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NPTE EXAM PREP > MSK > Flashcards

MSK Flashcards

1
Q

Deep Neck Flexors

A

Longus capitis and colli
Rectus capitis

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2
Q

Cervical Flexors

A

SCM
Scalenes
Longus colli

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3
Q

Cervical Extension

A

Upper trap
splenius cervicis
ILS cervicis
cervical multifidi

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4
Q

Cervical Lateral Bending

A

SCM

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5
Q

Cervical Rotation

A

SCM

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6
Q

Shoulder Flexion

A

anterior deltoid
coracobrachialis
pec major (clavicular head)
biceps brachii

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7
Q

Shoulder Extension

A

posterior deltoid
lat dorsi
teres major
triceps brachii

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8
Q

Shoulder Abduction

A

middle deltoid
supraspinatus

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9
Q

Shoulder Horizontal ABD

A

posterior deltoid
infraspinatus
teres minor

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10
Q

Shoulder Horizontal ADD

A

anterior deltoid
pec major

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11
Q

Shoulder ER

A

infraspinatus
teres minor
posterior deltoid

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12
Q

Shoulder IR

A

subscapularis
lat dorsi
teres major
pec major
anterior deltoid

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13
Q

Scapula Elevation

A

upper trap
levator scapulae

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14
Q

Scapular Depression

A

lat dorsi
lower trap
pec major and minor

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15
Q

Scapular Protraction

A

serratus anterior
pec minor

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16
Q

Scapular Retraction

A

rhomboids
middle trap

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17
Q

Scapular Upward Rotation

A

traps (upper and lower)
serratus anterior

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18
Q

Scapular Downward Rotation

A

rhomboids
levator scap
pec minor

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19
Q

Laminectomy post-surgical protocols

A

lifting restrictions
active motion restrictions, especially extension

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20
Q

Spinal Fusion post-surgical protocols

A

lifting restrictions
active motion restrictions, especially bending and twisting
formal PT ~6 weeks

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21
Q

THA post-surgical protocols

A

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)

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22
Q

TKA post-surgical protocols

A
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23
Q

TSA post-surgical protocols

A

protect subscapularis repair
-no active elevation, ER at 0 or 90, or resisted IR
-no WB through arms
-lifting/carrying precautions

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24
Q

SLAP repair protocols

A

avoid contracting or stretching biceps
no AROM/AAROM
no reaching behind back
no lifting or WB through arms

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25
Q

RTC repair protocols

A

immobilization period in sling
no AROM, lifting, or WB through arms for several weeks

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26
Q

ACLR protocols

A

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

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27
Q

UE Myotomes

A

C4: shoulder shrug
C5: shoulder abduction
C6: elbow flexion, wrist extension
C7: elbow extension, wrist flexion
C8: thumb extension
T1: finger abduction

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28
Q

UE Dermatomes

A

C4: collarbone
C5: anterolateral upper arm
C6: lateral forearm and thumb
C7: middle finger
C8: ulnar hand
T1: lateral forearm
T2: axilla

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29
Q

LE Myotomes

A

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

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30
Q

LE Dermatomes

A

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

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31
Q

Reflex Testing

A

C5: biceps brachii
C6: brachioradialis
C7: triceps brachii

L4: patella
S1: achilles

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32
Q

Axillary Nerve Innervations (C5-C6)

A

deltoids
teres minor

*Erb’s palsy: inability to abduct or ER

33
Q

Musculocutaneous Nerve Innervation (C5-C7)

A

biceps brachii
brachialis
coracobrachialis

34
Q

Median Nerve Innervation (C6-T1)

A

pronator teres
flexor carpi radialis
palmaris longus
flexor digitorum superficialis

35
Q

Anterior Interosseous Nerve Innervation

A

1/2 of flexor digitorum profundus (lateral 2)
pronator quadratus
flexor pollicis longus

thenar muscles (recurrent branch)
lateral 2 lumbricals (palmar digital branch)

36
Q

Radial Nerve Innervation (C5-T1)

A

triceps brachii
brachioradialis
extensor carpi radialis longus

37
Q

Ulnar Nerve Innervation

A

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

38
Q

Posterior Interosseous Nerve Innervation

A

extensor carpi radialis brevis
extensor pollicis longus
extensor pollicis brevis
extensor digitorum
extensor digiti minimi
extensor indicis
abductor pollicis longus
supinator

39
Q

Femoral Nerve Innervation

A

pectineus
sartorius
iliacus
quads
- rec fem
- vastus lateralis
- vastus medialis
- vastus intermedialis

40
Q

Obturator Nerve Innervation

A

obturator externus
gracilis
adductor brevis
adductor magnus (flexor portion)
adductor longus

41
Q

Superior Gluteal Nerve Innervation

A

gluteus minimus
gluteus medius
TFL

42
Q

Inferior Gluteal Nerve Innervation

A

glute maximus

43
Q

Sciatic Nerve

A

hamstrings
- biceps femoris (long head)
- semimembranosus
- semitendinosus
adductor magnus (h/s portion)

44
Q

Tibial Nerve Innervation

A

superficial
- plantaris
- gastrocnemius
- soleus

deep
- flexor hallucis longus
- flexor digitorum longus
- tibialis posterior

45
Q

Fibular Nerve Innervation

A

common:
- biceps (short head)

superficial:
- fibularis longus
- fibularis brevis

deep:
- fibularis tertius
- tibialis anterior
- extensor hallucis longus
- extensor digitorum longus
- intrinsics –> EHB, EDB

46
Q

Pain Types

A

nociceptive: injury/inflammation to non-neural tissue

nociplastic: abnormal pain processing within CNS, strong psychosocial factors

neuropathic: lesion/disease in PNS or CNS

47
Q

Pain Descriptors

A

muscle: cramping, aching, sore, dull, heavy
visceral: deep, boring
neurological: burning, sharp, shooting, itchy
vascular: pulsing, beating, throbbing, pounding
emotional: excruciating, unbearable, exhausting

48
Q

Anthropometry and Standardized Sites

A

determines overall percentage of body fat through skinfold measurements
-always on R side

  1. abdominal 6. midaxillary
  2. tricep* 7. subscapular*
  3. bicep 8. suprailiac
  4. chest/pec 9. thigh
  5. medial calf

*most common

49
Q

End Feel

A

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

50
Q

MMT grading

A

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

51
Q

Swing Phase of Gait (Standard)

A

40% of gait

  1. acceleration
  2. midswing
  3. deceleration
52
Q

Stance Phase of Gait (Standard)

A

60% of gait

  1. heel strike
  2. foot flat
  3. midstance
  4. heel off
  5. toe off
53
Q

Swing Phase of Gait (Ranchos)

A
  1. initial swing
  2. mid swing
  3. terminal swing
54
Q

Stance Phase of Gait (Ranchos)

A
  1. initial contact
  2. loading response
  3. midstance
  4. terminal stance
  5. pre-swing
55
Q

Biomechanical Requirements of Gait
(hip, knee, and ankle excursion)

A

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

56
Q

Special Tests: Shoulder

RTC
SLAP
Impingement
Instability
Biceps Tendon

A

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

57
Q

Special Tests: Elbow

ligamentous instability
epicondylitis
neurological dysfunction

A

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)

58
Q

Special Tests: Wrist/Hand

ligamentous instability
vascular insufficiency
contracture/tightness
neurological dysfunction
misc

A

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)

59
Q

Special Tests: Hip

contracture/tightness
pediatric
miscellaneous

A

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

60
Q

Special Tests: Knee

ligamentous instability
meniscal pathology
swelling
misc

A
  1. Lachman’s: 20-30 degrees (ACL)
  2. 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)

61
Q

Special Tests: Ankle

ligamentous instability
misc

A

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)

62
Q

Special Tests: Cervical Spine

A
  1. cervical flexion rotation test
  2. distraction test
  3. (foraminal) compression test
  4. vertebral artery test
63
Q

Special Tests: Lumbar/Sacroiliac Region

A
  1. gaenslen’s
  2. sacral thrust
  3. SI compression/distraction
  4. slump
  5. SLR
  6. thigh thrust
64
Q

Thoracic Outlet Syndrome Tests

A
  1. Roos
  2. Adson’s maneuver
  3. Allen test
  4. Wright test (hyperabduction)
  5. Costoclavicular syndrome test
65
Q

Ottawa Knee Rules

A
  1. > 54 years old
  2. isolated tenderness at patella
  3. inability to flex to 90 degrees
  4. tenderness at fibular head
  5. inability to WB for 4 steps
66
Q

Ottawa Foot/Ankle Rules

A

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

67
Q

Canadian C Spine rules

A

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

68
Q

Fracture Types

(8 general categories)

A
  1. avulsion: a portion of bone becomes fragmented at the site of tendon attachment
  2. closed: skin remains intact
  3. communited: breaks into fragments
  4. compound: break protrudes through the skin
  5. greenstick: break on one side of the bone that does not damage periosteum of the other side (often seen in children)
  6. nonunion: break that fails to heal after 9-12 months
  7. stress: break due to repeated forces on a particular portion
  8. spiral: break shaped like an “S” due to torsion and twisting
69
Q

SALTER Harris Classification

A

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

70
Q

Scoliosis (Cobb angle)

A

Cobb angles:
>40 surgery
25-40: orthosis and continued observation
<25: therapy and exercise with continued observation

71
Q

Scoliosis Types

A

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

72
Q

TMJ Muscle Actions

A

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

73
Q

TMJ motion norms

A

opening: 40-50mm
- >50mm is excessive
- <35mm limited

lateral excursion: 8-12mm either direction without pain

protrusion: 6-7mm

74
Q

Upglide/Downglide Restrictions

A

downglide restriction on R: limited R-sided motion and extension w pain on R

upglide restriction on L

75
Q

Patellofemoral pain syndrome

A

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

76
Q

GH Joint Capsule
(capsular tension with motion)

A

ER: ant superior/inferior (0/90)
IR: post superior/inferiro (0/90)
flexion: post inf
and: ant inf
horiz abd: ant
horiz add: post

77
Q

Rheumatoid Arthritis

A

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

78
Q

Active and Passive Insufficiency

A

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)

79
Q

TFCC

A

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

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