MSK Practical Flashcards
Observation Questions
-prefering to sit, stand or move
-changing position often
-ADL assistance
-visible discomfort
-observations match Hx
-eye contact
When to Scan
- No obvious MOI
- Proximal Cause for Distal S/s
- Non-mechanical sounding Sx
LQ Scan
- Vitals***
- Observation: posture, plumb line
- Gait: look for gross abnormalities
- Functional MMts: squats***
- Balance Testing***
- Clear the spine**
- SI Joint Provocation**
- Myotomes: include functional testing (heel and toe walking)
- Dermatomes
- DTR: patellar, med hamstring, achilles
- UMN Testing: Babinski, clonus***
- Neurodynamic Testing: SLR, slump test**
- LE ROM: FABER, flx, DF/PF, toe flx/ext
- Pulses (optional)
- Lymph Nodes (optional)
Physical Examination Components
- Pt Hx
- Systems Review
- Observation
- Scanning Exam (if needed)
- AROM>PROM>RROM & Flexibility
- Muscle
- Joint Play
- Palpation
- Special Tests
Normal End Feels
Bony/Hard: bone on bone
-elbow ext
-hard ending
-no joint play
Elastic: muscle tendon unit
-stretches with recoil
-wrist flextion causing finger flexion
-muscle adhesions= passive stretch
Soft: soft tissue
-elbow flexion
Capsular: produced by capsule or ligaments
-with pain= 1-2 Oscillation
-Adhesions= 3 sustained and 3-4 oscillation mobilization
Abnormal End Feels
Springy: articular surface
-rebound sensation
-knee flexion with displaced meninscus
Boggy: viscous fluid in joint
-squishy sensation
-blood in joint or sepsis
Spasm: reactive muscle reaction
-unyielding spasm
-recent trauma or tear
-no joint play
Empty: pain stops you
-no joint play if with assessment
Grade I Oscillatory Mobilization Grades
-small amplitude
-0-25%
-beginning of available joint play
-Pain
-acute stage
Grade II Oscillatory Mobilization Grades
-large amplitude
-25-75%
-middle joint play
-acute and sub acute stage
-pain
Grade III Oscillatory Mobilization Grades
-large amplitude
-50-100%
-end of joint play
-joint adhesions
-Subacute and chronic stages
Grade IV Oscillatory Mobilization Grades
-small amplitude
-75-100%
-end of joint play
-intense
-joint adhesion
-chronic stage
Grade V Oscillatory Mobilization Grades
-high velocity low amplitude thrust
-quick movement that exceeds resistance
-100+%
-Subacute to chronic stages
Grade I Sustained Mobilization Grades
-loosen to neutralize joint pressure
-no stress on capsule
-decrease compression
-used with gliding motion
Grade II Sustained Mobilization Grades
-take up slack to separate joint surfaces
-eliminate joint play
-determine joint sensitivity
Grade III Sustained Mobilization Grades
-stretch
-large distraction w/ 6 sec hold
-increase mobility
-treat hypomobility
-joint adhesions
Oscillatory Joint Mobilizations
-pain dominant
-III-IV for stiffness
Contraindications for Manual Therapy
-infection
-Fever
-Cancer
-Acute Circulatory Condition
-Open Wound
-Fracture
-Hematoma
-Advanced DM
-Hypersensitivity
-Abnormal Endfeel
-RA
-Cellulitis
-Constant, Severe pain
-Extensive radiation of pain
-Condition not evaluated
Precautions for Manual Therapy
-Joint effusion or inflammation
-RA (non-exacerbation)
-Osteoporosis
-Pregnancy (over spine)
-Dizziness
-Steroid or anti-coagulant
Examination to Treatment w/ Mobilizations
- Baseline Assessment
-pain, s/s, ROM, Strength - Determine Grade
-impairment, stage, irritability - Contraindications and Precautions
- Take up Slack
-assess joint play - Arthrokinemattics and Pt Position
- Only 1 Surface Moves
- Re-assess after Treatment
-pain, s/s, ROM, Strength
Convex on Concave
-roll and glide in opposite direction
-pt move with glide
Concave on convex
-roll in glide in same direction
-pt move with glide
Joint Play (Spine)
-Hypomobile, Normal, Hypermobile
-Only skip if they have normal, pain free motion
- Know joint surface shape
- Determine hand placement
3.Grade Motion compared to other side and expected motion - Assess Pain/no pain and mobility
Neurodynamic Mobility Exam
-Subjective (Pain, spasms, paresthesias)
-Observation
-Palpation
-ROM
-Resisted testing
-Nerve provocation test
3 Signs of a Positive NTPT
- Reproduces Pt s/s
- Movement of distant body part causes responses
- Test differences from L to R
Straight Leg Raise
-test for sciatic n
- actively raise leg
- passively raise leg
- DF
- Pt lift head
Pain in 0-30: acute/severe MSK
Pain in 30-70: nerve issue
Pain >70: not positive
Crossed SLR sign: opposite s/s, disc protrusion
Sensitizers:
-Tibial: DF > Eversion > Toe Ext
-Sural: DF > Inversion
-Common fib: PF > Inversion