Musculoskeletal System Flashcards
What should you ask if someone presents with an injury?
“Has this ever happened before, how was it treated?”
When does the evaluation of a musculoskeletal injury happen?
- The moment you first lay eyes on the patient
*observe them when they’re unaware
If a patient has full AROM is there a reason to do PROM
No
If there is restricted AROM is there a reason to test PROM
Yes
*is the motion due to pain or physical restriction
How must you test limbs
Compare bilaterally
What can warmth indicate while palpating
Infection
*always need to rule out
What tends to be warmer proximal or distal limbs?
Proximal
*bc distal has terminal blood supply
What does bogginess feel like
- Spongy
- Mushy
- Often present with infection
When beginning to palpate what side should you palpate first
- Work towards the painful area, dont start there
*examine contralateral side first
How to document ROM
- FROM/ROM intact
- Record if any movement or plane is limited
- Record degree of limitation
What are the two types of ROM
AROM
*patient is moving limb
PROM
*provider is moving limb for patient
What factors influence ROM
- Patients willingness to move
- Muscular strength
- Motor control
- Osteoligamentous stability (any torn ligaments)
- Available joint motion (contracture, bone spurs)
How does instability occur
- Results from deficiency in a joint stabilizing structure
*joint can dislocate
*joint may move in an unnatural way
What is laxity
looseness of a joint, but may not be serve enough to cause instability
*double jointed
What are the grade 0-2 of strength
0 = no muscular contraction detected
1 = barely detectable flicker or trace of contraction
2 = active movement of the body part with gravity eliminated
What are grades 3-5 of strength
3 = active movement against gravity (cant move against pressure)
4 = active movement against gravity and some resistance
5 = “normal” active movement against full resistance without even dent fatigue
What is the correct way to document strength
Full or 5/5
What is the most active joint in the body
Temporomandibular joint
*opens and closes up to 2,000 times /day
How is the TMJ formed
- By the fossa and articular tubercle of the temporal bone and the condylomata of the mandible
- Midway between the external acoustic meatus and Zygomatic arch
What is the muscles of mastication innervated by>
CN V
What type of joint is the TMJ
Condylar synovial joint
*fibrocartilaginous disc
*synovial membrane
What does swelling, tenderness and decreased ROM of the TMJ indicate
Arthritis
How to palpate the TMJ
- Place index fingertips anterior to tragus
- As patient open mouth, fingertips will drop into the joint spaces
*asses for smoothness of motion, clicking, or snapping
How to test for ‘glide’ ‘hinge’ ‘protrusion and retraction’
Glide = upper portion
Hinge = lower portion (open and close jaw)
Protrusion and retraction = jut the jaw forward
How to test for lateral movement of the jaw and how many fingers should fit vertically in the mouth
Lateral = move jaw side to side
Three fingers should fit
*bottom teeth should be in front of top teeth with mandibular protrusion
What to palpate when inspecting the spine
- Vertebral processes and para spinal musculature
What is kyphosis, lordosis, and scoliosis
Kyphosis = excessive curvature of the thoracic spine
Lordosis = excessive curvature of the lumbar spine
Scoliosis = lateral “s” shape curvature of the spine with twisting
What is normal curvature of the neck
Cervical lordosis
What causes poker straight neck
Inflammation of the neck muscles
How to test ROM of the cervical spine
Flexion
*chin to chest
Extension
*tilt head back as far as possible
Lateral flexion
*touch ear to shoulder
Rotation
*look over shoulder and touch chin to shoulder
What to test first with the cervical spine
Asses ROM then asses motion against resistance for strength testing
What type of normal curvature does the thoracic spine have?
Mild kyphotic curvature
*20 to 40 degrees
What happens to the spine as we age
There will be an increase in the thoracic kyphosis and a decrease in the lumbar lordosis
*more pronounced in females
How to observe the lumbosacral spine
Have the patient sitting (ensure the patient is stabilized from the waist down)
*flexion
*extension
*lateral flexion
*rotation
How to test strength for the lumbosacral spine
Have the patient sitting then bend forward against hands
What is an inappropriate tool to use to measure lumbar sacral spine ROM
Goniometer
*mainly used for a single axis joint (shoulder, knee)
What are some factors that will limit the lumbar sacral spine ROM
Quantity
*tight hamstrings limit lumbo pelvic forward bending and stress lumbar spine to over-flex
Quality
*unilateral facet contracture causes deviation toward affected side with flexion
What can be used to test ROM of the lumbar sacral spine
Inclinometer
*fluid filled
*needle is mobile
How to test lumbar sacral spine flexion
- Have patient bend forward to touch toes
*lumbar lordosis should decreased
*movement should be smooth and symmetrical
How to measure degree of flexion for the lumbar sacral spine flexion
- Mark spine at L-S junction as well as 10 cm above and 5cm below this mark
- With flexion, will normally see a 4cm increase between the marks
How to test for lumbar extension
- Stabilize the pelvis and have the patient bend backwards
- Goal is spine movement not LE
*causes pain in 60-75% of individuals
How to test for lumbar rotation
- Stabilize the pelvis
- Easiest to do with patient seated
- Have patient twist to the left and to the right
How much of the humeral head is in contact with the glenoid
25% of the humeral head
*humeral head coverage increased up to 75% with glenoid labrum
*joint space thinning is seen with OA
What are the rotator cuff muscles and what is their function
SITS
Surprapspinatus
Infraspinatus
teres minor
Subscapularis
*keeps humeral head within joint
*Abduction, external rotation, internal rotation
What to ask if someone is presenting with a RCT
Difficulty sleeping
*may sleep in a recliner
Outstretched / overhead use
*having elbow away from body is painful
*difficulty reaching behind back
What will be present on a glenohumeral dislocation
Missing rounded contour of the deltoid
*anterior most often
Asymmetry of the shoulder can indicate what
Patients with a RCT
*shoulder will be higher
*RCT is a humeral head depressor
What can atrophy of the shoulder be indicative of
Sign of chronic glenohumeral joint pathology
*may be seen with chronic RA
What can effusions of the shoulder be due to?
Capsule redundancy
*will hide a lot of fluid
What are the normal ranges of AROM for the shoulder
- Forward flexion 160 to 190
- Abduction 160/adduction
- External rotation 70 to 90
- Internal rotation 60 to 90
What is the apley scratch test for
Assess both abduction and ER at the same time and IR and adduction
How to assess PROM in the shoulder
- Immobilize the scapula to prevent rotation
*use one arm to push down on shoulder
*use other arm to do the PROM exercises - Abduction
- Internal and external rotation
How to passively assess shoulder internal and external rotation
- Have arm at patients side with elbow flexed at 90 and abduct to 90 degrees
- Can also assess with shoulder abducted to 90 degrees
*IR is down
*ER is up
How to assess for scapular winging
Push-ups against the wall
What to focus on with injuries to the elbow
Repetitive activities
What surface anatomy are you observing for the elbow
- Medial epicondyle
- Lateral epicondyle
- Olecranon
- Ulnar groove
What is the carrying angle for men and women
5-10 men
10-25 women’s (hips)
*arm is at side with palm in supination, forearm deviates towards the thumb (valgus)
What do the medical epicondyle, lateral epicondyle and olecranon from when flexed and in extension
Flexed = isosceles triangle
Extension = straight line
What is normal flexion and extension of the elbow
Flexion = 145 to 155
Extension = 0
*if hyperextends “cubits recurvatum”
*doesn’t fully extend then flexion contracture
How to test elbow strength
- Flexion and extension
- Pronation and supination
- Wrist flexion and extension
*bc the attachments at the elbow are wrist flexors / extensors
What is the Brachioradialis
Forearm flexor
What are you palpating for at the wrist
- Distal radius (styloid)
- Anatomical snuff box (at the level of the wrist over scaphoid)
- Distal ulna (styloid)
- Triangular fibrocartilage (ulnar side of wrist)
- Extensor carpi ulnaris tendon
What does the triangular fibrocartialge look like on X ray
Triangle
*dark on X ray
What are the normal flexion, extension, radial / ulnar deviation of the wrists
Flexion / extension = 90
Radial / ulnar deviation = 20 R 30 U
How to test the ROM of the fingers
Flexion = make a fist
Extension = put all digits straight
Abduction = spread all fingers
Adduction = fingers all together
Thumb flexion and extension = touch base of pinky (f) hitch hike (e)
Thumb palmar abduction = sticking in front and away from palm
Thumb adduction = attach to index finger
How should you tell the patient to direct where the pain is located
Point with one finger to painful area
What does groin and lateral pain indicate
Groin pain = true hip pathology
Lateral = muscular or bursal etiology
What does unequal heights of the iliac crest (knee creases or buttocks) mean
Unequal leg lengths
What is the traditional method to determine leg length discrepancy
Use bony landmarks and tape measure
*but the flesh will move
1. Have the patient supine, flex knees with heels together. Keep hips and heels square (look at knees)
2. Measure the distance between the ASIS and the medial medial malleolus
How to measure leg lengths when the legs are straight and hips are square
Examiner will pull on the legs with the thumbs distal to medial malleoli
*observe location of thumbs
What are the normal ranges of the hip
Flexion = 0-125 knee straight, should be more with knee flexed
Extension = 0-15 knee straight
Adduction 45 to 0
Abduction 0 to 45
Internal rotation 0 to 45
External rotation 0 to 45
What is the trendelenburg sign
Pelvis tilts / tip towards the normal side when weight is put on the affected / weakened side
What is the trendelenburg gait
- Abnl gait due to weakness of gluteus medius msucles
- Pelvis on unaffected side drops the moment of heel strike on the affected side
- Lateral deviation of the trunk towards affected side
What are the three articular surfaces of the knee
Medially
*femoral condyle and tibial plateau
Laterally
*femoral condyle and tibial plateau
Patellofemoral joint
What are the knee ligaments and their functions
ACL
*prevents anterior tibial displacement
PCL
*prevents posterior tibial displacement
MCL
*prevents abduction and internal tibial rotation
LCL
*prevents adduction of the tibia
What is genu Varum and genu valgum
Varum = bow legged
Valgum = knock kneed
How to palpate the popliteal space
Best done with the patient standing
What are the normal ranges of motion for the knee
Extension = -10 to 0
Flexion = 135 to 150
*complete when supine “touch heels to buttocks”
What is related to neurological problems pes cavus or pes planus
Pes cavus
*high arch
What are the normal ranges for ankle ROM
Extension / Dorsiflexion = 20 degrees
Flexion / plantar flexion = 50 degrees
Inversion = 5 degrees
Eversion = 20 degrees
