Musculoskeletal Assessments Flashcards
Pain scales
Thermometer Pain Rating Scale
Visual Analogue Scale (VAS)
Numerical Pain Scale
McGill Pain Questionnaire (Ma’am Elaine Fav)
Verbal Descriptor Grading
0 - no pain
1 - slight pain
2- mild pain
3 - moderate pain
4 - severe pain
5 - extreme pain
6 - worst pain
Pain patterns for vascular
Throbbing
Pounding
Pulsing
Beating
Neurogenic pain patterns
Sharp
Crushing
Pinching
Itchy
Stinging
Shooting
Electrical
Musculoskeletal pain patterns
Aching
Sore
Deep
Cramping
Dull
Mnemonics for pain assessment
PQRST
SOCRATES
PQRST
Provoking factors
Quality of Pain
Region and radiation
Severity or associated symptoms
Temporal factors
SOCRATES
Site
Onset
Character
Radiation
Associations
Time course
Severity
Chronic Pain assessment tool
Waddell’s Nonorganic Signs and Behavioral Symptoms
Signs of Tenderness test
superficial
nonanatomic (deep)
Signs of simulation tests
Axial loading
Acetabular rotation
light vertical loading over the pt’s skull reproduces pain on the lumbar region instead of the cervical region
axial loading
lumbosacral pain from upper trunk rotation, back pain reported when the pelvis and shoulders are passively rotated in the same plane as the pt stands.
acetabular rotation
Signs of Distraction Tests
SLR
Double leg raise
when there is same results in SLR in supine and sitting there is a presence of a/an
organic pathology
in what position should SLR be worse/better
Worse in supine
Better in sitting
organic response after SLR
greater degree of double leg raising
Signs of regional disturbances
weakness
sensory disturbances
cogwheeling or giving away of many muscle groups that cannot be explained on neurological basis
weakness
diminished sensation fitting a “stocking” rather than a dermatomal pattern
sensory disturbance
overreaction behaviors during an examination
guarding
bracing
rubbing
sighing
clenching of teeth
grimacing
what are trigger points and in what condition is it present?
pain c deep pressure and often radiates locally
found in myofascial pain syndrome
what are tender points and in what condition is it found
pain c light touch and does not radiate
found in fibromyalgia syndrome
structures affected in fibromyalgia syndrome
cutaneous
subcutaneous
ligaments
tendon
What are the systemic issues in fibromyalgia syndrome?
sleep
emotional issues
fatigue/tiredness
Common sites for digital palpation c approximation
low cervical
2nd rib
lat epicondyle
occipital
trapezius
supraspinatus
gluteal
GT
where can multiple points for fibromyalgia syndrome be found?
Greater Trochanter
components of measuring range of motion
PROM
AROM
normal range
end feel
conditions where an abnormal soft end feel is found
soft tissue edema
synovitis
conditions where abnormal firm end-feel is found
increased muscular tonus
capsular, muscular, ligamentous shortening
conditions where abnormal hard end-fee is found
chondromalacia
OA
loose bodies in jts
Myositis ossificans
Fracture
conditions where empty end feels are found
acute jt inflammation
bursitis
abscess
fracture
psychogenic disorder
hard capsular end feel is found when the pt has
frozen shoulder/adhesive capsulitis
spastic end feel is found when the pt has
UMN lesion
soft capsular end feel is found when the pt has
synovitis or soft tissue edema
bone to bone abnormal end feel is found when the pt has
acute subacromial bursitis
a springy block end feel is found when the pt has
meniscus tear
a mushy tissue stretch is found when the pt has
tight muscle
a late muscle spasm end feel is found when the pt has
spasm due to instability or pain
Accessory jt motion grade 0
ankylosed
joint mob is not indicated; surgery should be considered
Accessory jt motion grade 1
considerable hypomobility
Accessory jt motion grade 2
slight hypomobility
implications of treatment for accessory jt motion grades 1 and 2
grade 3 and 4 joint mobilization for mobility
implications of treatment for accessory jt motion grade 3
no jt mob needed
implications of treatment for accessory jt grade 4 and 5
jt mob grades 3 and 4 are joint mob are contraindicated
accessory jt motion grade 3
normal
accessory jt motion grade 4
slight hypermobility
accessory jt motion grade 5
considerable hypermobility
accessory jt motion grade 6
unstable
strong and painless isometric testing
no lesion
strong and painful isometric testing
minor lesion in ms or tendon
weak and painless isometric testing
disorder of nervous system or neuromuscular junction
disuse atrophy or complete rupture
weak and painful isometric testing
neoplasm or fx
the only reliable and valid assessment tool for shoulder
Shoulder Pain and Disability (SPADI)
ad cap stage 1
first 3 mos
painful shoulder movement, minimal restriction in motion
ad cap stage 2
3-9 mos
painful shoulder movement, progressive loss in GH joint motion
ad cap stage 3
9-15 mos
reduced pain c shoulder movement, severely restricted GH jt motion
ad cap stage 4
15-24 mos
minimal pain, progressive normalization of GH jt motion
minimum detectable change in SPADI
13 pts (90% confidence)
MMT grade 5
Normal
Full ROM against gravity
Max resistance
MMT grade 4+
Good plus
Full ROM against gravity
Near max resistance
MMT grade 4
Good
Full ROM against gravity
Moderate resistance
MMT grade 4-
Good minus
Full ROM against gravity
Near mod resistance
MMT grade 3+
Fair plus
Full ROM against gravity
Slight resistance
MMT grade 3
Fair
Full ROM against gravity
No resistance
MMT grade 3-
Fair minus
At least 50% ROM against gravity
no resistance
MMT grade 2+
Poor plus
Full ROM, no gravity
slight resistance
MMT grade 2
Poor
Full ROM, no gravity
no resistance
MMT grade 2-
Poor minus
At least 50% ROM, no gravity
no resistance
MMT grade 1+
Trace +
Minimal observable motion (< 50% ROM)
no resistance
MMT grade 1
Trace
No observable motion but has ms contraction
MMT grade 0
Zero
No muscle contraction
Gold standard assessment tool for neck problems
Neck Disability Index
Assessment tool for LBP
Oswestry Low Back Pain Disability (Oswestry Disability Index)
Spondylolisthesis slip grade 1
<25%
Spondylolisthesis slip grade 2
25-49%
Spondylolisthesis slip grade 3
50-74%
Spondylolisthesis slip grade 4
75-99%
Spondylolisthesis slip grade 5
> /= 100% (spondyloptosis)
can be used to evaluate the functional impairment with a disorder of one or both LE
Lower Extremity Functional Scale (LEFS)
Max score for LEFS
80
What does a lower score in LEFS mean?
greater disability
Minimal detectable change in LEFS
9 points
0-20% score on Oswestry Disability Index
Minimal disability
21-40% score on Oswestry Disability Index
Moderate disability
41-60% score on Oswestry Disability Index
severe disability
61-80% score on Oswestry Disability Index
crippled
81-100%
bed bound or exaggerating
Max score in Neck Disability Index
50
Ankle sprain grade 1
Loc: AntaFi lig
Edema & Ecchy: Slight & Local
WB: Full or partial
Stretched ligaments
No instability
Ankle sprain grade 2
Loc: AntaFi and CaFi ligs
Edema & Ecchy: Moderate & Local
WB: difficult s crutches
Partial ligamentous tear
No or slight instability
Ankle sprain grade 3
Loc: AntaFi, PotaFi, CaFi ligs
Edema & Ecchy: Significant & Diffuse
WB: Impossible s significant pain
Complete ligamentous tear
Definite instability
Ligamentous instability grade 1
0-5 mm
Ligamentous instability grade 2
6-10 mm
Ligamentous instability grade 3
11-15 mm
Ligamentous instability grade 4
> 15 mm
Ligamentous injury grade 1
tenderness to palpation s jt laxity
Ligamentous injury grade 2
tenderness to palpation c jt laxity but a good endpoint
Ligamentous injury grade 3
tenderness to palpation c significant jt laxity and no endpoint
Female Athlete Triad
Inadequate eating
Menstrual abnormalities
Skeletal demineralization
Two components of the “Quick Dash” assessment tool
disability/symptoms portion (30 items, scored 1-5)
optional high-performance sport/music or work potion (4 items, scored 1-5)
how many items must be answered to calculate for DASH score?
27 out of 30
horizontal maxillary fracture, separating the teeth from the upper face
Le Fort I
pyramidal fracture, with the teeth at the pyramid base, and nasofrontal suture at its apex
Le Fort II
craniofacial disjunction
Le Fort III
Salter-Harris type 1
straight horizontal fx (S - straight)
Salter-Harris type 2
(A) above
Salter-Harris type 3
(L) lower or below
Salter-Harris type 4
(T) through or two
Salter-Harris type 5
(ER) erasure of growth
amputation of the whole shoulder complex
forequarter
removal of the humerus
shoulder disarticulation
horizontal amputation of the humerus
transhumeral
horizontal amputation slightly above the humerus
elbow disarticulation
horizontal amputation in the forearm
transradial
horizontal amputation of the wrist
wrist disarticulation
horizontal amputation of the carpal bones
transcarpal
horizontal amputation in the metacarpal area
transmetacarpal
horizontal amputation of the phalangeal area
transphalangeal
ankle disarticulation with the attachment of the heel pad to the distal end of tibia
syme’s amputation
horizontal amputation of the calcaneus
boyd’s
vertical amputation of the heel/calcaneus
pirigo
partial tarsal amputation through the midtarsal jts
chopart
complete metatarsal amputation
Lisfranc’s amputation
partial metatarsal amputation through metatarsal bones
transmetatarsal
T score for normal bone mineral density -1
-1.0 or above
T score for pts c osteopenia
-1.0-(-2.5)
T score for pts c osteoporosis
-2.5 or less
T score for pts c severe osteoporosis
-2.5 or less
RA class 1
able to perform usual ADLs
RA class 2
able to perform self-care and vocational activities, but limited in avocational activities
RA class 3
able to perform self-care activities, but limited in vocational and avocational activities
RA class 4
limited in performing self-care, vocational, and avocational activities
OA grade 0
no radiographic findings of OA
OA grade 2
definite osteophytes c unimpaired jt space
OA grade 1
minute osteophytes of doubtful clinical significance
OA grade 3
definite osteophytes c moderate jt space narrowing
OA grade 4
definite osteophytes c severe jt space narrowing and subchondral sclerosis
Used to assess back pain, RA, SLE, and fibromyalgia
Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC)
