Musculoskeletal Flashcards
Gold standard for assessing/diagnosing an ACL tear?
Lachman’s test
Test to assess for ACL laxity
Anterior drawer test
In the assessment of the musculoskeletal pain it is helpful to the the patient do this:
Point to the location with one finger
Most clavicle fractures occur here:
Mid-shaft
The full movement potential of the joint is known as:
ROM
These are the fibrous bands connecting bone-to-bone
Ligaments
These are connective tissues that attach muscle-to-bone
Tendons
When a joint having full ROM and the range is stopped by the anatomy of the joint
End feel
In the assessment of the MS having hot and/or swollen joints OR focal/diffuse weakness OR unrelenting pain OR poorly localized pain are considered
Red flags
When assessing active and passive ROM, this one should be completed first
Active ROM
A muscle strength testing resulting in “contraction is weak, but there is a full active movements against resistance” would be graded:
M-3
Muscle strength testing that resulted in “some muscle strength against resistance” would be graded as:
M-4
Passive range of motion differs from active range of motion in that it is more specific to:
Evaluation of a particular joint and NOT be dependent upon the supporting structures
Any joint movement that decreases the angle between two bones
Flexion
Moving the limb or hand laterally away from the body is:
Abduction
Moving the limb or hand toward or across the midline of the body is:
Adduction
Developing areas of cartilage tissue near the end of the long bones is known as:
Epiphyseal plates
Movement type:
Any joint movement that increases the angle and straightens the joint
Extension
Movement type:
Can occur within the vertebral column, at a pivot joint, or at a ball-and-socket joint
Rotation
Movement type:
Turning the foot to the angle the bottom of the foot toward the midline
Inversion
Movement type:
Turning the bottom of the foot away from the midline
Eversion
Movement type:
Rotation of the radius that returns the bones to their parallel positions and moves the palm to the anterior facing positiong
Supination
Movement type:
The body movement that moves the forearm from the supinated position to the palm backward position
Pronation
Movement type:
Moving of the limb, hand, or fingers in a circular pattern, using the sequential combination of flexion, adduction, extension, and abduction motions; movements of a body region in a circular manner
Circumduction
Muscle strength scale:
No movement
0
Muscle strength scale:
Trace movement
1
Muscle strength scale:
Full passive range of motion
2
Muscle strength scale:
Full range of motion against gravity, no resistance
3
Muscle strength scale:
Full range of motion with resistance, though weak
4
Muscle strength scale:
Full range of motion, full strength
5
This test helps to identify nerve root compression with a intervertebral disc; Passively extending and rotating the patient’s neck to the affected side while applying axial pressure by pressing down on the top of the head resulting in a positive test with radicular pain on to the arm on the same side is the _______ test
Spurling test
This test helps eliminate facet joint etiology; Increased pain/numbness with cervical extension and and lateral flexion is this test
Extension-rotation test
This helps to assess for lumbar radiculopathy; With the patient lying supine, they lift one leg at a time to a 90 degree angle, if pain is elicited between a 30-70 degree extension, this is noted as a positive sign of this test
Straight leg raise
The deep breath/bear down maneuver that can illicit localized or radiating pain
Valsava maneuver
This test identifies shoulder impingement; With the elbow at a 90 degree angle, raise the arm to a 90 degree shoulder angle (touchdown sign) then internally rotate, pain is a positive sign of this test
Hawkins-Kennedy test
This test looks for supraspinatus impingement; Stabilizing the patient’s scapula while passively forward flexing the arm in a pronated position is this test
Neer test
This test helps identify supraspinatus weakness; Have the patient abduct both arms to a 90 degree angle (T stance) and pronate their forearms so the thumbs are facing the ground while you try to adduct their arms down, inability to hold the arm is a positive _____ test
Empty can test
This helps indicate subacromial impingement; Ask the patient to abduct the arms horizontally at approximately 30 degrees and bring both arms up overhead to touch (trace the sun motion), a positive pain or inability to bring arms overhead is a positive _____ test
Painful arc test
This is the test used to assess for a rotator cuff tear; have the patient flex their elbows at 90 degrees and attempt to externally rotate the should while you provide resistance. Inability/pain when doing this or should coming up to ear on one side is a positive _____ test
External rotation resistance test
This is to test for tennis elbow; stabilize the elbow, pronate the hand, ask the patient to make a fist and extend their wrist against resistance
Cozen test
Tennis elbow’s medical term
lateral epicondylitis
Golfer’s elbow medical term
medial epicondylitis
The test for golfer’s elbow; stabilize the elbow, supinate the hand and close the fist, then have the patient flex their wrist against resistance
Golfer elbow test
With the wrist stabilized, apply varus force to the medial side of the elbow with it is flexed to a 20-30 degree angle is how you preform this test
Varus stress test of the elbow
With the wrist stabilized, apply a valgus force to the lateral elbow with it flexed at a 20-30 degree angle is how you preform this test
Valgus stress test of the elbow
This is the test to access for ulner nerve damage; with a support wrist and relaxed elbow, tap the ulner nerve as it moves through the ulner notch; numbness or tingling is a positive sign
Tinel’s sign
This test helps to assess for DeQuervain’s syndrome; stabilize the forearm, have the patient grab their thumb in their fist then ulner deviate the wrist
Finkelstein test
This test helps with diagnosing carpal tunnel syndrome; have the patient sit with the dorsum of the hands touching and maximal wrist flexion for approx 1 minute; numbeness/tingling is a positive sign
Phalen’s test
This tests for hip flexor contracture and tightness; with the patient supine, have them bring one knee to their chest; passive contralateral leg flexion is a positive sign
Thomas test
This tests for hip flexor, sacroiliac, or hip inter-articular pathology; while supine, have the patient flex, abduct and externally rotate the hip until the ankle rests upon the contralateral knee then apply downward pressure; pain/decreased ROM is positive
FABER test
This test is for intra-articular pathology specifically arthritis; while the patient is supine, hold the ankle or knee and passively internally and externally rotate the leg; groin pain is positive
Log roll test
This tests intra-articular hip pathology; with the patient supine, have them flex the hip 30-45 degrees, apply a downward pressure on the ankle; pain in groin is positive
Stinchfield’s test
This tests weakness of the abductor musculature; have the patient stand on one leg for 10 seconds then switch; pelvic dip on the unsupported side is positive
Tredelenburg’s test
Test for the MCL; with the pt supine and relaxed, hold the ankle of the patient and apply valgus stress to the lateral knee; pain or laxity is positive
Valgus stress test of the knee
Test of the LCL; with the pt supine and relaxed, hold the ankle of the patient and apply varus stress to the medial knee; pain or laxity is positive
Varus stress test of the knee
This test helps identify ACL injury; with pt supine, have them flex the hip 45 degree and flex the knee 90 degrees to rest foot on table, stabilize pt foot and leg while applying an anterior force; increased laxity is indicative of ACL tear
Anterior drawer test
This tests PCL injury; with pt supine, have them flex hip 45 degrees and knee 90 degrees to place foot on table, sit on foot to stabilize then place hands behind proximal tibia and apply posterior force; increased laxity is positive for PCL tear
Posterior drawer test
This is the gold standard for ACL tear; with pt supine and relaxed, place the outside (proximal) hand over the thigh and the inside (distal) hand over the tibia while applying anterior translation force on the tibia while stabilizing the thigh; excessive anterior tibial translation is positive for ACL tear
Lachman’s test
This test meniscus tear; with pt supine, use one hand to grasp the pt’s ankle and the other to stabilize the knee, flex the knee, externally rotate the tibia and apply valgus force with extending the knee; pain or clicking is positive
McMurray’s test
This assesses patellar laxity; place the knee in full extension and apply lateral force to the medial borders of the patella
Apprehension test
This tests joint effusion in the knee; have pt supine with both legs extended, place one hand superior to the patella and the other applies downward pressure in a milking motion; you will feel the fluid if present
Ballottement test
This test knee joint effusion; gently press slightly medial to the patella then move in an ascending motion and apply pressure firmly on the lateral aspect of the knee; positive tests show a “bulge” of the knee
Bulge sign
This tests for high ankle injuries/fractures; squeeze the tibia and fibula together; pinpoint or distal pain is positive
Squeeze test
This tests for ankle ligamentous injury; with the foot relaxed, passively move foot into an adducted position; pain or laxity is positive
Talar tilt
This tests the integrity of the Achilles tendon; prone pt or seated with foot unsupported, squeeze the belly of the gastrocnemius; lack of passive plantar flexion is positive
Thompson test
Key history/Physical findings:
Numbness and tingling over the median nerve; hx of repetitive activity such as writing or typing; pain with gripping objects; decreased grip strength; atrophy of thenar eminence; Positive Phelan’s and Tinel’s sign; weakness of thumb strength and opposition
Carpal Tunnel syndrome
Key history/Physical findings:
Seen in young children (1-4y/o); hx of arm jerking motion; pain at the elbow/wrist; child will not want to move the arm; child is holding arm in a flexed/pronated position
Radial head subluxation (dislocated elbow)
Key history/Physical findings:
Commonly seen in the 4th/5th digits; inability to completely straighten affected finger(s); nodules on flexor tendons on palmar side of hand; without intervention it can progress to skin puckering and flexion contraction
Dupuytren’s contracture
Key history/Physical findings:
Hx of traumatic injury or repetitive movements; degenerative tears can be exacerbated insidiously; pain and weakness with overhead activities; dominant arm; described pain as a dull ache; decreased ROM; positive empty can test, external rotation resistance test and/or lag test; often negative xrays; MRI with partial or full thickness tear
Rotator cuff tear
Key history/Physical findings:
Pain over lateral epicondyle of humerus with activation of wrist extension; pain may radiate from lateral side of elbow to forearm/wrist; pain is worse when shaking hands/squeezing; pain is worse when holding wrist stiff or moving with force; decreased grip strength; positive Cozen’s test
Lateral epicondylitis (tennis elbow)
Key history/Physical findings:
Anterior knee pain centered over tibial tubercle or distal patellar tendon; common in adolescents during puberty; often worsens during activity and resolves with rest; typically unilateral; painful, bony bump on the tibia just below the knee
Osgood-Schlatter disease
Key history/Physical findings:
Hx of previous trauma or injury; pain isolated to a single joint; pain will often improve with mild-to-moderate activity; pain worsens in the morning and improves throughout the day; pain worsens with prolonged activity; pain with active and passive ROM; decreased ROM; tenderness to palpation over joint line; positive xray showing joint cartilage degeneration
Osteoarthritis
Key history/Physical findings:
Begins asymptomatic; loss of height over time; bone fractures are common; T-score <-2.5 (porosis) or -1 to -2.5 (penia)
Osteoporosis/Osteopenia
Key history/Physical findings:
More common in women; onset typically in middle age; hx of smoking; positive family history; pain in multiple joints; tender, warm, edematous joints; morning stiffness typically lasting 1-2 hours; anorexia; fatigue; commonly affects the PIP or MCP joints; firm lumps under the skin with ulner deviation of the fingers; positive RF, ANA, anti-CCP, short-term CRP elevation and long-term ESR elevation
Rheumatoid arthritis
Key history/Physical findings:
Hx of ETOH use; high purine diet; red, inflamed, exquisitely tender joint (often thumb, great toe, or knee); acute onset with no known injury; joint discomfort that lasts several weeks; limited ROM in affected joint; joint aspiration positive for monosodium urate crystals; serum ESR and CRP elevated in acute flares
Gout
Key history/Physical findings:
Tenosynovitis of the abductor pollicis longus and extensor pollicis brevis; a “sticking” sensation in the thumb when movig it; pain and edema over radial styloid; pain exacerbated with active wrist ulnar deviation; diffculty moving thumb and wrist when performing activities that involve grasping or pinching; positive Finkelstein’s test
DeQuervain’s syndrome
Angled inward, bent, or twisted inward
Varus
Angled outward, bent, or twisted outward
Valgus
