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NPTE > Musculoskeletal > Flashcards

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
Q

Common Injury/Impairments of Fibular Nerve

A
  • 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
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26
Q

Can you perform joint mobilizations in the closed position of a joint?

A

NO

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27
Q

When should you perform Grade I and Grade II Mobilizaitons?

A

when pain/muscle guarding is present

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28
Q

When should you perform Grade III and IV mobilizations?

A

No pain present, decreased mobility

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29
Q

Grade I Mobilization

A

Slow, small-amplitude motion at the beginning of the range

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30
Q

Grade II Mobilization

A

slow, large-amplitude motion within range but not reaching limit

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31
Q

Grade III

A

slow, large amplitude motion in middle to end of available range Through R1 up to R2

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32
Q

Grade IV

A

quick, small amplitude motion at limit of available range and into resistance (R2)

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33
Q

Grade V

A

HIGH VELOCITY SMALL AMPLITUDE at limit of available range

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34
Q

TMJ Compression Test

A

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

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35
Q

The Purpose of Neurodynamic Testing

A

assess the ability to provoke sx by placing the limb in specific patterns that tension the nerve
- serve as evaluation and treatment

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36
Q

What is a positive Nerve Tension test?

A

REPRODUCTION OF SYMPTOMS
different sx side to side

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37
Q

What is the most lax position of the anterior cruciate ligament?

A

30 degrees of knee flexion

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38
Q

Typical MOI of ACL

A

rapid valgus couples with tibial internal rotation at low degrees of flexion

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39
Q

ULTT 1A

A

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)

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40
Q

ULTT 2A

A

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

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41
Q

ULTT 2B

A

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

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42
Q

ULTT 3 Ulnar Nerve Bias

A

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

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43
Q

Open-Pack Position

A

minimal surface contact and maximal joint play
- we perform joint mobs in this position

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44
Q

Closed-Pack Position

A

maximum surface contact and maximum surface tension
- DO NOT perform joint mobilizations in this position

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45
Q

Isokinetic Muscle Contraction

A

constant-velocity muscle action that requires special equipment

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46
Q

What are osteokinematics?

A

Movement between bones

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47
Q

What are arthrokinematics?

A

movement between joint surfaces

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48
Q

What type of joint is the thumb and what are the arthrokinematics?

A

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

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49
Q

Attachments of the shoulder joint capsule

A

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

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50
Q

Arthrokinematics of Shoulder Flexion

A

Anterior roll posterior glide

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51
Q

Arthrokinematics of Shoulder Extension

A

posterior roll anterior glide

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52
Q

Upper trap Stretch

A

Rotation of neck to ipsilateral side, side bend away and add neck flexion

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53
Q

Levator Scap Stretch

A

contralateral side flexion and rotation –> smell ur armpit

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54
Q

Scalene stretch

A

Extension, side bend of neck contralaterally, and rotation to the same side

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55
Q
A
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56
Q

SCM stretch

A

contralateral side bend and ipsilateral rotation

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57
Q

Short Muscles in Swayback Posture and Elongated muscles in sway back posture

A

Short
- hip extensors
- lumbar extensors
- upper bas
elongated
- hip flexors
- lower abdominals
- low thoracic extensors

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58
Q

Definition of 1st, 2nd, and 3rd degree sprain

A

1st –> few fibers torn
2nd –> half the lig is torn
3rd –> fully torn

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59
Q

Froment’s Sign

A

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
Q

Smith’s Fracture

A

the radius goes anterior

61
Q

Colle’s Fracture

A

The radius goes posterior
aka a dinner fork deformity

62
Q

Name & Describe the Joint mob grades

A

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
Q

Does stretching or strengthening give an immediate correction to Inominate bone rotation?

A

STRETCHING

64
Q

In what phase of the gait cycle do the hamstrings contract eccentrically?

A

Terminal Swing

65
Q

Active insufficiency

A

the inability of a two joint muscle to shorten simultaneously at both joints (the action of the muscle)

66
Q

Passive Insufficiency

A

the inability of a two joint muscle to lengthen simultaneously at both joints
(opposite action of the muscle)

67
Q

6 Weeks post-op Achilles repair should a patient’s shoes allow them any plantar flexion?

A

YES SLIGHT PLANTAR FLEXION
1-1.5 cm heel lift

68
Q

Thompson Test

A

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
Q

Apley’s Compression Test

A

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
Q

Upward Rotators of the Scapula

A

USL
Upper trap
Serratus Anterior
Lower trap

71
Q

Downward Rotators of the Scapula

A

Rhomboids
Levator Scap
Pec Minor

72
Q

Screw Home Mechanism

A

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
Q

Congenital Torticollis

A

Ipsilateral cervical side flexion
Contralateral flexion

74
Q

Characteristics of Adhesive Capsulitis

A

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
Q

Common Presentation of Adhesive Capsulitis

A

Ages 40-65 years; females
Associated with DM and thyroid disease
Self limiting
Resolves on its own
Capsular pattern loss

76
Q

Treatment for Adhesive Capsulitis

A

Increase ROM with GH mobilizations; may need closed manipulation under anesthesia

77
Q

Presentation for Lateral Epicondylitis

A

Ages 30-50 years
Pain over lateral epicondyle of humerus mainly with gripping activities
Poor mechanics or faulty equipment; + special tests

78
Q

Treatment for Lateral Epicondylaia

A

Aka tennis elbow
RICE , NSAIDs, cryotherapy, thermotherapy
TENS
Increase strength, flexibility, and endurance of wrist flexors; may use a strap

79
Q

Medial Epicondylitis Presentation

A

Golfer’s elbow
Pain over medial epicondyle, including forearm and wrist
Pain with gripping and excessive pronation activities
(+) special tests

80
Q

Complication for both Smith and Colle’s fracture

A

COMPLEX regional pain syndrome

81
Q

What arch would you take to treat plantar fasciitis?

A

Medial longitudinal arch

82
Q

ACL Injury MOI

A

Contact or noncontact
Twisting injury associated with hyperextension and valgus stress and tibial rotation

83
Q

Characteristics of PFPS

A

Pain or discomfort in anterior knee; decreased quads strength; decreased LE flexibility, increased tibial torsion or anteversion

84
Q

What is congenital hip dysplasia?

A

Developmental dysplasia
Malalignment of femoral head within acetabulum

85
Q

Typical Presentation of Congenital Hip Dysplasia

A

Females > males
Asymmetrical hip abduction with tightness; apparent femoral shortening
Test: Ortolani test, Barlow test, and ultrasound used for dx

86
Q

Treatment for Congenital Hip Dysplasia

A

Pelvic harness; splinting; traction; bracing; closed or open reduction with hip spica cast; stretching; strengthening

87
Q

What is Juvenile idiopathic arthritis?

A

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 (</= 4 joints)

88
Q

Presentation of Juvenile RA

A

Asymmetrical; involvement of multiple joints; most common form is asymmetric oligoarticular (formerly called pauciarticular) involving 4 or fewer joints

89
Q

Treatment of Juvenile RA

A

DMARDS
NSAIDs
Corticosteroids
PROM and AROM
Positioning
Splinting
Strengthening
Postural training
Increase endurance
Modalities (paraffin wax, therapeutic ultrasound, cryotherapy)

90
Q

What is Legg-Calve- Perthes

A

A vascular necrosis; degeneration of the femoral head

91
Q

Presentation of Leg Calve Perthe

A

Ages 3-13
Males > Fenales
Antalgic gait, (+) trendelenburgh
Limited hip ABD, IR, and extension
MAYBE hip flexion and abduction contractures

92
Q

Treatment of Leg Calve Perthes

A

MAINTAIN FEM HEAD IN POSITION
Stretching
Splinting
Use of crutches
Aquatic therapy
Traction

93
Q

What is slipped capital femoral epiphysis?

A

Femoral head displaced from femoral normal alignment

94
Q

Presentation of slipped capital femoral epiphysis

A

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
Q

Treatment of Slipped capital femoral epiphysis

A

NSAIDs; surgical growth plate stabilization; osteotomies, bedrest, casting; traction; strengthening, stretching, increase ROM and endurance

96
Q

What is Osteogenesis Imperfecta?

A

Osteogenesis imperfecta is a connective tissue disorder that affects the formation of collagen during bone development; genetic, autosomal dominant

97
Q

Presentation of Osteogenesis Imperfecta

A

Pathological fractures
Osteoporosis
Hypermobile joints
Bowing of long bones; scoliosis
Impaired respiratory function

98
Q

Treatment of Osteogenesis Imperfecta

A

Handling and positioning techniques; AROM; strengthening exercises; emphasize symmetrical movement; use of orthotics, wheelchair

99
Q

What is Talipes Equinovarus?

A

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
Q

Yergason’s Test

A

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
Q

Bone Mineral Density Classification on T-Score
DEXA

A

> /= to -1.0, normal; low risk for fracture
less than - 1.0 to -2.4 = osteopenia
</= -2.5 = osteoporosis

102
Q

What do you want to avoid in patients with Osteoporosis or osteopenia? What do you want to prioritize?

A

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
Q

Arthrokinematics of the Proximal Radio-Ulnar Joint (Pronation)

A

Anterior roll and posterior glide of the radial head

104
Q

When is the inferior glenohumeral ligament taut/stretched?

A

90 degrees of shoulder abduction

105
Q

When is the middle glenohumeral ligament taut/stretched?

A

45-60 degrees of shoulder abduction

106
Q

Motions of Lower Trap and testing in MMT

A

Scapular depression
adduction
upward rotation

TIP: imagine yourself doing this MMT

107
Q

What is the action of the lumbricals?

A

MCP flexion
IP extension

(think of lumbrical grip)

108
Q

What muscles does the suprascapular nerve supply?

A

the supraspinatus and infraspinatus muscles
RTC assists in overhead motion/lifting the arm

109
Q

Arthrokinematics of Hip Internal Rotation and Hip External Rotation

A

Hip IR: Anterior roll posterior Glide

Hip ER: Posterior roll anterior Glide

110
Q

When would I do a lateral hip glide?

A

General treatment to create space in the joint

111
Q

Ottawa Ankle Rules

A

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
Q

Bilateral Arch Index

A

Normal 0.30
>0.30 = pes planus
<0.30 = pes cavus

113
Q

What creates compression of the patella?

A

pull from quads

114
Q

What is the MOST indicated treatment for a contacture?

A

Prolonged stretching

Low load long duration

115
Q

Actions of Lats

A

shoulder extension, adduction, internal rotation

116
Q

What is the MOST effective glenohumeral mobilization?

A

posteroinferior translatory glides

117
Q

Capsular Pattern of Restriction for the shoulder

A

lateral rotation > abduction > internal rotation

118
Q

What is typically associated with an increased Q angle?

A

COXA VARA
FEMORAL ANTEVERSION
GENU VALGUM

119
Q

TMJD Hypomobility

A

limited ROM
pain free

120
Q

TMJD Synovitis

A

inflammation
decreased ROM
no deflection or deviation

121
Q

TMJD Capsulitis

A

decreased ROM
painful
deviation/deflection

122
Q

Compensatory posture for excessive femoral retroversion

A

medial tibial torsion

123
Q

2 point gait pattern

A

reciprocal forward motion of device and person’s opposite LE
(using the walking sticks)

124
Q

Swing-To gait pattern

A

Bilateral swing of LEs with device

125
Q

3 point Gait pattern

A

classic crutch
one leg two crutches

126
Q

4 point gait pattern

A

one movement at a time NOT SEGMENTAL

127
Q

Recommended Positions for Transtibial Amputees

A

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
Q

When is the middle glenohumeral ligament most taut?

A

Shoulder abducted between 45 and 90 degrees

129
Q

When is the middle glenohumeral ligament most taut?

A

Shoulder abducted between 45 and 90 degrees

130
Q

When is the coracohumeral ligament most taut?

A

Inferiority directed force with the humerus by the side

131
Q

When is the inferior glenohumeral ligament most taut?

A

Shoulder abducted to 90 degrees with anterior directed force

132
Q

What is the normal end feel for radial deviation?

A

Bone to bone

133
Q

What is normal varus during heel strike/initial contact?

A

0-4 degrees of varus

134
Q

What is a Hill-Sach’s lesion?

A

a traumatic gleohumeral dislocation that can cause a compression fracture on the posterior humeral head

135
Q

What makes up the meniscus composite score?

A
  • 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
Q

Causes for Circumduction Gait of the Transfemoral Prosthetic Limb

A
  • 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
Q

Reiter Syndrome

A

Reactive arthritis
usually asymmetric and occurs after an infection
presents over several weeks
can cause pain in multiple joints

138
Q

How to palpate the supraspinatus tendon insertion

A

extension and internal rotation

139
Q
A
140
Q

Craniocervical flexion Test

A

Test of endurance and activation of deep neck flexors
involves performing nod against pressure biofeedback

141
Q

Freiberg Disease

A

idiopathic segmental avascular necrosis of the head of a metatarsal

142
Q

What medication could increase someone’s risk for osteonecrosis?

A

corticosteroid use
pain likely exacervated with WB activity

143
Q

functional ROM of pronation and supination

A

50 degrees

144
Q

Humeroulnar Distraction

A

Used to increase flexion or extension of the elbow joint

145
Q

Milking Maneuver Test

A

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

NPTE (7 decks)

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