MSK Assessment Flashcards
What are ‘special’ questions to ask in an assessment?
(deleted itself) :-(
Weight bearing lunge test.
a functional measure of ROM (ankle dorsiflexion)
Foot parallel to wall. Bend knee to touch wall. Move foot as far back as possible with knee still touching wall. Measure distance.
What are some serious red flag pathologies?
- Fracture
- Infection
- Malignant
- Visceral
- Cauda Equina Syndrome
- Cervical Spine: Cervical artery dysfunction, cervical instability, cervical myleopathy
What are some red flag questions when a patient has neurological symptoms?
- Do you have any P&N or numbness?
- Have you experienced any weakness or difficulty moving/controlling your body? (any loss of balance or coordination?)
- Do you experience muscle cramps or spasms?
What are some red flag questions when a patient has systemic symptoms?
- Have you had unexplained weight loss recently?
- Do you have a history of cancer?
- Have you experienced pain waking you at night and stopping you from getting back to sleep?
What is a red flag question for a patient who has had trauma or injury?
Have you recently experienced a significant trauma or injury?
What are red flag questions for a patient who is at risk of infection?
- Have you had a recent infection or operation?
- Do you have a fever or night sweats?
What are red flag questions for a patient who has had spinal trauma or injury?
- Have you recently experienced a significant trauma or injury to your back?
- Did your back pain start after a fall or accident?
What are red flag questions for a patient who you suspect has Cauda Equina Syndrome (CES)?
- Do you have severe pain down both legs?
- Have you noticed any changes in your bowel, bladder or sexual function?
- Do you have difficulty controlling your bowel or bladder?
- Can you feel your saddle area when you wipe?
- Have you noticed any disturbances in your walking?
What are red flag questions for a patient who has history of spinal infection?
- Have you had a recent infection or operation, especially one that involved the spine?
- Do you have a fever along with back pain?
What is a red flag question for a patient who has spinal inflammatory conditions?
Do you have any difficulty moving/stiffness in back or joints >30mins in the morning?
What is a red flag question for pathological lower limb vascular symptoms?
Have you noticed any changes in skin colour or temperature in your legs?
What are red flag questions for pathological lower limb joint swelling & deformity?
- Have you experienced any sudden swelling or deformity in your joints?
- Have you experienced any trauma?
- Do you have a history of joint diseases such as rheumatoid arthritis?
How do you assess dermatomes?
- Gently stroke skin with tissue over the dermatomes
- Compare both sides (find % of sensation reduction or some degree of quantification)
- Document sensation changes
What are you assessing for when looking at myotomes?
assessing for weakness (not pain)
What are the reasons for reduced ROM?
- Pain
- Swelling
- Scar tissue
- Ligament shortening
- Muscle Tightness
- Mechanical block (loose body/cartilage)
- Joint stiffness
What are some reasons for reduced ROM that you want to push hard to overcome?
- Ligament shortening
- Joint stiffness
- Muscle tightness
- Scar tissue
What are some reasons for reduced ROM that you want to push gently to overcome?
- Swelling
- Pain
What is a reason for reduced ROM that you don’t want to push to overcome?
- Mechanical block
When assessing muscle strength of hip adduction, what muscles are being assessed at 0 or 45 degrees of hip flexion?
- Adductor magnus
- Adductor longus
- Gracilis
When assessing muscle strength of hip adduction, what muscles are being assessed at 90 degrees of hip flexion?
Pectineus
How do you ‘resist’ muscles to assess strength of hip adduction muscles?
- Squeeze fist in between knees
- Pull/resist against one side
What are some functional tests for strength/stability of the hip?
- Single leg balance (Trendelenburg?)
- Squat (double/single leg)
- Bridge (double/single leg)
- Clam/hip abduction (single leg)
- Prone hip extension
What are (2) examples of capacity tests used to assess the hip?
- Hamstring – SL bridge to failure – expect 25 reps in runners
- Abductors / gluteal – Side lying leg lift to failure (watch for compensation)
What are the neural integrity tests?
- Dermatomes
- Myotomes
- Reflexes
What are the Upper Motor Neurone Lesion Tests?
- Clonus
- Babinski
How do you conduct a reflex assessment?
- Patient needs to be relaxed and comfortably supported
- A tendon reflex is elicited by briskly striking the tendon of a muscle which is on a slight stretch
Which segments are you assessing when conducting a reflex assessment on the Quads tendon?
L3/4
Which segments are you assessing when conducting a reflex assessment on the Achilles tendon?
L5/S1
What does a brisk/hyperactive reflex indicate?
Upper motor neuron pathology
What does a diminished/absent reflex indicate?
Lower motor neuron pathology
What can be done to help elicit reflexes?
‘Reinforcement’ - tense muscles
What are the contraindications to neurodynamic assessment?
- Malignancy
- Cauda equina / cord involvement
- Active inflammatory or infective disease
- Bone disease
- Joint instability, fracture or dislocation
What are the precautions to neurodynamic assessment?
- Rheumatoid Arthritis
- Osteoporosis
- Spondylolisthesis
- Hypermobility
- Pregnancy
- Vascular disorders
- Previous malignant disease
- Recent trauma
- Psychological issues.
How do you conduct a neurodynamic test?
- Test the pain free side first (baseline).
- Explain to patient what you’re looking for + when they should respond (“let me know as soon as you feel any pulling, stretching, tightness or pain”)
- Move slowly, adding components on one at a time
- Once the sensation is reported clarify what the patient can feel and where
- Remove a component at a joint away from the sensation to confirm neural
- Document range, response and final position
How do you conduct a straight leg raise?
Passive hip flexion with the knee in extension
What are the sensitising tests for a straight leg raise?
- Dorsiflexion
- Hip adduction
- Hip medial rotation
- Neck flexion
FADDIR & FABER tests are used to diagnose which intra-articular pathologies?
- Labral tears
- Femoroacetabular impingement (FAI)
- Osteoarthritis
What is the Keel StarTBack Tool?
The patient is asked to think about the last 2 weeks and tick “disagree” or “agree” for questions 1-8 and then give a scale for question 9.
- Back pain spread down the leg(s)
- Pain in the shoulder or neck at some time
- Only walked short distances due to back pain
- Dressed more slowly due to back pain
- “It is not safe for a person with a condition like mine to be physically active”
- “Worrying thoughts have been going through my mind a lot of the time”
- “I feel that my back pain is terrible and it’s never going to get any better”
- “In general, I have not enjoyed all the things I used to enjoy”
- How bothersome has your back pain been?
What is the femoral nerve slump test?
testing the top leg
How do you conduct the femoral nerve slump test?
- Lie on the opposite side to the one you want to test
- Patient holds the lower leg to their chest and flexes neck
- The uppermost knee if flexed and the hip extended.
How do you conduct a desensitising test during the femoral nerve slump test?
Cervical extension (should ease symptoms)
What are the aims when treating neurodynamic problems?
- Reduce the mechanosensitivity of the nervous system
- Restore its normal capabilities for movement
What is the role of a physio in pain management?
- Assessment
- Treatment and needed
- Red flag assessment
- Pain education / demystifying pain
- Goal setting
- Encourage self management
- Onwards referral to pain specialist
Describe a pain assessment.
- Subjective ratings scales: VAS, NRS, faces pain scales
- Objective measures: McGill pain questionnaire, Pain beliefs and attitudes inventory, EQ-5D
- Visual observations: pain behaviours, communication changes
- Physiological responses: HR, BP, sweating, colour
