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Musculoskeletal Flashcards

1
Q

Name all the main Nerves of the Brachial Plexus

A

Musculocutaneous N. C5-C6
Axillary N. C5-C6
Radial N. C5-1
Median N C6-C8
Ulnar N C8-T1

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2
Q

Anatomy of the Musculocutaneous Nerve

A

It comes from the lateral cord of the brachial plexus and travels distally to innervate and pierce the coracobrachialis going to the biceps brachii and then emerges from flexor fascia and terminates as the lateral antebrachial cutaneous nerve

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3
Q

Primary impairments with musculocutaneous Nerve injury

A

Weak Shoulder flexion, elbow flexion, supination
shoulder instability

Typically due to injury of the lateral cord or upper trunk of the brachial plexus

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4
Q

Anatomy of the Axillary nerve

A

Emerges from the posterior cord and travels to the axilla where it divides and branches to the teres minor, travels posterior to surgical neck, and innervates deltoid + skin

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5
Q

Primary Impairments of Axillary Nerve Injury

A

weakness of shoulder ER, shoulder instability, weakness with abduction, extension, and flexion (actions of the deltoid) –> maybe some numbness over the deltoid

Typically due to shoulder dislocation or Fxs

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6
Q

Anatomy of the Radial Nerve

A

Emerges from the posterior cord at the pec minor and travels posteriorly to innervate the triceps and then travels distally to pierce the supinator muscle and divides into two branches one being PIN (Posterior interosseus nerve) which innervates extensors + posterior forearm

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7
Q

Causes of injury to the radial nerve

A
  • shoulder dislocation
  • mid-shaft humerus fx
  • “Crutch” palsy
  • triceps injury
  • (tennis elbow )impingement of lateral epicondyle of the elbow
  • radial head fx
  • superficial trauma to the superficial radial nerve
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8
Q

Primary Impairments of Radial nerve Injury

A
  • wrist drop (inability to extend wrist due to length of tension/flexion)
  • weak shoulder and elbow extension
  • weak supination, abductor and extensor pollicis
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9
Q

Anatomy of the Median Nerve

A

emerges from the lateral and medial chord of the brachial plexus travelling to the elbow deep between cubital fossa and bicipital aponeurosis (medial to brachial artery), moves to the forearm b/w pronator teres heads, and then travels between flexor digitorum profundus and superficialis into the carpal tunnel where it becomes the million dollar nerve!

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10
Q

Primary Impairments of Median Nerve Injury

A

Decreased wrist and finger flexion
decreased intrinsic hand motion
sensory changes and progressive weakness
–> typically a carpal tunnel injury and maybe hypertrophy of the pronator teres

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11
Q

Ulnar Nerve C8-T1 Anatomy

A

Emerges from the medial cord at the lower border of the pec minor and travels to medial epicondyle through the cubital tunnel –> then passes through flexor carpi ulnaris and enters hand via pisiform and hook of the hamate (Guyon’s Canal) where it is covered by the palmaris brevis and volar ligament

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12
Q

Ulnar Nerve Injury Primary Impairments

A
  • wrist flexion, weak/limited finger flexion
  • Claw Hand Deformity: damage to the ulnar nerve that results in weak lumbricals 3-4 (unable to extend digits)
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13
Q

What are the main nerves that make up the Lumbosacral plexus?

A

Femoral Nerve (L2-L4)
Obturator Nerve (L2-L4)
Sciatic Nerve (L4, L5, S1-S3)
Tibial/Posterior Tibial Nerve (L5, L5,S1-S3)
Common Fibular Nerve (L4, L5, S1, S2)

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14
Q

Anatomy of the Femoral Nerve

A

Posterior Divisions of lumbosacral plexus –> lateral border of psoas –> superior to inguinal ligament and under it to the femoral triangle –> found lateral to femoral artory
INNERVATES QUADS AND SARTORIUS

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15
Q

Common Injury/Impairments of the Femoral Nerve

A

Hip dislocation, hip fx, pelvis fx, Delivery
Weakness in hip flexion and knee extension loss

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16
Q

Obturator Nerve Anatomy L2-L4

A

Emerges from anterior divisions of the lumbar plexus –> through obturator canal –> medial obturator foramen –> medial thigh to innervate adductors and obturator externus

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17
Q

Common Injury and Impairments of Obturator Nerve L2-L4

A

Uterine pressure and damage during labor
you’ll see adductor weakness/weakness of ER (difficulty crossing legs)

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18
Q

Anatomy of Sciatic Nerve (L4,L5; S1-S3)

A
  • comes from sacral plexus
  • tibial nearve/common fibular nerve seen in the sheath
  • exits pelvis via sciatic forament –> travels down under the piriformis –> travels between isch tub and greater trochanter –> innervates some hamstring and adductor magnus + biceps femoris short head
    Proximal to popliteal fossa branches to common fibular and tibial nerve
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19
Q

Common Injury/Impairments of Sciatic Nerve

A

Piriformis syndrome or hip dislocation/reduction
- issues with hip ER/extension
- various motor and sensory problems throughout the LE
- nerve pain

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20
Q

What is the largest nerve in the body?

A

The sciatic nerve

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21
Q

Tibial/Post Tibial N.

A

anterior rami of sacral plexus, travels with common fibular nerve as sciatic –> sends a branch form the sural nerve. Innervates posterior compartment of the leg and then branches to form the lateral plantar nerve and the calcaneal nerve

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22
Q

What two nerves form the sural nerve?

A

Sural nerve gets a branch from the common fibular n. and the tibial n.

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23
Q

Common Injury/Impairments of the Tib/Post tib Nerve. L4,L5 s1-s3

A

tarsal tunnel syndrome
entrapment of plantar and calcaneal nerves due to overpronation
may see weakness and postural changes in the foot such as pes cavus or toe clawing

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24
Q

Anatomy of the Common Fibular Nerve L4,L5 S1,S2

A

from the sciatic nerve passes between the biceps femoris and lateral head of the gastroc sending a branch to the tibial nerve to form the sural nerve –> passes laterally around fibular head and branches to superficial and deep fibular nerves

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25
Common Injury/Impairments of Fibular Nerve
- pressure or force through lateral leg - fx or fibular head or rupture of LCL - crossing legs too long may see weakness or sensory issues of anterior compartment of the leg, difficulty with eversion, vet drop, pes valgus
26
Can you perform joint mobilizations in the closed position of a joint?
NO
27
When should you perform Grade I and Grade II Mobilizaitons?
when pain/muscle guarding is present
28
When should you perform Grade III and IV mobilizations?
No pain present, decreased mobility
29
Grade I Mobilization
Slow, small-amplitude motion at the beginning of the range
30
Grade II Mobilization
slow, large-amplitude motion within range but not reaching limit
31
Grade III
slow, large amplitude motion in middle to end of available range Through R1 up to R2
32
Grade IV
quick, small amplitude motion at limit of available range and into resistance (R2)
33
Grade V
HIGH VELOCITY SMALL AMPLITUDE at limit of available range
34
TMJ Compression Test
Patient is seated or supine; PT supports and stabilizes head with one hand and uses the hand to push the mandible superior, creating a compressive load on the TMJ (+) = TMJ pain
35
The Purpose of Neurodynamic Testing
assess the ability to provoke sx by placing the limb in specific patterns that tension the nerve - serve as evaluation and treatment
36
What is a positive Nerve Tension test?
REPRODUCTION OF SYMPTOMS different sx side to side
37
What is the most lax position of the anterior cruciate ligament?
30 degrees of knee flexion
38
Typical MOI of ACL
rapid valgus couples with tibial internal rotation at low degrees of flexion
39
ULTT 1A
Median nerve/brachial plexus Step 1: scapular depression Step 2: arm abduction to 90 degrees Step 3: wrist extension Step 4: Shoulder ER Step 5: Elbow extension *cervical side bending can be used to confirm cervical distribution (if better ipsilaterally then c-spine is implicated)
40
ULTT 2A
Median Nerve Step 1: Scap stabilization Step 2: Elbow extension Step 3: shoulderER and supination Step 4: wrist extension Step 5: arm abduction to 90 *cervical side bending
41
ULTT 2B
Radial Nerve Step 1: Scap Stabilization Step 2: Elbow extension Step 3: shoulder IR and forearm pronation Step 4: patient makes a fist and thucks tumb into the palm of the hand Step 5: wrist flexion Step 6: arm abduction *cervical sidebending, scap depression and release to confirm proximal contribution
42
ULTT 3 Ulnar Nerve Bias
Step 1: wrist extension Step 2: forearm pronation Step 3: elbow flexion Step 4: Shoulder ER Step 5: scapular depression Step 6: shoulder abduction *cervical sidebending
43
Open-Pack Position
minimal surface contact and maximal joint play - we perform joint mobs in this position
44
Closed-Pack Position
maximum surface contact and maximum surface tension - DO NOT perform joint mobilizations in this position
45
Isokinetic Muscle Contraction
constant-velocity muscle action that requires special equipment
46
What are osteokinematics?
Movement between bones
47
What are arthrokinematics?
movement between joint surfaces
48
What type of joint is the thumb and what are the arthrokinematics?
Saddle joint - for radial adduction and abduction (flexion and extension) --> concave surface moves on the convex - flexion: ulnar glide - extension: radial glide Palmar adduction/abduction - adduction: anterior glide - abduction: posterior glide
49
Attachments of the shoulder joint capsule
The capsule attaches along the rim of the glenoid fossa and extends to the anatomic neck of the humerus. The fibrous capsule of the GH joint is relatively thin and is reinforced by thicker external ligaments. Long head of biceps also contributes to GH stability by crossing superior to the humeral head
50
Arthrokinematics of Shoulder Flexion
Anterior roll posterior glide
51
Arthrokinematics of Shoulder Extension
posterior roll anterior glide
52
Upper trap Stretch
Rotation of neck to ipsilateral side, side bend away and add neck flexion
53
Levator Scap Stretch
contralateral side flexion and rotation --> smell ur armpit
54
Scalene stretch
Extension, side bend of neck contralaterally, and rotation to the same side
55
56
SCM stretch
contralateral side bend and ipsilateral rotation
57
Short Muscles in Swayback Posture and Elongated muscles in sway back posture
Short - hip extensors - lumbar extensors - upper bas elongated - hip flexors - lower abdominals - low thoracic extensors
58
Definition of 1st, 2nd, and 3rd degree sprain
1st --> few fibers torn 2nd --> half the lig is torn 3rd --> fully torn
59
Froment's Sign
When you have a pt grasp a piece of paper and the clinician pulls the paper (+) thumb will start flexing, indicates ulnar nerve is compromised (ADDUCTOR POLLICIS IS WEAK)
60
Smith's Fracture
the radius goes anterior
61
Colle's Fracture
The radius goes posterior aka a dinner fork deformity
62
Name & Describe the Joint mob grades
Gr. 1: small amplitude performed at the beginning of range Gr. 2: large amplitude movement performed within range but not reaching the limit Gr. 3: large amplitude rhythmic oscillations are performed up to the limit of available motion and are stressed into tissue resistance Gr. 4: small amplitude rhythmic oscillations at limit of available motion and into tissue resistance Gr. 5 thrust small amplitude high velocity
63
Does stretching or strengthening give an immediate correction to Inominate bone rotation?
STRETCHING
64
In what phase of the gait cycle do the hamstrings contract eccentrically?
Terminal Swing
65
Active insufficiency
the inability of a two joint muscle to shorten simultaneously at both joints (the action of the muscle)
66
Passive Insufficiency
the inability of a two joint muscle to lengthen simultaneously at both joints (opposite action of the muscle)
67
6 Weeks post-op Achilles repair should a patient's shoes allow them any plantar flexion?
YES SLIGHT PLANTAR FLEXION 1-1.5 cm heel lift
68
Thompson Test
An achilles rupture test you squeeze the calf muscle a (+) test if they don't go into PF (-) test they go into plantar flexion
69
Apley's Compression Test
Meniscus test Pt is prone, flex knee to 90 degrees. Internally and externally rotate the tibia while applying longitudinal compression (+) = pain or limitations in mobility compared to the uninvolved side
70
Upward Rotators of the Scapula
USL Upper trap Serratus Anterior Lower trap
71
Downward Rotators of the Scapula
Rhomboids Levator Scap Pec Minor
72
Screw Home Mechanism
Open Chain: the tibia must laterally rotate to achieve full extension and medially rotate to "unlock" Closed Chain: the Femur must medially rotate to achieve full extension and laterally rotate to "unlock" into flexion this is bc the lateral condyle of the femur is flatter
73
Congenital Torticollis
Ipsilateral cervical side flexion Contralateral flexion
74
Characteristics of Adhesive Capsulitis
Restricted PROM and AROM Dense adhesive fibrosis with scarring in the capsule; chronic inflammation may be seen in rotator cuff, biceps tendon, and synovial tissue
75
Common Presentation of Adhesive Capsulitis
Ages 40-65 years; females Associated with DM and thyroid disease Self limiting Resolves on its own Capsular pattern loss
76
Treatment for Adhesive Capsulitis
Increase ROM with GH mobilizations; may need closed manipulation under anesthesia
77
Presentation for Lateral Epicondylitis
Ages 30-50 years Pain over lateral epicondyle of humerus mainly with gripping activities Poor mechanics or faulty equipment; + special tests
78
Treatment for Lateral Epicondylaia
Aka tennis elbow RICE , NSAIDs, cryotherapy, thermotherapy TENS Increase strength, flexibility, and endurance of wrist flexors; may use a strap
79
Medial Epicondylitis Presentation
Golfer’s elbow Pain over medial epicondyle, including forearm and wrist Pain with gripping and excessive pronation activities (+) special tests
80
Complication for both Smith and Colle’s fracture
COMPLEX regional pain syndrome
81
What arch would you take to treat plantar fasciitis?
Medial longitudinal arch
82
ACL Injury MOI
Contact or noncontact Twisting injury associated with hyperextension and valgus stress and tibial rotation
83
Characteristics of PFPS
Pain or discomfort in anterior knee; decreased quads strength; decreased LE flexibility, increased tibial torsion or anteversion
84
What is congenital hip dysplasia?
Developmental dysplasia Malalignment of femoral head within acetabulum
85
Typical Presentation of Congenital Hip Dysplasia
Females > males Asymmetrical hip abduction with tightness; apparent femoral shortening Test: Ortolani test, Barlow test, and ultrasound used for dx
86
Treatment for Congenital Hip Dysplasia
Pelvic harness; splinting; traction; bracing; closed or open reduction with hip spica cast; stretching; strengthening
87
What is Juvenile idiopathic arthritis?
Aka juvenile RA an autoimmune disease that is inflammation of the joints and connective tissue; can be - systemic (includes fever, rash, enlarged lymph nodes) - polyarticular (>/= 5 joints) or oligoarticular (
88
Presentation of Juvenile RA
Asymmetrical; involvement of multiple joints; most common form is asymmetric oligoarticular (formerly called pauciarticular) involving 4 or fewer joints
89
Treatment of Juvenile RA
DMARDS NSAIDs Corticosteroids PROM and AROM Positioning Splinting Strengthening Postural training Increase endurance Modalities (paraffin wax, therapeutic ultrasound, cryotherapy)
90
What is Legg-Calve- Perthes
A vascular necrosis; degeneration of the femoral head
91
Presentation of Leg Calve Perthe
Ages 3-13 Males > Fenales Antalgic gait, (+) trendelenburgh Limited hip ABD, IR, and extension MAYBE hip flexion and abduction contractures
92
Treatment of Leg Calve Perthes
MAINTAIN FEM HEAD IN POSITION Stretching Splinting Use of crutches Aquatic therapy Traction
93
What is slipped capital femoral epiphysis?
Femoral head displaced from femoral normal alignment
94
Presentation of slipped capital femoral epiphysis
Common in young adolescents; pain in groin, medial thigh, or knee; limping; ER of leg Limition in capsular pattern (hip flexion, abduction, and IR; pain on weight bearing
95
Treatment of Slipped capital femoral epiphysis
NSAIDs; surgical growth plate stabilization; osteotomies, bedrest, casting; traction; strengthening, stretching, increase ROM and endurance
96
What is Osteogenesis Imperfecta?
Osteogenesis imperfecta is a connective tissue disorder that affects the formation of collagen during bone development; genetic, autosomal dominant
97
Presentation of Osteogenesis Imperfecta
Pathological fractures Osteoporosis Hypermobile joints Bowing of long bones; scoliosis Impaired respiratory function
98
Treatment of Osteogenesis Imperfecta
Handling and positioning techniques; AROM; strengthening exercises; emphasize symmetrical movement; use of orthotics, wheelchair
99
What is Talipes Equinovarus?
Clubfoot Adduction of the forefoot Varus of the rear foot PF at the ankle Due to in utero positioning Treated via splinting and serial casting positioning
100
Yergason's Test
Purpose: assess the integrity of transverse ligament (covering biceps tendon) Description: patient sitting with elbow flexed to 90 and stabilized against the thorax and with the forearm pronated. Resist the supination of the forearm and external rotation of the shoulder.
101
Bone Mineral Density Classification on T-Score DEXA
>/= to -1.0, normal; low risk for fracture less than - 1.0 to -2.4 = osteopenia
102
What do you want to avoid in patients with Osteoporosis or osteopenia? What do you want to prioritize?
AVOID flexion exercises, high impact activites PRIORITIZE balance training, weight bearing, resistance exercises, lifestyle modifications * calcium, vitamin D, estrogen bisphosphonates can be good too
103
Arthrokinematics of the Proximal Radio-Ulnar Joint (Pronation)
Anterior roll and posterior glide of the radial head
104
When is the inferior glenohumeral ligament taut/stretched?
90 degrees of shoulder abduction
105
When is the middle glenohumeral ligament taut/stretched?
45-60 degrees of shoulder abduction
106
Motions of Lower Trap and testing in MMT
Scapular depression adduction upward rotation TIP: imagine yourself doing this MMT
107
What is the action of the lumbricals?
MCP flexion IP extension (think of lumbrical grip)
108
What muscles does the suprascapular nerve supply?
the supraspinatus and infraspinatus muscles RTC assists in overhead motion/lifting the arm
109
Arthrokinematics of Hip Internal Rotation and Hip External Rotation
Hip IR: Anterior roll posterior Glide Hip ER: Posterior roll anterior Glide
110
When would I do a lateral hip glide?
General treatment to create space in the joint
111
Ottawa Ankle Rules
Inability to weight bear immediately after or for the first 4 steps 2-3 inches (6cm) above malleoli tip of medial/lateral malleolus 5th met TTP navicular TTP
112
Bilateral Arch Index
Normal 0.30 >0.30 = pes planus <0.30 = pes cavus
113
What creates compression of the patella?
pull from quads
114
What is the MOST indicated treatment for a contacture?
Prolonged stretching Low load long duration
115
Actions of Lats
shoulder extension, adduction, internal rotation
116
What is the MOST effective glenohumeral mobilization?
posteroinferior translatory glides
117
Capsular Pattern of Restriction for the shoulder
lateral rotation > abduction > internal rotation
118
What is typically associated with an increased Q angle?
COXA VARA FEMORAL ANTEVERSION GENU VALGUM
119
TMJD Hypomobility
limited ROM pain free
120
TMJD Synovitis
inflammation decreased ROM no deflection or deviation
121
TMJD Capsulitis
decreased ROM painful deviation/deflection
122
Compensatory posture for excessive femoral retroversion
medial tibial torsion
123
2 point gait pattern
reciprocal forward motion of device and person's opposite LE (using the walking sticks)
124
Swing-To gait pattern
Bilateral swing of LEs with device
125
3 point Gait pattern
classic crutch one leg two crutches
126
4 point gait pattern
one movement at a time NOT SEGMENTAL
127
Recommended Positions for Transtibial Amputees
Supine with no pillow under the knee of involved leg Side-lying on the non-involved limb with the involved hip and knee extended Prone Why: most common contractures include hip and knee flexion contractures
128
When is the middle glenohumeral ligament most taut?
Shoulder abducted between 45 and 90 degrees
129
When is the middle glenohumeral ligament most taut?
Shoulder abducted between 45 and 90 degrees
130
When is the coracohumeral ligament most taut?
Inferiority directed force with the humerus by the side
131
When is the inferior glenohumeral ligament most taut?
Shoulder abducted to 90 degrees with anterior directed force
132
What is the normal end feel for radial deviation?
Bone to bone
133
What is normal varus during heel strike/initial contact?
0-4 degrees of varus
134
What is a Hill-Sach's lesion?
a traumatic gleohumeral dislocation that can cause a compression fracture on the posterior humeral head
135
What makes up the meniscus composite score?
- hx of catching or locking - pain with hyperextension - pain with end-range flexion - pain with end range of motion - joint line tenderness - (+) McMurray's
136
Causes for Circumduction Gait of the Transfemoral Prosthetic Limb
- the limb is too long - foot unit is plantarflexed - knee unit is locked - poor socket fit or inadequate suspension - lack of knee control - ABduction contracture
137
Reiter Syndrome
Reactive arthritis usually asymmetric and occurs after an infection presents over several weeks can cause pain in multiple joints
138
How to palpate the supraspinatus tendon insertion
extension and internal rotation
139
140
Craniocervical flexion Test
Test of endurance and activation of deep neck flexors involves performing nod against pressure biofeedback
141
Freiberg Disease
idiopathic segmental avascular necrosis of the head of a metatarsal
142
What medication could increase someone's risk for osteonecrosis?
corticosteroid use pain likely exacervated with WB activity
143
functional ROM of pronation and supination
50 degrees
144
Humeroulnar Distraction
Used to increase flexion or extension of the elbow joint
145
Milking Maneuver Test
special test for the medial (ulnar) collateral ligament of the elbow valgus stress to elbw (+) is reproduction of sx such as apprehension, medial joint pain, gaping, and/or instability and a partial tear of UCL would be indicated

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