Musculoskeletal Flashcards
thumb abduction test
tests integrity of medial nerve by isolating straight of abductor polices brevis muscle
patient places hand palm up, raise thumb perpendicular, apply downward pressure on thumb
weakness - carpal tunnel
Phalen test
tests integrity of medial nerve
patient holds both wrists in fully palmar flexed position with dorsal surfaces pressed together for 1 minute
numbness and paresthesia in distribution of median nerve = carpal tunnel
note: reverse Phalen test: wrists in full extension
Tinel sign
tests integrity of medial nerve
strike patient’s wrist with index or middle finger where medial nerve passes under flexor retinaculum
tingling radiation from first to hand in pattern of median nerve = positive tine sign / suggestive of carpal tunnel
Neer test
evaluates rotator cuff muscles
passive test; forward flex patients strait arm with thumb pointing down (inward rotation) up to 150 degrees
increased shoulder pain = rotator cuff inflammation or tear
Hawkins test
evaluates rotator cuff muscles
passive test; abduct arm to 90 degrees, flex below at 90 degrees, internally rotate arm to its limit
increased shoulder pain = rotator cuff inflammation or tear
Supraspinatus strength
rotator cuff muscle
patient place arm in 90 degrees abduction, 30 degrees forward flexion, and internally rotated (thumb points down); apply downward pressure on arm against patient resistance
pain = inflammation or tear in muscle
subscapularis strength
rotator cuff muscle
hold arm at side, elbow flexed to 90 degrees, and rotate arm medially against resistance
pain = inflammation or tear in muscle
infraspinatus and teres minor strength
rotator cuff muscle
hold arm at side, elbow flexed to 90 degrees, and rotate arm laterally against resistance
pain = inflammation or tear in muscle
strait leg raising test
part of lower spine assessment; tests for nerve root irritation or lumbar disc herniation at L4, L5, and S1 levels
patient supine with neck flexed; ask patient to raise leg keeping it extended (Jackie said was passive test)
radicular pain below knee = disk herniation
crossover pain in affected leg (when unaffected leg is raised) = sciatic nerve impingment
femoral stretch test
part of lower spine assessment; tests for nerve root inflammaton at L1, L2, L3, and sometimes L4 levels
patient lies prone and extend leg behind them at hip
pain = positive sign for nerve root irritation
Thomas test
used to detect flexion contractures of hip that may be masked by excessive lumbar lordosis
patient supine, fully extend one leg flat on table and flex other leg with the knee to chest; observe ability to keep extended leg flat on table
lifting extended leg = hip flexion contracture in extended leg
Trendelenburg test
detects weak hip abductor muscles
ask patient to stand and balance first on one foot then the other; observe hip level from behind
iliac crest drops on side of lifted leg = hip abductor muscles on weight-bearing side are weak
ballottement
determined presence of excess fluid or effusion in knee
with knee extended, apply downward pressure on supra patellar pouch with web of one hand; push patella sharply downward against femur with fingers of other hand; release pressure against patella, but keep fingers lightly touching
effusion = tapping or clicking when patella is pushed against femur; patella will also float out when released
bulge sign
used to determine present of excess fluid in knee
with patient’s knee extended, milk the medial aspect of knee upward 2 -3 times, then milk lateral side of patella
bulge of returning fluid to the hollow area medial to the patella = excess fluid
McMurray test
used to detect torn medial or lateral meniscus
patient supine, one knee flexed, thumb and finger on either side of joint space and other hand on heel, fully flex knee
- rotate foot and knee outward (valgus stress), extend and flex knee - test medial
- rotate foot and knee inward (cars stress), extend and flex knee - tests lateral
palpable or audible click, grinding, pain, limited extension = positive sing for torn meniscus
anterior and posterior drawer test
used to identify instability of ACL and PCL
patient supine, knee flexed 45-90 degrees, place foot flat on table, thumbs on either side of anterior tibia just distal to tibial tuberosity
- draw tibia forward (testing ACL)
- push tibia backward (testing PCL)
movement greater than 5mm = indicated injury
Lachman test
evaluates ACL integrity
patient supine, flex knee 10-15 degrees with heel on table; one hand above knee to stabilize femur and one hand grips proximal tibia; pull tibial anteriorly
moment greater than 5mm = unexpected
note: be sure to compare to uninjured side
varus (abduction) and valgus (adduction) test
used to identify instability of MCL and LCL
patient supine, knee extended; stabilize femur with one hand and hold able with other hand
- apply varus force (toward midline) to ankle and internal rotation
- laxity = injury to LCL
- apply valgus force against ankle (away from midline) and external rotation
- laxity = injury to MCL
Murphy sign
test for cholecystitis (inflammation of gallbladder)
have patient take deep breath during deep palpation on left side, below liver margin, lateral to rectus abdominis muscle
pain and abrupt end to inspiration = positive Murphy’s sign; inflamed gallbladder touched examiners fingers
if no pain, but enlarged = common bile duct obstruction
ascites
accumulation of fluid in peritoneal cavity; causes abdominal swelling
rebound tenderness
used to assess for peritoneal inflammation; can be used for appendicitis
press fingers (90 degree angle to stomach) gently but deeply into abdomen in region remote form pain; rapidly withdraw hand - causes sharp, stabbing pain at site of peritoneal inflammation
positive Blumberg sign: sharp pain with rebound
positive McBurney sign: rebound tenderness in lower right quadrant; suggests appendicitis
McBurney’s sign
assesses for appendicitis
positive sign: rebound tenderness in lower right quadrant; suggests appendicitis
iliopsoas muscle test
performed when expect appendicitis (appendicitis would irritate lateral part of muscle)
patient supine, ask to raise (flex at hip) strait leg while you apply pressure downward
pain = positive psoas sign; indicates irritation of iliopsoas muscle
obturator muscle test
performed when suspect ruptured appendix or pelvic abscess due to irritation of obturator muscles
patient supine, ask patient to flex right leg at hip and knee to 90 degrees; hold leg above knee, grasp ankle, and rotate leg laterally and medially
pain in right hypogastric region = positive sign; indicates irritation of obturator muscle
ballottement
palpation technique used to assess an organ or mass; can be one handed (freely movable object will float up to fingers when press) or two handed (one hand on flank and one on anterior abdominal wall to grasp mass)
peritonitis
inflammation of peritoneum (lining of stomach)
• Limited abdominal motion can indicate this
• Use rebound tenderness to assess
peristalsis
movements from wave0like muscles contractions used to move food in abdomen
spasm
a sudden, violent involuntary contraction of a muscle or a group of muscles attended by pain and interference with function, producing involuntary movement
fasciculation
small local contraction of muscles, visible through the skin, representing a spontaneous discharge of a number of fibers innervated by a single motor nerve filament
bowel sounds
Increased BS: diarrhea
Decreased BS: inflammation of the peritoneum
High pitched sounds: early obstruction
