Musculoskeletal Flashcards
ROM needed for gait
Hip flexion 30º; hip flexion 10º; knee flexion 60º; ankle DF 10º; ankle PF 20º
Shoulder flexion/extension ROM
flexion 180º, extension 60º
Shoulder IR/ER ROM
IR 70º, ER 90º
Wrist flexion/extension/UD/RD
flexion 80º, extension 70ª, RD 20º, UD 30º
Hip flexion/extension/ABD/ADD/IR/ER
flexion 120º, extension 30º, ABD 45º, ADD 30º, IR/ER 45º
Shoulder flexion muscles
anterior deltoid, coracobrachialis, pec major, biceps brachii
Shoulder extension muscles
lats, posterior deltoid, teres major
Shoulder ABD muscles
middle deltoid, supraspinatus
Shoulder ADD muscles
pec major, lats, teres major
Shoulder IR muscles
subscapularis, teres major, pec major, lats, anterior deltoid
Shoulder ER muscles
teres minor, infraspinatus, post deltoid
Scapular depression muscles
lats, pec major and minor, lower trap
Scapular protraction muscles
serratus anterior, pec minor
Scapular upward rotation muscles
upper+lower trap, serratus anterior
Scapular downward rotation muscles
rhomboids, levator scap, pec minor
Hip flexion muscles
iliopsoas, sartorius, rectus femoris, pectineus
Hip ABD muscles
glut med/min, piriformis, obturator internus
Hip IR muscles
TFL, glut med/min, pectineus, adductor longus
Hip ER muscles
glut max, obturator internus/externus, piriformis, gemilli inf/sup, sartorius
Knee flexion muscles
biceps femoris, semimem/tendinosus, sartorius
Plantarflexion muscles
tib posterior, gastroc, soleus, peroneus long/brev, plantaris, flexor hallicus
Dorsiflexion muscles
tib anterior, ext hallicus longus, ext digitorum longus, peroneus tertius
Ankle Inversion muscles
tib posterior and anterior, flex digitorum longus
Type I muscle fibers
aerobic, red, tonic, slow oxidative, low fatigue, high capillary, high myoglobin, high blood supply, high mitochondria
Type II muscles fibers
anaerobic, white, phasic, fast glycolytic, large fibers
Muscle spindle
in belly of muscle; muscle length and rate of change of length for postural control and involuntary movements
Golgi tendon organ
in tendons; tension from muscle contraction and rate of change in tension
Non-opioid agents
acetominophen, NSAIDs (naproxen, ibuprofen, aspirin)
Non-opioid agents effects
analgesia, anti-inflammatory and anti pyretic effects, reduce prostaglandin formation (decreases inflammation process and impulse formation of pain fibers)
Non-opioid agents side effects
N/V, vertigo, abdominal pain, GI distress or bleeding, ulcers
Opioid agents
morphine, meperidine, oxycodone, fentanyl, codeine
Opioid agent effects
analgesia for acute severe pain, stimulates opioid receptors in CNS to prevent pain impulses from reaching targets
Opioid agent side effects
Mood swings, sedation, confusion, vertigo, dulled cognitive fxn, orthostatic hypotension, constipation, incoordination, dependence, tolerance
Glucocorticoid agents (corticosteroids)
hydrocortisone, cortisol, prednisone, prednisolone, dexamethasone
Glucocorticoid agents effects
provide hormonal anti-inflammatory and metabolic effects for suppression of articular and systemic diseases, reduces inflammation in chronic conditions that can damage healthy tissues
Glucocorticoid (corticosteroid) side effects
muscle atrophy, GI distress, weakening/breakdown of tissues (bone, lig, tendon, skin), at risk of osteoporosis, hypertension, modd changes, drug induced cushings, immune system is weakened
Disease modifying anti-rheumatic agents (DMARDs) effects
slow/halt progression of rheumatic disease, used in early stages to prevent widespread damage of affected joints, induces remission by modifying pathology and inhibiting immune response responsible
DMARD side effects
nausea, HA, joint pain/swelling, toxicity, GI distress, sore throat, fever, liver dysfunction, hair loss, retinal damage, potential for sepsis
Plastic AFO
for tone reduction (not flexible for swelling)
Metal AFO
to allow for swelling
Leaf spring AFO
plastic AFO with trim line posterior to malleoli to assist DF and prevent foot drop - requires adequate medial/lateral ankle control
floor reaction AFO
assists knee extension during stance by positioning of a calf band or at the ankle
HKAFO
for hip/knee/ankle/foot weakness, control rotation at hip, heavy and restricts patients to swing thru/to gait
Milwaukee orthosis
promote realignment of spine due to scoliotic curvature
Good posture plumb line
through external auditory meatus, through middle of shoulder, posterior to hip, anterior to knee, anterior to lateral malleolus, through calcaneocuboid joint
Upper Quarter screen myotomes
C1 cervical rotation, C2-4 shoulder elevation, C5 shoulder ABD, C5-6 elbow flex, C6 wrist ext, C7 elbow ext and wrist flex, C8 thumb ext, T1 finger ADD
Upper quarter screen dermatome
C2 post head, C3 post lateral neck, C4 AC joint, C5 lateral arm, C6 lateral forearm/thumb, C7 palmar DIP, C8 little finger and ulnar hand, T1 medial forearm
Lower quarter screen functional
L4-5 heel walking, S1 toe walking, L4-S1 SLR
lower quarter screen myotomes
L1-2 hip flex, L3-4 knee ext, L4-5 ankle DF, L5 great toe ext, S1 ankle PF
Lower quarter screen dermatome
L2 anterior thigh, L3 middle 1/2 anterior thigh, L4 patella and medial malleolus, L5 fib head and dorsum of foot, S1 lateral/planter foot, S2 medial posterior thigh, S3-5 perianal area
SI joint tests
FABER, SI joint compression/distraction tests, thigh thrust, sacral thrust, Gaenslen’s test (hyperext hip in off table hip flexor stretch)
Knee Anterior drawer test
high false negative for ACL - knee capsule is primary restraint while knee is flexed at 90ºnot the ACL
hammer toes
hyperextension at MTP and DIP and flexion at PIP (boutinniere of toes)
morton’s toe
looks like 2nd toe is longer than 1st, but it is first metatarsal shorter than 2nd metatarsal
Feiss line for navicular drop
apex of medial malleolus and plantar aspect of 1st MTP joint
Tinel’s sign for tarsal tunnel syndrome
posterior tibial nerve tapping (medial ankle)
Ankle tests
anterior drawer, talar tilt, kleiger’s ER test, squeeze test for fx/syndesmotic sprain, bump test for fx, thompson’s for achilles rupture
Lateral pivot shift test
anterolateral knee instability; 20 deg tibial IR starting in complete extension, then increase force of IR while applying a valgus force while slowly flexing knee (positive = tibia’s position on femur reduces as leg is flexed at 30-40º, during extension the anterior subluxation is felt = ACL, posterolateral capsule, or IT band)
Valgus/varus tests at 0 and 30 deg
at 0º = collateral ligament and joint capsule, at 30º, just collateral ligament
Slocum’s drawer test
rotational instability: anterolateral = ACL, anterolateral/posterolateral capsule, LCL, ITB, popliteus; anteromedial = ACL, MCL, anteromedial/posteromedial capsule
McMurray’s test
full flexion for isolation of posterior meniscal horns
Wilson’s test
osteochondral defect of knee; actively extends knee in tibial IR until pain, then ER at that same level of extension (positive = relieved pain at ER)
Noble’s compression test
ITB; supine with knee flexed, thumb over lateral femoral condyle while passively ext/flex knee (positive = pain under thumb, commonly at 30º)
patellar pain findings
diffuse, mostly anterior, catching without locking, stiffness and pain from sitting, pain going downstairs, pain with patellar compression and rising from a squat
Clarke’s sign
chondromalacia patellae; supine knee extended, contract quads while pressure is maintained on patella (positive = pain and inability to hold contraction)
Hip scouring test
for oscheochondral defects or arthritis, possibly a labral tear
Milgram’s test
bilateral SLR 2-4” off table - lumbar nerve root impingement
Kernig’s test
unilateral active SLR until pain, then flex knee (if alleviated then positive) - bulging disc, irritation of dural sheath or meninges causing nerve root impingement
SLR test
passive hip flexion until pain, then ext till no pain, then passive DF - sciatic nerve
Well SLR test
passive SLR of unaffected side - herniated disc
Quadrant test
extend, sidebend and rotate to one side, then overpressure on shoulders - radicular pain (compression of intervertebral foramina on lumbar nerve roots), local pain (facet joint), PSIS (SI joint)
Slump test
slumps, rounds shoulders, flex neck, knee ext, ankle DF
Long sit test
alignment; if painful side goes longer to shorter (anterior rotation of that side), if painful side goes shorter to longer (posterior rotation of that side)
Spurling’s test
extend neck, lateral bend then compression on top of head - nerve root impingement
Vertebral artery test
passively ext and laterally flexes neck, rotated towards laterally flexed side and held for 30 seconds (positive = dizzy, confusion, nystagmus, unilateral pupil changes, nausea = occlusion of cervical vertebral arteries)
Neer impingement test
elbow extended, humerus IR and forearm pronated, forward flexion with resistance
Yergason’s test
biceps tendon subluxation; elbow flexed to 90º at side in neutral position, resist ER force and supination force
O’Brien’s test/active compression test
SLAP; shoulder at 90º flexion and 15º horiz ADD, full IR with resistance (pain), then full ER (should decrease pain) - pain/clicking (labral tear), pain at AC joint (AC pathology)
Adson’s test
TOS; shoulder ER and ABD 30º, elbow extended thumb up, palpate radial pulse and ER and ext shoulder while face is rotated towards that side and in neck ext, inhale and hold breath (positive = radial pulse decreases/absent = subclavian artery occluded between anterior/middle scalenes and pec minor)
Allen’s test
TOS; elbow 90º flexed with shoulder ABD 90º, palpate radial pulse and passively horiz ABD and ER with patient head rotates to opposite shoulder - pec minor compressing neurovascular bundle
posterior rotatory instability test
supine, elbow and shoulder flexed 90º, forearm fully supinated; apply valgus stress and axial compression and extend elbow with forearm still in supination (positive = elbow subluxes as it extends and relocates when flexed)
Dupuytren’s contracture
flexion contracture of MCP and PIP joints due to shortening/adhesion of palmar fascia - mostly 4th and 5th fingers
swan neck deformity
flexion of MCP and DIP and hyperextension of PIP - volar plate injuries, malunion fx of middle phalanx, trauma to finger flex/ext muscles, or rheumatoid arthritis
volkmann’s ischemic contracture
flexion contracture of wrist and fingers - can occur after forearm fx, fx or dislocation of elbow, or forearm compartment syndrome
Jersey finger
avulsion of flexor digitorum profundus tendon - cannot actively flex DIP
Mallet finger
avulsion of extensor digitorum longus tendon - cannot actively extend distal phalanx
Boutinniere deformity
rupture of central extensor tendon - Ext of MCP and DIP and flexion of PIP joint
Handicap ramp ratio
1:12
Ely’s test
rectus femoris length; prone, PROM knee flexion (positive = hip flexion with knee flexion)
Knee OA clinical prediction
> 50 years old, stiff >30 minutes, crepitus, bony tenderness, bony enlargement, no palpable warmth
Palpate supraspinatus tendon
shoulder 30º extension, fall off acromion to humerus
palpate infraspinatus and teres minor tendons
shoulder 90º flexion, 10º ADD, 20º ER
Legg Calve Perthes
M>F, age 3-12, degeneration of femoral head 2/2 avascular necrosis; limited hip IR/ADD, pain in groin area radiates to medial thigh and knee; bracing 8years old
CAM labral lesions
abrasion of acetabular cartilage with avulsion from labrum and bone due to non-spherical femoral head/neck contact with acetabular rim
Pincer labral lesions
labral degeneration, ossification of acetabular rim and deepening of acetabulum from repeated contact with femoral head
Slipped capital femoral epiphysis (SCFE)
youths, decreased hip flexion, IR ABD; positive drehmanns (ER and ABD with passive hip flexion); NWB and immobilization for 1-4 months post op
Achilles Tendinopathy Intervention Recommendations
A - eccentric loading B - low level laser, ionto dexa C - orthoses, night splints D - heel lift F - manual therapy, taping
Plantar fasciitis intervention recommendations
A - orthotics
B - modalities (dexa/acetic ionto), stretching, night splints
C - taping
E - manual therapy
Knee ligament sprains intervention recommendations
A - ther-ex
B - immediate mobilization for ROM, Neuromuscular re-ed, NMES, early ROM and weight bearing, eccentric strengthening
C - CPM, early WB, cryotherapy
Ankle DF and inversion muscles
extensor hallicus longus and tibialis anterior
ankle DF and eversion muscles
extensor digitorum longus and peroneus tertius
ankle PF and inversion muscles
tib posterior, flexor digitorum longus, flexor hallicus longus, gastroc, soleus
ankle PF and eversion muscles
peroneus brevis, peroneus longus
DF muscles in gait
initial swing and loading response (eccentrically)
PF muscles in gait
midstance, terminal stance, off in pre-swing
inversion muscles in gait
during swing and midstance
eversion muscles in gait
midstance and terminal stance
THA precautions anterior
hip flexion < 90º, ER < 45º, and extension < 10º
THA precautions posterior
hip flexion < 90º, no IR or ADD
Carpal tunnel (what runs through)
4 flexor digitorum superficialis tendons
4 flexor digitorum profundus tendons
1 flexor pollicis longus tendon
1 median nerve
Cubital Tunnel syndrome
ulnar nerve compression; decreased sensation along ulnar nerve, decreased strength hand intrinsics, decreased grip strength, impaired ADD of 5th digit
Shoulder capsular pattern
ER, ABD, IR
Hip capsular pattern
flexion, ADD, IR
