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Physical Diagnosis Block III > Musculoskeletal Exam + Gait Assessment > Flashcards

Musculoskeletal Exam + Gait Assessment Flashcards

1
Q

lateral bending

A

lateral flexion of the trunk (try touching the outside of your ankles with your fingers while facing forward)

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2
Q

rotation

A

turning around a central axis (looking left and right)

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3
Q

inversion

A

when sole on the foot is visible medially

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4
Q

eversion

A

when the sole of the foot is visible laterally

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5
Q

supination

A

rotational movement of the radioulnar joint that positions palm up, or lateral aspect of the foot down

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6
Q

pronation

A

rotational movement of the radioulnar joint that positions palm down and the medial aspect of the feet down

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7
Q

radial deviation

A

wrist or fingers shift in the direction of the radius (thumb)

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8
Q

ulnar deviation

A

wrist or fingers shift in the direction of the ulna (pinky)

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9
Q

5/5 muscle strength

A

full ROM against gravity and resistance

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10
Q

3/5 muscle strength

A

full ROM against gravity (no resistance)

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11
Q

passive ROM exceeds AROM by how many degrees?

A

5

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12
Q

Any congenital or acquired muscle disease, marked clinically by focal or diffuse muscular weakness?

A

Myopathy

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13
Q

Any disease of the nerves

A

Neuropathy

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14
Q

disease that affects multiple peripheral nerves

A

Polyneuropathy

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15
Q

break of a bone, an injury upon assessment that is painful, swollen and deformed

A

fracture

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16
Q

trauma to ligaments

A

sprain, common in ankles

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17
Q

trauma to the muscle or the musculotendinous unit

A

strain

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18
Q

displacement of any part

A

dislocation

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19
Q

a partial or incomplete dislocation

A

sublaxation

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20
Q

bone under middle finger

A

capitate

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21
Q

bone under ring finger

A

hamate

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22
Q

bone under pointer finger

A

trapezoid

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23
Q

small bones on thumb

A

sesamoids

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24
Q

bone under thumb

A

trapezium

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25
Q

big bone of bottom of thumb/palm

A

scaphoid

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26
Q

to test for winged scapula

A

Scapular winging, have patient push against wall

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27
Q

to test for rotator cuff tear

A

Drop arm test, arm held out abducted at 90 degrees, with gentle pressure downward to arm drops and he is unable to lower his arm slowly to his side

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28
Q

to test for biceps tendonitis

A

Yergason test, arm flexed at 90 at patient’s side. hold wrist and elbow at try to externally rotate arm while patient resists and pull downward on his elbow at the same time. If tendon is unstable in groove, will pop out and elicit pain = positive.

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29
Q

to test for shoulder dislocation

A

Apprehension test, abduct and externally rotate arm to position where might easily dislocate, patient will have a noticeable look of apprehension or alarm and will resist further motion.

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30
Q

to test for tennis elbow/lateral epicondylitis

A

Tennis elbow test, elbow flexed 90 degrees, stabilize forearm at lateral epicondyle, palm down, and instruct patient to make fist and apply pressure to top of fist - pain in epicondyle is positive

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31
Q

to test for cubital tunnel syndrome

A

Tinel sign, tapping over the ulnar nerve at elbow, look for tingling sensation to 4th or 5th fingers

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32
Q

to test for radial and ulnar vascular patency

A

Allen test, compress both arteries, have patient pump fist and release pressure on one artery at a time

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33
Q

to test for DeQuervain’s tenosynovitis (aka Gamer’s thumb) - inflammation of thumb sheath

A

Finkelstein test, ulnar deviation of wrist, thumb tucked into palm, pain = positive

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34
Q

to test for carpal tunnel syndrome

A

Phalen’s test, forced wrist palmar flexion by placing tops of hands together with fingers pointing down. or tapping at ulnar nerve at wrist (tingling at 4/5 finger)

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35
Q

What is the cervical nerve associated with the Biceps deep tendon reflex?

A

C5

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36
Q

What is the cervical nerve associated with the brachioradialis reflex?

A

C6

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37
Q

What is the cervical nerve associated with the triceps reflex?

A

C7

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38
Q

cervical nerves associated with shoulder dermatome assessment?

A

supraclavicular (C3-C4), axillary nerve (C5-C6)

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39
Q

Cubitus Valgus

A

lower arm is angled away from the body, carrying angle greater than 15 degrees

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40
Q

Dupuytren’s contracture

A

Thickened areas of the palmar fascia that form discrete nodules on the ulnar side side proximal to the ring and little fingers. Cause flexion deformity of the fingers.

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41
Q

Cubitus Varus

A

decrease in carrying angle. “gunstock” deformity.

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42
Q

Swan-neck deformity

A

IP joint hyperextended and DIP is flexed

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43
Q

Olecranon bursitis

A

swelling of the bursa overlying the olecranon process of the elbow - does not infiltrate the joint

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44
Q

Boutonneire deformity

A

proximal IP joint becomes markedly flexed and the DIP extended

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45
Q

dislocation of the shoulder

A

displacement of the humeral head from glenoid fossa

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46
Q

Bony fragment palpable on the dorsal surface of the DIP

A

mallet finger

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47
Q

jelly-like, pea-sized benign tumors of the soft tissue on the wrist (dorsal or ventral)

A

ganglion cysts

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48
Q

palpable bony nodules on the dorsal and lateral aspect of DIP. can indicate osteoarthritis

A

Heberden’s nodes

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49
Q

firm, non-tender lesions that occur on pressure points in RA patients

A

Rheumatoid nodules

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50
Q

narrowing and compression of the median nerve

A

carpal tunnel syndrome

51
Q

normal carrying angles

A

about 5 degrees in males, 10-15 in females

52
Q

The hip can:

A

flex, extend, hyperextend, abduct, adduct, rotate internally and externally

53
Q

the knee can:

A

flex, extend, hyperextend

54
Q

the ankle can:

A

plantar flex, dorsiflex, invert, evert

55
Q

the great toe can:

A

flex, extend, hyperextend

56
Q

bowlegged at the knees

A

genu varum

57
Q

knock-knees

A

Genus valgum

58
Q

pigeon toed

A

pes varus

59
Q

toes out

A

pes valgus

60
Q

flat feet/fallen arch

A

pes planus

61
Q

High instep

A

pes cavus

62
Q

What spinal nerve associated with Patellar reflex?

A

L4

63
Q

What spinal nerve associated with achilles reflex?

A

S1/S2

64
Q

involuntary repetitive and variably sustained reflex

A

clonus (usually of the ankle)

65
Q

To test the integrity of the achilles tendon:

A

Thompson or Simmond’s test, squeeze calf muscle in prone positon - should cause the foot to plantar flex. If no movement = positive

66
Q

To test for excess fluid or effusion of the knee:

A

Patellar ballotement, push patella in and quickly release it, fluid flows to sides of joint and then back causing the patella to rebound

67
Q

To test for instability of ACL or PCL:

A

Drawer sign, lying supine and knees bend with feet on table, draw tibia forward and backward. Movement greater than 5mm is unexpected

68
Q

True leg length, you measure:

A

anterior super iliac spine to medial malleolus of the ankle

69
Q

apparent leg length, you measure:

A

umbilicus to medial malleolus

70
Q

To test for DVT:

A

Homan’s sign, dorsiflex the foot. calf pain = positive

71
Q

what would you expect to hear during a positive ortolani test?

A

palpable click. If have a congenitally dislocated hip, the femoral head slides over the acetabular rim. click may also be audible as the femoral head enters and leaves the acetabular.

72
Q

If a clunk or sensation felt as the femoral head exits the acetabulum posteriorly.

A

positive Barlow test

73
Q

to test for excess fluid in the knee:

A

Patellar bulge sign, milk the areas around the patella and observe for a bulge of returning fluid to the hollow area medial to the patella.

74
Q

Another area that you can use the apprehension test?

A

Patella femoral syndrome or acute knee injury, glide the patella laterally and look at face

75
Q

To detect medial or lateral meniscus tears?

A

McMurray test, fully flex the knee. When rotate foot and knee outward (valgus stress) = medial tear, rotate inward (varus stress) = lateral tear.

76
Q

to test for ligamentous damage:

A

Apley’s distraction - patient lies prone with knee flexed and upward traction applied while rotating (reduced meniscal pressure) and elicits pain in ligaments. Downward force = Apley’s grinding test

77
Q

to evaluate the quality of the patella articulation surfaces:

A

Patellofemoral grinding tests, push patella distally and ask patient to contract quads, pain and crepitation = positive

78
Q

varus stress on the knee:

A

rupture of LCL when ankle is pushed in

79
Q

valgus stress on the knee:

A

rupture of MCL, when ankle is pushed out

80
Q

hyperextension of the metatarsarsopharangeal joint with flexion of the toe’s proximal joint

A

hammer toe

81
Q

“back knee:

A

Genu Recurvatum

82
Q

great toe point away from the midline (lateral deviation)

A

Hallux valgus

83
Q

hyperextension of the metatarsophalangeal joint with flexion with the toe’s proximal and distal joints

A

“Claw toe’

84
Q

Nerve pain/irritation that most often occurs between 3rd and 4th toes, or 4th and 5th

A

Morton’s Neuroma

85
Q

an increased convex curvature of the spine

A

thoracic kyphosis

86
Q

Extremely sharp kyphosis

A

Gibbus deformity

87
Q

Accentuation of the lumbar curvature (concavity)

A

Lumbar Lordosis

88
Q

lateral curvature of the spine

A

scoliosis

89
Q

combination of kyphosis and scoliosis

A

kyphoscoliosis

90
Q

To relieve cervical pain by widening the neural foramen

A

Distraction Test, neck traction upwards by lifting the head

91
Q

To reproduce pain referred to the upper extremities from cervical spine

A

Compression Test, press down on the top of patient’s head.

92
Q

To test for space-occuying lesion (herniated disc or tumor) in spinal cord

A

Valsalva Test, have patient hold breath and bear down and see where the pain is coming from

93
Q

To determine the state of the subclavian artery

A

Adson Test, take radial pulse at wrist, then abduct, extended and externally rotate arm. Takes deep breath and turn head toward arm tested.

94
Q

Tests for sacroiliac instability

A

Pelvic rock test, pushing inward/medially

95
Q

Used to detect pathology of the hip or sacroiliac joint

A

Fabere Patrick test, heel up on opposite knee (like a man sits. pressing down indicates SI joint problem

96
Q

To evaluate strength of gluteus medius muscle

A

Trendelenburg test, observe dimples on back, should be level. Then raise one leg and the dimple on that side should go up = medius you’re standing on is strong. If it was weak then dimple goes down.

97
Q

to asses hip flexion, or possible contracture:

A

Thomas Test, one leg flexes up and in a normal patient the opposite leg will stay down. If contracture, the rest leg would lift as well.

98
Q

uneven pelvis

A

Pelvic Obliquity

99
Q

normal gait width between feet

A

2-4 inches

100
Q

Normal step length

A

15 inches

101
Q

You spend what percentage of time in stance phase?

A

60%

102
Q

What percentage in swing phase?

A

40%

103
Q

4 components of stance phase:

A
  1. foot or heel strike 2. foot flat 3. mid stance (equal body weight over everything) 4. Toe off –> into swing phase
104
Q

3 components of swing phase:

A
  1. Acceleration 2. Midswing 3. Deceleration (slow down right before contact)
105
Q

In what phase of gait are the most problems in?

A

Stance phase, because is a weight-bearing and the length of the phase

106
Q

If gait has no arm movement?

A

Parkinson’s (they shuffle)

107
Q

The affected leg is still and extended with plantar flexion, foot is dragged with toe scraping, the affected arm is flexed and adducted with no swing

A

Spastic Hemiparesis

108
Q

Scissoring of both sides, short steps, dragging ball of foot

A

Spastic Diplegia

109
Q

when walking, excessive hip and knee elevation to flip foot up to compensate for dropped foot. Can’t walk on their heels.

A

steppage/drop

110
Q

Wide-based gait, swaying of the trunk. Can’t walk heel-to-toe

A

Cerebellar ataxia (problem in cerebellum - no fine motor control, but getting signals in fine)

111
Q

Not getting sensory input and watches the ground to guide their steps

A

Sensory ataxia

112
Q

If patient has a positive Romberg sign, what kind of Ataxia do they have?

A

Sensory

113
Q

jerky, dancing movements (Harlem Shake)

A

Dystonia

114
Q

Uncontrolled falling occurs

A

Ataxia - patient can’t coordinate movements due due to cerebellar issues (Descending tract) or sensory deprivation (ascending tract)

115
Q

Patient lurches toward weakened side to place center of gravity over the hip.

A

Adductor/Abductor lurch (causes by weakened gluteus medius)

116
Q

Positive Trendelenburg test, what kind of lurch?

A

Adductor or Abductor

117
Q

Caused by weakened Gluteus Maximus:

A

Extensor Lurch, have to thrust thorax to maintain hip extension

118
Q

Causes an excessively harsh heel strike

A

Back knee - genu recurvatum

119
Q

Antalgic

A

limping, limit the amount of time of weight-bearing on affected leg.

120
Q

Test designed to reproduce back and leg pain so its cause can be determined:

A

Straight leg raising test

121
Q

Used to determine if patient is exaggerating or faking when he says he can’t move his leg:

A

the Hoover test, When patient tries to perform a straight leg raise, but your hand under the calcaneus of the oppsoite resting leg. If you feel pressure = actually injured. If not pushing down = FAKER!

122
Q

What will exaggerate any unexpected findings in gait assessment?

A

Hell-to-toe walking

123
Q

If a patient is falling… consider the following:

A

vestibular functions, vision, CV disease, neurologic disease

Physical Diagnosis Block III (2 decks)

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