Musculoskel Review Flashcards
What are examples of Abnormal firm end feels?
increased tone, tightening of capsule, ligament shortening
What are examples of abnormal hard end feels?
fracture, osteoarthritis, osteophyte formation
What are examples of abnormal soft end-feels?
edema, synovitis, ligament instability/tear
When is the Tibialis Anterior at peak muscle activity during the gait cycle?
Just after heel strike, eccentric lowering of the foot into plantar flexion
When is the Gastroc-soleus group at peak activity during the gait cycle?
During late stance phase during the concentric raising of the heel during toe-off
When are the quads at peak activity during the gait cycle?
1st in periods of single support during early stance and 2nd just before toe off to initiate swing
When are the hamstrings at peak activity during the gait cycle?
late swing phase when decelerating the unsupported limb
What is the hip flexion ROM for normal gait?
0-30 degrees
What is the hip extension ROM for normal gait?
0-10 degrees
What is the knee flexion ROM for normal gait?
0-60 degrees
What is the knee extension ROM for normal gait?
0 degrees
What is the ankle dorsiflexion ROM for normal gait?
0-10 degrees
What is the ankle plantarflexion ROM for normal gait?
0-20 degrees
What are some common impairments that may cause foot slap during gait?
weak dorsiflexors, dorsiflexor paralysis
What are some common impairments that may cause toe down instead of heel strike?
Plantar flexor spasticity, plantar flexor contracture, weak dorsiflexors, dorsiflexor paralysis, leg length discrepancy, hindfoot pain
what are some common impairments that may cause clawing of the toes during gait?
toe flexor spasticity, positive support reflex
What are some common impairments that may cause heel lift during mid stance?
insufficient dorsiflexion range, plantar flexor spasticity
What are some common impairments that may cause no toe off during gait?
forefoot/toe pain, weak plantar flexors, weak toe flexors, insufficient plantar flexion ROM
What are some common impairments that may cause exaggerated knee flexion at contact?
weak quads, quad paralysis, hamstring spasticity, insufficient extension ROM
What are some common impairments that may cause hyperextension of the knee in stance?
compensation for weak quads, plantar flexor contacture
What are some common impairments that may cause exaggerated knee flexion at terminal stance?
knee flexion contracture, hip flexion contracture
What are some common impairments that may cause insufficient knee flexion with swing?
knee effusion, quad extension spasticity, plantar flexion spasticity, insufficient knee flexion ROM
What are some common impairments that may cause excessive knee flexion during swing?
flexor withdrawal reflex, lower extremity flexor synergy
What are some common impairments that may cause insufficient hip flexion at initial contact?
weak hip flexors, hip flexor paralysis, hip extensor spasticity, insufficient hip flexion ROM
What are some common impairments that may cause insufficient hip extension at stance?
insufficient hip ext ROM, hip flexion contracture, lower extremity flexor synergy
What are some common impairments that may cause circumduction during swing?
Compensation for weak hip flexors, compensation for weak dorsiflexors, compensation for weak hamstrings
What are some common impairments that may cause hip hiking during swing?
Compensation for weak dorsiflexors, compensation for weak knee flexors, compensation for extensor synergy pattern
What are some common impairments that may cause exaggerated hip flexion during swing?
Lower extremity flexor synergy, compensation for insufficient ankle dorsiflexion
Describe ludington’s test for biceps tendon pathology
patient is in sitting and is asked clasp both hands behind the head with fingers interlocked, pt asked to alternately contract the biceps - absence of movement in the biceps tendon may be indicative of a rupture
Describe speeds test for biceps tendonitis
Pt is in sitting or standing with elbow extended and forearm supinated, PT resists active shoulder flexion w/ hand one hand over bicipital groove. Positive test - pain or tenderness in bicipital groove
describe yergason’s test for biceps tendonitis
pt is in sitting with elbow in 90 degrees of flexion and forearm pronated w/ humerus stabilized against the thorax. PT resists active supination and lateral rotation. Positive - pain or tenderness in the bicipital groove
What are the tests for rotator cuff pathology or impingement?
Drop arm test - rotator cuff pathology
Hawkins kennedy - impingement supraspinatus
Neer test - impingement of supraspinatus
Supraspinatus test (empty can) - tear of supraspinatus, or impingement, or suprascapular nerve involvement
What are the tests for thoracic outlet syndrome?
Adson maneuver
Allen test
Costoclavicular syndrome test - subclavian artery compression between 1st rib and clavicle
Roos test
Wright test - compression in the costoclavicular space
Describe the glenoid labrum tear test
Pt in supine, PT places hand on posterior aspect of humeral head and the other hand stabilizes the humerus proximal to the elbow, PT abducts and laterally rotates arm over pts head and applies anterior force to humerus. Positive w/ clunk or grinding sound - may be indicative of labral tear
What are the tests for ligamentous instability in the elbow?
Varus stress test - LCL sprain
Valgus stress test - MCL sprain
What are the epicondylitis tests for the elbow?
Cozen’s test - Lateral Epicondylitis
Lateral epicondylitis test
Medial Epicondylitis Test
Mill’s test - Lateral epicondylitis
What are the neurologic dysfunction tests at the elbow?
Tinels sign - tapping between the olecrenon process and medial epicondyle creates tingling sensation indicating possible ulnar nerve compression or compromise
What are the ligamentous instability tests in the wrist/hand?
Ulnar collateral ligament instability test - valgus force to the mcp joint of the thumb - positive w/ excessive valgus movement and may be indicative ucl or accessory ligament tear
What test, tests for vascular insufficiency in the wrist/hand?
Allen test - pt makes a fist several times in succession, PT compresses radial and ulnar arteries, delayed or absent flushing hand on the radial or ulnar half of the hand may be indicative of occlusion in the radial/ulnar artery
What are the contracture/tightness tests in the wrist/hands?
Bunnel-littler test - lack of flexion in PIP joints w/ MCP extension - tight intrinsics or capsular tightness; PIP full flexion w/ slight MCP flexion may be indicative of intrinsic muscle tightness w/o capsular tightness
Tight retinacular ligament test - PIP in neutral, DIP attempted to flexion if unable may be indicative of tight retinacular ligaments or capsule. PIP then put in flexion if DIP can flex, retinacular ligaments tight w/o capsular tightness
What are the neurologic tests in the wrist/hand?
Froments sign - pt holds piece of paper between thumb and index finger, PT attempts to pull away - psotive test w/ flexion of DP of thumb due to adductor pollicis muscle paralysis - ulnar nerve compromise
Phalens Test - Carpal tunnel syndrome, wrists in flexion held for 60s, positive test w/ tingling in the thumb, index finger, and middle finger - median nerve compression
Tinel’s sign - PT taps volar aspect of pts wrist tingling in the thumb, index finger, middle finger and lateral half of ring finger - CTS median nerve compression
Describe finkelsteins test
Test for dequervaines disease - thumbs in a fist w/ ulnar deviation - pain indicative of tenosynovitis
What is the grind test for?
DJD in the CMC joint of the thumb
What is Murphy’s test?
If 3rd metacarpal is level with 2nd and 4th metacarpals when pt makes fist in sitting or standing, it may be indicative of a dislocated lunate
What are the tests for contractures/tightness at the hip?
Ely’s test - rectus femoris contracture
Ober’s test - TFL contracture w/ hip extension and adduction in sidelying
Piriformis test - sidelying PT pushes knee into adduction - pain or tightness indicative of piriformis tightness or compression of sciatic nerve from piriformis
Thomas test - hip flexion contracture
Tripod sign - tight hamstrings
90-90 SLR - Hamstring tightness
Describe Craig’s Test
Pt in prone w/ test knee flexed to 90 degrees, PT palpates GT and medially and laterally rotates the hip until the GT is // to the table, measures degree of femoral anteversion. Normal anteversion in an adult is 8-15 degrees.
Describe Faber test (Patricks Test)
Pt in supine w/ test leg flexed, abducted and laterally rotated at the hip onto the opposite leg. PT slowly lowers the test leg through abduction towards the table. Positive if test leg cannot abduct below the level of the opposite leg - iliopsoas, SI, or hip joint abnormalities.
Describe the quadrant scouring test
Pt positioned in supine, therapist passively flexes and adducts the hip w/ knee in maximal flexion, while compressing the femur. Positive w/ grinding, catching, or crepitus in the hip - possibly indicative of arthritis, AVN, or osteochondral defect
Describe trendelenburg test
Pt positioned in standing, and is asked to stand on one leg for 10s - positive w/ drop of the pelvis on the unsupported leg - glute med weakness on the supported side.
What are the ligamentous instability tests of the knee?
Anterior drawer - ACL injury
Lachman - ACL injury
Lateral pivot-shift - shift or clunk indicative of anterolateral rotary instability
Posterior drawer - PCL injury
Sag sign - PCL injury
Slocum Test - Anterolateral instability/anteromedial stability
Valgus stress test - MCL, PCL, posterior oblique ligament, and postermedial capsule injury
Varus Stress test - LCL, PCL, Arcuate complex, and posterolateral capsule
What are the tests for meniscal pathology?
Apleys compression test
Bounce Home test
McMurray Test - posterior meniscal lesion
What are the tests for swelling?
Brush Test
Patellar tap test
what is clarkes sign for?
Patello-femoral dysfunction
What is hughtston’s plica test?
Pt in supine, therapist flexes knee and medially rotates the tibia with one hand while the other hand attempts to move the patella medially and palpate the medial femoral condyle. Positive w/ popping over the medial plica while the knee is passively flexed and extended.
What is the noble compression test for?
IT Band friction syndrome
What is the patellar apprehension test?
PT applies lateral force to the patella w/ pt in supine and knees extended, positive w/ apprehension or quad contraction - indicative f patella subluxation or dislocation
What are the ligamentous instability tests for the ankle?
Anterior drawer - Anterior talofibular ligament sprain
Talar Tilt - Excessive adduction - indicative of calcaneofibular ligament sprain
What is the Thompson test?
Squeezing of the gastroc muscle belly in prone w/ absence of plantarflexion may be indicative of an achilles rupture
What are the Cervical spine special Tests?
Foraminal Compression - Lateral flexion of the head w/ compression causes pain radiating to the the same side as flexion - indicative of nerve root compression
Vertebral Artery Test - tests for compression of the vertebral artery
Lumbar special tests
SIJ Stress test - SIJ dysfunction indicated by UL pain in the SIJ or gluteal area w/ posteriorforce to the ASIS
Sitting flexion test
Standing flexion Test
What is Legg-calve-perthes disease?
Characterized by degeneration of the femoral head due to a disturbance in blood supply. Four distinct stages - condensation, fragmentation, re-ossification, and remodeling
What is osteogenesis imperfecta?
connective tissue disorder that affects the formation of collagen during bone development - 4 types
What are the 3 classifications of scoliosis?
Functional, neuromuscular, degenerative
What diseases is neuromuscular scoliosis seen in?
CP & Marfan syndrome
How is a grade I sprain classified?
mild pain and swelling, little to no tear of the ligament
How is a grade II sprain classified?
moderate pain and swelling, minimal instability of the joint, minimal to moderate tearing of the ligament, decreases joint ROM
How is a grade III sprain classified?
severe pain and swelling, substantial joint instability, total tear of the ligament, substantial decrease in ROM
How is a grade I strain classified?
localized pain, minimal swelling, and tenderness
How is a grade II strain classified?
localized pain, moderate swelling, tenderness, and impaired motor function
How is a grade III strain classified?
a palpable defect of the muscle, severe pain, and poor motor function
