Lecture 1: Introduction

Question 1

Total Musculoskeletal Assessment

Answer 1

• Pt. History
• Observation
• Examination of movement
• Special Test
• Reflexes & Cutaneous distribution
• Palpation
• Diagnostic Imaging

Question 2

Components of Physical Assessments

Answer 2

Vital Signs
OI
Palp
ROM
MMT
Sensory Eval

Question 3

Other Components of Physical Assessment

Answer 3

Neuro Exam
Special Tests
Postural Assessment
Functional Assessment
Gait Analysis
Movement Screening & Sports Assessment

Question 4

“Looking” or “Inspection” phase
- Gains info on visible defects, malalignments, & functional deficits

Answer 4

Observation / Ocular Inspection

Question 5

Ant. view normal body alignment

Answer 5

Nose, xiphisternum, & umbilicus

Question 6

Lat. view normal body alignment

Answer 6

Tip of ear, tip of acromion, highest point of iliac crest, lat. malleolus

Question 7

Deformities present even at rest
- D/t bony configurations or congenital in nature

Answer 7

Structural deformity

Question 8

Result of assumed postures and disappear when posture is changed
- Imbalances in the muscle that would lead to a apparent deformities

Answer 8

Functional deformity

Question 9

Example of a functional deformity

Answer 9

• Scoliosis due to a short leg seen in an upright posture disap- pears on forward flexion
• A pes planus (flatfoot) on weight bearing may disappear on non-weight-bear- ing

Question 10

Caused by muscle action and are present when muscles contract or joints move
- Not usually evident when the muscles are relaxed

Answer 10

Dynamic deformity

Question 11

“Neutral Pelvis” Position

Answer 11

Anterior superior iliac spines are one-to-two finger widths lower than the posterior superior iliac spines

Question 12

Loud grinding noise to a squeaking noise

Answer 12

Crepitus

Question 13

Caused by a tendon moving over a bony protuber- ance

Answer 13

Snapping

Question 14

May be an indication of early nonsymptomatic pathology
- TMJ joint

Answer 14

Clicking

Question 15

Used to confirm or refute the suspected diagnosis, which is based on the history and observation

Answer 15

Examination

Question 16

Red Flags in examination

Answer 16

• Severe unremitting pain
• Pain unaffected by medication or position
• Severe night pain
• Severe pain with no history of injury
• Severe spasm
• Inability to urinate or hold urine
• Elevated temperature (especially if prolonged)
• Psychological overlay

Question 17

Minimum seconds that each contraction is held

Answer 17

5 seconds

Question 18

Position in which resisted isometric movements are done

Answer 18

Resting or neutral position

Question 19

Groups of muscles supplied by a single nerve root

Answer 19

Myotomes

Question 20

Ensures that all possible outcomes of pathology are assessed
- Rule out possibility of referral of symptoms
- Narrow down where pathology is location

Answer 20

Scanning/Screening Examinations

Question 21

Upper Limb Scan

Answer 21

• Cervical spine
• TMJ
• Scapular area
• Shoulder area
• Upper arm & Forearm
• Wrist, hand, & fingers

Question 22

Lower Limb Scan

Answer 22

• Lumbar spine
• Pelvis
• Hip
• Knee
• Ankle, feet, & toes

Question 23

What the patient feels

Answer 23

Subjective set of data

Question 24

Responses that can be measured or are found by the examiner

Answer 24

Objective set of data

Question 25

When to use scanning examination

Answer 25

• There is no history of trauma • There are radicular signs • There is trauma with radicular signs • There is altered sensation in the limb • There are spinal cord (“long track”) signs • The patient presents with abnormal patterns • There is suspected psychogenic pain

Question 26

Another term for Active Movements

Answer 26

Physiological Movements

Question 27

Movements dependent upon contractile, nervous, & inert tissues

Answer 27

Active Movements

Question 28

Contractile, nervous, and inert tissues are involved or moved during active movements

Answer 28

Active or physiological movements

Question 29

A common cause for abnormal movement as is muscle weakness, paralysis, or spasm

Answer 29

Pain

Question 30

Inability to move through the available ROM

Answer 30

Lag

Question 31

Movements primarily performed to determine the available anatomical ROM and end feel

Answer 31

Passive movements

Question 32

Another term which refers to passive movements

Answer 32

Anatomical movements

Question 33

The end of passive movement

Answer 33

Anatomical barrier

Question 34

Useful for measuring and record- ing joint or fracture deformities

Answer 34

Goniometry

Question 35

This index used in isolation, if positive, means the individual has widespread joint hypermobility

Answer 35

Beighton Hypermobility Index (BHI)

Question 36

Measures joint mobility and skin abnormalities

Answer 36

Brighton Diagnostic Criteria (BDC)

Question 37

Limitation of range

Answer 37

Hypomobility

Question 38

Excess of range

Answer 38

Hypermobility or Laxity

Question 39

More susceptible to ligament sprains, joint effusion, chronic pain, recurrent injury, paratenonitis

Answer 39

Hypermobile Joints

Question 40

More susceptible to muscle strains, pinched nerve syndromes, and paratenonitis resulting from overstress

Answer 40

Hypomobile Joints

Question 41

Three types of hypomobility

Answer 41

Myofascial - hypertonicity of muscles Pericapsular - capsular / ligamentous origin Pathomechanical - result of joint trauma

Question 42

The sensation the examiner “feels” in the joint as it reaches the end of the ROM

Answer 42

End Feel

Question 43

A “hard,” unyielding sensation that is painless - ex. Elbow extension

Answer 43

Bone-to-Bone

Question 44

Yielding compression (mushy feel) that stops further movement ex. Knee flexion

Answer 44

Soft tissue approximation

Question 45

A hard or firm (springy) type of movement with a slight give; Most common type - ex. Ankle dorsiflexion, shoulder lateral rotation, finger extension

Answer 45

Tissue stretch

Question 46

Invoked by movement, with a sudden dramatic arrest of movement often accompanied by pain

Answer 46

Muscle Spasm

Question 47

Occurs early in the ROM, almost as soon as movement starts - associated with inflammation and is seen in more acute conditions

Answer 47

Early muscle spasm

Question 48

Form of muscle hypertonicity that offers increased resistance to stretch involv- ing primarily the flexors in the upper limb and extensors in the lower limb (FUEL) - In UMN lesions

Answer 48

Spasticity

Question 49

“Firm” or tightness of the muscle

Answer 49

Mushy

Question 50

Thicker stretching quality to it; can be pushed but there is restriction - ex. Frozen shoulder

Answer 50

Hard capsular

Question 51

Similar to normal tissue stretch end feel but with a restricted ROM - there is a springy or bouncy return; we expect something acute - there is edema or swelling

Answer 51

Soft capsular

Question 52

Restriction occurs before the end of ROM would normally occur or where this end feel would not be expected

Answer 52

Bone-to-Bone (abn)