grades 0 during combined trunk extension?
thoracic or lumbar adjacent to specific segement of spine
430
what are some common subsitutions that may be observed during combined trunk extension MMT?
1. if spine extensors are weak and hip extensors are strong, pt will no be able to raise upper trunk from table. Instead pelvis will tilt posteriorly while L spine moves into flexion
2. When back extensors are strong and hip extensors are weak, pt can hyperextend the low back and won't be able to raise trunk without stabilization from PT
431
what muscles are primarily tested during trunk flexion?
1. Rectus abdominis
2. obliquus externus
3. obliquus internus
432
what musles assist with trunk flexion?
Psoas major/minor
433
how should the pt be positioned for grades 3 and up during trunk flexion MMT?
1. supine
2. hands behind head for grade 5
3. hands across chest for grde 4
4. hands out for grade 3
5. Instruct pt to "keep your chin pointed at ceiling and lift your head, shoulder, and back off the table"
6. check for scapular clearance
434
how should a pt be positioned for grade 2 trunk flexion MMT?
1. hook lying
2. instruct pt to lift head from table
3. if scapula does not lift its a grade 2
435
how should pt be positioned for grade 1 trunk flexion MMT?
1. hook lying
2. ask pt to lift their head off table
3. if they cannot lift head off table then cradles head and ask them to lean forward
4. if rib depression is observed = grade 2
5. no rib depression but muscle activation = grade 1
436
if a pt coughs and you observe rib depression what grade should be given for trunk flexion?
grade 2
cough with no palpable contraction is a grade 1
437
what muscle is primarily tested during trunk rotation?
internal and external obliques
438
Instructions and positioning for trunk rotation grade 5
1. supine
2. hands behind head
3. Instruct pt to "keep your chin pointed at the ceiling and lift your head, shoulders, and back off the table and to the side"
4. look for scapular clearance
439
Instructions and positioning for trunk rotation grade 4
1. supine
2. hands across chest
3. instruct pt to "keep your chin pointed at the ceiling and lift your head, shoulders, and back off the table and to the side"
4. check for scapular clearance
440
Instructions and positioning for trunk rotation grade 3
1. supine
2. hands out
3. Instruct pt to "keep your chin pointed to the ceiling and lift your head, shoulders, and back off the table and to the side"
4. check for scapular clearance
441
Instructions and positioning for grade 2 trunk rotation
1. supine
2. hands by side
3. pt is unable to raise scapula off the table, but therapist can observe depression of rib cage
442
Instructions and positioning for grade 1 trunk rotation
1. hook lying
2. PT supports pts with arm under upper trunk/shoulders
3. palpate for internal oblique contraction
443
T/F: bringing your left elbow to your right knee during trunk rotation testing is testing the left external and internal oblique?
FALSE
tests the left external and right internal oblique
444
what is a common substitution that may be observed during trunk rotation testing?
if the pt has overactive pectoralis muscles, you will observe shoulder shrug/elevation with trunk flexion
445
what are the scapular movements tested with MMT?
1. elevation
2. adduction
3. abductino
4. upward rotation
5. depression and downward rotation
446
what muscles primarily are assessed during scapular upward rotation and abduction?
serratus anterior
447
why is upward rotation with abduction a significant motion for the scapula?
contributes to scapulo humeral rhythm
weakness in upward rotators may lead to dysfunction and downward rotation of scapula
increases risk for impingement
448
T/F: the serratus anterior can never be graded higher than the grade assigned to shoulder flexion?
TRUE
weak deltoid = loss of lever for testing = cannot apply resistance in this test
449
for grades 4 and 5, how should the pt be positioned for serratus anterior MMT?
1. sitting
2. shoulder flexed to 130 w/elbow extended
3. apply resistance at distal humerus in a downward direction
4. stabilize/palpate lateral edge of scapula to see if it maintains an abudcted and upwardly rotated position
450
how should the pt be positioned for a grade 3 serratus anterior MMT?
1. sitting
2. shoulder flexed to at least 90 with elbow extended
3. check position
* is it uncoordinated? = weak serratus ant
4. pt can get into position but cannot hold against resistance
451
how should the pt be positioned for grades 0,1,2 serratus anterior MMT?
1. sitting
2. PT supported weight of arm and moves it into position of aprox 90 flex
3. Instruct pt to "hold your arm in this position, let it relax. Now hold your arm up again. Let it relax"
4. palpate serratus anterior
452
alternative testing position for serratus anterior MMT?
1. supine
2. shoulder flexed to 90, neural rotation
3. elbow extended
4. instruct pt to make a fist and punch straight up into your hand
453
T/F: it is alright to test scapular elevation bilaterally?
TRUE
454
pt positioning for grades 3 and up scapular elevation MMT?
similar to how we performed it in systems review
455
gravitiy minimized positioning for scapular elevation
1. prone or supine
2. neutral head (turning may influence activation of muscles)
456
what muscles primarily perform scapular adduction (retraction)?
1. middle trapezius
2. rhomboid major
457
what muscles assist with scapular adduction (retraction)?
1. rhomboid minor
2. upper and lower trapezius
3. levator scapulae
458
for grades 4 and 5 how should the pt be positioned for scapular adduction (retraction) MMT?
1. prone
2. arm abducted 90 and elbow flexted to 90
3. head turned to either side
4. stabilize contralateral scapula
5. apply resistance at distal humerus (if posterior deltoid was a grade 3 at least)
459
if a pt has a posterior deltoid that graded less than a 3, how should the pt be positioned during scapular adduction (retraction) MMT?
1. set up is exactly the same as grades 3 and up
2. main difference is lever arm changes from distal humerus to posterior shoulder
460
for grades 0,1,2 how should the pt be positioned during scapular adduction (retraction) MMT?
1. prone
2. shoulder abducted 90, elbow flexed 90
3. PT supports the weight of the arm
4. other hand is placed along upper medial border of scapula being tested to palpate
5. instruct pt to move arm through full ROM
461
what are some common substitutions that may be observed during scapular adduction (retraction) MMT?
1. rhomboid overtaking middle trap = scapula will adduct and rotate downwards
2. no scapular adduction is observed but shoulder moves = posterior deltoid solely working
462
what muscle primarily is tested during scapular downward rotation and depression?
lower trapezius
463
what muscles assist in scapular depression and downward rotation?
1. latissimus dorsi
2. pectorals
464
for grades 3 and up, how should the pt be positioned during scapular depression and downward rotation MMT?
1. prone
2. test arm overhead to 145 of abduction
3. head turned to either side
4. thumb up
5. apply downward force at distal humerus
6. other hand palpating along spine for lower trap
465
for grades 0,1,2 how should the pt be positioned during scapular depression and adduction (downward rotation) MMT?
1. prone
2. support arm and position it to 145 abduction
3. thumb pointed up
4. palpate lower trap between base of spine of scapula and lower T vertebrae
466
what is primarily tested during scapular downward rotation and adduction?
rhomboid major
467
what muscles assist in scapular downward rotation and adduction?
1. rhomboid minor
2. levator scapulae
468
T/F: the rhomboid are frequently underrated during MMT?
TRUE
evidence suggests they are difficult to accurately assess
469
clinical weakness of the rhomboids is a strong diagnostic test for what?
subscapular nerve lesion or muscle tear
470
for grades 3 and up, how should the pt be positioned during rhomboid MMT?
1. prone
2. arm behind back
3. instruct pt to "lift hand from back"
4. apply resistance in outward and downard direction at the distal humerus
\*shoulder extensors must be graded as 3 or higher to do this
471
for grades 0,1,2 how should the pt be positioned when testing the rhomboids?
1. prone or sitting
2. place pts arm behind back
3. support under arm and shoulder (prone) under wrist (sitting)
4. palpate medial border of scapula for rhomboids
472
what are some common substitutions that may be observed during rhomboid MMT?
1. Fibers of the middle trapezius can substitute for the adduction action of the rhomboids but not the downward rotation component
2. When substitution occurs, the patient's scapula will adduct with no downward rotation.
Palpation skills and visual observation will confirm this substitution
473
what muscle primarily is tested during scapular depression and shoulder extension?
latissimus dorsi
474
what can assit the lats in scapular depression and shoulder extension?
1. teres major
2. posterior deltoid
475
when does the latissimus dorsi act as a scapular depressor?
when the origin is fixed
476
how should the pt be positioned during MMT of the latissimus dorsi?
1. prone
2. arms by side
3. head turned to either side
4. pt depresses scapula down towards feet
5. resistance is applied at the forearm directly upward towards pt's head resisting motion
477
alternative testing position for latissimus dorsi MMT?
1. sitting
2. hands placed on table
3. instruct pt to lift their bottom off the table while palpating lats bilaterally
4. apply resistance downwards resisting motion
can be done if PT is unable to cause pt to yield against max resistance in prone
