MSK - Subjective, Observation, Neuro Scan Flashcards
Name 10 screening questions you could use to identify red/yellow flags in a subjective history?
- B/L or quad parasthesia (spinal cord)
- Hemiparasthesia or facial parasthesia (brainstem)
- Dizziness, vertigo, drop attacks (VBI)
- Periodic LOC (cerebral or VBI)
- Changes in hearing, vision, speech (brainstem)
- Changes in bowel or bladder function (cauda equina)
- Saddle parasthesia/anaesthesia (cauda equina)
- Unexplained weight loss (cancer)
- Constant unrelenting pain (cancer, CV, systemic)
- Persistent night pain (cancer)
What are the components of an MSK history? (13)
Intro Patient Profile HPI MOI Pain/symptom questions PMH Meds Family History Social History Functional Status Precautions/Contraindications Specific/focused questions Chief Concerns and goals
What are the questions to ask about pain/symptoms?
Location Onset Radicular/referral Duration Frequency Intensity Characteristic Aggravating Relieving Associated symptoms
Name 6 common gait deviations, including common causes and reason deviation develops
Foot slap - weak DF
Vaulting - limited DF, clear limb during swing
Hip Hiking - foot drop, weak hip flexors, LLD, clear limb during swing
Circumduction - foot drop, weak hip flexors, LLD, unable to perform swing
High steppage gait - paresis/weak DF, LLD, unable to perform push off
Trendelenburg - weak hip abd
Name the 3 normal and 5 abnormal end feels
Normal: Bone to bone Tissue Stretch Soft tissue approximation Abnormal: Muscle spasm (often from joint instability) Capsular (early in ROM) Springy block Bone to bone (early in ROM) Empty
What are the active movements that can be performed in the C-spine? What are the normal ranges and end feels?
Flexion 45-50°
Extension 70-90°
Side Flexion 20-45°
Rotation 70-90°
Cervical retraction (upper csp flex, lower ext)
Cervical protraction (upper csp ext, lower flex)
End feel = tissue stretch all movements
What are the active movements that can be performed in the T-spine? What are the normal ranges and end feels?
Flexion 20-45° - 2.7cm increase if measuring from C7-T12 with tape measure Extension 25-45° - 2.5cm decrease Side Flexion 20-40° Rotation 35-50° Costovertebral expansion Rib motion End feels = tissue stretch all movements
What are the active movements that can be performed in the L-spine? What are the normal ranges and end feels?
Flexion 40-60° - 7-8cm increase Extension 20-35° Side Flexion 20-35° Rotation 3-18° End feels = tissue stretch
What are the UE myotomes?
C1-C2 - neck flexion C3 - neck side flexion C4 - shoulder elevation C5 - shoulder abduction C6 - elbow flexion, wrist extension C7 - elbow ext, wrist flexion C8 - thumb ext, wrist UD T1 - finger abd/add
What are the LE myotomes?
L1-L2 - hip flexion L3 - knee extension L4 - ankle DF L5 - big toe extension S1 - hip ext, ankle PF, ankle eversion S2 - ankle PF, knee flexion
What are the nerve roots associated with the LMN reflexes?
C5/6 = biceps, brachioradialis C7/8 = triceps L3/4 = patellar S1/2 = achilles
What is the grading for LMN reflexes?
0 - no response 1 - decreased response 2 - normal 3 - exaggerated response 4 - clonus/very brisk
What are the UMN reflexes?
Clonus - DF ankle and hold in DF (abnormal = 5 beats or more)
Babinski - pointed object along lateral aspect of foot (heel and across ball of foot) (abnormal = extension or splaying of toes)
Hoffman - middle finger keep PIP in extension and flick DIP into flexion (abnormal = flexion of any fingers)
What are UE scan tests?
Spurling’s Test - sitting, place axial load to head in neutral; if no symptoms repeat in SF to unaffected and then affected side; +ve = reproduction of nerve root compression into UE
Distraction Test - only if pt currently has nerve root compressions symptoms; with one hand under chin and other around occiput, lift upward to traction Csp; +ve = reduction in symptoms
What are the LE scan tests?
SLR - adduct and IR hip and flex until tightness in posterior calf, back off then DF foot or ask to flex neck and see if symptoms reproduced (before 35 = nerve slack taken up; at 35 roots under tension; 60-70 sciatic roots tense over disc; >70 likely MSK pain from hamstring). Nerve Biases: SID = sural; TED = tibial; PIP = peroneal
Slump Test - sitting legs unsupported, hands behind back and slump posture, chin to chest, extend knee and DF foot; if symptoms ask to extend neck. +ve = relief when extend neck
