Practical Flashcards
Subjective Interview
-establish relationship and trust
-Determine understanding of PT
-Determine understanding of condition
-search for clues about condition
-determine current interventions from other clinicians
-Medications
-look for red flags
-determine what to examine
-formulate hypothesis
Biopsychosocial Model
Biology: how does their body work
Psychology: current mindset
Social: what do they do, what is around them, who is around them
Patient History
-Determine understanding of condition
-determine current interventions from other clinicians (current and other conditions)
-prior level of function
-health habits/risks
-Medications
-past PT experiences
-Family Hx
Patient Environment
-Physical environment
-Living environment/Assistance
-Work/recreation/social/school/sport
Mental Orientation Assessment
-AOx3
-Name, location, current date
C1/C2
Chin in/up
C3
Cervical lateral flexion
C4
Shoulder elevation
C5
Shoulder abduction
C6
-Elbow flexion
-Wrist extension
C7
-elbow extension
-wrist flexion
C8
Thumb extension
T1
Finger abduction/adduction
L2
Hip flexion
L3
Knee extension
L4
Ankle dorsiflexion
L5
Big toe extension
S1
Ankle Plantarflexion
S2
Knee flexion
Sensory Grading
Absent: 0
Impaired: 1
Normal: 2
Not Testable: NT
C3 Dermatomes
Clavicle
C4 Dermatomes
Shoulder
C5 Dermatomes
Upper arm
C6 Dermatomes
-Lateral forearm
-Thumb
-2nd finger
C7 Dermatomes
Middle Finger
C8 Dermatomes
Last 2 fingers
T1 Dermatomes
Medial forearm
L1 Dermatomes
Cooch pit
L2 Dermatomes
Upper thigh
L3 Dermatomes
Medial knee
L4 Dermatomes
Medial Malleolus
S1 Dermatomes
-under Lateral Malleolus
-Heel
L5 Dermatomes
-front of shin
-dorsum of foot
C2 Dermatomes
Back of head/neck
S2 Dermatomes
-popliteal space
Deep Tendon Reflex Grades
No reflex: 0
Minimal Response: 1+
Normal: 2+
Overly Brisk: 3+
Extremely brisk; cross over reaction: 4+
Biceps Tendon
C5
-Elbow flexion
Brachioradialis Tendon
C6
-radial dev
Triceps Tendon
C7
-elbow extension
Patellar Tendon
L4
-knee extension
Achilles Tendon
S1
-plantarflexion
CN I
Olfactory (sensory)
-smell
1) cover 1 nostril and smell different
CN II
Optic (sensory)
-visual acuity
1) consensual contralateral light response
2) eye chart
CN III
Oculomotor (motor)
-eye movement
1) eye movements except lateral and down/in
2) consensual ipsi light response
3) cover eye and pupillary constriction of contra
CN IV
Trochlear (Motor)
-eye movement (down and in)
-H test
CN V
Trigeminal (Both)
-Mandibular movement and face sensation
Motor: clench jaw and feel masseter and temporalis
Sensory: check in forehead (ophamalic), checks (maxillary), and jaw (mandibular)
CN VI
Abducens (motor)
-lateral eye movements
-H test
CN VII
Facial (both)
-facial movement and taste
Motor:
1) smile
2) frown
3) move eyebrows
Sensory:
-close eyes and place sweet/salt on anterior 2/3rds of tongue
CN VIII
Vestibulocochlear (sensory)
-hearing and vestibular
Hearing:
1) rub fingers together
2) whisper word identification
3) Weber Test: tuning fork on head
4) Rhine Test: tuning fork on mastoid
Vestibular:
1) touch nose then pt finger
2) turn head while looking at thumb
CN IX
Glossopharyngeal (Both)
-gag reflex and taste
Sensory:
1) sour/bitter taste on posterior 1/3 tongue
Motor:
1) swallowing
CN X
Vagus (both)
Motor:
1) saw ah, uvula deviation to strong side
2)Swallowing
3) SCM
Sensory
CN XI
Accessory (motor)
1) shoulder shrug
2) head turning
CN XII
Hypoglossal (motor)
1) stick tongue out, deviates to weak side
Cerebellar UE
-dysmetria finger to nose (5 times)
-Diysdiadochokinesia: pronation/supination
-rebound test
Cerebellar LE
-hell shin test: 5 times
-romberg: 30 s arms crossed EO/EC
-toe tapping
-gait
UMNL Testing
-hypereflexia, hypertonia
-Clonus: forced DF; foo quickly PF
-Babinski: foot scrape; toe abduction
-Hoffman: middle finger flick; finger flexion with “C”
-Pronator Drift
-Shimizu: twitch of shoulder
Coordination Testing Recommendations
-test 1 of each: UP, LE, unsupported gait
Dysmetria
-error in trajectory
-inability to touch target
Dysdiadochokinesia
-inability to perform rapid alternating mmts
Standing Tests
-Romberg
-Tandem Sharpend Romberg
LMNL
-hyporeflexia, weakness, atrophy
Sensation Testing Order
-test sensation on face EO/EC
-test sensation on extremeties
-dermatomes
-unpredictable pattern
-check dermatome vs peripeheral
-check another tract
Evaluation Testing Order
-Dermatome
-Dermatome vs PN
-Myotome
-Reflex
-ROM Screen
-ROM Testing
-Manual Muscle Testing
Red Numbers Goni
-0-90
Black Numbers Goni
-0-180
Arc Format of ROM
Starting (or hyper) -0 (or hypo)- endrange
Spine MMT Scale
0: no contraction
1: Contraction w/o movement
2: partial ROM against gravity
3: Full ROM AG, no arms by side
4: Full ROM AG, arms crossed
5: Full ROM AG, hands behind head
Manual Muscle Testing Scale
0: no contraction
1: Contraction w/o movement
2-: Move through partial ROM with GR
2: Full ROM with GR
2+: Full ROM with GR and Resistance OR partial ROM against gravity
3: Full ROM AG, no resistance
4: Full ROM AG, some resistance
5: Full ROM AG, max resistance
Elbow ROM Values
Flexion: 140-150
Extension: 0
Supination: 80
Pronation: 80
Wrist ROM Values
Flexion: 80
Extension: 70
Rad Dev: 20
Ulnar Dev: 30
Finger ROM Values
-MCP:
Flex/ext: 90/45
-PIP:
-Flx/Ext: 100/0
-DIP:
-Flx/Ext: 90/0
Cervical Flexion Inclinometer ROM
-Cranium to T1
-50
Cervical Flexion Goni ROM
-0-40
Stationary: Perp. floor
Axis: Ear hole
Movement: Base of nose
-take resting, subtract from final number
Cervical Extension Tape Measure ROM
-Chin to sternal notch
Cervical Extension Inclinometer ROM
-superior cranium and T1
Cervical Extension Goni ROM
0-50
Stationary: Perpendicular to floor
Axis: ear hole
Movement: Base of nose
Cervical Lateral Flexion ROM Tape Measure
-Mastoid to lateral acromion
Cervical Lateral Flexion ROM Inclinometer
-Superior cranium to T1 (frontal plane)
Cervical Lateral Flexion ROM Goni
-0-22 (180 hold)
Stationary: Perp to floor
Axis: C7
Movement: bisect cranium
Cervical Rotation ROM Tape Measure
-Tip of nose to lateral acromion
Cervical Rotation ROM Inclinometer
-PROM
-Supine
-Center of forehead (frontal plane)
Cervical Rotation ROM Goni
-0-50
Stationary: btwn acromion
Axis: Center of cranium
Movement: nose
Cervical AROM Values
Flx: 40
Ex: 50-70
LSB: 22
Rot: 70-90
Thoracolumbar AROM Values
Flx: 60
Ex: 25
LSB: 35
Rot: 45
Lumbar AROM Values
Flx: 40-50
Ex: 15-20
LSB: 25
Cervical End Feel
firm
T/L Spine Flexion/extension: Inclinometer
-flex 60 and ext 25
-t1 to s2
T/L Spine Lateral Flexion: Goni
-35 (180 hold)
Stationary: perp to ground
Axis: S1
Movement: c7
T/L Spine Lateral Flexion: Inclinometer
-25
-t1 to s2
T/L Spine Rotation: Goni
-45
Stationary: between iliac crest
Axis: top of head
Movement: bwteen acromion
Thoracic Spine Flexion/Extension: Tape Measure
-C7 to L1
-Stop when pelvis tilts
-for flexion que patient to bend with their head first (slide, hands-down legs)
-for extension que patient to look up at the ceiling and lift their chest
Lumbar Spine Flexion/Extension: Tape Measure
-T12 to S2
T/S Spine Flexion/extension: Tape Measure
-c7 to S2
Floor: middle finger tip to floor
T/S Spine Lateral Flexion: Tape Measure
Floor: middle finger tip to floor
Lumbar Spine Flx/Ext: Inclinometer
-flx: 60 and ex: 25
-t12 to s2
Lumbar Spine Lat flx: Inclinometer
-25
-t12-s2
Shoulder End Feels
firm
Shoulder ROM Values
Flexion: 180
Extension: 50-60
Abd: 180
Internal Rot: 70-80
External Rot: 90
Flexion: Shoulder Complex
-180
-stabilize trunk
Stationary: mid thorax
Axis: greater tub
Movement: lat epi
Flexion: GH
-120
-stop when scap moves
-stabilize trunk and scap
Stationary: mid thorax
Axis: greater tub
Movement: lat epi
Extension: Shoulder Complex
-60
-prone
-stabilize trunk
Stationary: mid thorax
Axis: greater tub
Movement: lat epi
Extension: GH
-20
-prone; stop when scap moves
-stabilize trunk and scap
Stationary: mid thorax
Axis: greater tub
Movement: lat epi
Abduction: Shoulder Complex
-180
-supine
Stationary: parallel to sternum
-stabilize trunk
Axis: ant. acromion
Movement: bisect humerus
Abduction: GH
-100-130
-supine; stop when scap moves
-stabilize trunk and scap
Stationary: parallel to sternum
Axis: ant. acromion
Movement: bisect humerus
IR/ER: Shoulder Complex
-IR: 70 ER: 90
-supine; 90/90; towel under humerus
-stabilize trunk
Stationary: perp to ground
Axis: olecranon
Movement: bisect ulna
IR/ER: GH
-IR: 50-60 ER: 90
-supine; 90/90; towel under humerus; stop when scap moves
-stabilize trunk and scap
Stationary: perp to ground
Axis: olecranon
Movement: bisect ulna
Elbow Flexion/Extension Goni
-0 (hard)-150 (soft)
-supine
-towel under elbow for hyperextension
Stationary: acromion
Axis: lateral epi
Movement: radial styloid
Forearm Pronation Goni
-80 (firm)
-sitting, elbow flexed
Stationary: midline of humerus
Axis: ulnar styloid
Movement: dorsal wrist
Forearm Supination Goni
-80 (firm)
-sitting, elbow flexed
Stationary: midline of humerus
Axis: ulnar styloid
Movement: ventral wrist
Wrist Extension/Flexion Goni
-flexion: 80
-Extension: 70
-firm
Stationary: lateral ulna
Axis: triquetrum
Movement: 5th metacarpal
Wrist Radial/Ulnar Deviation Goni
-radial: 20 (hard)
-ulnar: 30 (firm)
Stationary: midline of forearm
Axis: dorsal capitate
Movement: 3rd metacarpal
MCP 2-5 Flx/ext
Flx: 90 (firm)
Ext: 45 (firm)
Stationary: Midline of metacarpal
Axis: Dorsal MCP
Movement: Dorsal phalanx
MCP 2-5 Ab/Ad
-45 (firm)
Stationary: Midline of metacarpal
Axis: Dorsal MCP
Movement: Dorsal phalanx
PIP and DIP Flx/Ext
PIP flx: 100
DIP flx: 90
Stationary: Proximal phalanx
Axis: Dorsal IP
Movement: Distal phalanx
CMC Thumb Flx/Ext
Flx: 15 (soft)
Ext: 20 (firm)
Stationary: Ventral midline of radius
Axis: Palmar 1st CMC
Movement: Midline of 1st MC
CMC Thumb Adduction
-0
Stationary: Lateral midline of 2nd MC
Axis: Lateral Radial Styloid
Movement: Midline of 1st MC
CMC Thumb Abduction
-70
Stationary: Ventral midline of radius
Axis: Palmar 1st CMC
Movement: Midline of 1st MC
MCP Thumb ROM
Flx: 50-60
Ext: 0
Stationary: Dorsal midline of metacarpal
Axis: Dorsal MCP
Movement: Dorsal midline of proximal phalanx
IP Thumb
Flx: 80
Ext: 20
Stationary: Dorsal midline of proximal phalanx
Axis: Dorsal IP
Movement: Dorsal midline of distal phalanx
Thumb Opposition
-check if can reach pinky MCP
-measure distance from tip to MCP
Composite Flexion
-distance of tip of finger to distal palmar crease
Deep Cervical Flexors MMT
-longus colli (c2-c6)
-use fourth or fifth digit to apply resistance to the chin to untuck it
90/90 arms
-head nod, no lifting
Cervical Flexors MMT
-longus Capitus, SCM (CN XI and Ventral rami C2 and C3), Ant. scalene
90/90 arms
-Supine
-Chin to test; push forehead; gaurd behind the head
Cervical Extensors MMT
-errector Spinae (Dorsal rami C1-C8), Capitus, upper Trap
-Prone; 90/90
-Lift head off table (no sternum); push base of cranium; guard front
Cervical Anterolateral Flexors MMT
-SCM (CN XI and Ventral rami C2 and C3)
-supine; 90/90 arms
-ipsi Lateral flexion and contra rotation; push forehead; guard behind
Grading Scale
0, 1, 2 , 3, 4, 5
Trunk Flexion MMT: Upper Abs
-Rectus ab (T7-t12)
-Supine; inf angle of scap must clear
2: partial
3: stretch toward toes
4: arms crossed
5: arms behind head
Trunk Flexion MMT: Lower Abs
–Rectus ab (T7-t12)
-Supine w/ hips flexed; arms crossed
2: angle greater than 70 when pelvic tilts
3: angle 70-30 when pelvic tilts
4: angle 30 when pelvic tilts
5: angle 0
Trunk Extension MMT
-errector spinae (T1-L5)
-Prone; pillow under abdomen; stablize thighs; sternum clears
2: partial
3: arms at side
4: arms behind back
5: arms behind head
Pelvic Elevation MMT
-quadratus lumborum (T12-L4)
-supine; hold sides of table; elevate test side of pelvis toward shoulder
Scapular Elevation MMT
Muscle: Upper Trap (CN XI and ventral rami c3-c4) & Levator (C3-c5 dorsal scapular n)
Position: Sitting
Palpate: Trap at clavicle
Movement: Shrug shoulder amd lat flex and rotate head away; with hands crossed at mastoid and top of shoulder resist
Stabilize: Top of shoulder
GR Position: Prone shrug
Scapular Adduction MMT
Muscle: Middle trap (CN XI and ventral rami c3-c4)
Position: Prone; 90/90 thumb up; head on opposite side
Palpate: middle trap near midline
Movement: Lift arms; push medial border into protraction OR long lever at distal humerus then functional at wrist
Stabilize: Contra thorax
GR Position: Seated; towel under straightened elbow to side; thumb up
Scapular Depression and Adduction MMT
Muscle: Lower Trap (CN XI and ventral rami c3-c4)
Position: Prone; thumb up; arm in y pose (130 ab), head on opposite side
Palpate: lower trap near SP
Movement: Lift arm and push scap down into hand; resist on medial boarder of scap OR at distal humerus then functional at wrist
Stabilize: contra thorax
GR Position: N/A
Scapular Downward Rotation and Adduction MMT
Muscle: Rhomboids (C5 dorsal scap n)
Position: Prone; hand behind back; head on opposite side OR UE bent in slight abd (chicken wing)
Palpate: Rhomboids between med border
Movement: lift hand and resist a medial border OR olecranon
Stablize: Contra throax
GR Position: Seated (not for AP)
Scapular Upward Rotation and Abduction MMT
Muscle: Serratus Ant. (c5-C7 long thoracic)
Position: Seated, scaption (130)
Palpate: btwn ribs and ant scap
Movement: Lift arm and stand in front and resist distal humerus AND lat border of scap resisting UR
Stabilize: Ipsi shoulder GH
GR Position: N/a
Shoulder Flexion MMT
Muscle: ant. delt (c5-c7 axillary) and coracobrach (c5-c7 musculocute)
Position: Seated, thumb up
Palpate: ant delt
Movement: lift arm; resist distal humerus then wrist for functional
Stablilize: superior acromion
GR Position: sidelying
Shoulder Extension MMT
Muscle: c5-c8 post delt (axillary), lats (thoracodorsal), teres minor (subscap)
Position: prone; palm up
Palpate: lateral ribs near lat
Movement: lift arm, resist distal humerus
Stabilize: ipsi thorax
GR Position: sidelying
Shoulder Scaption MMT
Muscle: ant delt, mid delt, supraspinatus (c5-c7)
Position: seated, thumb up
Palpate: supraspinatus
Movement: lift arm, resist distal humerus
Stabilize: superior acromion
GR Position: semi-sidelying
Shoulder Abduction MMT
Muscle: c5-c6 mid delt and supraspinatus (suprascap)
Position: Sitting,
Palpate: mid delt
Movement: lift arm, resist distal humerus
Stabilize: superior acromion
GR Position: Supine
Shoulder Horizontal Abduction MMT
Muscle: post delt (c5-c6) axillary
Position: prone, 90 elbow, neural shoulder
Palpate: post delt
Movement: lift elbow toward back, resist distal humerus
Stabilize: ipsi thorax
GR Position: seated with elbow on towel, palm down
Shoulder Horizontal Adduction MMT
Muscle: pec major (c5-t1 med and lat pectoral nerves)
Position: Supine, edge of bed,
Palpate: pec major lateral side
Movement: General: flexed arm across body; resist at distal humerus
Clavicular: straight arm
Sternal: straight arm; thumb toward opposite ASIS
Stabilize: ipsi lat clavicle
GR Position: sitting; elbow on towel
Shoulder External Rotation MMT
Muscle: infraspinatus (c5-c6 suprascapular) & teres major (c5-c6 axillary)
Position: Prone; 90/90; use towel
Palpate: teres major
Movement: Lift arm; resist distal radius using webspace
Stabilize: Scapula
GR Position: Prone with dangling arm
Shoulder Internal Rotation MMT
Muscle: subscap (c5-t1 upper and lower subscapular) & pec major (c5-t1 me and lat pectoral) & lats (c5-t1 thoeracodorsal)
Position: Prone; 90/90; use towel
Palpate: subscap under scap
Movement: Lift arm posteriorly; resist distal radius using webspace, PT in front of
Stabilize: upper scap
GR Position:
Elbow Flexion MMT (Biceps)
Muscle: Bicep (c5-c6)
Position: Sitting; palm up
Palpate: Bicep
Movement: Flex then go to 90; pull wrist
Stabilize: ipsi acromion
GR Position: Sitting w/ arm on table, palm facing pt
Elbow Flexion MMT (Brachialis)
Muscle: Brachialis (C5-c6)
Position: Siting, palm down
Palpate: Medial to bicep
Movement: Flex then go to 90; pull wrist
Stablize: ipsi acromion
GR Position: Sitting w/ arm on table, thumb dragging
Elbow Extension MMT
Muscle: Tricep (C7-c8)
Position: Supine; shoulder at 90, supination
Palpate: Tricep
Movement: Extend elbow; push distal wrist
Stablize: ipsi acromion
GR Position: Sitting w/ arm on table
Elbow Flexion MMT (Brachioradialis)
Muscle: Brachioradialis (C5-c6)
Position: Siting, thumb up
Palpate: Anterolateral forearm
Movement: Flex then go to 90; pull wrist
Stablize: ipsi acromion
GR Position: Sitting w/ arm on table, thumb facing patient
Forearm Supination MMT
Muscle: Supinator (PIN c5-c6)
Position: Sitting, elbow 90, pronated
Palpate: Supinator; anterior lateral radius
Movement: Supinate; try to put them into pronation
Stabilize: Elbow
GR Position: Sitting, arm up, transverse plane
Forearm Pronation MMT
Muscle: Pronator Teres (median c6-c7)
Position: Sitting, elbow 90, supinated
Palpate: Pronator Teres
Movement: Go into pronation, try to put into supination
Stabilize: Elbow
GR Position: Sitting, arm up, transverse plane
Radial Wrist Flexion MMT
Muscle: FCR (c6-c7) Median
Position: Supinated wrist flexion
Palpate: Proximal forearm over radius
Movement: Flexion; reisist over metacarpals 1 and 2 into flexion and ulnar dev
Stabilize: Dorsal forearm
GR Position: Forearm in midpronation; test both FCU and FCR
Ulnar Wrist Flexion MMT
Muscle: FCU (c7-c8) Ulnar
Position: Supinated wrist flexion
Palpate: Proximal forearm over ulna
Movement: Flexion; reisist over 5th metacarpal into extension and rad dev
Stabilize: Dorsal forearm
GR Position: Forearm in midpronation; test both FCU and FCR
Radial Wrist Extension MMT
Muscle: ECRL Radial (c6-c7)
Position: Sitting; arm pronated
Palpate: Dorsal Proximal Forearm over radius
Movement: Extend Wrist; resist using metacarpals 1 and 2 into flexion and ulnar dev
Stabilize: Ventral forearm
GR Position: Forearm in midpronation; test both ECU
Ulnar Wrist Extension
Muscle: ECU (PIN c7-c8)
Position: Sitting; arm pronated
Palpate: Dorsal Proximal Forearm over ulna
Movement: Extend Wrist; resist using 5th metacarpal into flexion and rad dev
Stabilize: Ventral forearm
GR Position: Forearm in midpronation; test both ECU and ECRL
Finger MCP Flexion MMT
Muscle: Lumbricals (c8-t1)
Position: Sitting; palm up
Palpate: Palm, in between metacarpals on radial side, fingers extended
Movement: Flex then go to 90; pull proximal phalynx all together
Stabilize: Wrist
GR Position: Sitting w/ arm on table, neutral forearm; allow MCP flx
Finger PIP Flexion MMT
Muscle: FDS (c8-t1)
Position: Sitting; palm up
Palpate: Middle forearm
Movement: Flex then go to 90; hold proximal phalynx, and resist middle phalynx 1 finger at a time
Stabilize: Proximal phalynx
GR Position: Sitting w/ arm on table, neutral forearm; allow MCP flx
Finger DIP Flexion MMT
Muscle: FDP (c8-t1)
Position: Sitting; palm up
Palpate: Middle forearm over ulna
Movement: Flex then go to 90; hold middle phalynx, and resist distal phalynx 1 finger at a time
Stabilize: Middle phalynx
GR Position: Sitting w/ arm on table, neutral forearm
Finger MCP Extension MMT
Muscle: Extensor Digitorum (c7-c8)
Position: Sitting; palm down, wrist over edge
Palpate: Middle forearm
Movement: Extend MCPs, and resist proximal phalynx 1 at a time
Stabilize: Metacarpals
GR Position: Sitting w/ arm on table, neutral forearm;
Finger Abduction MMT
Muscle: DABS (c8-t1)
Position: Sitting; palm down, wrist over edge
Palpate: Dorsal side of hand between metacarpals
Movement: Splay finger and use 1 finger to apply resistance
Stabilize: Wrist
GR Position: N/a
Thumb MCP Flexion MMT
Muscle: Flexor Pollicis Brevis (c8-t1)
Position: Sitting; palm up
Palpate: Thenar pad
Movement: Flex; resist at proximal phalanx ; IP stays extended
Stabilize: 1st metacarpal
GR Position: N/a
Thumb IP Flexion MMT
Muscle: FPL (c8-t1)
Position: Sitting; palm up
Palpate: 2 inch above wrist on radius
Movement: Flex IP; hold proximal phalynx, and resist Distal phalynx
Stabilize: Proximal phalynx
GR Position: N/a
Thumb MCP Extension MMT (EPB)
Muscle: EPB (c7 -c8)
Position: Sitting; palm up
Palpate: dorsal didtal wrist
Movement: Extend MCP; hold metacarpal, and resist proximal phalynx
Stabilize: 1st metacarpal
GR Position: N/a
Thumb IP Extension MMT
Muscle: EPL (c7-c8)
Position: Sitting; palm up
Palpate: 2 inch above dorsal wrist midline
Movement: Extension IP; hold proximal phalynx, and resist Distal phalynx
Stabilize: MCP joint
GR Position: N/a
Thumb Abduction MMT (APL)
Muscle: APL (c6-c7)
Position: Sitting; palm up
Palpate: base of the 1st metacarpal
Movement: Abduction; and resist metacarpal
Stabilize: n/a
GR Position: Pronation
Thumb Abduction MMT (APB)
Muscle: APB (c8-ti)
Position: Sitting; palm up
Palpate: base of the 1st metacarpal
Movement: Abduction; and resist prox phalynx
Stabilize: n/a
GR Position: Neutral
Finger Adduction MMT
Muscle: PADS (c8-t1)
Position: Sitting; palm down, wrist over edge
Palpate: Dorsal side of hand between metacarpals 4 and 5
Movement: Bring fingers together and use 1 finger to apply resistance
Stabilize: Wrist
GR Position: N/a
Thumb Adduction MMT
Muscle: Adductor Pollicis (c8-t1)
Position: Sitting; palm down
Palpate: Thenar webspace
Movement: Adduction; and resist medial proximal phalynx
Stabilize: Metacarpals
GR Position: Neutral
Opposition MMT
Muscle: Opponens Pollicis and Opponens digiti minimi (c8-ti)
Position: Sitting; palm up
Palpate: Lateral 1st and 5th metacarpal
Movement: Opposition; and resist 1st and 5th metacarpal
Stabilize: n/a
GR Position: N/a
Thomas Test
-LE flexibility
-edge of plinth
-bend both knees
-bend one, let other down and check for discrepancies
-flexed hip with knee 90: iliopsoas
-ext hip with >90: rectus
-abducted: ITB
-flx hip and ER: short sartorius
Ober’s Test
-tightness of TFL and ITB
-sidelying, lower leg flexed
-abduct, ER, extend hip
-lower and look for movement
Straight Leg Raise Test
-short hamstrings
-supine, both knees extended
-passive SLR to 70 deg is norm
-more than 91 deg hypermobile
Popliteal Angle Test
-distal hamstring flexibility
-supine witth test leg 90 deg hip with relaxed knee
woman: can extend to 30
men: can extend to 40
Ely’s Test
-short rectus fem
-prone, passive knee flexion
-check for hip rise
FABER
-like quadrant without compression
-test for inguinal pain, SI pain
-hip flex, abducted, ER
-press on opposite ASIS
Piriformis Flexibility Test
-hip flexed to 100, maximally ER
-slowly adduct to get stretch of piriformis
-stand on opp side
Clearing the Lumbar Spine
AROM
-Flexion: Bend forward
-Extension: hands on hips
-Lat SB: arms to the side
-Rotation: arms crossed, stabilize hips
RROM
-Flexion: resist being pulled back
-Extension: resist being pushed
-Lat SB: push shoulder down, stabilize contra pelvis
-Rotation: Pull one shoulder back, stabilize contra pelvis
Overpressure
-Flexion: sitting, Bend forward hands together, stabilize low back with forearm and push upper back with other forearm
-Extension: sitting, cross arms and arch back, stabilize low back with forearm and push chest
-Lat SB: sitting, lean to one side using trunk only, push ipsi shoulder down, stabilize contra pelvis
-Rotation: arms crossed, rotate to one side, push isi shoulder
Leg Length
Apparent leg length: umbilcus to med mall
True length: ASIS to med mall
*3 bridges first
Quadrant Scour Test
-degeneration of hip/labrum
-flex hip to 90
-compress joint in 4 quadrants
FADIR Test
-like quadrant without compression
-test for labral, impingement, normal end feels
-hip flex, adducted, IR
Normal ROM Hip
Flx: 120
Ext: 20
IR: 45
ER: 45
Abd: 45
Add: 45
SLR: 90F and 70M
Normal End Feels Hip
-Flx: soft
-Everything: firm
Casular Pattern Hip
-IR < Ext < Abd
Functon ROM Hip
Standing from seated: 100 hip flx
Tie shoes: 115 hip flx, 18 abd, 13 ER
Sitting Cross legged: 85 hip flx, 35 Abd, 45 ER
Hip Flexion ROM
-120 (soft)
-supine, knee flexed
-stabilize pelvis
Stationary: lat midline Pelvis
Axis: greater trochanter
Movement: midline of femur to Lateral epicondyle
Hip Abduction and Adduction ROM
-45 ab, 20 add (firm)
-supine, knee extended
-stabilize pelvis
Stationary: Opposite ASIS
Axis: ASIS
Movement: Midline of femur
Hip Extension ROM
-20 (firm)
-prone, knee extended
-stabilize pelvis
Stationary: lat midline Pelvis
Axis: greater trochanter
Movement: midline of femur to Lateral epicondyle
Hip IR/ER ROM
-45 (firm)
-sitting or prone, knee flexed
-stabilize pelvis
Stationary: Perpendicular to ground or table
Axis: Patella
Movement: Midline of tibia
Q Angle
-Males: 13-15 & Female: 17-20
-supine
-stabilize pelvis
Stationary: ASIS
Axis: Mid patella
Movement: Tibial tubercle
Knee Flexion ROM
-150 (soft)
-supine, knee flexed
Stationary: lat midline femur to g troch
Axis: lat epi
Movement: lat mal
Knee Extension ROM
-5 (firm)
-supine, knee ext
-towel under ankle
Stationary: lat midline of femur to greater troch
Axis: Lateral Epicondyle
Movement: Lateral malleolus
Hip Flexion MMT
Muscle: Psoas Major (L2-L4)
Position: Sitting, holding onto plinth
Palpate: Distal to inguinal lig
Movement: bring Knee up, resist at distal femur
Stabilize: Ipsi pelvis
GR Position: Sidelying, leg supported by PT
Hip Flexion, Abduction, ER MMT
Muscle: Sartorius (L2-L3)
Position: Siting, holding onto plinth
Palpate: Below ASIS
Movement: flex hip, ER, abduction; resist at distal thigh and ankle
Stabilize: N/a
GR Position: Supine, slide heel on shin of opposite leg
Hip Extension MMT
Muscle: Glute max (L5-S2), Hamstrings (L5-s2)
Position: Prone, knee extended
-PT on contra side
Palpate: Glute max
Movement: Extend leg and resist distal femus
Stabilize: Pelvis
GR Position: Sidelying, knee extended
Hip Extension isolating Gluteus Maximus MMT
Muscle: Glute max (L5-S2)
Position: Prone, knee flexed
-PT on contra side
Palpate: Glute max
Movement: Extend leg and resist distal femus
Stabilize: Pelvis
GR Position: Sidelying, knee flexed
Hip Extension w/ Tight Hip Flexors MMT
Muscle: Glute max (L5-s2)
Position: Prone, bent over and holding plint, knee extended
-PT on contra side
Palpate: Glute max
Movement: Extend leg and resist distal femus
Stabilize: Pelvis
GR Position: N/a
Hip Abduction MMT
Muscle: Glute Medius (S1-S2)
Position: Sidelying, testing knee extended
Palpate: Below iliac crest
Movement: Abduct hip, resist distal femur
Stabilize: Iliac Crest
GR Position: Supine, abduct while suine
Hip Flexion w/ TFL MMT
Muscle: TFL (L4-s1)
Position: Sidelying, knee extended, hip flexed to 45
Palpate: TFL, supeprior lat glute
Movement: Lift leg, resist at distal femur
Stabilize: Iliac crest
GR Position: Longsitting
Hip Adduction MMT
Muscle: Adductors (L2-L4)
Position: Sidelying on testing side, knees extended, PT suppporting higher leg
Palpate: Medial Thigh
Movement: Support non test leg and resist testing leg adduction at distal femur
Stabilize:
GR Position: Supine
Hip ER MMT
Muscle: Piriformis (L4-S1)
Position: Sitting, knee flexed with towel
Palpate: Btwn sacrum and greater trochanter
Movement: Resist at outer knee and inner ankle
Stabilize: Outer knee
GR Position: Supine, knee extended
Hip IR MMT
Muscle: Gluteus Min and FL (L4-S1)
Position: Sitting, knee flexed with towel
Palpate: Anterior glut/TFL
Movement: Resist at inner knee and outer ankle
Stabilize: inner knee
GR Position: Supine, knee extended
Knee Flexion MMT
Muscle:
-Medial: semitendinosis
-Lateral: biceps femoris (L5-s2)
Position: Prone, flexed knee
Palpate: Hammies
Movement:
-Normal: resist distal tibia
-Medial: IR tibia and resist obliquely (lateral)
-Lateral: ER and resist obliquely (medially)
Stabilize: Pelvis
GR Position: Sidelying on test leg, PT in front of pt
Knee Extension MMT
Muscle: Quads (L2-L4)
Position: Sitting, knee slightly flexed, hold plinth
Palpate: Mid quad
Movement: flex knee and resist distal tibia
Stabilize: Pelvis
GR Position: Sidelying on test limb
Talo-Cural DF/PF ROM
-DF: 20 and PF: 50 (firm)
-supine,leg off plinth for PF
-prone, leg flexed for DF
-stabilize calf
Stationary: lateral fibula
Axis: Lateral malleolus
Movement: 5th metatarsal
Tarsal Joints SUP/PRON ROM
-SUP: 35 & PRON: 20 (firm)
-supine, legs off plinth
-stabilize calf, “down and in” or “up and out”
Stationary: midline of tibia
Axis: Anterior ankle btwn malleoli
Movement: midline of 2nd metatarsal
Subtalar ROM
-inversion and eversion 5 (firm)
-prone, legs off plinth
Stationary: midline of lower leg
Axis: posterior ankle btwn malleoli
Movement: midline of calcaneus
MTP all Toes ROM
-Great toe flx: 45, ext: 70
-2-5 flx: 40, ext: 40
(firm)
-supine, legs off plinth, ankle flexed
-stabilize metatarsals
Stationary: midline of metatarsals
Axis: medial MTP joint
Movement: midline of proximal phalanx
MTP Great Toe AB/AD ROM
-Abd: 10
-Add: 30
(firm)
-supine, feet on floor
-stabilize metatarsals
Stationary: dorsal midline of metatarsals
Axis: dorsal MTP joint
Movement: dorsal midline of proximal phalanx
Toes IP ROM
-Great toe: flx: 60, ext: 0
(firm)
-PIPs: flx: 35, ext: 0
-DIPs: flx: 60, ext: 5
-supine, legs off plinth, ankle flexed
-stabilize metatarsals
Stationary: Dorsal midline of proximal phalanx
Axis: dorsal IP joint
Movement: midline of distal phalanx
Normal ROM Ankle
PF: 50
DF: 20
Inv: 30
Ev: 20
Rearfoot
-Inv: 5
- Ev: 5
Normal Toe ROM
Hallux First MTP
-Flx: 45
-ext: 70
-Abd:10
-Add: 30
First Ip
-flx: 60
Digits 2-5
-PIP flx: 35
-DIP flx: 60
End feels of Ankle
-firm
Ankle Plantar Flexion MMT
Muscle: Gastroc and soleus (S1-s2)
Position: Standing, 2 fingers for balance
Palpate: Achilles
Movement: Heel Raises
5: 25+
4: 10-24
3:1-9
2+: full range prone with resistance
2: partial range in standing and completes full range without resistance
2-: partial range prone
Stabilize: n/a
GR Position: Prone, feet off plinth
Dorsiflexion and Inversion MMT
Muscle: Tibialis Anterior (L4-S1)
Position: Sitting
Palpate: Ant tib
Movement: Patient puts foot up and in, resist
Stabilize: Ankle
GR Position: Long sit
Inversion MMT
Muscle: Tibialis Posterior (l5-s1)
Position: Sidelying on test side
Palpate: btwn medial mal and navicular
Movement: Hold foot inward, resist over medial side
Stabilize: Calf/ankle
GR Position: Longsit
Eversion with Plantar Flexion MMT
Muscle: Fibularis Longus/Brevis (L4-SI)
Position: Sidelying on non testing side
Palpate: Lateral fibula
Movement: Move foot outward, resist laterally
Stabilize: ankle/calf
GR Position: Longsit
Great Toe Abduction MMT
Muscle: Abductor Hallucis
Position: Long sit, feet off
Palpate: Medial big toe
Movement: Move toe outward, resist
Stabilize: Foot
GR Position: N/a
2-4 and Hallux MTP Flexion MMT
Muscle: Lumbricals and Flexor hallucis Brevis (L5-S3)
Position: Long sitting, foot off table
Palpate: Lumbricals, proximal big toe plantar side
Movement: Flex toes, resist at proximal phalanx (2-4 together, big toe alone)
-only 0-5
Stabilize: foot
GR Position: N/A
2-4 and Hallux DIP and PIP Flexion MMT
Muscle: Flexor digitorum (both) and Flexor hallucis longus (L5-S2)
Position: Long sitting, foot off table
Palpate: FDL, posterior leg medial to achilles
Movement: Flex toes, resist at distal phalanx (2-4 together, big toe alone)
-only 0-5
Stabilize: Metarsald or proximal phalanx
GR Position: N/A
2-4 and Hallux MTP and IP Extension MMT
Muscle: Extensor digitorum (both) and Extensor hallucis Brevis (L4-S1)
Position: Long sitting, foot off table
Palpate: EDL: anterior, medial lower leg
EDB/EHB: lateral dorsum of foot
Movement: extend toes, resist at proximal phalanx (2-4 together, big toe alone)
-only 0-5
Stabilize: metatarsals
GR Position: N/A
Big Toe Extension MMT
Muscle: Extensor hallucis longus (L4-S1)
Position: Long sitting, foot off table
Palpate: EHL: dorsal proximal phalanx of toe
Movement: Flex toes, resist at distal phalanx (2-4 together, big toe alone)
-only 0-5
Stabilize: proximal phalanx
GR Position: N/A
Girth Meausurement
-Mid mal on dorsum
-head of 5th metatarsal
-under heel
-above mal
-back to center
Clearing the Lumbar Spine
AROM
-Flexion: Bend forward
-Extension: hands on hips
-Lat SB: arms to the side
-Rotation: arms crossed, stabilize hips
RROM
-Flexion: resist being pulled back
-Extension: resist being pushed
-Lat SB: push shoulder down, stabilize contra pelvis
-Rotation: Pull one shoulder back, stabilize contra pelvis
Overpressure
-Flexion: sitting, Bend forward hands together, stabilize low back with forearm and push upper back with other forearm
-Extension: sitting, cross arms and arch back, stabilize low back with forearm and push chest
-Lat SB: sitting, lean to one side using trunk only, push ipsi shoulder down, stabilize contra pelvis
-Rotation: arms crossed, rotate to one side, push isi shoulder
