Physical MSK Exam Correlates Flashcards
cervical nerve roots are named for….
the vertebra below them (vs T/L named for vertebra above!)
this gives us a C8
why start c spine exam at c5?
c1 and 2 are rare and catastrophic (no appointment)
C3/4/5 keep diaphragm alive
C5
strength - blocker - deltoid and biceps
sensation - lateral arm, biceps reflex
c6
strength - beggar - wrist extensors
sensation - 6 shooter, thumb/index finger
brachioradialis reflex
c7
motor - kisser - triceps, wrist flexors
sensation - 7 heaven - middle finger
triceps refex
c8
motor - grabber - finger flexors
sensation - ulnar forearm, palmar pinky
t1
motor - spock - finger abduction (interossei)
sensation - medial elbow
how to test for disc herniation and spondylolysis
spurlings test - bend, rotate, and extend
compresses posterior exiting roots
urgent injury requiring neurosurgical decompression, compression of terminal nerve roots in L spine
cauda equine syndrome
most common msk condition
lower back pain
spine flexion causes _______ compression –> pushing nucleus pulposa _______
anterior; posteriorly
two red flags of cauda equine syndrome
bowel or bladder changes
and
saddle anesthesia or sensation changes
7 red flags of history
history of cancer night pain constitutional symptoms: fever, weightloss, nightsweats trauma numbness bowel/bladder changes saddle sensation changes
common vertebra for nerve compression
L4, L5, S1
L4
motor-tibialis anterior
sensation - medial foot/ankle
reflex - patellar (quads)
L5
motor- ext halluces longus (big to dorsiflexion)
sensation - dorsal foot
S1
motor - plantar flexion
sensation - lateral foot/ankle
Achilles reflex
FABER
flexion ABduction external rotation
positive straight leg raise –>
neural tension
positive single leg stork–>
spondylolysis - stress fracture of pars interarticularis
fracture of pars interarticularis
scottie dog neck –> vertebral slippage
hip vs shoulder - which is true ball and socket
hip.
shoulder sacrifices stability for mobility (30% contact of glenoid + labrum which increases contact area)
rotator cuff muscles
supraspinatous infraspinatous teres minor subscapularis SITS
reason for rotator cuff force
sit close to joint surface
which way do rotator cuff muscles steer?
infero-medial force
impingement syndrome
if the rotator cuff muscles do not counteract the upward force of beach muscles (deltoid, pecs, lats) then supraspinatous and subacromial burse get pinched between humeral head and acromion
how many bones in feet?
26
2 arches in foot that act as springs
transverse arch side to side longitudinal arch (heel to metatarsals
plantar fasciae
electrically and physically connected to musculature
when stretched corresponding nerves end signals to fire musculature of the gastroc/soleus to complete gait cycle
degeneration of the plantar fascia where it attaches at calcaneus
plantar fasciitis
most ankle sprains occur at
ATFL anterior talo-fibular ligament
medial ankle ligament
deltoid ligament
if foot is flat, first ligament to get injured is?
if in air plantar flexion?
which is most common?
flat - CFL calcaneofibular ligament
air - MOST COMMON - ATFL (ankle unstable)
SYNDESMOSIS of tibia and fibula
where the bones join via interosseus ligament
what test to use to check for Achilles rupture?
Thompson squeeze
ankle anterior drawer tests for?
ATFL integrity
test for CFL integrity?
talar tilt/varus stress
most common cause of overuse shoulder pain
impingement syndrome
the only bony bridge from the upper extremity to the spine
clavicle
an inferiorly directed overload force will cause…
AC joint disruption (shoulder separation)
medially directed overload force will cause…
S curve clavicle fracture
what allows for the final 10-20 degrees of shoulder abduction and forward flexion?
AC joint
if there is atrophy in muscles, what is present?
a nerve injury!
painful arc of impingement
at the end of abduction, ac joint becomes maximally compressed and so when hand is raised over head (about 80-130 degrees) there is pain
indicates shoulder impingement
squared shoulder indicates
anterior glenohumeral dislocation
what test is for supraspinatous?
empty can strength test
what does lift off test test?
subscapularis
neers test
thumb down and passive shoulder flexion
+ = impingement
what do impingement tests try to do?
greater trochanter is rotated under the acromion to narrow subacromial space
two impingement of shoulder tests?
neers and hawkins
instability shoulder test?
apprehension
sensation that shoulder will dislocate or pop out of joint
scarf test is for,,,
AC joint pain
origin of most elbow pain
lateral epicondyle
what runs through the medial epicondyle?
ulnar nerve
what bone spans both rows of carpals?
scaphoid
FOOSH
fall on outstretched hand
scaphoid fracture
blood supply for this bone runs distal to proximal so healing could be compromised
what two tendons cause dequervains tenosynovitis?
abductor policis longus and extensor policis brevis
what is the test for dequervains syndrome?
finkelstein
big bony C with a tough transverse ligament over the top
carpal tunnel
carpal tunnel syndrome
9 flexor tendons AND medial nerve
compact space can get inflamed and irritated
pressure causes median nerve to get irritated and damaged
superficial flexor goes to,…
deep flexor goes to…
s - middle phalynx
d - distal phalynx
what does resisted long finger extension test?
lateral epicondylitis
lateral elbow triangle is formed by
lateral epicondyl, radial head, and olecranon
allen test
plug ulnar and radial arteries and watch color to return to make sure they are both working
two tests for carpal tunnel?
phalen maneuver
tinels test
parasthesia or tingling = +
which quad spans two joints?
rectus femoris
hips muscles that span two joints?
rectus femoris
sartorius
IT band
hamstrings
Fadir
flexion adduction and internal rotation
what run down the sides of knees and provide side to side stability
MCL and LCL
what provide knee front to back stability?
ACL/PCL
___ is always in front and goes lateral to medial
ACL (lateral femoral condyle to front of tibia
three things excessive rotation of knee can cause
meniscus tears
cruciate ligament injurt
patellorfemoral pain
overuse (non acute) knee pain is caused by
vague pain, increased pain with increased activity, and history of increased physical activity
effusion is…
fluid INSIDE a joint capsule
what is the test for effusion?
warm cold warm test and loss of skin dimples
knee pain –> chronic, and has effusion
meniscus tear
osteo/reactive arthritis
infection
gout
knee pain, chronic NO effusion
IT band, pes anserine bursa, politeal cyst, patellofemoral syndrome
knee, trauma and no effusion
collateral ligament or popliteal cyst
knee, trauma and effusion
fracture, dislocation, ligament injury
which horns of menisci are more likely to tear?
posterior
LCL and MCL - what do they feel like
LCL -pencil like
MCL - broad
they never tear in the middle
baker cyst
popliteal cyst caused by meniscal tear, arthritis, or cartilage damage
three muscles at pes anserine
sartorius, gracilis, semitendinosus
two tests for menisci
mcmurrays and thessaly
tests for acl and pcl
acl - anterior drawer and lachmans(the most sensitive)
pcl - posterior drawer
what does the varus and valgus stress tests check (knee)
MCL, LCL
4 patellar tests
compression
shrug
retropatellar facets
apprehension
patellorfemoral sydrome
increased pysical activity –> pain and crepitus
anterior knee pain
treat with stretch and strengthening
special tests for ankle
talar tilt (CFL) anterior drawer (ATFL) thomson squeeze (achilles rupture) proprioreception (ligaments in tact)
knee special tests
patellar - compression, retropatellar, apprehension, shrug
meniscal - mcmurrays, thessaly
ligaments - post/ant drawers, lachmans, varus and valgus
shoulder special tests
neers
hawkins
apprehension
elbow special tests
resisted long finger
wrist and hand special tests
allen test
phalen and tinels
finklesteins
L spine tests
Left and right straight leg raise
FABER
single leg stork
C spine special test
spurlings
