Musculoskeletal Content Flashcards
How would you test shoulder flexion?
Ask the patient to raise your arms in front of you and overhead
How would you test shoulder extension?
Raise your arms behind you
How would you test shoulder abduction?
Raise your arms out to the side and over-head
How would you test shoulder adduction?
Cross your arms in front of your body
How would you test internal shoulder rotation?
Place one hand behind your back and touch your shoulder blade
How would you test external shoulder rotation?
Raise your arm to shoulder level; bend your elbow and rotate your forearm toward the ceiling
Describe how you would test the range of motion for the elbow (Flexion, extension, supination, pronation)
- Flexion - Bend your elbow
- Extension - Straighten your elbow
- Supination - Turn your palms up as if carrying a bowl of soup
- Pronation - Turn your palms down
Describe how you would test the range of motion for the wrist (Flexion, extension, adduction, abduction)
- Flexion - With palms down, point your fingers toward the floor
- Extension - With palms down, point your fingers toward the ceiling
- Adduction (Radial deviation) - With palms down, bring your fingers toward the midline
- Abduction (Ulnar deviation) - With palms down, bring your fingers away from the midline
Describe how you would test the range of motion for the neck (Flexion, extension, rotation, lateral bending)
- Flexion - Bring your chin to your chest
- Extension - Look up at the ceiling
- Rotation - Look over one shoulder and then the other
- Lateral Bending - Bring your ear to your shoulder
Describe how you would test the range of motion for the spinal column (Flexion, extension, rotation, lateral bending)
- Flexion - Bend forward and try to touch your toes
- Extension - Bend back as far as possible
- Rotation - Rotate from side to side
- Lateral bending - Bend to the side from the waist
Describe how you would test the range of motion for the hip (Flexion, extension, abduction, adduction, external rotation, internal rotation)
- Flexion - Bend your knee to your chest and pull it against your abdomen
- Extension - Lie face down, then bend your knee and lift it up
- Abduction - Lying flat, move your lower leg away from the midline
- Adduction - Lying flat, bend your knee and move your lower leg toward the midline
- External rotation - Lying flat, bend your knee and turn your lower leg and foot across the midline
- internal rotation - Lying flat, bend your knee and turn your lower leg and foot away from the midline
Describe how you would test the range of motion for the knee (Flexion, extension, internal rotation, external rotation)
- Flexion - Bend or flex your knee
- Extension - Straighten your leg
- internal rotation - While sitting, swing your lower leg toward the midline
- External rotation - While sitting, swing your lower leg away from the midline
Describe how you would test the range of motion for the ankle and foot (Flexion, extension, inversion, eversion)
- Flexion (plantar flexion) - Point your foot toward the floor
- Extension (Dorsiflexion) - Point your foot toward the ceiling
- inversion - Bend your heel inward
- Eversion - Ben your heel outward
What are the different planes and positions of the body
What are the 4 signs of joint inflammation?
- Swelling - Palpable swelling may involve: (1) the synovial membrane, which can feel boggy or doughy; (2) effusion from excess synovial fluid within the joint space; or (3) soft tissue structures, such as bursae, tendons, and tendon sheaths.
- Warmth - Use the backs of your fingers to compare the involved joint with its unaffected contralateral joint, or with nearby tissues if both joints are involved.
- Redness - Redness of the overlying skin is the least common sign of inflammation near the joints and is usually seen in more superficial joints like fingers, toes, and knees.
- Pain or tenderness - Try to identify the specific anatomic structure that is tender.
What are some signs of TMJ inflammation?
- Swelling, tenderness, and decreased range of motion
- Dislocation can be caused by trauma
- Pain with chewing, jaw clenching, teeth grinding
- Can be accompanied by a headache
What is the most common type of shoulder pain?
Rotator cuff disorders
How do you rule out an elbow fracture after an injury?
After injury, preservation of active range of motion and full elbow extension makes fracture highly unlikely
What are some normal changes in the spine with aging?
Increased thoracic kyphosis occurs with aging
What causes Rheumatoid Arthritis?
Chronic inflammation of synovial membranes with secondary
erosion of adjacent cartilage and bone, and damage to ligaments and tendons
What are the most common locations RA is found?
- Hands—initially
- small joints (PIP and MCP joints)
- feet (MTP joints),
- wrists, knees, elbows, ankles
What is the pattern of spread for RA?
Symmetrically additive: progresses to other joints while persisting in initial joints
What causes osteoarthritis?
Degeneration and progressive loss of joint cartilage from mechanical stress, with damage to underlying bone, and formation of new
bone at the cartilage margins
How would you test the tinel sign and what is it used for?
- Tapping lightly over the course of the median nerve in the carpal tunnel as shown in Figure 16-44.
- Aching and numbness in the median nerve distribution is a positive test for carpal tunnel
How would you test thumb abduction and what is this test used for?
- To test thumb abduction, ask the patient to raise the thumb straight up as you apply downward resistance (Fig. 16-43).
- Weakness on thumb abduction is a positive test for carpal tunnel syndrome
How would you test the Phalen sign and what is this test used for?
- To test Phalen sign, ask the patient to hold the wrists in flexion for 60 seconds with the elbows fully extended (Fig. 16-45).
- Alternatively, ask the patient to press the backs of both hands together to form right angles. These maneuvers compress the median nerve.
- Numbness and tingling in the median nerve distribution within 60 seconds is a positive test for carpal tunnel syndrome
How do you grade a patient’s muscle strength?
Remember that a muscle is strongest when shortest, and weakest when longest
How do you grade a patient’s reflexes?
- Hyperactive reflexes - seen in CNS lesions of the descending corticospinal tract. Look for associated upper motor neuron findings of weakness, spasticity, or a positive Babinski sign.
-
Hypoactive/absent reflexes - Hypoactive or absent reflexes (hyporeflexia)
occur in lesions of the spinal nerve roots, spinal nerves, plexuses, or peripheral nerves. Look for associated findings of lower motor unit disease, namely weakness, atrophy, and fasciculations.
What are dermatomes?
- A dermatome is the band of skin innervated by the sensory root of a single spinal nerve.
- Knowledge of dermatomes helps you localize neurologic lesions to a specific level of the spinal cord, particularly in spinal cord injury
How do you test the biceps reflex and what dermatomes== are tested?
- The patient’s elbow should be partially flexed and the forearm pronated with palm down. Place your thumb or finger firmly on the biceps tendon. Aim the strike with the reflex hammer directly through your digit toward the biceps tendon (Figs. 17-47 and 17-48).
- Observe flexion at the elbow, and watch for and feel the contraction of the biceps muscle
- C5, C6
How do you test the triceps reflex and what dermatomes are tested?
- The patient may be sitting or supine. Flex the patient’s arm at the elbow, with palm toward the body, and pull it slightly across the chest. Strike the triceps tendon with a direct blow directly behind and just above the elbow (Figs. 17-49 and 17-50).
- Watch for contraction of the triceps muscle and extension at the elbow.
- C6 & C7
How do you test the brachioradialis reflex and what dermatomes are tested?
- The patient’s hand should rest on the abdomen or the lap, with the forearm partly pronated. Strike the radius with the point or flat edge of the reflex hammer, about 1 to 2 inches above the wrist (Fig. 17-52).
- Watch for flexion and supination of the forearm.
- C5 & C6
How do you test the patellar reflex and what dermatomes are tested?
- Briskly tap the patellar tendon just below the patella (Fig. 17-53).
- Note contraction of the quadriceps with extension at the knee
- L2, L3, L4
How do you test the Achilles reflex and what dermatomes are tested?
- If the patient is sitting, partially dorsiflex the foot at the ankle. Persuade the patient to relax.
- Strike the Achilles tendon, and watch and feel for plantar flexion at the ankle (Fig. 17-56).
- Also note the speed of relaxation after muscular contraction.
What is clonus and how do you test it?
- Clonus occurs when there are hyperactive reflexes
- To test for clonus, use the ankle. Place the knee in a partly flexed position. With your other hand, dorsiflex and plantar flex the foot a few times while encouraging the patient to relax, then sharply dorsiflex the foot and maintain it in dorsiflexion (Fig. 17-58).
- Look and feel for rhythmic oscillations between dorsiflexion and plantar flexion. Normally the ankle does not react to this stimulus.
- There may be a few clonic beats if the patient is tense or has exercised.
What is a fracture?
A break in the structural continuity of the bone
