MSK Flashcards
ULTT1
Median nerve bias
Abduct arm to 110 degrees, flex elbow to 90, externally rotate shoulder, extend elbow, wrist, and fingers
ULTT1 biases …
median nerve, roots C5-7, anterior interosseous nerve
ULTT2
same as the ULTT1 except that you only abduct the arm to 10°
Biases Median nerve + axillary nerve + musculocutaneous nerve
ULTT2 biases …
Median nerve + axillary nerve + musculocutaneous nerve
ULTT3
radial nerve
Depress the shoulder and bring the arm into 10° of abduction. Then flex your patient’s wrist and fingers, pronate the forearm and flex the elbow to 90°. Now slowly extend the elbow to lengthen the neurological structures
When can ULTT be determined positive
When 1 or more is present
greater than 10 degrees difference side to side
Reproduction of pain
Contralateral cervical side bending increases symptoms, or ipsilateral side bending decreases symptoms
ULTT4
ulnar nerve bias
Shoulder girdle depression
Shoulder abduction 110
Shoulder external rotation
Forearm PRONATION
Wrist and Finger extension
Elbow flexion
MMT clavicular head pec major
pure horizontal adduction
MMT sternal head pec major
pulling down adduction toward the opposite pocket
Palpation of extensor carpi radialis longus
In line with 2nd metacarpal
Palpation of extensor carpi radialis brevis
In line with third metacarpal
Psoas abcess
collection of pus in psoas muscle
Chondromalacia patella
“runners knee”
dull aching pain in front of knee and behind patella
irritation of the hyaline cartilage undersurface of the patella
typically see more pain with inactivity
Early muscle training should be ….
focus on isometric and eccentric contractions because muscle tension is better maintained than concentric
Increased hip retroversion produces
toe out during gait
Males tend to have more anteversion or retroversion
retroversion
Females tend to have more anteversion or retroversion
anteversion
If patient presents with toe in gait pattern they are most likely …
anteverted
If patient presents with toe out gait pattern they are most likely …
retroverted
If Craigs tests measures 8-15 degrees =
normal
If Craigs test measures greater than 15 degrees =
anteversion
If Craigs test measures less than 8 degrees =
retroversion
Egawa sign
indicative of ulnar nerve palsy
with patients hand flat on the table, have them lift the middle finger and radially/ulnar deviate it
Froments sign
Flexion of phalanx of thumb via FPL (median nerve) to compensate for weak adductor pollicis
Jeannes sign
ulnar nerve palsy
MCP hyperextension with thumb IP flexion
compensate for weak adductor pollicis
Main restraints to horizontal shear force in AC joint
superior and inferior AC ligaments
Coracoacromial ligament prevents
upward displacement of the humeral head
Ober vs Modified Ober Test
Ober - knee bent
Modified Ober - knee straight
TMJ Anterior disc displacement symtpoms
affected joint will have limited ROM. ipsilateral deviation, and a hard end-feel as the mandibular condyle jams against the displaced disk
Bruxism
clenching of jaw/grinding of teeth
Otitis
infection/inflammation of ear
think otolith
Epistaxis
nose bleed
Structural vs functional scoliosis
functional - easily corrected with postural correction/typical of musculature imbalance - no rib hump seen
structural scoliosis - fixed rib hump
Digital prehension grasp
same thing as 3 point chuck
ex holding a pencil
Tip pinch grip
picking a coin or marble up off the table with thumb and index finger only
Hook grasp
carrying a bucket handle
Deeper water w/ aquatic therapy is going to ….
increase bouyancy
increase resistance/drag
Weak and pain free
total rupture
Weak and painful
partial rupture or fracture
Strong and painless
normal
strong and painful
grade 1 tear - minor muscle or tendon injury
Surgery for compression fracture
vertebroplasty or kyphoplasty
Common areas for compression fractures
T10-12
Surgery for spinal instability
spinal fusion
Measuring carpometacarpal abduction
fulcum at radial styloid
Normal knee flexion ROM
140 degrees
Can perform 75% of the task independently
minA
Can perform 50% of the task
modA
Can only perform 25% of the task
maxA
MMT grading 2- (poor-)
cannot complete ROM even in gravity eliminated
cannot complete ROM even in gravity eliminated
MMT grading 2- (poor-)
MMT grading 2 (poor)
Can complete full ROM in gravity eliminated
Can complete full ROM in gravity eliminated
MMT grading 2 (poor)
MMT grading 2+ (poor+)
Can only initiate movement against gravity
Can only initiate movement against gravity
MMT grading 2+ (poor+)
MMT grading 3- (fair-)
completes more than half of range against gravity, but cannot complete full
completes more than half of range against gravity, but cannot complete full
MMT grading 3- (fair-)
MMT grading 3 (fair)
full ROM against gravity, but no resisitance
full ROM against gravity, but no resistance
MMT grading 3 (fair)
MMT grading 3+ (fair+)
completes full ROM and holds min resistance
completes full ROM and holds min resistance
MMT grading 3+ (fair+)
Amount of knee flexion for
walking
stairs
bike
60 degrees
90-100?
90 degrees
What exercises are contraindicated for ankylosing spondylitis
Flexion
need to emphasize extension and rotation
Wider or narrower intracondylar notch = higher risk of ACL tear
narrower - think females are “skinner”
PF and inversion most likely damages what ligament in the ankle
ATFL
DF and inversion most likely damages what ligament in the ankle
CF ligament
Joint mob for isolated ER deficit
anteiror glide
Joint mob for adhesive capsulitis ER deficit
posteiror glide
Normal shoulder ROM
160-180 total
120 GH
60 scapula
Normal shoulder extension ROM
60 degrees
Normal shoulder ER ROM
80-90
Normal shoulder IR ROM
60-70
Normal shoulder abduction ROM
170-180
Normal elbow flexion ROM
140-150
Normal elbow extension ROM
0
Normal forearm pronation/supination ROM
80 degrees
Normal wrist flexion ROM
80-90
Normal wrist extension ROM
70-80
Normal radial deviation ROM
20 degrees
Normal ulnar deviation ROM
30-40
Normal cervical flexion and extension
45 degrees
Normal cervical lateral flexion
45
Normal cervical rotation
60-90
Normal hip flexion ROM
120
Normal hip extension ROM
10-15
Normal hip IR ROM
30-45
Normal hip ER ROM
40-60
Normal hip abduction
30-50
Normal hip adduction
30
Normal knee flexion ROM
135-140
Normal MCP flexion
90
Normal PIP flexion
100-115
Normal DIP flexion
90
Normal ankle PF
40-65
Normal ankle inversion
40
Normal ankle eversion
15-30
Normal thoracic flexion
35
Normal thoracic extension
25
Normal thoracic lateral flexion
35
Normal thoracic rotation
45
Normal TMJ opening
40 mm
Normal TMJ lateral deviation
10-15 mm
Normal TMJ protrusion/retrusion
3-4 mm
TMJ arthrokinematics with mouth openeing
Anterior roll anterior glide
Muscles involved in mandibular elevation (closing mouth)
masseter
medial pterygoid
temporalis
Muscles involved in mandibular depression (opening mouth)
lateral pterygoid
Dorsal displacement of radius
Colles fracture
Strong and painless
normal
Strong and painful
tendonitis or small tear
Weak and painful
grade 2 tear or mod to severe tendonitis
or bursitis
Weak and painless
complete tear or nerve pathology
Tendonitis vs bursitis
full PROM pain at end range = tendonitis
decreased AROM and PROM difficult = bursitis
No pain with PROM
tendonitis or bursitis
tendonitis
Achilles tendonitis vs plantar fasciitis
achilles - burning in heel, pain with activity, swelling, thickening, morning stiffness
PF - worse at rest or in morning, barefoot
Cold intolerance
hypothyroidism
Trigger finger
inflammation of tendon sheath - popping and clicking sensation
typically worse in the morning
sign of buttock
perform SLR, then flex knee/hip - if it does not relieve pain = positive test
dupentreyn contracture is most common in
4th//5th digit
lisfranc injury
metatarsal fracture
difficulty pushing off
inability to bear weight
lisfranc injury MOI
twisting on PF foot
brake pedal injury
Turf toe MOI
forceful hyperextension of big toe - resulting in rupture or stretching of plantar complex
Central tendon rupture / volar slippage
boutannire deformity
First class lever
forces on either side of fulcrum
Effort is the force that causes movement
Resistance is the force that opposes movement
- contraction of tricep at elbow
Second class lever
Forces on same side of axis
Resistance is between the effort force and the axis of rotation
- toe raises
Third class lever
Forces on same side of axis
Effort force is closer to the axis than the resistance force
Ex: elbow flexion
Diarthrodial joint
freely moving joint encased within a synovial membrane/joint capsule
examples
Bilateral contraction of lateral pterygoid =
protrusion
P in pterygoid = Protrusion
Unilateral contraction of lateral pterygoid =
contralateral lateral deviation
Unilateral contraction of medial pterygoid
contralateral lateral deviation
Bilateral contraction of medial pterygoid
Mandibular elevation and protrusion
P in pterygoid = Protrusion
Aattachment site of temporalis
coronoid process of mandibel
Bilateral contraction temporalis
elevation and retraction
Unilateral contraction temporalis
ipsilateral lateral excursion
Normal mandibular depression
40 mm
approx 4 finger width
Lateral excursion normal ROM
1/4 of opening
aka 10 mm
Normal protrusion ROM
6-9 mm
Normal retrusion
3 mm
Arthrokinemtics of TMJ depression
posterior roll anterior glide
Muscles involved in mandibular protrusion
medial and lateral pterygoids + masseter
Muscles involved in lateral excursion (opening mouth)
ipsilateral temporalis and masseter
contralateral medial/lateral pterygoids
ADDwR
at rest, the disk in sitting anterior to the condylar head while the mouth is closed
during opening, the disk reduces back - click/pop
TMJ disk usually almost always displaces which direction
anteriorly
ADDwoR
disk remains anteriorly throughout mandibular depression/elevation - no clicking
C curve with opening TMJ
indicates capsular pattern
deviates to side of restriction
S curve with opening TMJ
indicated motor control issue
Total dislocation of condyle
lock jaw
Most common cause of TMD
myofasical pain
basically the muscles are overworked and create referred pain
Medications for dystonia
botox
Referral pattern of Temporalis musle
maxillary (upper) teeth
Referral pattern of Masseter musle
mandibular (lower) teeth
Mandible deflection
when madible deviates to one side without returning to center
Capsular pattern TMJ
limited mouth opening
deflection and protrusion to ipsilateral side
limited lateral excursion contralaterally (ipsi?)
Scalloping of tongue =
parafunction or bruxism
Is medial pterygoid or lateral pterygoid palpable
medial
Behavioral modification technique
positive reinforcement only
negative reinforcement should be ignored
If hypoglycemic in clinic - give
OJ to act fast
If delayed onset hypoglycemia - give
crackers
TMJ hypermobility
55 mm
Biting down on cotton roll results in gapping on
ipsilateral TMJ
compression to contralateral
Trigeminal nerve reflex normal
very slight or no movement at all
Trismus
lockjaw
common after dental procedures - muscle spasms
Most muscle complexes in the body operate with what type of lever
Second class
Equinovarus
PF
inversion
adduction of forefoot
most commonly seen congenitally - SMA, etc
Hindfoot varus places talus in more
externally rotated position
Hindfoot valgus places talus in more
internally rotated position
Closed chain pronation results in what motion at the
talus
calcanues
talus: PF, adduction, IR
calcanous: eversion
Eichoff vs FInklestein
eichoff - make a fist, ulnar deviate (what you think is finklesteins)
finklestein test - passive flexion of thumb into palm
Best special test to rule out Dequerveins
Wrist hyper abduction test
Costophrenic angle
point where chest wall and diaphragm meet - should be sharp
blunting of this angle would indicate hyperinflated lungs
Increased subcostal angle =
hyperinflation, blunted costophrenic angle
Subcostal angle
angle between xiphoid and R/L costal margin
increased or flatter angle would be a result of hyperinflated lungs
Which mucles are likely to be tight with spinal stenosis
hip flexors from forward flexed posture
anterior chest wall
plantarflexors
Neurogenic claudication =
stenosis origin
Caludication pain above knees
stenosis
below knees would be more vascular
Gait considerations spinal stenosis
excessive trunk/hip flexion
excessive DF
Will SLR be positive with spinal stenosis
No hip flexion makes them feel better
Positive 2 stage treadmill test
If distance in time is greater with slouched position/increased incline on treadmill test =
stenosis
Deliurium sympotms
fluctuating state of attention - worse at night
personality changes and hallucinations are only intermittent
Normal AA ROM
35-45; think about how half of motion in cspine comes from AA joint
SLAP repair early intervention
careful ROM of IR - does not stress repair as ER does
Patients taking Lasix can experience what type of ion imbalance
hypokalemia (low potassium)
diuretics do not spare K - they get excreted with water
Short acting vs long acting bronchodilator
short - emergency use
long - daily use - would be inappropriate to administer in acute episode
Salter Harris 1
straight across entire epiphysis
caused by shearing or torsion
immobilized with cast
Cause of Salter Harris 1
shearing or torsion
Treatment for Salter Harris 1
immobilized with cast
Salter Harris II
affects metaphysis
most common
caused by shear or avulsion with angulation
good prognosis
treated with immobilization
Salter Harris II affects
metaphysis
SALTER acrynym
1 - S - Straight across
2 - A - above (metaphysis)
3 - L - Lower (epiphysis)
4 - TE - through everything (both)
5 - R - cRush
Salter harris III affects
epiphysis
Sharp purser test places the pt into
20-30 degrees flexion
stabilize C2 and shear forehead on C2
positive test = cranial movemnt or increase in sx
Common VBI symptoms
dizziness
N and V
ataxia
CN V sensory abnormalities
nystagmus
PICA symptoms
Flexor carpi radialis action and innervation
flexion/radial deviation
median n
Flexor carpi ulnaris action and innervation
flexion and ulnar deviation
ulnar nerve
FDS innervation and action
flexion of PIP
FDP innervation and action
flexion of DIP
radial half (2nd and 3rd digits) - median n
ulnar half (4th and 5th) - ulnar n
Forearm flexors that do not arise from medial epicondyle
flexor pollicis longus
FDP
pronator quadratus
Thumb IP normal ROM
80 flex
0 ext
Thumb MCP normal ROM
50 flex
0 ext
Thumb CMC normal ROM
50 total arc abd/add
Sural nerve tension test
knee extension
ankle DF
knee inversion
sural nerve goes down lateral side of leg
Eversion for tibial nerve
Vasuclar portion of meniscus
Outside 1/3rd
inside is avascular
Osgood Shlatters vs PFPS
Osgood - pain with more activity
PFPS - pain with rest, prolonged sitting
Crank vs Clunk test
crank - supine arm abducted, add axial load through humerus with IR/ER
clunk - supine elevation + anteiror translation of GH joint + ER
Biceps load 1 vs 2
1 - 90 abd
2 - 120 abd
both with contraction of biceps tension with max ER
TOS special test - locate radial pulse + shoulder extension, cervical rotation/extension to ipsilateral side
Adsons
Positive allens test
90/90 pitcher position
dissipation of radial pulse with contralateral head turn
Wright test
hyperabduction to compress costoclavicular space
stretching the pic minor and occluding pulse
locate radial pulse + shoulder extension, cervical rotation/extension to contralateral
Halstead
Halstead vs Adsons
Adsons - ipsilateral head turn
Halstead - contralateral head turn
Positive test for anterior/posterior drawer shoulder
increased translation of half or more of HH diameter
Lateral pivot shift elbow
Tests for posterolateral instability
In supine, test arm overhead, extended elbow and forearm supinated.
Axial load + Flex elbow and apply a valgus stress
40 degrees of flexion = clunk
In what range would you expect a positive lateral pivot shift test elbow
40 degrees
Mills test
M= P
Mills = Passive
basically stretching of tendons at lateral eppicondyle
pronate, flex wrist
Cozens test
C = A
Cozen = Active
resisted active wrist extension, radial deviation,
Maudleys test
M = middle finger
resisted 3rd finger extension
Hand of benediction can mean what
ulnar n injury - when attempting to open hand
median nerve injury - when attempting to close hand
Mortons neuroma most commonly affects
bt 3rd and 4th toe
Pinch grip test
AIN
if unable to perform tip to tip - will be pulp to pulp
Posteiror hip precautions
flex past 90
hip adduction
IR past neutral
anterior approach is jsut the opposite
Why is hip dislocation more common with post approach
labrum is thicker anteriorly/superiorly
Normal angle of inclination
120-130 degrees
coxa vara - less than 120
coxa valga - more than 130
Deviations seen with coxa valga
increased leg length
circumducted gait
An anteverted femoral head lies more …
anteriorly
thus they have more observed femoral IR (bc they are starting in relative ER)
Normal toe in/out angle
10 degrees
Dysplasia results in medial or lateralized joint center
lateral
Sensation loss between 1nd and 2nd toe
deep peroneal nerve
Deep peroneal nerve muscles
tibA
extensor digitorum longus/brevis
EHL/EHB
Tunnel 1
APL EPB
Tunnel 2
ECRB - attaches to 2nd metacarpal
ECRL - attaches to 3rd metacarpal
Tunnel 3
EPL
Tunnel 4
ED
EI
Tunnel 5
Extensor digiti minimum
Tunnel 6
ECU
Swan neck deformity cause
contracture of instrinsic muscles
laceration of extensor mechanism
volar plate rupture - unopposed extensor mechanism
Trigger finger
thickened pulley mechanism of finger
stuck in flexion - manually extend
more freq in women
Trigger finger interventions
orthosis or surgery
Bunnel littler test
start with MCP extension, flex PIP and measure
with MCP flexion - flex PIP and should get more motion
Jersey finger
ring finger FDP avulsion
Forefoot valgus =
PF first toe
Forefoot varus =
DF first toe
Wedge vs post
wedge is on outside of foot
post on inside - sole
When to use medial wedge
flexible rearfoot valgus
rigid rearfoot varus
If forefoot or rearfoot deformity is fixed.. where does wedge go
in gap
rigid forefoot varus - medial
rigid forefoot valgus - lateral
Anteversion at the hip results in
at the tibia
at the femur
medial tibial torsion
medial femoral torsion
Retroversion at the hip results in
at the tibia
at the femur
lateral tibial torsion
lateral femoral torsion
Coxa vara = genu valgum =
femoral anteversion
Coxa valga = genu varum =
femoral retroversion
Radial glide of CMC on trapezium =
for thumb extension
Upper crossed syndrome
Weak cervical flexors
Weak lower trap/serratus
Tight SCM/pec
Tight upper trap levator
PWB in boot for achilles until
6 weeks or so
progressively wean from boot
How to prevent deformities w boutannire
flexion of DIP (which is hyperextendede)
Sensory. of medial calf
saphenous nerve
Sensory of lateral calf
sural
L in sural = latearl
What does the obturaetor externus/internus do?
externally rotate
Athetoid CP
slow writhing movments - mixed tone
Which form of CP presents with slow writhing movements - mixed tone
Athetoid
Optimal screening time fro scoliosis
9-11 females
11-13 males
Provide anterior-directed resistance to the right PSIS during swing.
Promotes increased stp length on opposite side
constipation referred pain
anterior hip groin or thigh region.
NOrmal EKG changes with exercise
P wave increases
everything else decrease
depression of ST with upsloping
Innervation of all the foot PF
tibial nerve - gastgroc/soleuos, FDL, FHL, post tib
Deep peroneal nerve sensory
1st webspace of foot
Increased or decreased hct after burn
increased because of relative fluid/plasma loss
Elevated BUN =
dehydration
Is cerebellum impaored with SCI?
no
