module 21 MS part 1 Flashcards
4 parts to the MS exam
inspection
palpation
ROM
muscle-strength
Inspection
posture and spine joints gait positioning symmetry gross deformity or misalignment hypertrophy or atrophy unusual movement discoloration swelling
Palpation
tenderness inflammation edema crepitus tone joint mobility: passive or active
passive palpation
provider is manipulating the joint
- how the joint feels
active palpation
provider palpating the joint while the pt moves it through its ROM
- looking for crepitus, popping, tracking issues
ROM
flexion extension and hyperextension rotation adduction abduction pronation supination eversion inversion
Active ROM
activating contractile elements of limb or joint
- muscles, tendons, nerves
stressing non-contractile components
- bones, ligaments, menisci
Determining which component is affected or limiting ROM not immediately possible.
passive ROM
testing only non-contractile components of joint
- bones, ligaments, menisci
P-ROM > A-ROM
problem is either with the muscle of the nerve supplying the muscle
- by removing stress on these components during P-ROM, greater ROM was achieved.
- torn or avulsed muscle
P-ROM = A-ROM
suggests the problem is within the joint
- frozen shoulder syndrome, dislocations, fractures
Muscle strength testing
combine with ROM
test in all ranges
think in opposites
test large muscle groups
Strength testing: 0
no muscle contraction is detected visually or with palpation
Strength testing: 1
a trace of muscle contraction is detected visually or with palpation, but no movement of the joint.
Strength testing: 2
pt is actively able to move the muscle when gravity is removed. (side to side, or laying on side)
Strength testing: 3
pt is able to actively move the muscle against gravity but not against any resistance
Strength testing: 4
pt is able to actively move against some resistance
- compare side to side
Strength testing: 5
pt is able to actively move against and overcome resistance applied
orthopedic tests purpose
pinpoint specific nature of an MS injury
- isolate specific structures
- eliciting pain
- identifying laxity
orthopedic tests process
take joint through specific motions to determine
- if the joint moves correctly
- if specific movements cause pain
straight leg test
tests for nerve root irritation
- Lasegue sign
- Bragard sign
Lasegue sign
straight leg raise of more than 30 degrees
- tests for pain in the affected or unaffected leg
- L4, L5, or S1 nerve root irritation or herniation
Bragard sign
passive straight leg raise
- when pt feels pain slightly lower leg, dorsiflex foot, and internally rotate leg.
- pain below knee at less than 70 degrees indicates herniated nucleus pulposus at L5 or S1
Femoral stress/stretch test
pt in prone position
- pt raises affected leg by extending hip; leg straight
- pain indicates nerve root irritation, usually L1, L2, or L3
- pain is in anterior thigh
Low back pain red flags
Bowel or bladder dysfunction or significant change
Saddle paresthesia
Lower extremity weakness
Back or lower extremity muscle atrophy
Knee pain location of pain
can reveal the origin or affected anatomy
- tendon
- meniscus
- ligament
- bones
Tests for knee effusion
ballottement test
bulge test
ballottement test
palpate patella downward against femur
listen for clicking sound
- can do with or without milking fluid
McMurray test
used to detect medial or lateral meniscus damage
- click/pop with pain = meniscus tear
Knee flexed, 90 degree, then lower leg rotated medially or laterally.
Apleys test
for complaints of locking - evaluated problems with meniscus Pt position - prone with knee flexed 90 degrees, or supine with proper stabilization. -- click/ pop and pain = meniscus tear
valgus or varus stress test
tests for damage to medial or lateral collateral ligaments
Pt Position:
- supine with knee extended.
Stabilize femur with one hand and hold the ankle with other hand.
Varus: force against the ankle toward midline and internal rotation.
- laxity: injury to the lateral collateral ligament
Valgus: force against the ankle away from midline and external rotation
- laxity: injury to medial collateral ligament
Anterior and posterior drawer test
identify anterior and posterior cruciate ligament instability (ACL/PCL)
Pt position
- lie supine and flex the knee 45 to 90 degrees placing foot flat on table
- place both hands on lower leg with thumbs on the ridge of the anterior tibia
- Move the tibia forward and then backward
– >5mm in either direction is abnormal
ACL
normally resists posterior displacement of femur on tibia
PCL
normally resists anterior displacement of femur on tibia
Red flags of joints
excessive joint laxity or movement obvious deformity muscle weakness - nerve injury - avulsion muscle atrophy - carpal tunnel syndrome interruption of pulses
