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Tests and Measures Exam 1 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

What are the types of clinical reasoning?

A
  • Algorithms
  • Forward reasoning
  • Interactive reasoning
  • Conditional reasoning
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2
Q

What does HOAC stand for and what is it used for?

A
  • Hypothesis oriented algorithm for Clinicians ll

* Method for hypothesis development and provides a good algorithm to use for reflection of clinical practice

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3
Q

What occurs with Forward Reasoning?

A
  • Have a pre-existing expectation and looking for information that fits
  • Uses past experiences
  • “If then” pattern recognition
    - If x is green then x is a frog
    - If x is a frog then x croaks and eats flies
    - Need some experience and needs to be careful to make quick judgments or you may miss something
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4
Q

What occurs with Backward Reasoning?

A
  • Starts with a hypothesis and works backward
    - If x croaks and eats flies then x is a frog
    - If x is a frog then x is a green
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5
Q

What occurs with interactive reasoning?

A
  • Teaching, patient focused
  • Getting to know the patient and involving them in the problem solving process
  • Can be difficult for a novice
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6
Q

What occurs with conditional reasoning?

A
  • Reflection time
    • Good or bad- can invite criticism and make self aware to mistakes that were made
    • Exhausting
    • Difficult for a novice
    • Hallmark of an expert clinician
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7
Q

What does the Nagi Model look at?

A
  • Pathology
  • Impairment
  • Functional Limitation
  • Disability
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8
Q

What does the International Classification of function (ICF) look at?

A

**Ability slant to the Nagi Model

  • Body structure and function
  • Activity
  • Participation
  • Contextual factors
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9
Q

What does the ICF look at?

A

*focuses on human functioning and provides a unified, standard language and framework that captures how people with a health condition function in their daily life rather than focusing on their diagnosis or the presence or absence of disease.

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10
Q

What are the objectives of palpation?

A
  • Detect abnormal tissue texture and location
  • Detect asymmetries of position
  • Detect sensitivity to palpation/pressure
  • Detect changes in findings to note improvements/regression of symptoms
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11
Q

What is one of the most sensitive parts of the body?

A

The hand

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12
Q

What are the phases of palpatory sense?

A
  • Reception- proprioception and mechanoreceptors of the hand receive stimulation from the tissues palpated
  • Transmission- information transmitted through peripheral and central nervous system to the brain
  • Interpretation- this inflammation is analyzed and interpreted
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13
Q

What enhances interpretation?

A

Experience!!

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14
Q

What parts of the hand are used for specific purposes in palpation?

A
  • Thumb and fingertips- pressure probes for differences in depth
  • Finger pads- Fine discrimination of textural differences, skin, contour temperature
  • Palm of the hand- Stereognostic sense of contour and shape
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15
Q

How do you test stereognosis?

A

The patient identifies common objects placed in hands without visual cues

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16
Q

What is stereognosis?

A

*The ability to perceive and recognize the form of an object using cues from texture, size, spatial properties

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17
Q

What are the principles of palpation?

A
  • Move slow
  • Avoid excessive pressure- layer your palpation and don’t start deep
  • Concentrate/focus
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18
Q

What is ACROM?

A

Active range of motion- the arc of motion attained by a subject during unassisted voluntary joint motion

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19
Q

What does the AROM allow the examiner to do?

A
  • Screen for abnormal movements (quality amongst quantity)
  • Assess patients willingness to move
  • Assess patients ROM and coordination
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20
Q

What does AROM give an idea of?

A

Gives an indication of contractile tissue status

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21
Q

What is PROM?

A

Passive range of motion- the arc of motion attained by an examiner without assistance from the subject

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22
Q

What does PROM allow the examiner to do?

A
  • Detect pain
  • Give an indication of true joint mobility
  • Assess the tissue that is limiting the motion (end feel)
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23
Q

What are 5 end feels and a description of their limitation?

A
  • Hard- Bone
  • Soft- Soft tissue approximation (muscle)
  • Firm- Capsular, ligament, muscle stretch
  • Boggy- Edema, synovitis
  • Empty- Pain
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24
Q

What does PROM provide the examiner information about?

A
  • Integrity of joint surfaces

* Extensibility of joint capsule and associated ligaments

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25
Q

What is a capsular pattern?

A

Pathological conditions involving the entire joint capsule cause a particular pattern of restrictions involving all or most of the passive motions of the joint

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26
Q

What are the factors affecting ROM?

A
  • Age
  • Gender
  • Body Mass (adipose tissue or muscle mass)
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27
Q

What can goniometry determine?

A
  • A joint position (resting/End Range)
  • Total amount of motion available at a joint
  • Muscle length
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28
Q

What is goniometry used for?

A

*Used to measure and document the amount of active and passive joint motion

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29
Q

What is goniometric validity?

A

*The degree to which an instrument measures what it is purported to measure: the extent to which it fulfills it’s purpose

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30
Q

What does most research support when considering goniometric validity?

A
  • Face- the instrument generally appears to measure what it’s supposed to measure
  • Content- whether or not an instrument adequately measures and represents the domain of content (the substance) of the variable of interest
  • Criterion related- Justifies the validity of the instrument by comparing measurements made with the instrument to a well established gold standard of measurement (ex. radiography)
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31
Q

What is goniometric reliability?

A

*the amount of consistency between successive measurements of the same variable on the same subject under same conditions

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32
Q

What does goniometric reliability vary upon?

A

Varies based on the body part being measured

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33
Q

How is the reliability for the ROM of the extremities?

A

Good to excellent reliability

*Upper > Lower

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34
Q

What type of measurements have higher goniometric reliability measurements?

A

Fixed position measurements have more reliability than motion measurements

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35
Q

What is an intrarater and an interrater and which is better for reliability? Also how much deviation is ok in each?

A
  • Intrarater= one examiner (better choice)
    - 4-5 degrees deviation by one examiner
  • Interrater= two examiners
    - 5-7 degrees deviation between examiners
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36
Q

How much degree difference is necessary to show true changes?

A

6-12 degrees

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37
Q

How do you improve your reliability?

A

CONSISTENCY!

  • well defined positions
  • well defined anatomical landmarks for alignment
  • same device to take successive measurements
  • same examiner taking successive measurements
  • use the device that is suitable in size to the joint being measured (ex. larger for shoulder, hip, knee, elbow, and smaller for wrist, fingers, ankle
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38
Q

What are ROM measurement tools?

A
  • Universal goniometer
  • Gravity dependent goniometer- pendulum/bubble inclinometer, single/double inclinometer
  • Region specific ROM device- CROM/BROM
  • Tape measure
  • visual estimation
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39
Q

What are the characteristics of the Universal Goniometer?

A
  • Most common instrument used to measure joint motion (Clinical > Research)
  • Plastic/Metal
  • Many different sizes- arms vary from 1-14 inches in length
  • Flexible vs rigid
  • Built in bubble levels
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40
Q

What is the anatomy of a goniometer?

A
  • Stationary Arm- usually placed on the bone proximal to the joint being tested
  • Movement Arm- placed distally to the joint being tested
  • Fulcrum- placed over the axis (changes during movement)
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41
Q

What are the characteristics of an inclinometer?

A
  • Gravity dependent goniometers-
    - uses gravity on pointer (pendulum) and fluid levels (bubble) to measure motion
    - 360 degree protractor
  • Single inclinometer Method
    - Good for obtaining total ROM
    - Doesn’t eliminate compensations (so may need to use 2)
  • Digital inclinometer- Android Play Store: Clinometer
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42
Q

When and why do you use the double inclinometer Method?

A
  • Better when trying to isolate movement to a specific location (only lumbar ROM minus thoracic, minus hip flexion)
  • Elimates compensations
  • A little more difficult to perform
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43
Q

What are a CROM/BROM and what are they used for?

A

*Joint specific measurement device
CROM=Cervical
BROM= ‘back’/lumbar
*Can be more reliable due to consistency (inter and intra)

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44
Q

What is the tape measure typically used for?

A
  • Skin distraction
  • Chin to chest
  • Finger tip to floor
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45
Q

Why do some examiners use visual estimation?

A
  • Some choose to use this over goniometric measurements but NOT recommend: Subjective vs. Objective
  • Useful in the learning process and can help reduce errors due to incorrect reading
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46
Q

What is the optimal testing position for a patient? what are alternative positions?

A

OPTIMAL

  • Place the joint in starting position of 0 degrees
  • Permit complete ROM (against gravity/gravity assist)
  • Provide stabilization for the proximal joint segment

ALTERNATIVE
*Needed when the optimal testing positions cannot be attained because of patient limitations

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47
Q

What are normal patient testing positions?

A
  • Supine
  • Prone
  • Sitting
  • Standing
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48
Q

What is important when testing several joints/motions and why?

A

*Important to have a planned examination sequence so you avoid having a painful patient move into multiple positions and flare-up

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49
Q

Where should you stabilize when assessing ROM?

A

*Stabilize the patients body and proximal joint so motion can be isolated and a “true measurement” can be read

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50
Q

When would you want combined motions to occur when assessing ROM?

A

*Functional tasks such as shoulder IR/ER, Flex/ABD (GH vs total motion)

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51
Q

When documenting ROM what are measurements needed to take and what are they?

A
  • End Position- point in which ROM ended (ex. 145 degree knee flexion)
  • Actual ROM- Points measured from (Ex. 0-50 degrees of elbow flexion or 20-70 degrees of elbow flexion)
  • Total ROM- The number of degrees actually measured (both of the above examples are 50 degrees total ROM)
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52
Q

What is WNL and what does it constitute?

A

“Within Normal Limits” and constitutes normal pain-free ROM during active or passive motion

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53
Q

What are hypo/hypermobile?

A
  • Hypomobile ROM: an elbow that doesn’t acheive full extension. Ex. (theta) 0-20-50
  • Hypermobile ROM: an elbow that starts in 20 deg hyperextension and ends at 140 deg flexion. Ex. 20-0-140
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54
Q

How are muscle length testing measured?

A

*Measured indirectly by determining the maximal passive motion of the joints crossed by the muscle

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55
Q

How do you perform Manual muscle tests and how should they be applied?

A
  • Manual resistance applied to a limb or other body part to objectify strength
  • Should be applied slowly, building up, never sudden or uneven
  • Applied in the direction of the ‘line of pull’ of the muscle
  • It’s important to stabilize proximal segments to avoid substitutions/compensations
  • *Very subjective test
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56
Q

What are characteristics of Manual Muscle testing?

A
  • can be applied to a general motion (wrist extension)
  • Can be more muscle specific (ECRL/ECU)
  • When able, compare to uninvolved side
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57
Q

What are the grades and descriptions for manual muscle testing?

A 
0 = no activity = absent
1 = Trace motion, muscle contracts, no motion = trace
2- = Can't complete full ROM in gravity eliminated position = Poor-
2 = Full ROM, gravity eliminated = Poor
2+ = Full ROM gravity eliminated, less than 1/2 ROM against gravity = Poor+
3- = Full ROM gravity eliminated, more than 1/2 ROM against gravity = Fair-
3 = Full ROM, against gravity = Fair
3+ = Full ROM, against gravity, min resistance = Fair+
4 = Full ROM, against gravity, mod resistance = Good
5 = Full ROM, against gravity, max resistance = Normal
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58
Q

What is the most commonly used Manual Muscle test and what does it entail?

A
  • Break Test
  • The patient is asked to hold body part at mid-point in ROM and to not allow the examiner to “break” the hold by the manual resistance
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59
Q

What influences manual muscle testing?

A
  • Positioning- length of the muscle being tested and one vs. two joint muscles
  • Proper stabilization
  • Where the resistance force is being applied- short vs. long lever arm
  • Pain- maybe not just muscle weakness
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60
Q

What does pre positioning the muscle influence in MMT?

A

large influence on strength and can be positioned by patient or therapist

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61
Q

What does the length tension curve with MMT show?

A
  • Within about 10% the resting length of the muscle, the tension the muscle exerts is maximum
  • At lengths above or below this optimum length the tension decreases
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62
Q

Where is resistance usually applied in one and two joint muscles and why?

A

One joint= applied at end ROM bc it allows for consistency
Two joint = applied at or near mid-range
*Providing resistance at consistent test positions can yield good reliability as well

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63
Q

How is most stabilization completed during MMT?

A

manually by the PT

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64
Q

What are characteristics of long lever arm resistance?

A
  • The longer the lever arm the greater the challenge for the muscle being tested
  • Longer lever arms may be indicative of more functional demands
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65
Q

Where should resistance be applied for a long lever arm in MMT?

A

*Near the distal end of the segment to which the muscle attaches, but be cautious of excessive strain on the joints caught in the middle

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66
Q

What are some noteworthy factors when doing MMT?

A
  • Pain- can be a limiting factor
  • Fatigue- testing before vs after exercise
  • Sensory loss- if a patient can’t feel the resistance you may not have a consistent/accurate assessment
  • Hand dominance
  • Therapist communication- consistent instruction needed!
  • The patient- do they want to show off or seem more impaired than they really are?
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67
Q

How would you test and document a patient who had limited knee flexion to 20 degrees?

A

You would test them in their ROM of 20 degrees and if they can hold a max resistance than they get a 5 MMT

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68
Q

What will patients do when they need more strength because they are weak?

A

They will substitute, whether it’s conscious or unconsciously done

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69
Q

When is MMT more reliable and valid?

A

In the presence of profound weakness (neurological condition)

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70
Q

What are some limitations to MMT?

A
  • lack of objectivity
  • Reliability varies considerably
  • lacks sensitivity
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71
Q

How do you test using a dynamometer?

A
  • set to second handle position from the inside
  • Patient is sitting with their arm resting at side and elbow flexed to 90 degrees, wrist btwn 0-30 deg extension and 0-15 deg ulnar deviation
  • Therapist tells patient to squeeze as hard as they can and then records the average of 3 successive trials
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72
Q

What are anthropometric measurements and when are they used?

A
  • comparative measurements of the body used in nutritional assessments
  • used with infants/children growth and development
  • Adults- height, weight, BMI, percent of body fat
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73
Q

What are the BMI categories?

A

Underweight= < 18.5
Normal Weight= 18.5 - 24.9
Overweight= 25 - 29.9
Obesity= BMI of 30 or greater

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74
Q

When would a therapist screen both extremities at the same time?

A
  • Speed up the process
  • Usually not be stabilized proximally
  • Not a “true” assessment
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75
Q

If weakness or loss of motion is found when bilaterally screening extremities what should you do?

A
  • Weakness = re-test unilaterally with stabilization to get a more accurate representation of the weakenss
  • Loss of motion = re-test motion with same method of quantification
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76
Q

Why do we care about posture?

A
  • ROM
  • Function
  • Breathing
  • Pain
  • Weakness
  • Organ function
  • vision
  • independence/ mobility for life
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77
Q

What positions do we assess posture?

A
  • Statically- standing, sitting, lying down
  • Dynamic- Walking, running, jumping
  • Should be done from different angles (lateral, front, back)
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78
Q

How should a patient be when assessing their posture and what do we look for?

A
  • Must be adequately undressed- first without shoes then with bc they can effect posture
  • They should be examined in habitual or relaxed posture
  • Look for asymmetry (normal btwn sides)
  • Look for muscle wasting, soft tissue swelling, bony englargment
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79
Q

What is normal posture and what does it align with?

A
  • The position where minimal stress is applied to each joint
  • Straight line passing through:
    - earlobe/EAM
    - Bodies of cervical vertebra
    - Tip of the shoulder
    - Midway through the thorax
    - Bodies of the lumbar vertebra
    - Slightly posterior to hip joint
    - Slightly anterior to the axis of the knee joint
    - Just anterior to lateral malleolus
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80
Q

What are the characteristics of good posture in an anterior view?

A
  • Head is straight
  • Tip of nose in line with manubrium and umbilicus
  • Upper trap neck line and bulk should be equal, slopes approximately equal
  • Shoulders level- dominant side slightly lower
  • Clavicles and AC joints level and equal
  • Arms equidistant from the waist
  • Palms facing the body
  • Iliac crests level
  • ASIS level
  • Patellae point straight ahead
  • Knees are straight
  • Heads of fibulae are level
  • Arches are present in the feet and on the two sides
  • Feet angle out equally
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81
Q

What questions should you ask when assessing posture anteriorly?

A
  • Is the head tilted- torticollis?
  • Is there facial asymmetry?
  • Which side is the patients dominant side?
  • Any protrusion or depression of ribs?
  • Do the hips look level?
  • Do they have pronated/supinated feet?
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82
Q

What constitutes “good” posture in a posterior view?

A
  • Head is in midline
  • Shoulders are level
  • Scapular spines and inferior angles are level- the base of spine is at T3/4 and inferior angles at T7
  • Medial borders of scapula are equidistant from the spine- 3/4 finger width from spinous processes
  • Spine is straight- (posterior line of reference is spine of C7 through the gluteal cleft)
  • Ribs are symmetrical on both sides
  • Arms are equidistant from the body
  • PSIS are level
  • Gluteal folds are level
  • Knee joints are level
  • Both achilles tendons descend straight to calcanei
  • Heels are straight
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83
Q

What questions would you ask when assessing posture posteriorly?

A
  • Does the head look straight?
  • How do the shoulder level compare to the front, is there contour of the upper traps?
  • Do the scapula look symmetrical?
  • Does the spinal column look straight- scoliosis?
  • Is the pelvis level?
  • How do the PSIS relate to the ASIS?
  • Are the knee creases equal?
  • Are the achilles tendons symmetrical?
  • What’s happening at the rear foot?
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84
Q

What type of muscle activation and activity are need for posture muscular activity?

A
  • Muscle activation= isometric

* Activity= Endurance

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85
Q

In a clinic how do they train posture?

A

*Train core muscles, bracing, 3 sets of 10
But this isn’t endurance training so a person needs to get into the position and do activities to increase endurance and increase posture

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86
Q

What are some lateral view faulty alignments?

A
  • Hyperlordosis
  • Kyphosis
  • Kypholordosis
  • Flat Back
  • Round Back
  • Dowager’s Hump
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87
Q

What are some symptoms/problems with Hyperlordosis?

A
  • Pelvic anterior tilt
  • Hip flexion
  • Abdominals and hamstrings elongated and weak
  • Erector spinae and hip flexors short and strong
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88
Q

what are some symptoms/problems with kyphosis/kypholordosis?

A
  • *Increased thoracic curvature that can be accompanied by lumbar lordosis
  • Rhomboids are elongated and weak
  • Serratus anterior, pec major/minor, teres are short and strong
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89
Q

What are some symptoms/problems with Sway Back?

A
  • Spine bends back sharply at the lumbosacral angle which causes entire pelvis to shift forward and puts hips into extension
  • Abs and hip flexors are elongated and weak
  • The glutes are shortened and strong
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90
Q

what are some symptoms/problems with Flat back?

A
  • Decreased pelvic inclination to 20 deg and mobile lumbar spine
  • flexors are elongated and weak
  • Extensors are short and strong
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91
Q

What are some symptoms/problems with Dowager’s Hump?

A
  • Often seen in older patient’s- especially women
  • 1-3 thoracic vertebrae
  • Mainly caused by osteoporosis- anterior wedging of the vertebral bodies
  • Results in a flexed head and protruding abdomen- maintain center of gravity
  • Structural issue bc vertebral bodies are no longer square but wedge shaped
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92
Q

What are some anterior view faulty alignments?

A
  • Torticollis
  • Lateral Pelvic tilt
  • Hip anteversion/retroversion
  • Coxa vara/valga
  • Genu varum/valgum
  • Bowing of tibia
  • Foot pronation/supination
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93
Q

What are some symptoms/problems with torticollis?

A
  • Can be congenital or acquired, mostly acquired and due to inactivity. In utero if this happens then the muscles don’t elongate or develop
  • “Scoliosis of the cervical spine”
  • Contracted SCM so treatment is to stretch the SCM
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94
Q

What are some posterior view faulty alignments?

A
  • Scoliosis
  • Do the forward flexion test
  • Rearfoot varus/valgus
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95
Q

What do you do for the forward flexion test and what does it test for?

A
  • Tests for scoliosis
    • ask the patient to flex forward at the hips while both knees are straight and feet together
  • is there asymmetry (rib hump)
  • Pathological kyphosis
  • Lumbar spine straightens/flexes normally
  • Any restrictions to forward bending
96
Q

What are symptoms/problems with scoliosis?

A

*Functional vs. Structural
Functional= caused by postural problems, nerve root irritation, compensation from LLD, contracture (non- progressive)
Structural= bony deformity (congenital or acquired), excessive weakness
-lacks normal flexibility, asymmetrical SB
-Does not disappear on flexion
-Progressive
-Idiopathic accounts for 75-85% of all cases
*Named superior first
*Wedging of the vertebral bodies
*Other changes (shoulder height and scapular position)

97
Q

What are symptoms/problems from a Rib Hump?

A
  • Fixed rotational prominence on the convex side
  • Seen when patient flexes forward
  • Spine rotates to one side and ribs push out posterior and appear higher
  • Narrowing of the thoracic rib cage occurs
  • Vital capacity is considerably lowered if the lateral curvature exceeds 60 deg- malposition of organs within the rib cage also occurs
98
Q

What are symptoms/problems with Upper Crossed Syndrome?

A
  • Results from forward head posture
  • Loss of lower cervical lordosis
  • Extension of upper cervical spine
  • Increased kyphosis of cervical thoracic junction
  • Internal rotation of shoulder girdles
  • Tight pectoralis Major/minor, upper trap, levator scapula, SCM
  • Weak deep neck flexors, lower and middle trap, serratus anterior, rhomboids
99
Q

What are some symptoms/problems with Pigeon Chest (pectus carinatum)?

A
  • Sternum projects forward and downward causing protrusion of the sternum and ribs
  • Increased in AP diameter
  • Congenital deformity
  • Restricts ventilation volume
100
Q

What are some symptoms/problems with Funnel Chest?

A
  • Sternum is pushed posterior by overgrowth of the ribs
  • AP diameter is decreased
  • Congenital deformity
  • Heart my be displaced
  • Hollow depression on inspiration
101
Q

What are some symptoms/problems with Barrel Chest?

A
  • Sternum projects upward
  • Large rib cage, round torso
  • Increased AP diameter
  • Emphysema patients often have this
102
Q

What is scapular tilting?

A

When the inferior angle of the scapula pops out due to tightness of pectoralis minor

103
Q

What is scapular winging?

A

When the weak serratus anterior or palsy/nerve damage to it causes the whole border of the scapula to wing out

104
Q

What muscles are tight during scapular adduction?

A

rhomboids

105
Q

What muscles are tight during scapular abduction?

A

Serratus Anterior

106
Q

How can a lower extremity effect posture?

A
  • Leg length difference (LLD)
  • Knee hyperextension
  • Knee varus/valgus
  • Foot pronation/supination
107
Q

What is the difference between a true and apparent LLD?

A 
True= There is a bone imbalance
Apparent= Muscle imbalance which causes the appearance of a LLD
108
Q

What occurs at the knees, foot, and hip during genu varus and valgus?

A

Genu Varus- Knees are out, foot is supinated and hips are in ER/retroversion
Genu Valgus- Knees are in, pronated foot, hips in IR

109
Q

What alignments should there be in a sitting posture?

A
  • Ear over acromion
  • Slight cervical lordosis
  • Retracted scapula in proper position
  • Slight thoracic kyphosis
  • Slight anterior tilt with lumbar lordosis
110
Q

What should you consider when in sitting posture?

A
  • Femur support
  • Lumbar support
  • Vision alignment
  • Height of seat
  • Feet Position
111
Q

What is the capsular pattern of the glenohumeral joint?

A

*ER > AB > IR

112
Q

What is the capsular pattern of the SC joint?

A
  • Pain at extremes of ROM

* Horizontal Adduction and full elevation

113
Q

What is the closed pack position of the SC joint?

A

*Full elevation

114
Q

What is the closed pack position of the AC joint?

A

*90 degrees of Abduction

115
Q

What is the capsular pattern of the AC joint?

A

*Pain at extremes of ROM

116
Q

What is the location of the ST joint?

A
  • Sagittal Plane- tipped 10 dg forward
  • Transverse Plane- 30 dg anterior to frontal plane
  • Frontal Plane- Essentially parallel to vertebral column
117
Q

How many muscles attach to the scapula?

A

17!!

118
Q

How much upward/downward rotation, protraction/retraction, and elevation/depression are at the scapula?

A
  • Upward/downward rotation = 60 dg
  • Protraction/retraction = 15 cm
  • Elevation/Depression = 12 cm
119
Q

What does scapulohumeral rhythm allow?

A

*Allows muscles to maintain good length-tension relationship to minimize active insufficiency

120
Q

When does the 2:1 ratio of scapulohumeral rhythm occur?

A
  • Typically after 30 dg of shoulder elevation

- 0-30 dg is mostly scapular setting

121
Q

What is the summary of clavicular movement during upward rotation?

A
  • As the scapula upwardly rotates the distal end of the clavicle elevates to 30 dg.
  • The costoclavicular and coracoclavicular ligaments become taught and cause a posterior rotation of the clavicle
    - Rotates 45 dg to get the final 60 dg of scapular ROM
122
Q

What is the summary of the AC joint movement?

A

Mainly functions as a pivot point

  • 4.3 dg IR
  • 14.6 dg upward rotation
  • 6.7 dg posterior tilting
123
Q

What is the scapular movement from 0-30 dg?

A
  • Minimal to no scapular movement
  • Scapula is setting
  • Axis at spine of scapula near vertebral border
124
Q

What is the scapular movement from 30-60 dg?

A
  • Fossa rotates upward with GH joint

* Axis moves towards the glenoid fossa and is at the AC joint by 90-100 dg of elevation

125
Q

What are the borders of the Axilla?

A
  • Anterior: Pec major and minor, subclavius
  • Posterior: Subscapularis, teres major, and latissiumus
  • Medial: Serratus anterior, ribs 2-6, intercostals
  • Lateral: Bicipital groove, coracobrachialis, short head of biceps
126
Q

What are the contents of the Axilla?

A
  • Lymph nodes
  • Brachial Plexus
  • Axillary vessels (Vein and artery)
127
Q

What manual muscle tests of the scapula should be performed sitting?

A
  • Scapular Abduction and Upward Rotation

* Scapular Elevation

128
Q

What manual muscle tests of the scapula should be performed in prone?

A
  • Scapular adduction
  • Scapular depression and adduction
  • Scapular depression and downward rotation
  • Scapular depression
129
Q

what can be palpated on the Bony anterior aspect of the neck?

A
  • C1 transverse process
  • Hyoid Bone
  • Thyroid cartilage
  • First Cricoid Ring
  • Carotid Tubercle
130
Q

How do you palpate the Hyoid bone?

A
  • Ask the patient to swallow while hand is cupped around anterior portion of neck, palpate just below chin
  • Level with C3
131
Q

How do you palpate the Thyroid Cartilage?

A
  • Inferior to the hyoid, notch will be palpable then feel above and below
  • Upper portion “Adams Apple” level with C4
  • Lower portion is level with C5
132
Q

How do you palpate the First Cricoid Ring?

A
  • Immediately inferior to thyroid cartilage
  • Use light pressure, don’t gag
  • Level with C6
133
Q

How do you palpate the Carotid Tubercle?

A
  • Laterally about 1 inch from First Cricoid Ring
  • Anterior tubercle of C6 transverse process
  • Palpable deep under muscles
    - can come in laterally to contact TP and the move anterior while staying under the musculature
  • Palpate separately!
    - Both at the same time could restrict blood flow of both carotid arteries that run adjacent to the tubercles
134
Q

How do you palpate the SCM?

A
  • In supine as patient turn their head to opposite side that is being palpated (can have them attempt to raise head from table to make if more prominent)
  • Trace the muscle from it’s origin to insertion
  • Palpate both sides to compare
135
Q

How do you palpate the thyroid gland?

A
  • Below Adams Apple
  • Overlies the trachea in a H pattern
  • Normal Gland is smooth and indistinct
136
Q

How do you palpate the Parotid gland?

A
  • Partially covers angle of mandible
  • Not distinctly palpable, if normal the angle will feel sharp/bony
  • If abnormal, will feel boggy/soft
137
Q

How do you palpate the supraclavicular Fossa?

A
  • Superior to clavicle and lateral to suprasternal notch
    • Normal is a smooth indentation
      - Englargement/swelling coud be from edema secondary to trauma, lumps may be due to enlarged lymph glands
    • Abnormal cervical rib may be felt here
    • Platysa crosses but does not fill
    • Cupola (dome) of the lung extends into fossa and sometimes injured by puncture wounds or clavicle fracture
138
Q

How do you palpate the spinous processes of cervical vertebrae?

A
  • Posterior to midline of cervical spine
  • No muscles cross midline so it’s indented
    • Tissue buldges lateral to spinous processes are deep paraspinals and superficial trapezius
    • Start at base of skull
    • First palpable spinous process is C2
    • Note normal lordosis
    • C7 and T1 are larger
    • Normally in line but slight anatomical variations due exist
      - Not necessarily “rotated”
139
Q

How do you palpate the cervical facet joints?

A
  • Move fingers laterally approx 1 inch
  • Feel for the facets between the cervical vertebrae
    • Small domes- layer your palpation to make sure you are “Down to the bone”
  • Patient needs to be relaxed
  • Palpate these bilaterally down to C7 and T1
140
Q

What is the AROM in the Upper cervical spine?

A
  • C0/1 and C1/2
    • Flexion: 0-10/15 dg
    • Extension: 0- <30 dg
    • Coupled SB/Rotation
    • Non-coupled SB/Rotation
141
Q

What is the AROM in the lower cervical spine?

A
  • C2/3 to C7/T1
    • Flexion: 0-35/45 dg
    • Extension: 0- <30 dg
    • Side bending
    • Rotation
    • Coupled SB/rotation
    • Non-coupled SB/rotation
142
Q

Between C1/C2 What percentage of cervical rotation occurs and what is the degree?

A
  • 50% of cervical rotation occurs here

* 35-45 dg occurs here

143
Q

What are the norms of combined cervical ROM with goniometer?

A 
Flexion: 0-40 dg
Extension: 0-50 dg
Lateral Flexion: 0-22 dg SD 7-8 dg
Rotation: L 49 dg, R 51 dg
                70-90 dg
144
Q

What two things do the craniocervical flexion test assess?

A
  • Uses a stabilizer (pressure cuff) placed under neck about to occiput to assess deep cervical flexors
  • *The strategy to perform upper cervical flexion
  • *Isometric endurance of deep cervical flexors
145
Q

What does the Neck flexor endurance test do?

A
  • Uses observation of neck folds and placement of therapists hand under the occiput to assess cervical endurance
  • Involves superficial cervical muscles but still assessing control of deep cervical flexors
146
Q

In the craniocervical flexion test Stage one, how is it performed?

A

Stage one: Analysis of performance

  • Patient supine, hook-lying with pressure biofeedback under neck just about to the occiput pumped to 20 mmHg
  • Patient requested to “Say Yes” so they slide the back of the head up the bed with a head-nod action to elevate the pressure from 20 to 22 mmHg
  • Hold 2-3 seconds then relax to starting position
  • Repeated through 2 mmHg increment to 30 mmHg
  • Tester analyses the motion and palpates the activity of SCM or anterior scalenes (minimal activity until last 1-2 stages)
147
Q

What are signs of abnormal patterns/poor activation of DNF when doing the craniocervical flexion test in stage one?

A
  • Range of head rotation does not increased with increments
  • Movement strategy is more head retraction
  • Patient lifts the head in attempts to reach target pressures
  • Movement is performed too quickly (speed)
  • Palpable activity of superficial flexors or hyoid muscles in 1st 3 stages.
  • Pressure dial does not return to starting position (Greater than 20 mmHg)
148
Q

What is the baseline assessment for the craniocervical flexion test in stage one?

A

*the stage of the test (increment) that the patient can acheive for the 2-3 seconds with correct movement without palpable activity

149
Q

What occurs during Stage 2 of the craniocervical flexion test?

A

Stage 2: Isometric Endurance

  • Patient performs head nod into first target pressure (22 mmHg) and holds for 10 seconds
  • If the patient can perform at least 3 repetitions of 10 second holds without substitutions, it’s progressed to the next target pressure
  • Therapist monitors movement strategy and pressure
150
Q

What are the signs of reduced endurance during stage 2 of the craniocervical flexion test?

A
  • Patient cannot hold the pressure steady
    - Decreases even though they seem to be holding the head in the flexed position
  • Over recruitment of superficial flexors
  • Pressure level is held but with a jerky action
    - Suggests an alternate muscle is being used to hold the pressure (weakness of deep cervical flexors)
151
Q

What is the baseline for stage 2 in the craniocervical flexion test?

A

The pressure level that the patient can hold steady for the repeated 10-second holds with minimal superficial muscle activity and absence of any other substitution strategies

152
Q

How is the Neck flexor endurance test performed?

A
  • In supine hook-lying with hands on stomach
  • Patient performs a “chin tuck” or upper cervical flexion and raises head from table approximately 1 inch
  • Therapist starts a timer while he places his hands under occiput and observes anterior neck skin folds
    • Preferred way is to use a skin crayon to draw a line across the folds
153
Q

When would you terminate the neck flexor endurance test?

A

Terminate the test if:

  • Edges of the lines drawn no longer touched for more than 1 second
  • Subjects head touched the raters hand for more than 1 second
154
Q

What are the norms for the neck flexor endurance test?

A

Norms:

  • Patients without neck pain = 38.95 seconds
  • Patient with neck pain = 24.1 seconds
155
Q

What does the somatosensory system do?

A
  • Receives information from the environment

* Testing how well the individual receives the necessary information

156
Q

What are the purposes of the sensory exam?

A
  • Identify a pattern of loss
  • Identify which sensations are affected
  • identify the degree to which sensations are limited
157
Q

What do our exam results of a sensory exam affect?

A
  • Interventions
    • With modality issues a person can’t tell if they’re being burned or not
  • Goal setting
  • Patient/family education
  • Discharge Planning
    - What things do we need to tell them to do when they’re at home so they’re safe and healthy?
158
Q

What patterns of sensory loss are tested for?

A
  • CNS/other systems
  • Glove-stocking or body segment
  • Peripheral nerve
  • Dermatomal
159
Q

What is motor testing for?

A
  • Assessing the efferent response to a stimuli
  • Stimuli used:
    - Isometric resistance to movement: myotomes
    - Deep tendon reflexes
  • Myotomes
    - Representative muscle of a single nerve root
160
Q

What are the components of sensory testing?

A
  • Cranial nerve testing
  • Sensory testing
    • Peripheral nerve distribution
    • Spinal nerve (dermatome) distribution
  • Myotome testing
  • Reflexes
    • Cranial nerve reflexes: Jaw reflex
    • Upper motor neuron reflex testing: Hoffman’s, Babinski, Clonus
    • Deep tendon reflex testing: UE and LE
161
Q

What is the purpose of a quick screen cranial nerve test?

A

*Determine if a full cranial nerve screen is necessary

162
Q

What is a dermatome?

A
  • Area of skin supplied by a single spinal nerve segment

* Ex. C4 is top of shoulders, C5 is deltoid area

163
Q

How do you test for a peripheral nerve?

A

*Test sensation in areas in which the nerve roots reside

164
Q

How do you test a spinal nerve root?

A

*Test area corresponding to that nerve root

165
Q

What can cause spinal nerve impingement?

A
  • Disc protrusion
  • Foramen closing/narrowing
  • Tumor or growth
166
Q

What is affected with a C5 nerve root impingement?

A

*Motor: Deltoid and biceps weakness
*Reflex: Biceps
Sensation: Lateral upper arm/deltoid

167
Q

What is affected with a C6 nerve root impingement?

A

Motor: Biceps and Wrist extensors
Reflex: Brachioradialis
Sensation: lateral forearm and thumb

168
Q

What is affected with a C7 nerve root impingement?

A

Motor: Wrist flexors
Reflex: Triceps
Sensation: Middle 3 fingers and part of palm

169
Q

What is affected with a C8 nerve root impingement?

A

Motor: Finger flexors
Reflex: No DTR associated
Sensation: medial side of forearm and pinky finger

170
Q

What is affected with a T1 nerve root impingement?

A

Motor: Interossei
Reflex: No DTR associated
Sensation: Medial upper arm

171
Q

What is affected with a L4 nerve root impingement?

A

Motor: Tibialis Anterior
Reflex: Patellar tendon
Sensation: Medial Portion of the foot and towards the big toe medial surface

172
Q

What is affected with a L5 Nerve root impingement?

A

motor: Extensor digitorum longus (check for extension of big toe)
Reflex: No DTR associated
Sensation: Over the top of the foot

173
Q

What is affected with a S1 nerve root impingement?

A

Motor: Peroneus Longus
Reflex: Achilles Tendon
Sensation: Lateral aspect of foot and up the back of the leg a little

174
Q

What are you looking for with axillary nerve peripheral nerve distribution (PND)?

A

Spinal Nerve Root: C5, C6
Sensation: Lower deltoid area (badge)
Looking for Motor weakness: Teres minor, deltoid

175
Q

What are you looking for with Musculocutaneous PND?

A

*Injuries rare
Spinal nerve roots: C5-7
Sensation: lateral forearm
Motor: Coracobrachialis, biceps, brachialis

176
Q

What are you looking for with Radial nerve PND?

A

Spinal nerve roots: C5-T1
Sensation: Back of arm, hand
Motor: elbow extension, wrist and finger extension, supination

177
Q

What are you looking for with median nerve PND?

A

Spinal Nerve roots: C6-T1
Sensation: Volar surface digits of 1,2,3 and 1/2 of 4
Motor: Pronation, wrist flexion, long finger flexors

178
Q

What are you looking for with Ulnar nerve PND?

A

Spinal nerve roots: C8-T1
Sensation: Volar/dorsal surface of digits 4,5
Motor: Little finger abduction, interossei, wrist flexion, finger flexion 4,5
*Injury at elbow is more common

179
Q

What are you looking for with Femoral nerve PND?

A

Spinal nerve roots: L2-L4
Sensation: Anterior thigh and medial lower leg/foot
Motor: Hip flexion, knee extension

180
Q

What are you looking for with Tibial nerve PND?

A

Spinal Nerve roots: L4-S3
Sensation: Posterior/Lateral leg, sole, heel
Motor: Ankle plantarflexion, inversion, toe flexion

181
Q

What are you looking for with Common Peroneal Nerve PND?

A

Spinal Nerve roots: L4-S2
Sensation: Lateral leg (Superficial peroneal nerve), Lateral aspect of knee and skin between big toe and 2nd toe (deep peroneal nerve)
Motor: Superficial= eversion, Deep= dorsiflexion, toe extension
*Injury = Foot Drop

182
Q

What does a stocking/glove pattern of sensory loss might mean?

A
  • Diabetic neuropathy
  • Cortical Lesion

*Doesn’t follow dermatome or peripheral nerve pattern

183
Q

In which direction do you go when mapping the borders of sensory loss?

A

*You map distal to proximal

184
Q

What tests can be done to test for which sensations are impaired?

A
  • Hot/cold
  • Proprioception
  • Light touch
  • vibration
  • sharp/dull
185
Q

What are the types of sensation?

A
  • light touch
  • Pressure
  • Sharp/dull pain
  • Deep bone vibration
  • Temperature
  • Point localization
  • Proprioception
  • Kinesthesia
  • Tactile localization
  • Two point discrimination
186
Q

What are the degrees of sensory deficits?

A
  • Absent
  • Intact
  • Impaired = partial loss/increased sensitivity
187
Q

How do you do a sensory examination?

A
  • Non-impaired followed by impaired
  • Superficial to deep
  • Distal to proximal (most for neural evaluation, esp. UMN)
  • Randomly with variation in timing
188
Q

How do you improve reliability in a sensory exam?

A
  • Use of consistent guidelines
  • Administration of tests by trained, skillful examiner
  • Subsequent retests by same individuals
  • Ensure patient’s understanding of test and ability to communicate
  • never use your fingers bc of temperature sensation
189
Q

What are the purposes of a motor exam?

A
  • Identify the pattern of strength loss

* Identify the degree to which strength is limited

190
Q

What are the procedures during muscle testing?

A
  • Isometric hold of the muscle groups supplied by a particular myotome (nerve root) or peripheral nerve
  • Use myotome key muscles testing if suspect nerve root compression or SCI
  • Use peripheral nerve muscle testing if a peripheral nerve lesion is suspected
191
Q

What is the myotome for C5?

A
  • Shoulder abduction

* Elbow flexion

192
Q

What is the myotome for C6?

A
  • Elbow flexion

* Wrist extension

193
Q

What is the myotome for C7?

A
  • Elbow extension
  • Wrist flexion
  • finger extension
194
Q

What is the myotome for C8?

A
  • Finger abduction/adduction
  • DIP flexion of middle finger, finger flexion/wrist flexion
  • Thumb ABD
195
Q

What is the myotome for T1?

A
  • ABD and ADD of fingers

* ABD of little finger

196
Q

What is the myotome for C4?

A

*Shoulder elevation/shrug

197
Q

What is the myotome for L2?

A

*Hip flexion

198
Q

What is the myotome for L3?

A

*Knee extension

199
Q

What is the myotome for L4?

A

*Ankle dorsiflexion

200
Q

What is the myotome for L5?

A

*Great toe extension

201
Q

What is the myotome for S1?

A
  • Ankle plantar flexion

* Eversion

202
Q

What is the myotome for S2?

A

*Knee flexion

203
Q

What are Deep Tendon Reflexes?

A
  • Reflex arc from the muscle spindle to the spinal cord (Ia phasic) and output back to the same muscle (agonist muscle fibers)
  • Loss or diminished conductivity in the DTR is abnormal
  • Do it 3 times to make sure the recovery time is good
204
Q

What are the UE DTRs?

A
  • C5 = biceps
  • C6 = Brachioradialis
  • C7 = Triceps
205
Q

What are the LE DTRs?

A
  • L3-L4 = Quadriceps
  • L5- S1 = Hamstrings
  • S1-S2 = Achilles
206
Q

What is Hoffman’s reflex and what is a positive test?

A
  • Technique: Hold the middle finger, flick the distal end

* + Test: IP joint of thumb on same hand flexes

207
Q

What is the Babinski Reflex and what is a positive test?

A
  • Technique: Stroke the bottom of the foot from a lateral (heel) to medial (toe) direction
    • Test: First toe extends and the other four toes fan outward
      • Indicates a presence of an abnormal reflex
208
Q

What can affect peripheral nerve distribution?

A
  • Sever, crush, or damage nerve
  • Impingement
  • Bell’s Palsy
  • Peripheral vestibular disorders
209
Q

What can affect dermatomal distribution?

A
  • SCI
  • Tumor at the nerve roots
  • Trauma nerve roots
  • Impingement nerve roots
210
Q

What can affect Body segment distribution?

A
  • Metabolic disturbances (diabetes, alcoholism, hypothyroidism)
  • Lyme’s disease
  • Burns
  • Toxins
  • Nutritional Deficits
  • CVA
  • TBI
  • MS
211
Q

When documenting the degree or severity of involvement in a motor/sensory exam what should be included?

A
  • Absent
  • Impaired
  • Hypersensitive
  • % accuracy
  • Delayed
  • Patient subjective report
212
Q

When documenting the body area affected what should be included?

A
  • Right/Left
  • UE/LE
  • Trunk
  • Face
213
Q

When documenting the modality tested what should be included?

A
  • Light touch
  • Sharp/dull
  • Proprioception
  • Tactile localization
  • Temperature
  • Deep pressure
  • Myotome
  • Vibration
214
Q

What are the 3 joints of the elbow?

A
  • Humeral Ulnar
  • Humeral Radial
  • Proximal Radioulnar
215
Q

What direction is the axis of movement of the humeroulnar joint?

A

*It is a hinge joint and moves downward and medial and responsible for the carrying angle

216
Q

What is the resting position of the humeroulnar joint?

A

*70 dg flexion and 10 dg supination (from neutral)

217
Q

What is the closed pack position and capsular pattern of the humeroulnar joint?

A
  • Closed pack position: Full extension and supination

* Capsular pattern: flexion, extension (% of flexion lost is less than extension)

218
Q

What are the bony landmarks of the humeroulnar joint?

A

*Trochlea of the humerus and trochlear notch of the ulna

219
Q

What kind of joint is the humeroradial joint and what are the bony landmarks?

A
  • It’s a uniaxial synovial hinge joint

* Bony Landmarks: Capitulum of the humerus and the head of radius

220
Q

What is the resting position, closed pack position, and capsular pattern of the humeroradial joint?

A
  • Resting Position: Full extension and supination
  • Closed pack position: Elbow flexed to 90 dg supinated to 5 dg (radial head closest to capitulum)
  • Capsular Pattern: Flexion, extension
221
Q

What kind of joint is the proximal radioulnar joint and what are the bony landmarks?

A
  • Uniaxial Pivot Joint

* Bony Landmarks: Head of radius on the radial notch of ulna

222
Q

What is the resting position, closed pack position, and capsular pattern of the proximal radioulnar joint?

A
  • Resting Position: 70 dg elbow flexion, 35 dg supination
  • Closed pack position: 5 dg supination
  • Capsular Pattern: Equal limitation of supination and pronation
223
Q

What is carrying angle?

A
  • Angle of intersection between a line connecting the midpoints in the humerus and the proximal ulna long axis of the humerus and long axis of the ulna
  • Should be symmetrical bilaterally
  • Necessary to have forearm clear the body when carrying an object in the hand
224
Q

What is the normal, valgus, and varus carrying angles?

A
  • Normal: males = 5-10 dg, females = 10-15 dg
  • Cubital Valgus: angle greater than 15 dg
  • Cubital Varus: angle is less than 5 dg
225
Q

What is the triangle sign?

A
  • Relationship of medial and lateral epicondyle and the olecranon
    • view both flexion and extension of the elbow
    • Flexion: these three points will form an equilateral triangle
    • Extension: these three points should be in a straight line
226
Q

What can a protective posture suggest?

A
  • Sign of pain, may have swelling in the elbow joint

* can be an olecranon bursitis

227
Q

What muscles originate on the lateral supracondylar ridge?

A

*From superior to inferior it’s Brachioradialis, ECRL, ECRB (which is actually on the epicondyle)

228
Q

How do you confirm if you are palpating the head of the humerus?

A

*You ask the patient to pronate and supinate so you feel the head spin under your fingers

229
Q

What is the cubital tunnel made up of?

A

*Medial epicondyle, olecranon process, and tendinous arch of the flexor carpi ulnaris

230
Q

How do you palpate the ECRL and ECRB?

A

*Clench fist and/or resist extension and radial deviation

231
Q

How do you palpate the Extensor digitorum communis?

A

*Extend fingers

232
Q

How do you palpate the Extensor Carpi Ulnaris?

A

*Extend and ulnarly deviate

233
Q

How do you palpate the Extensor digiti mini?

A

*Extend pinky

234
Q

What are the borders of the cubital fossa?

A
  • Medial Border: Pronator Teres
  • Lateral Border: Brachioradialis
  • Superior Border: Imaginary line btwn epicondyles
235
Q

What are the contents of the cubital fossa?

A
  • Biceps Brachii Tendon
  • Brachial Artery
  • Median Nerve
236
Q

How do you test for Hypermobility?

A
  • Beighton’s Test
  • Quick and straightforward
  • By itself a high score does not mean there is hypermobility syndrome, need other symptoms and signs
  • A low score should be considered with caution; numerous sites are not “counted” in the score
237
Q

What are the scoring system in the Beighton’s test?

A
  • 1 point if palms on ground and legs straight
  • 1 point for each elbow that bends backwards
  • 1 Point for each knee that bends backwards
  • 1 point for each thumb that touches forearm
  • 1 point for each little finger that bends >90 dg

*Total score: 9

Tests and Measures Exam 1 (3 decks)

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