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NPTE exam > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

Humeroulnar open/closed packed position

A

Open- 70 flexion, 10 supination

closed- full extension and supination

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2
Q

Humeroradial open/closed packed position

A

open- full extension and supination

closed- 90 flexion 5 supination

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3
Q

Hip open/closed (bony and ligamentous) packed position

A

open-30 flexion, 30 abduction, slight ER
closed ligamentous- full extension, abduction, and IR
closed bony- 90 flexion, slight abduction, slight ER (captain morgan)

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4
Q

Knee open packed position

A

25 flexion

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5
Q

Glenohumeral capsular pattern

A
  • greater limitation in ER, followed by abduction and IR
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6
Q

Elbow capsular pattern

A

loss of flexion more than extension

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7
Q

Hip capsular pattern

A

limited flexion and IR, some limited abduction

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8
Q

Knee capsular pattern

A

flexion limited, slight extension limitation

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9
Q

Scapula bony landmarks

A
  • covers 2nd-7th ribs
  • glenoid fossa faces anteriorly, laterally and superiorly, this causes true abduction(scaption) to be at 30 degrees anterior to frontal plane
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10
Q

C4 myotome

A

shoulder shrug (upper traps)

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11
Q

C5 myotome

A

shoulder abduction, flexion, extension (deltoid)

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12
Q

C6 myotome

A

elbow flexion and forearm supination (biceps)

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13
Q

C7 myotome

A

wrist ulnar flexion and elbow extension

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14
Q

C8 myotome

A

finge flexion, thumb MCP abduction

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15
Q

C5 reflex

A

biceps

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16
Q

C6 reflex

A

brachioradialis

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17
Q

C7 reflex

A

Triceps

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18
Q

Ulnar nerve innervations (6)

A

Flexor carpi ulnaris, adductor pollicis, abductor digiti, opponens digiti, flexor digiti quinti, interossei

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19
Q

Median nerve innervations (8)

A

Pronator group, flexor carpi radialis, palmaris longus, flexor digitorum, flexor pollicis longus, abductor pollicis brevis, flexor pollicis brevis, opponens pollicis

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20
Q

Radial nerve innervations (9)

A

brachioradialis, triceps, extensor carpi radialis, extensor digitorum, extensor carpi ulnaris, supinator, abductor pollicis longus, extensor pollicis longus/brevis, extensor indici

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21
Q

Ulnar nerve cord segments

A

C7-1

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22
Q

Median nerve cord segments

A

C6-T1

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23
Q

Radial nerve cord segments

A

C6-C8

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24
Q

Scapulothoracic and glenohumeral rhythm

A

-2:1 ratio
-first 30-60 occurs in glenohumeral
-120 at glenohumeral
60 at scapulothoracic

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25
Q

Normal angle of inclination and coxa vara/valga

A

Normal - 115-125
Coxa Vara- < 115
Coxa valga > 125

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26
Q

Femoral neck anterior rotation

A

normal - 10-15
Anteversion- 25-30
Retroversion - <10

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27
Q

L2 myotome

A

hip flexion and sartorious

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28
Q

L3 myotome

A

knee extension

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29
Q

L4 myotome

A

ankle dorsiflexion

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30
Q

L5 myotome

A

great toe extension

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31
Q

S1 myotome

A

foot eversion (fibularis longus/brevis)

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32
Q

SI joint nutation

A

flexion of sacrum with posterior rotation of Ilium

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33
Q

SI joint counter nutation

A

extension of sacrum with anterior rotation of Ilium

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34
Q

TMJ functional ROM (3 components

A
  • 40mm opening
  • 25mm rotation
  • 15mm translatory glide
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35
Q

SI joint nutation

A

flexion of sacrum with posterior rotation of Ilium

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36
Q

SI joint counter nutation

A

extension of sacrum with anterior rotation of Ilium

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37
Q

TMJ functional ROM (3 components

A
  • 40mm opening
  • 25mm rotation
  • 15mm translatory glide
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38
Q

Ankylosing spondylitits

A
  • morning stiffness
  • PROM and AROM loss
  • mostly male
  • flexed posture of entire spine
  • normal reflexes and sensation
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39
Q

Gout

A
  • deposit of uric acid crystals onto peripheral joints
  • often at knee or great toe
  • early ID is important
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40
Q

Psoriatic arthritis

A
  • Erosive degeneration in digits and axial skeleton
  • both sexes
  • acetaminophen, NSAID, corticosteroids
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41
Q

Rheunatoid arthritis

A
  • usually MCP and PIPs, can get ulnar drift
  • women 2-3x more likely
  • Juvenile RA= onset prior to 16 with 75% remission
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42
Q

Osteoporosis

A
  • metabolic disease depletes bone mineral density/mass
  • women 10x more
  • common fx sites= T/L spine, femoral neck, humerus, radius
  • Meds=calcium, vitamin D
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43
Q

Osteomalacia

A

-decalcification of bones d/t Vitamin D deficiency

sxs= severe pain, fxs, weakness, deformities,

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44
Q

Osteomyelitis

A
  • inflammatory response w/in bone caused by infection (usually staph)
  • more common in children and immunosuppressed adults, males>females
45
Q

Myofascial pain syndromee

A

-trigger points w/ characteristic referral pain pattern

46
Q

Bursitits

A

-inflammation of busa

sxs= pain w/ rest, PROM and AROM limited d/t pain no capsular pattern

47
Q

Myositis ossificans

A
  • painful abnormal calfication w/ muscle belly
  • usually direct trauma resulting in hematoma and calcification of muscle
  • frequent locations-quads, biceps, brachialis
  • surgery when mature lesion (6-24m) and loss of joint movement/nerve function
  • avoid aggressive stretching and MT
48
Q

Complex regional pain syndrome

A

-related to trauma or precipitating event
-dysfunction of sympathetic nervous system to include pain, claudication, vasomotor disturbances
CPRS 1= tissue injury, no nerve involvment
CPRS 2= clearly nerve injury
-long term sxs= muscle wasting, trophic skin changes, decreased bone density, weakness

49
Q

Paget’s disease (osteitis deformans)

A
  • unknown etiology, possibly viral infection
  • metabolic bone disease resulting in abnormal osteoclast/blast activity
  • spinal stenosis, facet arthropathy, possible spine fx
50
Q

Glenohumeral dislocations

A
  • 95% occur in anterior-inferior direction

- occurs with UE forced into ER, tears inferior glenohumeral ligament

51
Q

Hill Sachs vs Bankart lesion vs SLAP

A
  • Hill Sachs= compression fx of post. humeral head
  • SLAP= tear of rim above middle of socket, may include biceps tendon
  • Bankart= tear of rim below middle socket and inferior glenohumeral ligament
52
Q

Glenohumeral instability

A
  • traumatic=young throwing athletes
  • atraumatic= congenitally loose CT
  • shoulder in sling 3-4 post surgery
53
Q

Shoulder Labral tear sxs

A
  • non localized pain
  • pain worse w/ overhead or arm behind back
  • weakness and instability
  • pain w/ biceps resistance
54
Q

Thoracic outlet syndrom

A
  • compression areas= superior thoracic outlet, scalene triangle, clavicle and 1st rib, pec minor and thoracic wall
  • possible referred pain, possible parathesia, palor/coolness in hands
55
Q

AC/SC disorders

A
  • fall onto adducted shoulder

- avoid shoulder elevation during acute phase

56
Q

Rotator cuff tendonosis

A
  • impingement of insertion of RC on anterior acromion
  • 30-50 years, pain/weakness after eccentric load
  • weak abduction, rotation
  • tenderness to palpation RC
57
Q

Internal (posterior) shoulder impingement

A
  • irritation b/w RC and greater tuberosity or posterior glenoid/labrum
  • overhead athletes
  • pain in posterior shoulder
58
Q

Adhesive capsulitis (frozen shoulder)

A
  • inflammation/fibrosis in shoulder capsule usually d/t disuse after injury
  • ER greatest limited, followed by abduction/flexion
  • common with DM and thyroid
  • 45+ y/o, shoulder hiking
59
Q

Distal humeral fx

A
  • supracondylar fxs examine quickly d/t neurovascular status

- lateral epicondyle fxs common in young people, require ORIF

60
Q

Osteochondrosis of humeral capitellum

A
  • bone fragment detached, common in 12-15 y/o

- Panner’s disease= avascular necrosis of capitellum, <10 y/o

61
Q

Elbow dislocations

A
  • posterolateral are most common d/t FOOSH w/ elbow ext
  • can cause medial epicondyle avulsion fx d/t traction on UCL ligament
  • rapid swelling
62
Q

Dequervains tenosynovitis

A
  • abductor pollicis brevis

- extensor pollicis longus

63
Q

Colle’s fx

A
  • most common wrist fx

- dinner fork deformity w/ posterior displacement of radius fragment

64
Q

Smith’s fx

A
  • distal fragment of radius dislocates in volar (anterior) direction
  • garden spade deformity
65
Q

Scaphoid fx

A
  • most common carpal fx
  • high incidence of avascular necrosis
  • immobilized 4-8 weeks
66
Q

Dupuytrens contracture

A
  • banding in palm and digit flexion
  • men > women
  • MCP and PIP of 4-5 digits in non diabetes
  • 3-4 digits of diabetes
67
Q

Boutonniere deformity

A
  • rupture of central tendon of extensor hood
  • MCP and DIP ext, PIP flexion
  • trauma, RA, degeneration of central tendon
68
Q

Swan neck deformity

A
  • contracture of intrinsic muscles, dorsal sublux of lateral extensor tendons
  • flexion of MCP and DIP, extension of PIP
  • trauma, RA
69
Q

Ape hand deformity

A
  • thenar muscle wasting, 1st digit moves dorsally in line with 2nd
  • median nerve dysfunction
70
Q

Mallet finger

A
  • rupture of extensor tendon at insertion
  • flexion of DIP
  • trauma
71
Q

Gamekeepers thumb

A
  • sprain/ruture of MCP ULC ligament of 1st digit

- fall while skiing w/ poles

72
Q

Boxers fx

A

-fracture of 5th metacarpal

73
Q

Avascular necrosis of hip

A
  • decreased flexion, IR, abduction

- pain in groin and/or thigh, tenderness to palpation

74
Q

Trochanteric bursitis

A
  • inflammation of deep trochanteric bursa

- common with Ra

75
Q

Piriformis syndrome sxs

A
  • restriction in IR
  • pain w/ palpation to piriformis
  • pain referred to posterior thigh
  • weakness in ER
76
Q

Meniscal injury sxs

A
  • lateral/medial joint pain and effusion
  • joint popping
  • knee giving way during walking/joint locking
  • limited flexibility
77
Q

Knee fxs

A
  • medial femoral condyle most common, fall w/ shearing force to knee
  • tibial plateau, valgum and compression forces to knee, can occur with MCL injury
78
Q

Anterior compartment syndrome

A
  • chronic ACS sxs produced by exercise, deep/cramping feeling
  • acute ACS sxs produced by trauma causing swelling. this is medical emergency
79
Q

Anterior tibial periositits (shin splints)

A

-anterior tibialis and extensor hallucis longus

80
Q

Medial tibial stress syndrome

A
  • overuse of posterior tibialis/ soleus

- etiology may be excessive pronation

81
Q

Stress fxs

A
  • 49% of all stress fxs involve tibia

- 10% involve fibula

82
Q

Tarsal tunnel syndrome

A
  • entrapment of posterior tibial nerve w/in tarsal tunnel
  • over/excessive pronation causing tendonitis of posterior tibialis, may decrease tarsal tunnel space
  • sxs = pain, numbness, parathesia to medial ankle and plantar surface of foot
83
Q

Equinus

A

-plantar flexed foot caused by neuro disorder (CP)

84
Q

Hallux valgus

A

-normal metatarsophalangeal angle is 8-20

85
Q

Charcot-Marie-Tooth disease

A
  • peroneal muscular atrophy affecting motor and sensory nerves
  • initially affects lower leg/foot muscles, progresses to m. of hands and forearms
86
Q

Spinal stenosis

A
  • narrowing of spinal canal or intervertebral foramen
  • sxs= bilateral pain/parathesia in back, buttocks, thighs, calves, feet
  • better w/ flexion, worse w/ extension/walking
87
Q

Internal disc disruption

A
  • internal annulus is damaged w/ external structures normal
  • common in L spine
  • sxs= constant deep achy pain, increased pain w/ movement, no neuro findings, may have referred pain in LE
  • spinal manip may be contraindicated
88
Q

Esophageal cancer

A

pain to back, pain w/ swallowing, dysphagia, weight loss

89
Q

Pancreatic cancer

A

deep, gnawing pain radiates from chest to back

90
Q

Acute pancreatitis

A

mid epigastric pain radiating through to the back

91
Q

Cholecystitis

A

abrupt, severe abdominal pain

- RUQ tenderness, nausea, vomiting, fever

92
Q

Heart and lung disorders

A

can refer pain to chest, back, neck, jaw and UE

93
Q

Abdominal aortic aneurysm

A

usually appears as nonspecific lumbar pain

94
Q

Kidney, bladder, ovary, uterus

A

refer to trunk, pelvis, and thighs

95
Q

Transient synovitis in children

A
  • acute onset of sudden hip pain age 3-10
  • decreased abduction and IR
  • hip/groin pain, crying at night, antalgic gait
96
Q

Legg calve perthes disease

A

blood supply interrupted to femoral head
-age 2-13, 4x more in males
-weakness of psoas major,
cast 4-6 weeks

97
Q

Slipped capital femoral epiphysis

A

most common hip disorder in adolescents

  • femoral head displaced posteriorly/inferiorly
  • 2x more males, age 13, females age 11
  • decreased abduction, flexion, IR
  • vague pain at knee thigh hip
98
Q

Flexor tendon injuries of hand

A
  • immobilize 3-4 weeks w/ wrist and finger flexion IPs at 30-50 flexion
  • pt can perform resisted extension and passive flexion w/ splint
  • AROM at 4 weeks, extension first then flexion
99
Q

Extensor tendon repairs

A
  • immobilized with DIPs neutral for 6-8 weeks

- AROM at 6 weeks, extension first then flexion

100
Q

THA

A
  • cemented hips WFB immediately, used for fragile elderly/dementia
  • noncemented better for younger active, may be TDWB-WBAT
101
Q

Cementless THA weight bearing

A
  • 25% weeks 1-7
  • 50% week 8
  • 75% week 10
  • 100% week 12 w/o AD
102
Q

Hamstring graft ACLR

A
  • fewer sxs postoperatively
  • greater return to preinjury level
  • earlier rehab
  • more expensive
  • slower rehab
103
Q

Patella tendon ACLR

A
  • better maintaining graft tension postop
  • less expensive
  • faster healing
  • increased risk for AKP and lateral knee OA
  • increased risk for knee ext deficit
  • delayed rehab d/t quad atrophy
104
Q

ACLR ROM

A
  • CPM at 0-70 post surgery
  • 0-120 by week 6
  • hinged brace at 20-70 for 2-4 weeks
  • NWB for one week
  • wean pt from brace at 2-4 weeks
105
Q

Maitland grade 1-2

A

improve joint lubrication/nutrition

-decreased pain and muscle guarding

106
Q

Maitland grade 3-4

A

stretch ligaments, muscles, capsules

107
Q

Mailtland grade 5

A

regain normal joint mechanics

-decrease pain and muscle guarding

108
Q

Cervical headaches

A

thrust can be indication and contraindication

-ask females about birth control and smoking, combo can be vascular accident

NPTE exam (7 decks)

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