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Neuro PT Assessment > MSK Neck and Spine > Flashcards

MSK Neck and Spine Flashcards

1
Q

What are 3 types of joints

A

(1) Cartilaginous joint.
(2) Fibrous joint.
(3 Synovial joint

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2
Q

Cartilaginous joint.

(1) What type of movement does this joint have?
(2) Where is it found?

A

(1) minimal movement!
(2) Cartilage present between bony surfaces (symphysis pubis, vertebral bodies (intervertebral disk), AC joint, sternoclavicular joint).

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3
Q

Fibrous joint.

(1) What type of movement does this joint have?
(2) Where is it found?

A

(1) immovable!

(2) Skull sutures.

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4
Q

Synovial joint.
(1) What type of movement does this joint have?
(2) What 3 things comprise this type of joint?
(3-5) List 3 types of synovial joints and provide examples of each.

A

(1) Freely moveable.
(2) Articular cartilage, synovial fluid/joint capsule, ligament.
(3) Ball and Socket (hip and shoulder).
(4) Hinge joint (fingers, elbow).
(5) Condylar (knee, TMJ).

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5
Q

Temporomandibular Joint.

(1) What is this joint formed by?
(2) What kind of joint is it?

A

(1) The fossa and articular tubercle of the temporal bone and the condyle of the mandible.
(2) Contains a synovial membrane so is a synovial joint.

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6
Q

Temporomandibular Joint - INSPECTION.

(1) What 3 things should you look for?
(2) What should you check for bilaterally?
(3) If swelling is present where will it likely be?

A

(1) redness, swelling, deformity.
(2) TMJ symmetry.
(3) just anterior to the external auditory meatus.

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7
Q

Temporomandibular Joint - PALPATION.

(1) Where do you place your fingers?
(2) What do you have the patient do?
(3) What should you feel during the range of motion?
(4) What should you note?
(5) When is a snap or click ok?
(6) Explain how to check ROM.

A

(1) Anterior to the tragus, bilaterally.
(2) Open mouth.
(3) smooth ROM.
(4) swelling/tenderness.
(5) If there is NO PAIN.
(6) Open/close, protrude/retract, and side to side motion of jaw.

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8
Q

What are the vertebrae of the spine offset by?

A

intervertebral discs

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9
Q

What primarily supports the weight in the spine?

A

Vertebral bodies

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10
Q

(1) What protects the spinal cord?

(2) What protects the spinal nerves?

A

(1) Posterior vertebral arch.

(2) The intervertebral foramen.

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11
Q

(1) The vertebral column consists of how many vertebrae stacked on each other?
(2) What is the breakdown of these vertebrae by region?
(3) The spine has 1 fused what?

A

(1) 24.
(2) 7 cervical, 12 thoracic, 5 lumbar vertebrae.
(3) 1 fused sacrum and coccyx (vestigial tail).

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12
Q

Describe the movement of the spinal joints:

A

Slightly moveable between the vertebral bodies and articular facets (project from pedicle, superior facet faces up and inferior facet down).

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13
Q

(1) Intrinsic muscle definition?

(2) Extrinsic muscle definition?

A

(1) Muscle originates within the part or limb in which it inserts.
(2) Muscle does not originate within the part or limb in which it inserts.

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14
Q

Intrinsic muscles as they relate to the back:

(1) Intrinsic muscles extend from?
(2) What do they maintain?
(3) What do they move?
(4) What 3 groups are they divided into?

A

(1) the cranium to the pelvis.
(2) posture.
(3) vertebral column.
(4) superficial, intermediate and deep.

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15
Q

Extrinsic muscles as they relate to the back:

(1) Extrinsic muscles connect what?
These are the __(2)__-shaped muscles of the upper and mid back.
(3) What are 4 examples of extrinsic muscles of the back?

A

(1) the upper extremities to the trunk.
(2) V-shaped.
(4) Latissimus dorsi, trapezius, rhomboids, levator scapulae.

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16
Q

Muscles involved in C-spine motion - FLEXION: (3)

A

SCM, scalene, pre-verterbrals

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17
Q

Muscles involved in C-spine motion - EXTENSION: (3)

A

trapezius, splenius, small intrinsics

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18
Q

Muscles involved in C-spine motion - ROTATION: (2)

A

SCM, small intrinsics

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19
Q

Muscles involved in C-spine motion - LATERAL BENDING: (2)

A

Scalene, small intrinsics

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20
Q

With the patient in ERECT posture, what 3 NORMAL findings do you inspect for?

A

(1) Normal cervical lordosis (concavity - anterior curvature).
(2) Normal thoracic kyphosis (convexity - posterior curvature).
(3) Normal lumbar lordosis (concavity).

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21
Q

With the patient in ERECT posture, what EXAGGERATION findings do you inspect for in the thoracic region?

A

(1) Exaggeration of the thoracic kyphosis (hunchback = GIBBOUS).
(2) = dowagers hump.

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22
Q

Dowagers Hump

A

Exaggeration of the thoracic kyphosis in post menopausal women resulting from osteoporotic wedge fx’s

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23
Q

What 2 things should be inspected for equal height while looking from behind at the back?

A

shoulder height

iliac crest

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24
Q

(1) Where do you start palpation?
(2) What do you palpate?
(3) What is the most prominent palpation point?
(4) What should you be sure to note and why?
(5) What is roughly 2.5 cm lateral to spinous process but are not always palpable?
(6) What can tenderness at C1 - C2 in pts w/ RA indicate?

A

(1) C-spine.
(2) spinous processes.
(3) C7 spinous process.
(4) Any tenderness; may indicate fx.
(5) Facet joints.
(6) impending high cervical subluxation

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25
Q

What can indicate impending high cervical subluxation in RA patients?

A

Tenderness at C1 - C2 upon palpation.

26
Q

Patients w/ arm pain may have __(1)__ problems with or without neck pain.

A

C-Spine

27
Q

Shoulder pain rarely radiates past where?

A

the elbow

28
Q

If when evaluating a complaint of shoulder pain, during the shoulder exam you can take the pt through the entire shoulder ROM and provocative maneuvers without reproducing their pain, chances are the etiology of their pain is where?

A

the neck

29
Q

What should you note in the L-spine that may indicate spondylolisthesis (slippage anteriorly of one vertebra against another)?

A

step-offs (the vertebral body develops in a lop-sided-step-like fashion)

30
Q

(1) Where should you palpate SI joint?

(2) What can develop here?

A

(1) left and right of midline in sacrum.

(2) elderly can develop degenerative joint disease here.

31
Q

(1) What muscles should you palpate along the spine?

(2) What finding should you look for in these muscles and what does it indicate?

A

(1) paravertebral muscles.

(2) Spasm, indicates LS spine dysfunction.

32
Q

(1-2) Explain two techniques for palpation of the sciatic nerve in the sciatic notch.
(3) What does pain here indicate?

A

(1) Palpate sciatic notch with hip flexed and pt lying on opposite side just lateral to ischial tuberosity.
(2) Palpate sciatic notch with patient standing, lifting leg, flexing hip and knee.
(3) Nerve root compression.

33
Q

Range of Motion (ROM): C-Spine.

A

(1) Flexion: touch chin to chest.
(1) Extension: look up (tip: place hand over lumbar spine to feel if pt is bending L-S spine rather than neck).
(1) Rotation: turn neck and look over shoulder.
(1) Lateral bending: tilt head toward each shoulder.

34
Q

(1) Describe how to palpate the SCM.
(2) Describe a technique facilitate better palpation of SCM?
(3) What are some specific things to note on SCM palpation?
(4) Explain how to palpate the trapezius muscle.

A

(1) From origin to insertion.
(2) Have pt turn head to opposite side to facilitate palpation.
(3) Note spasm or hypertrophy w/ torticollis.
(4) From posterior neck towards acromion.

35
Q

How is the SCM often injured?

A

hyperextension injuries

36
Q

How is the superior portion of the trapezius often injured?

A

flexion injuries

37
Q

(1) What do you have the patient do for flexion of the spine?
(2) What is normal?
(3) What is abnormal?
(4) What patients may have difficulty doing this?
(5) What do you need to allow for when assessing this motion?

A

(1) bend forward to touch their toes,
(2) the normal lumbar lordosis should flatten out,
(3) if lumbar lordosis does not flatten out, may mean paravertebral muscle spasm.
(4) pts with lumbar disc dz.
(5) impairment with old age and body habitus (obesity).

38
Q

ROM: Extension of SPINE

A

(1) Place hand on pts posterior superior iliac spine (small of back).
(2) Have pt bend backwards to extend spine.

39
Q

ROM: Rotation of SPINE

A

(1) Place one hand on hip and the other on contralateral shoulder.
(2) Have pt assist you as you push shoulder first forward then back, noting rotational movement.

40
Q

ROM: Lateral bending of SPINE

A

(1) Place hand on pts hip.
(2) Have pt bend towards your hand.
(3) Perform bilaterally.
(4) Assist pt PRN w/opposite hand on shoulder.

41
Q

When assessing ROM of the spine, you always need to note any decreased mobility. What are 4 causes of decreased spinal mobility?

A

(1) OA,
(2) RA,
(3) ankylosing spondylitis,
(4) lumbar disc disease.

42
Q

The pt w/ suspected cervical radiculopathy may have neurological deficits where?

A

UE

43
Q

The pt w/ suspected cervical myelopathy could have deficits where?

A

UE or LE

44
Q

List 6 Special tests for the C-spine exam:

A

(1) Distraction test.
(2) Compression test.
(3) Valsalva test.
(4) Swallowing test.
(5) Adson’s test or maneuver.
(6) Wright’s test.

45
Q

Distraction Test

A

(1) Place open palm of your dominant hand under pts chin.
(2) Place other hand over occiput.
(3) Gently lift head to distract spine.
(4) Assess whether there is pain relief.
(5) Relieve pain due to narrowing of the neural foramen, OR by decreasing pressure on the capsules around the facet joints.

46
Q

Compression Test

A

(1) Press down on pts head.
(2) See if this provokes pain.
(3) symptoms of cervical or radicular pain.

47
Q

Valsalva Test

A

1) Have pt hold breath.
(2) Have patient bear down like having a BM.
(3) Identify if this produces pain anywhere (C-spine, L-S spine).
(4) Test increases intra-abdominal pressure causing increased intrathecal pressure (pressure inside the CNS/cord/nerve roots).
This may provoke pain in a dermatome affected by the pressure

48
Q

Swallowing Test

A

(1) Have pt swallow.
(2) Observe any difficulty.
(3) pts with anterior cervical disk herniation or bony osteophytes can sometimes have difficulty swallowing if the disk or osteophyte is pressing against the esophagus.

49
Q

Lumbar Spine Inspection

A

(1) redness, unusual markings, café-au-lait spots.
(2) Lipoma’s: sign of spina bifida (non-union of the vertebral arch).
(3) Posture: check for scoliosis, normal lumbar lordosis (straightening may indicate paravertebral spasm or exaggerated lordosis may indicate weakness of abdominal musculature)

50
Q

Fatty masses (lipoma’s) appearing as lumps along the lumbar spine may be a sign of?

A

Spina Bifida

51
Q

Inspect lumbar spine for normal lumbar lordosis. Straightening may indicate __(1)__ or exaggerated lordosis may indicate __(2)___.

A

(1) paravertebral spasm.

(2) weakness of abdominal musculature.

52
Q

(1) How is lumbar spine palpation best performed?
(2-4) Procedure?
(5) What finding may indicate spina bifida?

A

(1) Best done sitting on a stool behind pt.
(2) Place your fingers over the iliac crests.
(3) Thumbs should now rest over the lumbar spine at ~ L4 - 5 level.
(4) Palpate the spinous processes moving up then back down the lumbar vertebrae.
(5) Gaps between the lumbar vertebrae.

53
Q

Sacral Spine Exam

A

(1) Locate the posterior superior iliac spine by palpating from the crest and moving posteriorly and inferiorly.
(2) At the posterior superior iliac spine, move directly medially to S2 spinous process (sacrum is fused and spinous processes are smaller).
(3) Continue to palpate inferiorly till reaching the coccyx.

54
Q

(1) What aspect of the spine can only be fully palpated w/ rectal exam because of it’s anterior position?
(2) Explain the palpation technique.

A

(1) Coccyx.

(2) Index finger palpates intrarectally and thumb posteriorly.

55
Q

(1) What muscles should be palpated along each side of the L-S spine, and (2) What 2 things should be noted?
(3) Where do the Gluteal muscles originate from?
(4) What position are the gluteal muscles best palpated in?
(5) What do you have the patient do for gluteal muscle palpation?
(6) What should you palpate the gluteal muscles for?

A

(1) paraspinous muscles.
(2) spasm and tenderness.
(3) iliac.
(4) best palpated w/pt lying prone - but can be done with pt standing.
(5) squeeze buttocks cheeks together.
(6) bulk, tone, tenderness.

56
Q

L-S spine exam: Sacroiliac joint (SIJ).

(1-3) Palpation procedure?
(4) What can tenderness indicate?

A

(1) Locate iliac crests.
(2) Move medially toward the SIJ.
(3) Palpate joints bilaterally.
(4) SIJ DJD.

57
Q

Lumbar Spine Special Tests (3)

A

(1) Straight leg raising (SLR).
(2) Crossed straight leg raising test.
(3) Hoover test (for malingers)/

58
Q

Straight Leg Raising (SLR) TEST:

(1) What is the purpose of the test?
(2-6) Procedure?

A

(1) To stretch the sciatic nerve and reproduce back or leg pain.
(2) Supine position.
(3) Place hand on knee to make sure it stays extended.
(4) Lift leg by supporting heel with knee extended.
(5) Note the angle at which pt felt pain and location of pain (leg vs back).
(6) Now, lower leg till pain resolves, then dorsiflex foot, if still no pain = probably hamstring tightness. if pain w/ foot dorsiflexion = probably disc herniation.

59
Q

Straight leg raising (SLR) test: What allows you to stretch and assess the sciatic nerve without affecting the hamstrings?

A

Foot dorsiflexion

60
Q

Cross Leg Straight Leg Raising Test:

(1) Procedure?
(2) Findings?

A

(1) Perform the SLR Test on the UNINVOLVED side.

(2) If there is pain on the involved (crossed) side, this is even more suggestive that this is a herniated disc.

61
Q

Hoover Test:

(1) Purpose of test?
(2-7) Procedure?
(8-9) Findings?

A

(1) Test for malingers that say they are weak in a leg or can’t move it at all.
(2) Pt supine.
(3) Cup your hands under each heel.
(4) First, tell pt lift good leg.
(5) See if you feel downward pressure of “bad” leg.
(6) Second, tell patient to lift bad leg.
(7) If truly making an effort, you should feel the good leg push down to gain leverage.
(8) It is normal for someone to push down with the opposite leg to gain leverage.
(9) If they said they were paralyzed you should not feel this downward pressure.

Neuro PT Assessment (2 decks)

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