Exam 2/Practical Flashcards
What is the end feel and normative ROM for elbow flexion?
Soft end feel
150°
What is the end feel and normative ROM for elbow extension?
Hard end feel
0°
What is the end feel and normative ROM for elbow pronation?
Firm end feel
80°
What is the end feel and normative ROM for elbow supination?
Firm end feel
80°
What is the end feel and normative ROM for wrist flexion?
Firm end feel
80°
What is the end feel and normative ROM for wrist extension?
Firm end feel
70°
What is the end feel and normative ROM for Ulnar Deviation?
Firm end feel
30°
What is the end feel and normative ROM for Radial Deviation?
Hard end feel
20°
What is the end feel and normative ROM for Finger MCP flexion?
Firm end feel
90°
What is the end feel and normative ROM for Finger MCP extension?
Firm end feel
45°
What is the end feel and normative ROM for Finger MCP abduction?
Firm end feel
No normative value
(roughly 20-25°)
What is the end feel and normative ROM for Finger PIP flexion?
Can be Hard, Firm, Soft end feel
100°
What is the end feel and normative ROM for Finger PIP extension?
Firm end feel
0°
What is the end feel and normative ROM for Finger DIP flexion?
Firm end feel
90°
What is the end feel and normative ROM for Finger DIP extension?
Firm end feel
0°
What is the end feel and normative ROM for Thumb CMC flexion?
Soft end feel
15°
What is the end feel and normative ROM for Thumb CMC extension?
Firm end feel
20°
What is the end feel and normative ROM for Thumb CMC abduction?
Firm end feel
45-70°
What is the end feel and normative ROM for Thumb MCP flexion?
Can be Hard, Firm, Soft end feel
50°
What is the end feel and normative ROM for Thumb MCP extension?
Can be Hard, Firm, Soft end feel
0°
What is the end feel and normative ROM for Thumb IP flexion?
Can be Hard, Firm, Soft end feel
80°
What is the end feel and normative ROM for IP extension?
Can be Hard, Firm, Soft end feel
20°
When the opposing muscles is stretched to a point where it can no longer lengthen and allow further movement, what type of insufficiency is this?
Passive Insufficiency
When the muscle produces simultaneous movement at all the joints it crosses and reaches such a shortened position that it can no longer have the ability to develop effective tension, is what type of insufficiency?
Active Sufficiency
How do you grade a patient that can hold the test position against maximal resistance?
5
How do you grade a patient that can hold a test position against moderate to strong resistance?
4+
How do you grade a patient that can hold a test position against moderate resistance?
4
How do you grade a patient that can hold a test position against slight moderate to moderate resistance?
4-
How do you grade a patient that can hold against minimal resistance?
3+
How do you grade a patient that can hold a test position against gravity with no additional resistance applied?
3
How do you grade a patient that has gradual release from a test position and is unable to hold against gravity?
3-
How do you grade a patient that can move through full ROM in gravity minimized position and hold against resistance?
2+
How do you grade a patient that can move through full ROM in gravity minimized position?
2
How do you grade a patient that can move through partial ROM in gravity minimized position?
2-
How do you grade a patient when there is no motion, but the therapist feels or sees contractile activity of muscle?
1
How do you grade a patient that has no discernable palpable contractile activity?
0
What is the cervical plexus formed by?
It is formed by the anterior rami of C1-C4 with contributions of C5
What is the Brachial plexus formed by?
It is formed by the anterior rami of C5-T1
What is the definition of a Myotome?
-A muscle or group of muscles served by a single nerve root.
How are myotomes graded?
On a 0-5 scale (SAME AS MMT)
What is the movement of C1-C2 myotome?
Neck Flexion
What is the movement of C3 myotome?
Neck side flexion
What is the movement of C4 myotome?
Shoulder elevation or scapular elevation (Shrugging)
What is the movement of C5 myotome?
Shoulder ABD or ER
What is the movement of C6 myotome?
Elbow flexion or wrist extension
What is the movement of C7 myotome?
Elbow extension or wrist flexion
What is the movement of C8 myotome?
Thumb extension or Ulnar deviation
What is the movement of T1 myotome?
Hand intrinsics
What is the definition of Dermatome?
The area of skin supplied by a single nerve root
How are dermatomes graded?
0-Absent
1-Diminished
2-Normal
NT-Not Tested
Where is the sensation of C1 dermatome?
Anterior/Superior cranium
Where is the sensation of C2 dermatome?
Posterior cranium
Where is the sensation of C3 dermatome?
Lateral upper-mid cervical spine
Where is the sensation of C4 dermatome?
Superior and lateral shoulder
Where is the sensation of C5 dermatome?
Lateral arm
Where is the sensation of C6 dermatome?
Lateral thumb
Where is the sensation of C7 dermatome?
Dorsal midline of hand
Where is the sensation of C8 dermatome?
Ulnar forearm/hand
Where is the sensation of T1 dermatome?
Medial elbow
What is the definition of Sclerotome?
Area of bone or fascia supplied by a single nerve root
What is the definition of Deep Tendon Reflex (DTR)?
A brisk contraction of a muscle in response to a sudden stretch induced by a sharp tap on the tendon at the insertion of the muscle
When testing for DTR, patients can be classified as what?
Hyporeflexia: An absent or diminished response to DTP
Hypereflexia: The hyperactivity or repeating (Clonic) response to DTP
How are DTRs graded?
Graded 0-4:
-Grade 0: No response; always abnormal
-Grade 1: A slight but definitely present response; may or may not be normal
-Grade 2: A brisk response; normal
-Grade 3: A very brisk response; may or may not be normal
-Grade 4: Hypertonic. A tap elicits a repeating reflex (Clonus); always abnormal
What do you do below a grade 3 for Forearm Supination?
Patient is short sitting, therapist supports forearm at distal elbow, fingers palpate the supinator.
- Grade 2: Completes partial ROM
- Grade 1: Slight contraction, no movement
- Grade 0: No discernable palpable contractile activity
What do you do below a grade 3 for Forearm Pronation?
Patient is short sitting, therapist supports forearm at distal elbow, fingers palpate pronator teres.
- Grade 2: Completes partial ROM
- Grade 1: Slight contraction, no movement
- Grade 0: No discernable palpable contractile activity
What do you do below a grade 3 for Wrist Flexion?
Patient with elbow supported on table, in mid-position with hand resting on ulnar side. Therapist supports forearm proximal to wrist.
- Grade 2: Completes available range in gravity minimized position
Patient with supinated forearm supported on table. Therapist supports the wrist in flexion and palpates FCR and FCU tendons
- Grade 1: One or both tendons may have visible or palpable contraction, but the part doesn’t move.
- Grade 0: No discernable palpable contractile activity
What do you do below a grade 3 for Wrist Extension?
Patients forearm supported on table in neutral position, therapist supports wrist.
- Grade 2: Completes full range in gravity minimized position
Patients hand and forearm supported on table with forearm fully pronated. Therapist supports wrist in extension and palpates ECRL, ECRB, ECU separately.
- Grade 1: For any of the three muscles, there is visible or palpable contraction, no wrist motion occurs
Grade 0: No discernable palpable contractile activity
What do you do below a grade 3 for Finger PIP and DIP Flexion?
(PIP)
Test is the same, just palpate FDS.
Grade 2 - Complete ROM
Grade 1 - There is palpable and visible contraction
Grade 0 - No discernable palpable contractile activity
(DIP)
Test is the same, Palpate FDP.
Grading is the same as PIP
What do you do below grade 3 for Finger MCP Extension?
Test is the same except forearm is in mid-position.
Grade 2 - Complete range
Grade 1 - Visible tendon activity but no joint motion
Grade 0 - No discernable palpable contractile activity
What do you do below a grade 3 for Finger MCP Flexion?
Patients are is in mid-position.
Therapist stabilizes metacarpals
Grade 2 - Completes full ROM in gravity minimized position
Grade 1 - Minimal motion
Grade 0 - Absence of any discernable palpable contractile activity
What do you do below a grade 3 for Finger Abduction?
Test is the same.
Grade 2 - Patient can complete partial range of abduction
Grade 1 - Dorsal interosseous is palpable
Grade 0 - No discernable palpable contractile activity
What do you do below a grade 3 for Finger Adduction?
Test is the same
Grade 2 - Patient can complete partial range of adduction
-Palpation is rarely feasible, therapist’s finger against finger tested, therapist may detect slight outward motion for muscle less than Grade 2
What do you do below a grade 3 for Thumb MCP and IP Flexion?
(MCP)
Test is the same.
Grade 2 - Complete partial ROM
Grade 1 - Palpate FPL, and FPB
Grade 0 - No Discernable palpable activity
(IP)
Test is the same
Grade 2 - Holds test position
Grade 1 - Palpate tendon of FPL, (palpable activity)
Grade 0 - No discernable palpable activity
What do you do below a grade 3 for Thumb MCP and IP Extension?
-Patients forearm in pronation with wrist in neutral (Palm of table),
Therapist stabilizes the wrist over its dorsal surface,
“Straighten the end of the thumb”
Grade 2 - Thumb complets ROM
Grade 1 - Palpate tendon of EPL
Grade 0 - No discernable palpable contractile activity
What do you do below a grade 3 for Thumb Abduction?
Test is the same: (Abductor Pollicis Longus)
Grade 2 - Completes partial ROM
Grade 1 - Palpate tendon of the APL
Grade 0 - No discernable palpable contractile activity
(Abductor Pollicis Brevis)
Patients forearm in mid-position, wrist in neutral, therapist stabilized wrist in neutral
Grade 2 - Completes partial ROM
Grade 1 - Palpate the belly of the ABP in the center of Thenar eminence
Grade 0 - No discernable palpable contractile activity
What do you do below a grade 3 for Thumb Adduction?
Patients arm is in mid-position and wrist in neutral resting on table, Therapist stabilizes wrist on the table, stabilizes metacarpals
Grade 2 - Completes full ROM
Grade 1 - Palpate adductor pollicis
Grade 0 - No discernable palpable contractile activity
What do you do below a grade 3 for Opposition?
Test is the same
Grade 2 - Moves through range of opposition
Grade 1 - Palpate the Opponens pollicis, and palpate opponens digiti minimi
Grade 0 - No discernable palpable contractile activity
What is the goni placement for Wrist Flexion (DORSAL alignment)?
Stationary arm: Dorsal midline of forearm towards lateral epicondyle
Moving arm: Dorsal midline of 3rd metacarpal
Axis: Lunate
What is the goni placement for Wrist Flexion (ULNAR alignment)?
Stationary arm: Lateral midline of ulna toward olecranon process
Moving arm: Lateral midline of 5th metacarpal
Axis: Triquetrum
What is the goni placement for Wrist Extension (VOLAR alignment)?
Stationary arm: Volar midline of forearm towards bicipital tendon at elbow
Moving arm: Volar midline of 3rd metacarpal
Axis: Lunate
What is the goni placement for Wrist Extension (ULAR alignment)?
Stationary arm: Lateral midline of ulna toward olecranon process
Moving arm: Lateral midline of 5th metacarpal
Axis: Triquetrum
What is the goni placement for Ulnar Deviation?
Stationary arm: Dorsal midline of the forearm toward lateral epicondyle.
Moving arm: Dorsal midline of 3rd metacarpal
Axis: Capitate
What is the goni placement for Radial Deviation?
Stationary arm: Dorsal midline of the forearm toward lateral epicondyle
Moving arm: Dorsal midline of 3rd metacarpal
Axis: Capitate
