Musculoskeletal Exam + Gait Assessment Flashcards
lateral bending
lateral flexion of the trunk (try touching the outside of your ankles with your fingers while facing forward)
rotation
turning around a central axis (looking left and right)
inversion
when sole on the foot is visible medially
eversion
when the sole of the foot is visible laterally
supination
rotational movement of the radioulnar joint that positions palm up, or lateral aspect of the foot down
pronation
rotational movement of the radioulnar joint that positions palm down and the medial aspect of the feet down
radial deviation
wrist or fingers shift in the direction of the radius (thumb)
ulnar deviation
wrist or fingers shift in the direction of the ulna (pinky)
5/5 muscle strength
full ROM against gravity and resistance
3/5 muscle strength
full ROM against gravity (no resistance)
passive ROM exceeds AROM by how many degrees?
5
Any congenital or acquired muscle disease, marked clinically by focal or diffuse muscular weakness?
Myopathy
Any disease of the nerves
Neuropathy
disease that affects multiple peripheral nerves
Polyneuropathy
break of a bone, an injury upon assessment that is painful, swollen and deformed
fracture
trauma to ligaments
sprain, common in ankles
trauma to the muscle or the musculotendinous unit
strain
displacement of any part
dislocation
a partial or incomplete dislocation
sublaxation
bone under middle finger
capitate
bone under ring finger
hamate
bone under pointer finger
trapezoid
small bones on thumb
sesamoids
bone under thumb
trapezium
big bone of bottom of thumb/palm
scaphoid
to test for winged scapula
Scapular winging, have patient push against wall
to test for rotator cuff tear
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
to test for biceps tendonitis
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.
to test for shoulder dislocation
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.
to test for tennis elbow/lateral epicondylitis
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
to test for cubital tunnel syndrome
Tinel sign, tapping over the ulnar nerve at elbow, look for tingling sensation to 4th or 5th fingers
to test for radial and ulnar vascular patency
Allen test, compress both arteries, have patient pump fist and release pressure on one artery at a time
to test for DeQuervain’s tenosynovitis (aka Gamer’s thumb) - inflammation of thumb sheath
Finkelstein test, ulnar deviation of wrist, thumb tucked into palm, pain = positive
to test for carpal tunnel syndrome
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)
What is the cervical nerve associated with the Biceps deep tendon reflex?
C5
What is the cervical nerve associated with the brachioradialis reflex?
C6
What is the cervical nerve associated with the triceps reflex?
C7
cervical nerves associated with shoulder dermatome assessment?
supraclavicular (C3-C4), axillary nerve (C5-C6)
Cubitus Valgus
lower arm is angled away from the body, carrying angle greater than 15 degrees
Dupuytren’s contracture
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.
Cubitus Varus
decrease in carrying angle. “gunstock” deformity.
Swan-neck deformity
IP joint hyperextended and DIP is flexed
Olecranon bursitis
swelling of the bursa overlying the olecranon process of the elbow - does not infiltrate the joint
Boutonneire deformity
proximal IP joint becomes markedly flexed and the DIP extended
dislocation of the shoulder
displacement of the humeral head from glenoid fossa
Bony fragment palpable on the dorsal surface of the DIP
mallet finger
jelly-like, pea-sized benign tumors of the soft tissue on the wrist (dorsal or ventral)
ganglion cysts
palpable bony nodules on the dorsal and lateral aspect of DIP. can indicate osteoarthritis
Heberden’s nodes
firm, non-tender lesions that occur on pressure points in RA patients
Rheumatoid nodules
narrowing and compression of the median nerve
carpal tunnel syndrome
normal carrying angles
about 5 degrees in males, 10-15 in females
The hip can:
flex, extend, hyperextend, abduct, adduct, rotate internally and externally
the knee can:
flex, extend, hyperextend
the ankle can:
plantar flex, dorsiflex, invert, evert
the great toe can:
flex, extend, hyperextend
bowlegged at the knees
genu varum
knock-knees
Genus valgum
pigeon toed
pes varus
toes out
pes valgus
flat feet/fallen arch
pes planus
High instep
pes cavus
What spinal nerve associated with Patellar reflex?
L4
What spinal nerve associated with achilles reflex?
S1/S2
involuntary repetitive and variably sustained reflex
clonus (usually of the ankle)
To test the integrity of the achilles tendon:
Thompson or Simmond’s test, squeeze calf muscle in prone positon - should cause the foot to plantar flex. If no movement = positive
To test for excess fluid or effusion of the knee:
Patellar ballotement, push patella in and quickly release it, fluid flows to sides of joint and then back causing the patella to rebound
To test for instability of ACL or PCL:
Drawer sign, lying supine and knees bend with feet on table, draw tibia forward and backward. Movement greater than 5mm is unexpected
True leg length, you measure:
anterior super iliac spine to medial malleolus of the ankle
apparent leg length, you measure:
umbilicus to medial malleolus
To test for DVT:
Homan’s sign, dorsiflex the foot. calf pain = positive
what would you expect to hear during a positive ortolani test?
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.
If a clunk or sensation felt as the femoral head exits the acetabulum posteriorly.
positive Barlow test
to test for excess fluid in the knee:
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.
Another area that you can use the apprehension test?
Patella femoral syndrome or acute knee injury, glide the patella laterally and look at face
To detect medial or lateral meniscus tears?
McMurray test, fully flex the knee. When rotate foot and knee outward (valgus stress) = medial tear, rotate inward (varus stress) = lateral tear.
to test for ligamentous damage:
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
to evaluate the quality of the patella articulation surfaces:
Patellofemoral grinding tests, push patella distally and ask patient to contract quads, pain and crepitation = positive
varus stress on the knee:
rupture of LCL when ankle is pushed in
valgus stress on the knee:
rupture of MCL, when ankle is pushed out
hyperextension of the metatarsarsopharangeal joint with flexion of the toe’s proximal joint
hammer toe
“back knee:
Genu Recurvatum
great toe point away from the midline (lateral deviation)
Hallux valgus
hyperextension of the metatarsophalangeal joint with flexion with the toe’s proximal and distal joints
“Claw toe’
Nerve pain/irritation that most often occurs between 3rd and 4th toes, or 4th and 5th
Morton’s Neuroma
an increased convex curvature of the spine
thoracic kyphosis
Extremely sharp kyphosis
Gibbus deformity
Accentuation of the lumbar curvature (concavity)
Lumbar Lordosis
lateral curvature of the spine
scoliosis
combination of kyphosis and scoliosis
kyphoscoliosis
To relieve cervical pain by widening the neural foramen
Distraction Test, neck traction upwards by lifting the head
To reproduce pain referred to the upper extremities from cervical spine
Compression Test, press down on the top of patient’s head.
To test for space-occuying lesion (herniated disc or tumor) in spinal cord
Valsalva Test, have patient hold breath and bear down and see where the pain is coming from
To determine the state of the subclavian artery
Adson Test, take radial pulse at wrist, then abduct, extended and externally rotate arm. Takes deep breath and turn head toward arm tested.
Tests for sacroiliac instability
Pelvic rock test, pushing inward/medially
Used to detect pathology of the hip or sacroiliac joint
Fabere Patrick test, heel up on opposite knee (like a man sits. pressing down indicates SI joint problem
To evaluate strength of gluteus medius muscle
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.
to asses hip flexion, or possible contracture:
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.
uneven pelvis
Pelvic Obliquity
normal gait width between feet
2-4 inches
Normal step length
15 inches
You spend what percentage of time in stance phase?
60%
What percentage in swing phase?
40%
4 components of stance phase:
- foot or heel strike 2. foot flat 3. mid stance (equal body weight over everything) 4. Toe off –> into swing phase
3 components of swing phase:
- Acceleration 2. Midswing 3. Deceleration (slow down right before contact)
In what phase of gait are the most problems in?
Stance phase, because is a weight-bearing and the length of the phase
If gait has no arm movement?
Parkinson’s (they shuffle)
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
Spastic Hemiparesis
Scissoring of both sides, short steps, dragging ball of foot
Spastic Diplegia
when walking, excessive hip and knee elevation to flip foot up to compensate for dropped foot. Can’t walk on their heels.
steppage/drop
Wide-based gait, swaying of the trunk. Can’t walk heel-to-toe
Cerebellar ataxia (problem in cerebellum - no fine motor control, but getting signals in fine)
Not getting sensory input and watches the ground to guide their steps
Sensory ataxia
If patient has a positive Romberg sign, what kind of Ataxia do they have?
Sensory
jerky, dancing movements (Harlem Shake)
Dystonia
Uncontrolled falling occurs
Ataxia - patient can’t coordinate movements due due to cerebellar issues (Descending tract) or sensory deprivation (ascending tract)
Patient lurches toward weakened side to place center of gravity over the hip.
Adductor/Abductor lurch (causes by weakened gluteus medius)
Positive Trendelenburg test, what kind of lurch?
Adductor or Abductor
Caused by weakened Gluteus Maximus:
Extensor Lurch, have to thrust thorax to maintain hip extension
Causes an excessively harsh heel strike
Back knee - genu recurvatum
Antalgic
limping, limit the amount of time of weight-bearing on affected leg.
Test designed to reproduce back and leg pain so its cause can be determined:
Straight leg raising test
Used to determine if patient is exaggerating or faking when he says he can’t move his leg:
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!
What will exaggerate any unexpected findings in gait assessment?
Hell-to-toe walking
If a patient is falling… consider the following:
vestibular functions, vision, CV disease, neurologic disease
