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PD Block 3 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

muscle strength

A 
0- No firing of muscle fibers
1- No movement, slight contractility
2- Movement with gravity elminated
3- Movement against gravity
4- Movement against slight resistance 
5- Movement against full resistance
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2
Q

myopathy

A

affects muscles directly, most have proximal weakness or fatigue, normal
sensation, & reflexes intact until significant atrophy, pain not common

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3
Q

neuropathy

A

damage to nerves caused by trauma, disease, or component of systemic illness

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4
Q

sprain

A

trauma to ligaments that causes pain and disability, depending on the degree of injury to the ligaments, most severe cases ligaments are torn, most common in ankle joint

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5
Q

strain

A

from excessive stretch or forceful contraction beyond muscle capacity

  • Associated w: improper warm up, fatigue, or previous injury
  • Subjective: muscle pain, ranges from mild intrafibrous tear to total rupture
  • Objective: temporary muscle weakness, spasm, pain, contusion
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6
Q

shoulder (degrees)

A 
●	Flexion 150 deg
●	Hyperextension 40 deg
●	Abduction 150 deg
●	Adduction 30 deg
●	Internal rotation 70
●	External rotation 90
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7
Q

elbow (degrees)

A

● Flexion 150
● Hyperextension 5/extension 0
● Pronation 80
● Supination 80

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8
Q

wrist (degrees)

A

● Flexion 80
● Hyperextention 70/extension 0
● Radial deviation 20
● Ulnar deviation 30

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9
Q

fingers (degrees)

A

● Flexion 90

● Hyperextension 30/ extension 0

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10
Q

scapular winging

A
  • weakness for Serratus Anterior muscle palsy, Long Thoracic nerve (SALT)
  • pt. does push up or pushes out against wall - with shoulders retracted - “wings”
  • from trauma, lesions or inflamm to nerve (long thoracic) supplying SA muscle
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11
Q

drop arm test

A
  • tear in rotator cuff test
  • abducted arm (passively abduct arm to 90 degrees)- ask to slowly lower (+) for tears, arm will drop and will not be lowered in slow, smooth fashion
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12
Q

yergason test

A
  • test for unstable biceps (in bicipital groove)
  • grasp flexed elbow - hold wrist and externally rotate arm with resistance and pull down (+) tendon will pop out and pt, will have pain
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13
Q

apprehension test

A
  • chronic shoulder dislocation
  • abduct, external rotation of arm - if shoulder is ready to dislocate, pt will have a look of apprehension or alarm and will resist further movement
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14
Q

tennis elbow test (lateral epicondylitis)

A
  • reproduce pain with tennis elbow (lateral epicondylitis)
  • pt extends wrist, makes a fist - you apply pressure to dorsum in fist (forcing it into flexion) (+) sudden/severe pain at wrist extensor (lateral epicondyle)
  • usually worse in full elbow extension than when elbow flexed
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15
Q

tine sign (elbow/wrist)

A

-tenderness over neuroma
-(+) neuroma, tapping area of nerve btw olecranon and medial epiicondyle - tingling sensation down forearm (ulnar side)
provocative test for carpal tunnel syndrome
-for this, percuss median N (proximal to carpal tunnel)

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16
Q

allen test

A

-patency of ulnar and radial arteries

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17
Q

finkelstein test

A
  • stenosing tenosynovitis (tunnel 1 = thumb)
  • De Quervain’s Tenosynovitis
  • make a fist, thumb tucked in - stablize forearm - deviate wrist to ulnar side with other hand (+) sharp pain in tunnel = stenosing tenosynovitis
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18
Q

phalen test

A
  • reproduce symptoms of carpal tunnel

- flex pt wrist to maximum degree and hold for 1 min (+) tingling of fingers

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19
Q

primary sensory functions

A
  • superficial touch and pain (anterior and lateral spinothalmic spinal tract assessment -> soft (cotton ball) vs sharp (broken applicator), dull (cotton end of applicator)
  • vibration: dorsal columns of spinal tracts (place in DIP)
  • temp and deep pressure: only perform in superficial pain not intact (temp = lateral spinothalmic and deep pressure = anterior and posterior spinothalamic)
  • position of joints: dorsal column spinal tracts (proprioception)
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20
Q

cortical sensory (cerebral) functions

A

● Stereognosis: Posterior column
-place familiar object in pt’s palm to identify, different object bilaterally
-Failure if unable to identify– tactile agnosia
● Two-Point discrimination: Posterior column
-Use 2 fine, but not sharp, points at various locations. Ask the pt. where points felt &
how many. Gradually bring tips closer together. Expected that pt will report one tip at a greater distance on upper arm than finger tip
● Extinction Phenomenon: simultaneously touch an area bilaterally c/ sharp edge, ask for # of sites felt & where
● Graphesthesia: use a pointed, but not sharp, object to “write” on pt’s palm.
-pick #, letter, or symbol (different on each side) – take pt’s culture into account
-avoid too many curves, can be confusing
-May need to stand beside pt to avoid making it upside-down/ backwards from their
perspective
● Point Location: Posterior column
-touch a single site, have pt. point to where you touched

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21
Q

cubitus valgus

A

carrying angle greater than normal 5-15 degrees (normal male: 5, female 10-15)

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22
Q

dupuytren contracture

A

thickened areas/ nodules on palmar fascia result in contraction of pinkie finger (looks like trigger finger)

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23
Q

cubitus varus

A

decreased carrying angle

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24
Q

swan neck deformity

A

Hyperextension of the of proximal interphalangeal joint, with simultaneous flexion of the distal interphalangeal joint. Caused by rheumatoid arthritis.

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25
Q

olecranon bursitis

A

Localized swelling around elbow. Feels “boggy” and “thick.”

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26
Q

boutonniere deformity

A

Marked flexion of the proximal interphalangeal joint, due to extensor tendon avulsion. Middle of affected finger tender to palpation.

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27
Q

dislocation of shoulder

A

shoulder out of joint (“loss of lateral contour and appears indented under the point of the shoulder)

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28
Q

mallet finger

A

Tip of finger drops, and is not able to be fully extended due to extensor tendon tear. Similar to boutonniere deformity, but tear occurs more distally on finger.

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29
Q

ganglia/ganglion cyst

A

“Cystic, pea-sized swelling with jellylike consistency.” Seen on anterior or posterior aspect of wrist. Tender to palpation, and not fixed to underlying connective tissue

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30
Q

Heberden nodes

A

Palpable bony nodules on dorsal and lateral sufrace of distal interphalangeal joints.

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31
Q

rheumatoid nodules

A

Firm, nontender, fixed or mobile subcutaneous nodules. Most frequently seen near pressure points around elbow. Associated with rheumatoid arthritis.

32
Q

carpal tunnel syndrome

A

Narrowing of the carpal tunnel through which median nerve and finger flexor tendons run. Narrowing can cause compression of the median nerve which may result in restricted motor function and sensation.

33
Q

knee (degrees)

A
  • Flexion 135 deg
  • Extension 0 deg
  • Hyperextension 10 deg
34
Q

ankle (degrees)

A
  • Plantar flex 50 deg
  • Dorsiflex 20 deg
  • Inversion 30 deg
  • Eversion 20 deg
35
Q

great toe (degrees)

A
  • Flexion 30
  • Extension 0
  • Hyperextension 50
36
Q

patellar tendon reflex

A

T2-4

37
Q

Achilles tendon reflex

A

S1

38
Q

clonus

A

This test is done to assess the presence of upper motor neuron disease. Partially flex patient’s knee by holding at the back of lower leg.

  • Dorsiflex the foot and maintain flexion.
  • The presences of rhythmic oscillations between dorsiflexion and plantar flexion indicate upper motor neuron disease.
39
Q

Scale for deep tendon reflex

A 
0 no response
1+ sluggish or diminished
2+ active or expected responses
3+ brisk or more than expected
4+ hyperactive; may elicit clonus
40
Q

thompson or Simmonds test

A

● Associated condition: Achilles tendon rupture
● Procedure: Have patient lie prone on the table and squeeze the calf. Should see plantar flexion of the foot. If there is an Achilles rupture this will be diminished or absent.

41
Q

patellar ballottement

A

● Associated condition: Fluid accumulation between the joints (effusion)
● Procedure: Extend the patient’s knee, and push the patella into the trochlear groove and quickly release. If there is a large amount of fluid the knee will rebound.

42
Q

anterior drawer sign

A

● Associated conditions: ACL tear
● Procedure: With patient lying supine, flex the leg, stabilize the foot and hold the calf of the leg and pull towards you. If there is ACL tear the leg will go further than expected.

43
Q

posterior drawer sign

A

● Associated conditions: PCL tear
● Procedure: With patient lying supine, flex the leg, stabilize the foot, hold the calf of the leg with both hands and push the back.

44
Q

true/apparent leg length

A

● Associated condition: Expected asymmetry
● Procedure:
o True length: Measure from anterior superior iliac crest to malleolus.
o Apparent length: Measure from umbilicus to medial malleolus.
o Compare measurements of both legs
-if apparent leg length off = scoliosis

45
Q

homans sign

A

● Associated condition: Deep vein thrombosis

● Procedure: Passively dorsiflex patients foot to elicit pain in the calf.

46
Q

Ortolani maneuver

A

● Associated condition: Hip dislocation or subluxation(specifically in infants)
o Ortolani maneuver: With infant in the same position as the barlow test, slowly abduct the thigh while maintaining pressure. Listening for the femur to move back into the acetabulum.

47
Q

Barlow test

A

● Associated condition: Hip dislocation or subluxation(specifically in infants)
● Procedure:
o Barlow maneuver: Use a small amount of force. Test one hip at a time. With infant supine, flex the hip and knee to 90 degrees. Adduct the thigh and gently push downward on the femur. A positive sign is indicated when you hear a clunk or the sensation is felt as the femoral head dislocates from the acetabulum.

48
Q

patellar bulge sign

A

● Associated condition: Excess fluid in the knee
● Procedure: With knee extended, milk the medial and lateral aspects of the knee upward. Observe for a bulge of fluid to return to the space.

49
Q

apperhension test

A

● Associated condition: Patellar dislocation and subluxation
● Procedure: Patient should lie supine on the table with legs relaxed. Press against the medial side of the patella with thumb. Watch the patients face. If the patella begins to move or dislocate the patients face will show distress.

50
Q

Mcmurray test

A

● Associated condition: Medical meniscus tear
● Procedure: Have patient lie supine on table, with legs extended in neutral position. With one hand grab the heel and flex the leg. Place the other hand at the knee joint and begin to rotate the leg internally and externally (applying valgus and varus test). Feel for any tenderness, palpable or audible “clicking” may indicate a tear.

51
Q

Apley distraction/grinding test

A

·Distraction test (coll ligs)
o Associated condition: Ligamentous injury
o Procedure: Maintain the same position as the Apley grinding test.
-Apply traction to the leg while rotating the tibia internally and
externally. This reduces tension on the menisci and puts pressure on the ligaments. If there is a tear the patient will experience pain.
·Grinding test (for meniscus)
o Associated condition: torn meniscus
o Procedure: Have patient lie prone with leg flexed to 90 degrees.
-Stabilize the back of the thigh. Lean hard on the heel to compress the medial and lateral menisci between the femur and tibia. Rotate the tibia internally and externally. If this elicits pain there is probably a meniscus tear.

52
Q

patellofemoral grinding test

A

● Associated condition: Rough articulating surfaces of the patella and the trochlear groove of the femur. Patients with this often complain of pain when climbing stairs or getting up from a chair.
● Procedure: Patient will lie supine with legs relaxed in neutral position. Push the patella distally into the trochlear groove, then have patient flex their quadriceps. Palpate and offer resistance to the patella as it moves under your fingers. If there is roughness of the articulating surfaces you will feel crepitus. It should normally be smooth. If the test is positive the patient will usually complain of pain.

53
Q

varus/valgus stress

A

● Associated condition: Collateral ligaments damage
● Procedure:
o Valgus stress- To test the medial collateral ligament, apply stress by pushing on the lateral aspect of the knee with leg extended.
o Varus stress- To test the lateral collateral ligament strength, apply pressure on the medial aspect of the knee with leg extended.

54
Q

genu varum

A

outward bowing of the legs

55
Q

hammer toe

A

bending of the second - fifth toes (contracture)

56
Q

genu valgum

A

knees angle in and touch one another

57
Q

pes planus

A

flat feet

58
Q

genu recuryatum

A

knee bends backward

59
Q

hallux valgus

A

big toe points toward second toe

60
Q

claw toe

A

toe contracted at PIP and DIP joints

61
Q

pes cavus

A

high arch foot

62
Q

Morton’s neuroma

A

irritation and fibrosis of the nerve running between 3rd & 4th toes or 4th & 5th toes, most commonly

63
Q

neck (degrees)

A 
flexion: 30 degrees 
Extension: 0 degrees 
hyperextension: 30 degrees
lateral flexion: 40 degrees
rotation: 30 degrees
64
Q

back/spine (degrees)

A

forward flexion: 90 degrees
hyperextension: 30 degrees
lateral flexion: 30 degrees
rotation: 30 degrees

65
Q

hip (degrees)

A 
Flexion: 115 degrees
extension: 0 degrees
hyperextesion: 30 degrees
adduction: 30 degrees
abduction: 50 degrees
internal rotation: 30 degrees
external rotation: 50 degrees
66
Q

distraction test

A

To assess cervical spine pain and determine nerve impingement, place one hand under chin and the other under the occiput. Lift upwards gently. If there is cervical nerve compression occurring, this test should relieve the pain. Patient can be sitting or supine.

67
Q

valsalva test

A

Have the patient hold their breath and bear down. If pain occurs, have patient describe location. This tests for space-occupying lesion (herniated disc or tumor) by increasing intrathecal pressure. Pain may radiate to dermatome corresponding with neurologic level of c-spine pathology.

68
Q

adson test

A

Determines if there is compression of the subclavian artery. Find the patient’s radial pulse and begin to abduct, extend and externally rotate the arm. Have patient take a deep breath and turn their head toward the arm being tested. If there is compression of the subclavian artery, you will feel a marked diminution or absence of the radial pulse .

69
Q

compression test

A

Press down on top of a patient’s head while sitting or supine. If there is an increase in pain, note distribution and dermatome. Test will reproduce pain referred to the upper extremity from the cervical spine to help locate the neurologic level of a problem.

70
Q

straight leg raising test

A

Test to look for discogenic disease that may be compressing/affecting the sciatic nerve. Patient is supine and provider passively lifts the patient’s leg (kept straight) upwards. The foot is then dorsiflexed (toes toward shin) and if there is pain, it is likely sciatic. Make sure to distinguish sciatic pain from tight hamstrings.

71
Q

Hoover test

A

Provider places hands under patient’s heels during the active straight leg raise test. As the patient (lying supine) tries to lift one leg upwards, the opposite heel should be pressing downward. Used to determine patient effort.

72
Q

pelvic rock test

A

● Pt supine on exam table
● Place hands on iliac crests with thumbs on anterior superior iliac spine, palms on iliac tubercles
● Forcibly compress pelvis toward midline
○ If pt complains of pain around sacroiliac joint, may be pathology of joint itself (infection or secondary to trauma)

73
Q

Fabere or Patrick Test

A

**to detect pathology in hip, as well as sacroiliac joint
● Pt supine on table, foot of involved side on opposite knee
○ Inguinal pain is a general indication of pathology in hip joint or surrounding muscles
● Extend the ROM by placing one hand on flexed knee joint and the other on anterior superior iliac spine of the opposite side – press down on each as if opening the binding of a book
○ If pt complains of increased pain, may be pathology of sacroiliac joint

74
Q

Trendelenburg test

A

**to evaluate the strength of the gluteus medius muscle
● Stand behind pt and observe dimples overlying the posterior superior iliac spines (normally, dimples are even)
● Ask pt to stand on one leg
● Gluteus medius on standing leg should contract and elevate the pelvis on the unsupported side as soon as leg lifts off the ground
○ Elevation of pelvis on unsupported side indicates muscle is functioning properly, negative Trendelenburg
○ Pelvis remains in place/descends on unsupported side, gluteus medius is weak/nonfunctioning, positive Trendelenburg

75
Q

thomas test

A

**to detect Flexion contractures
● Pt supine with pelvis level and square to trunk
● Place your hand under pt’s lumbar spine
● Flexing pt’s hip, bring thigh up onto trunk
● As flexing pt’s hip, notice at what point his back touches your hand – this will be when flexion is isolated to hip joint
● Flex hip as far as possible (normal limits allow anterior portion of thigh to rest against abdomen, almost to chest wall)
● Repeat on other thigh
● Have pt hold one leg on chest and let other leg down until it is flat on table
○ if hip does not extend fully, pt may have a fixed flexion contracture of that hip
○ if pt rocks forward, lifting thoracic spine from table, or arches back to reform lumbar lordosis, a fixed flexion deformity is indicated

76
Q

pelvic obliquity

A

= tilted pelvis
● Upon observation and palpation, anterior superior iliac spines are not in the same horizontal plane
● A difference in apparent leg length (measure from umbilicus to medial malleoli) may also indicate pelvic obliquity

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