MSK Flashcards
Deep Neck Flexors
Longus capitis and colli
Rectus capitis
Cervical Flexors
SCM
Scalenes
Longus colli
Cervical Extension
Upper trap
splenius cervicis
ILS cervicis
cervical multifidi
Cervical Lateral Bending
SCM
Cervical Rotation
SCM
Shoulder Flexion
anterior deltoid
coracobrachialis
pec major (clavicular head)
biceps brachii
Shoulder Extension
posterior deltoid
lat dorsi
teres major
triceps brachii
Shoulder Abduction
middle deltoid
supraspinatus
Shoulder Horizontal ABD
posterior deltoid
infraspinatus
teres minor
Shoulder Horizontal ADD
anterior deltoid
pec major
Shoulder ER
infraspinatus
teres minor
posterior deltoid
Shoulder IR
subscapularis
lat dorsi
teres major
pec major
anterior deltoid
Scapula Elevation
upper trap
levator scapulae
Scapular Depression
lat dorsi
lower trap
pec major and minor
Scapular Protraction
serratus anterior
pec minor
Scapular Retraction
rhomboids
middle trap
Scapular Upward Rotation
traps (upper and lower)
serratus anterior
Scapular Downward Rotation
rhomboids
levator scap
pec minor
Laminectomy post-surgical protocols
lifting restrictions
active motion restrictions, especially extension
Spinal Fusion post-surgical protocols
lifting restrictions
active motion restrictions, especially bending and twisting
formal PT ~6 weeks
THA post-surgical protocols
anterior approach:
- no extension, ER
-sleep on surgical side if in sidelying
posterior approach:
-no flex beyond 90, add, IR
-no twisting upper body in standing
-sleep on back first 6 weeks or in sidelying on nonsurgical side with pillow between knees
general:
- no crossing legs
- avoid deep flexion (keep hips above knees)
TKA post-surgical protocols
TSA post-surgical protocols
protect subscapularis repair
-no active elevation, ER at 0 or 90, or resisted IR
-no WB through arms
-lifting/carrying precautions
SLAP repair protocols
avoid contracting or stretching biceps
no AROM/AAROM
no reaching behind back
no lifting or WB through arms
RTC repair protocols
immobilization period in sling
no AROM, lifting, or WB through arms for several weeks
ACLR protocols
period of immobilization (locked into extension)
- brace unlocked when patient can demonstrate good quad control
ROM- focus on restoring full extension
strengthening- initially isometric quad strengthening, hamstring strengthening, closed-chain exercises
*avoid open-chain exercises between 0-45 degrees of flexion should be avoided because it places excess stress on graft site (graft tisse most vulnerable between 6-8 weeks)
return to sport:
-no pain or effusion
-full ROM
-no instability
-quad 85-90% strength of unaffected
-hamstring 90-100% strength of unaffected
-functional leg test 85-90% of unaffected
UE Myotomes
C4: shoulder shrug
C5: shoulder abduction
C6: elbow flexion, wrist extension
C7: elbow extension, wrist flexion
C8: thumb extension
T1: finger abduction
UE Dermatomes
C4: collarbone
C5: anterolateral upper arm
C6: lateral forearm and thumb
C7: middle finger
C8: ulnar hand
T1: lateral forearm
T2: axilla
LE Myotomes
L2: hip flexion
L3: knee extension
L4: ankle DF
L5: great toe extension
S1: ankle PF
S2: knee flexion
ankle inversion: L4-5
ankle eversion: S1
LE Dermatomes
L1: groin
L2: anteromedial thigh
L3: medial knee
L4: anterior knee, medial leg, medial foot
L5: dorsum of foot
S1: lateral and plantar foot, posterolateral leg
S2: posteromedial thigh
S3-5: “saddle” area
Reflex Testing
C5: biceps brachii
C6: brachioradialis
C7: triceps brachii
L4: patella
S1: achilles
Axillary Nerve Innervations (C5-C6)
deltoids
teres minor
*Erb’s palsy: inability to abduct or ER
Musculocutaneous Nerve Innervation (C5-C7)
biceps brachii
brachialis
coracobrachialis
Median Nerve Innervation (C6-T1)
pronator teres
flexor carpi radialis
palmaris longus
flexor digitorum superficialis
Anterior Interosseous Nerve Innervation
1/2 of flexor digitorum profundus (lateral 2)
pronator quadratus
flexor pollicis longus
thenar muscles (recurrent branch)
lateral 2 lumbricals (palmar digital branch)
Radial Nerve Innervation (C5-T1)
triceps brachii
brachioradialis
extensor carpi radialis longus
Ulnar Nerve Innervation
flexor carpi ulnaris
1/2 flexor digitorum profundus (medial)
interossei (PAD and DAB)
medial 2 lumbricals
adductor pollicis longus
hypothenar muscles
- abductor minimi
- opponens minimi
- flexor digiti minimi brevis
Posterior Interosseous Nerve Innervation
extensor carpi radialis brevis
extensor pollicis longus
extensor pollicis brevis
extensor digitorum
extensor digiti minimi
extensor indicis
abductor pollicis longus
supinator
Femoral Nerve Innervation
pectineus
sartorius
iliacus
quads
- rec fem
- vastus lateralis
- vastus medialis
- vastus intermedialis
Obturator Nerve Innervation
obturator externus
gracilis
adductor brevis
adductor magnus (flexor portion)
adductor longus
Superior Gluteal Nerve Innervation
gluteus minimus
gluteus medius
TFL
Inferior Gluteal Nerve Innervation
glute maximus
Sciatic Nerve
hamstrings
- biceps femoris (long head)
- semimembranosus
- semitendinosus
adductor magnus (h/s portion)
Tibial Nerve Innervation
superficial
- plantaris
- gastrocnemius
- soleus
deep
- flexor hallucis longus
- flexor digitorum longus
- tibialis posterior
Fibular Nerve Innervation
common:
- biceps (short head)
superficial:
- fibularis longus
- fibularis brevis
deep:
- fibularis tertius
- tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
- intrinsics –> EHB, EDB
Pain Types
nociceptive: injury/inflammation to non-neural tissue
nociplastic: abnormal pain processing within CNS, strong psychosocial factors
neuropathic: lesion/disease in PNS or CNS
Pain Descriptors
muscle: cramping, aching, sore, dull, heavy
visceral: deep, boring
neurological: burning, sharp, shooting, itchy
vascular: pulsing, beating, throbbing, pounding
emotional: excruciating, unbearable, exhausting
Anthropometry and Standardized Sites
determines overall percentage of body fat through skinfold measurements
-always on R side
- abdominal 6. midaxillary
- tricep* 7. subscapular*
- bicep 8. suprailiac
- chest/pec 9. thigh
- medial calf
*most common
End Feel
Normal:
firm (stretch): ankle DF
hard (bone to bone): elbow extension
soft (soft tissue approximation): elbow flexion
Abnormal:
empty (cannot reach end feel)
firm: increased tone, capsule tightening, ligament shortening
hard: fracture, OA, osteophyte
soft: edema, synovitis, ligament instability/tear
MMT grading
0-5
0: no contraction
1: trace
2(-): less than full ROM in gravity-minimized position
2: full ROM in gravity-minimized position
2(+): less than half ROM against gravity
3(-): more than half ROM against gravity
3: full ROM against gravity only, no resistance
3(+): full ROM against min resistance
4(-): full ROM against min-mod resistance
4: full ROM against mod resistance
4(+): full ROM against mod-max resistance
5: full ROM against max resistance
Swing Phase of Gait (Standard)
40% of gait
- acceleration
- midswing
- deceleration
Stance Phase of Gait (Standard)
60% of gait
- heel strike
- foot flat
- midstance
- heel off
- toe off
Swing Phase of Gait (Ranchos)
- initial swing
- mid swing
- terminal swing
Stance Phase of Gait (Ranchos)
- initial contact
- loading response
- midstance
- terminal stance
- pre-swing
Biomechanical Requirements of Gait
(hip, knee, and ankle excursion)
Hip
- flexion: 0-30
- extension: 0-10
Knee
- flexion: 0-60
- extension: 0
Ankle
- DF: 0-10
- PF: 0-20
*great toe: 45-65 degrees of extension needed
Special Tests: Shoulder
RTC
SLAP
Impingement
Instability
Biceps Tendon
RTC: Biceps Tendon
1. Drop arm 1. Ludington’s
2. Belly press 2.
3. ER lag sign
SLAP:
1. Anterior shift
2. Biceps load
3. Crank test
4. Dynamic shear
Impingement:
1. Hawkins
2. Neers
3. Jobe’s empty can
Instability:
1. apprehension test
2. relocation test
3. positive sulcus sign
Special Tests: Elbow
ligamentous instability
epicondylitis
neurological dysfunction
ligamentous instability:
1. valgus stress test
2. varus stress test
epicondylitis:
1. lateral epicondylitis (Maudsley’s test)
2. medial epicondylitis
3. Cozen’s test (lateral)
4. Mill’s test (lateral)
neurological dysfunction:
1. elbow flexion test (ulnar)
2. pinch grip test (AIN- branch of median)
3. Tinel’s sign (ulnar)
Special Tests: Wrist/Hand
ligamentous instability
vascular insufficiency
contracture/tightness
neurological dysfunction
misc
ligamentous instability:
1. UCL instability test
vascular insufficiency:
1. Allen test
2. capillary refill test (ulnar and radial arteries)
contracture/tightness:
1. Bunnel-Littler test (lumbrical vs capsule)
2. tight retinacular ligament test (neut PIP, flex DIP)
neurological dysfunction
1. carpal compression test (median compression test)
2. froment’s sign (add pollicis)
3. phalen’s test (CTS)
4. tinel’s sign (nerve compression, CTS)
misc:
1. Finkelstein’s (deQuervain’s)
2. Grind test (thumb OA)
3. Murphy sign (lunate dislocation)
Special Tests: Hip
contracture/tightness
pediatric
miscellaneous
contracture/tightness:
1. Ely’s
2. Ober’s
3. Piriformis
4. Thomas
5. tripod sign
6. 90-90 SLR
pediatric:
1. Barlow’s
2. Ortolani’s
misc:
1. anterior labral tear test
2. Patrick’s
3. Craig’s
4. scour
5. tredelenburg test
Special Tests: Knee
ligamentous instability
meniscal pathology
swelling
misc
- Lachman’s: 20-30 degrees (ACL)
- anterior drawer: 90 degrees (ACL)
meniscal:
1. Apley’s (prone)
2. McMurray’s (supine)
3. bounce home test (supine, passive flex/ext)
4. Thessaly’s (standing on one leg, twist side to side)
Special Tests: Ankle
ligamentous instability
misc
ligamentous instability:
1. anterior drawer test (ATFL)
2. talar tilt (CFL)
3. lateral rotation stress/Kleiger test (deltoid lig or high ankle sprain, depending on where pain is felt)
misc:
1. Homan’s sign (DVT)
2. thompson test (Achilles rupture)
3. tibial torsion test
4. true leg length discrepancy (LLD)
Special Tests: Cervical Spine
- cervical flexion rotation test
- distraction test
- (foraminal) compression test
- vertebral artery test
Special Tests: Lumbar/Sacroiliac Region
- gaenslen’s
- sacral thrust
- SI compression/distraction
- slump
- SLR
- thigh thrust
Thoracic Outlet Syndrome Tests
- Roos
- Adson’s maneuver
- Allen test
- Wright test (hyperabduction)
- Costoclavicular syndrome test
Ottawa Knee Rules
- > 54 years old
- isolated tenderness at patella
- inability to flex to 90 degrees
- tenderness at fibular head
- inability to WB for 4 steps
Ottawa Foot/Ankle Rules
foot:
1. pain in the midfoot AND one or more of the following
2. inability to bear weight for 4 steps
3. tenderness at navicular or base of the 5th
ankle:
1. pain near malleolus AND one or more of the following
2. inability to bear weight for 4 steps
3. tenderness at tip or posterior edge of malleolus
Canadian C Spine rules
YES:
1. age >65
2. dangerous mechanism
3. paresthesias in extremities
MAYBE:
1. simple MVC
2. sitting position in ED
3. ambulatory
4. delayed onset of neck pain
5. absence of midline tenderness
WITH
1. inability to turn neck 45 degrees L/R
Fracture Types
(8 general categories)
- avulsion: a portion of bone becomes fragmented at the site of tendon attachment
- closed: skin remains intact
- communited: breaks into fragments
- compound: break protrudes through the skin
- greenstick: break on one side of the bone that does not damage periosteum of the other side (often seen in children)
- nonunion: break that fails to heal after 9-12 months
- stress: break due to repeated forces on a particular portion
- spiral: break shaped like an “S” due to torsion and twisting
SALTER Harris Classification
fracture including the growth plate
TYPE 1 S: straight across
TYPE 2 A: above
TYPE 3 L: low/below
TYPE 4 T: through
TYPE 5 ER: erasure
Scoliosis (Cobb angle)
Cobb angles:
>40 surgery
25-40: orthosis and continued observation
<25: therapy and exercise with continued observation
Scoliosis Types
idiopathic, most comomonly diagnose between 10-13, girls > boys
degenerative: normal aging process (structural)
functional: abnormalities in the body that directly impact the spine (nonstructural)
neuromuscular: developmental pathology resulting from alterations within the structure of the spine (structural)
congenital: abnormal vertebral development in utero
shoulder height asymmetry with/without presence of rib hump
TMJ Muscle Actions
elevation: masseter, medial pterygoid, temporalis
depression: infrahyoid, lateral pterygoid, suprahyoid
protraction: medial pterygoid, masseter, lateral pterygoid
retraction: digastric, medial pterygoid, temporalis
lateral excursion: medial pterygoid, masseter, lateral pterygoid, temporalis
*lateral pterygoid is most related to joint
TMJ motion norms
opening: 40-50mm
- >50mm is excessive
- <35mm limited
lateral excursion: 8-12mm either direction without pain
protrusion: 6-7mm
Upglide/Downglide Restrictions
downglide restriction on R: limited R-sided motion and extension w pain on R
upglide restriction on L
Patellofemoral pain syndrome
general pain and discomfort in the anterior knee
pain w squat, pain with loading the knee in flexion
quad weakness, patellar instability, repetitive forced
increased Q angle is a risk factor
male normal is 13
female normal is 18
GH Joint Capsule
(capsular tension with motion)
ER: ant superior/inferior (0/90)
IR: post superior/inferiro (0/90)
flexion: post inf
and: ant inf
horiz abd: ant
horiz add: post
Rheumatoid Arthritis
Systemic autoimmune disorder
Chronic inflammatory reaction
Onset may start in any joint, but typically small bones of hands, feet, wrists, and ankles
Exacerbations and remissions
Blood tests: rheumatoid factor, WBC count, erythrocyte sedimentation rate (inflammation), hemoglobin, and hematocrit values
Joint pain, morning stiffness, warm joints, decrease in appetite, malaise, fatigue, swan neck deformity, boutonnière deformity, low grade fever
DMARDs: slow acting, but can slow progression of joint deformity and destruction
Active and Passive Insufficiency
Active insufficiency: when a muscle that crosses multiple joints shortens across all the joints simultaneously, significantly reducing ability to generate force (too short to contract effectively)
Passive insufficiency: when a muscle is stretched to its maximum length across multiple joints, limiting ROM at the joints due to the muscle not being long enough to allow full movement at each joint simultaneously (too stretched to allow full ROM)
TFCC
Between ulna, lunate, and triquetrum
Provides stability to the wrist joint
Connecting the radius and ulna together
Allows for better distribution of forces through wrist
