Introduction to Musculoskeletal/Neuro Exam Flashcards
joints
cartilagenous, fibrinous, and synovial
ligament
bone to bone
-poor blood supply
tendon
muscle to bone
-good blood supply
bursa
synovial pouch
- cushion and decrease friction at joint
- will stop motion with significant inflammation
exam of major joints
inspect, palpation, range of motion, muscle strength
inspection of joint?
symmetry, alignment, bony/tissue deformities, redness, swelling
palpation of joint?
temperature, texture, crepitus, tenderness
range of motion of joint
joint function and stability, integrity of ligaments, tendons, burs,a especially if pain or trauma
active vs. passive range of motion
defined from patient’s action, not yours
TMJ
temporomandibular joint
TMJ exam?
inspect for symmetry, swelling, redness, lumps observe resting and normal activity palpate clicking, tenderness strength - clench teeth range of motion - open/close
pain vs tenderness?
pain - what patient tells you
tenderness - pain that you create
rotator cuff
supraspinatus, infraspinatus, teres minor, subscapularis
shoulder exam
inspect symmetry of bones and muscles
- include anterior, side, and posterior
- normal walking and conversation
**do while sitting and standing
palpate for tenderness, masses, bony structure symmetry, crepitus
range of motion
crepitus
like you are popping tiny bubbles under skin surface
-associated with some amount of swelling
range of motion of shoulder
flexion, extension, abduction, adduction, internal rotation, external rotation, circumduction
shoulder
rotator cuff and subacromial bursa
most common rotator cuff injury?
supraspinatus
test for supraspinatus
“empty can test”
arms out thumbs down
-put pressure downward against arm
test for infraspinatus and teres minor
elbows in and resist external rotation
test for subscapularis and pectoralis
elbows in and resist internal rotation
test for subscapularis
bear hug
hand over opposite shoulder then attempt to pull it away
also lift off
- hand over lumbar
- resist lifting arm off back
neer’s sign
sign of impingement
palpate acromion and bring arm into flexion
pain indicates impingement of rotator cuff
hawkin’s sign
sign of impingement
rotate head of humerus internally to pinch ligaments into acromion by greater trochanter
exam of elbow
inspect and palpate
range of motion
range of motion of elbow
flexion/extension
pronation/supination
radial/ulnar deviation
golfers elbow
medial epicondyle
tennis elbow
lateral epicondyle
olecranon bursitis
trauma, overuse, infection, arthritic condition
wrist and hand exam
inspect/observe
palpate skin, soft tissues, JOINTS, and masses
range of motion of wrist
flexion/extension
ulnar/radial deviation
range of motion of fingers
flexion/extension/abduction/adduction
range of motion of thumb
flexion/extension/abduction/adduction
also opposition**
most common place of osteoarthritis?
carpometacarpal joint
game-keepers thumb
ulnar collateral ligament (ski pole)
synovial thickening
occurs in arthritis
snuff box
scaphoid tender to direct palpation
test for carpal tunnel
*patients complaining of dropping things
tinels sign and phalens test
tinels sign
tap on nerve for carpal tunnel
phalens test
dorsum of hands (reverse prayer)
test for carpal tunnel
inspection of spine
from the side
-normal curves
from behind
- upright spinal column
- alignment
- skin markings, tags, or masses
sciatic nerve
through pelvis
normal cause of pain
range of motion of neck
flexion/extension
rotation
sidebending
thoracic/lumbar range of motion
flexion/extension
rotation
sidebending
sciatica
shooting pain down leg, constant or intermittent
-straight leg raise can be a positive test (60 degree)
central vs. peripheral impingement
-positive test = central impingement
true hip pain?
in the groin
inspection of hip?
swing - foot moving when walking
stance - foot on the ground
hip range of motion
flexion/extension
abduction/adduction
external/internal rotation
NAVEL
nerve, artery, vein, empty space, lymph nodes
medial ligament of ankle?
deltoid ligament
lateral ligaments of ankle?
posterior talofibular
anterior talofibular
calcaneofibular ligament
major muscle groups
upper arm flexor and extensor lower arm flexor and extensor upper leg flexors/extensors plantar flexors dorsiflexors
muscle strength chart?
0 - no contraction
1 - barely detectable flicker of contraction
2 - active movement of body with gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and some resistance
5 - active movement against full resistance without evident fatigue (normal muscle strength)
paresis
weakness or imcomplete paralysis
paralysis
loss of voluntary movement
spasticity
increased muscle tone dependent on rate of movement
rigididty
increased resistance that persists throughout movement
flaccidity
loss of muscle tone
bradykinesia
slow movement
tremor
repetitive oscillatory movement
resting (involuntary) and intention
nystagmus
rhythmic oscillation of eyes
ataxia
uncoordinated movement that isn’t smooth in appearance
involuntary movement
spontaneous movements that aren’t intentional
PNS sensory testing
soft and sharp testing of peripheral and dermatomes
deep tendon reflexes
use reflex hammer
-strike with brisk direct movement
biceps reflex?
C5-6
triceps reflex?
C6-7
Supinator or brachioradialis reflex?
C5-6
Knee reflex?
L2-L4
Ankle Reflex
S1
Clonus
hyperactive response required for assigning a reflex grade of 4 (usually achilles)
grading of reflex
0 - no response
1 - somewhat diminished, low normal
2 - average, normal
3 - brisker than average, not necessarily indicative of disease
4 - brisk, hyperactive, may have clonus (rhythmic oscillations between flexion and extension)
anesthesia
loss of sensation
paresthesia
abnormal sensation such as burning, prickling, or tingling
dysesthesia
abnormal or disagreeable sensations produced without stimuli or with stimuli that generally don’t cause such altered sensations