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DPT 730: MSK > Principles of MSK Examination and Evaluation: Test 1 > Flashcards

Principles of MSK Examination and Evaluation: Test 1 Flashcards

1
Q

what are the 2 models of disablement

A

traditional biomedical model for pain = doesn’t consider other complaints/sources

international classification of functioning, disability, and health = includes pain/function but also diseases/impairments; measures level of disability

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2
Q

key components of history (x7)

A

symptoms and behavior
onset/prior injury
symptom impact/function
imagining/diagnostic tests
pt perspective/goals
past med history/medications
RED Flags

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3
Q

what falls into the “symptoms and behavior” of a patient history

A

location

duration

changes

irritability

type (i.e. sharp, numb, deep ache, etc)

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4
Q

why isn’t all tissue in a stage of healing

A

can have pain and inflammation with symptoms but no healing is taking place

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5
Q

describe the use of imagining in creating a dx

A

high sensitivity low specificity

really good at ruling things out, not so good at telling what specifically IS wrong

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6
Q

what is the difference between a rigid and flexible body type

A

rigid = flatter spine with tight hips and genu and calcaneal varus; more propulsive

flexible = excessive spinal curve with hyper mobile hips and genu/calcaneal valgus; more absorbing

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7
Q

what are some examples of normal dominance asymmetries

A

ipsilateral shoulder depression

ipsilateral thoracolumbar SB an dRT

more hyperextended knee

flatter foot

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8
Q

difference between signs and symptoms

A

symptoms = subjective; reported by patient

sign = objective; measured by clinician

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9
Q

purpose of a scan (x5)

A

further assess for Red flags

assess neurological status

determine if symptoms are referred or radicular

assess severity of condition

identify need for more in depth biomechanics exam

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10
Q

what are AROM tests for (x5)

A

test willingness to move

ROM

integrity of contractile tissues

pattern of restriction

symptom reproduction

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11
Q

what does PROM test

A

integrity of inert and contractile tissues, ROM, and sensitivity

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12
Q

what do resisted tests test

A

integrity of contractile tissue (strength and sensitivity)

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13
Q

what do dural tests do

A

test dural mobility

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14
Q

what do neurological tests tell you

A

nerve conduction

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15
Q

what do dermatome scans test

A

afferent sensation

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16
Q

what do myotomes test

A

efferent (strength and flexibility)

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17
Q

how do you start a scan WITHOUT a recent trauma

A

start with respective spinal scan and work out

especially if history of spinal P!

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18
Q

how do you start a scan WITH a recent trauma

A

start with involved areas and then assess adjacent regions

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19
Q

aberrant motion in ROM testing indicates what

A

joint hyper mobility/instability

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20
Q

sharp curve for fulcrums in ROM testing indicate what

A

joint hypomobility

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21
Q

what are essential ADLs

A

walking, reaching, squatting, bending, turning, etc

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22
Q

improved function/pain with AROM indicates (x3)

A

inhibited muscle, regional interdependence, or disc injury

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23
Q

worse pain or function with AROM indicates what

A

acute injury/irritation

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24
Q

what is a red flag in regards to AROM

A

unwillingness to move/splinting

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25
Q

if during ROM testing pain occurs in the direction of the same AROM and PROM then what is indicated

A

a non-contractile tissue (i.e. cartilage, capsule, ligament, etc)

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26
Q

if during ROM testing PROM is restricted similarly to AROM in the same direction want is indicated

A

joint hypomobility or protective guarding is indicated

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27
Q

if during ROM testing PROM is significantly greater than AROM in the same direction then what is indicated

A

joint hyper mobility/instability

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28
Q

if both WB and NWB motions are limited, what is the likely cause and general Rx

A

cause = fused, fixated, or hypo mobile joint

Rx = improve joint mobility

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29
Q

if WB motion is limited but NWB motion is WNL, what is the likely cause/Rx

A

cause = joint hyper mobility/instability with impaired neuromuscular control

Rx = improve neuromuscular control

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30
Q

what is a capsular pattern of restriction

A

based on PROM

firm end feels; characteristic loss of motion

typically due to arthritis or prolonged disuse

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31
Q

what is non-capsular pattern of restriction

A

any pattern not in a capsular pattern

variety of reasons

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32
Q

what is indicated with there is a consistent block with combined motion

A

blocked no matter the path = hypo mobility

follow up with accessory motion test

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33
Q

what is indicated if there is an inconsistent block with combined motions test

A

hyper mobility/instability

follow up with stability tests

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34
Q

what is indicated with there is limited motion in opposing spinal quadrants during a combined motion test (i.e. L SB/RT into fox and R SB/RT into ext)

A

indicates fibrotic joint (scar tissue)

follow up with accessory motions

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35
Q

proper position for resists testing

A

slightly back off from P! that occurred with ROM

primarily test midrange with break test and “don’t let me move you”

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36
Q

what is resisted testing

A

NOT manual muscle testing/grading

apply gentle pressure to distal segment of joint

hold at least 3 sec to assess neuromuscular adaptation capacity and NOT max strength

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37
Q

strong and painful result of resisted test indicates what

A

mild injury (i.e. grade I strain)

only painful in lengthened range

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38
Q

weak and painful response to resisted testing indicates what

A

acute (mod to severe injury)

i.e. grade II/III strain or fracture

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39
Q

what does a weak and painless response to resisted testing indicate

A

neurological damage or chronic contractile rupture (i.e. tendon tear that has healed but not reattached properly)

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40
Q

what is indicated if the same pain occurs in one direction of AROM and/or resisted testing and the opposite direction of PROM

A

contractile tissue indicated

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41
Q

what is indicated with resisted testing go there are symptoms upon release

A

possible non contractile tissue as glide is released when muscle is relaxed

i.e. when you make the muscle contract it stabilizes the joint, but when you let off of that resistance the instability/symptoms return

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42
Q

what is indicated with there are multiple planes of weakness at one joint during resistance testing

A

possible acute/severe injury

i.e. fracture

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43
Q

what is indicated during resistance testing if there are multiple joints of weakness

A

indicates possible CNS issue

i.e. all UE joints are weak

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44
Q

what is indicated with weakness throughout a range and not just midrange during resisted testing

A

possible pathology is indicated

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45
Q

with repeated resisted testing, what does improved function/pain indicate

A

inhibited muscle and/or regional interdependence

poor muscle recruitment, but signal to recruit more as reps go on

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46
Q

with repeated resistance testing what does decreased force indicate

A

possible N palsy

fatiguing weakness

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47
Q

with repeated resistance testing what does consistent weak force indicate

A

deconditioned/torn muscle is indicated

something in contractile property isn’t changing; no capacity to recruit more muscle fibers

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48
Q

with repeated resistance testing what does worse pain/function indicate

A

acute condition

aggravating with more reps

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49
Q

when do you not perform a stress test

A

if known damage, deformity, or fusion is present

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50
Q

what are the steps of performing a stress test and the possible indications

A

start with rapid/shallow force

pain indicates acute condition (doesn’t take much to aggravate)

if no pain then apply a slower, larger, and deep force; hold for 10 sec

if only 10 sec hold causes pain a persistent condition is indicated (i.e. joint hyper mobility/instability)

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51
Q

what are some signs that further indicate hypermobility/instability with a stress test

A

** stress via compression/distraction not same as PROM end feel** (stressing joint structures)
late, empty, and/or soft end feels

click, clunk, and/or spasm (muscle guarding)

52
Q

if there is increased pain with distraction this indicates what

A

capsule, ligament, or annulus involved

53
Q

if there is decreased pain with distraction then what is indicated

A

indicates joint surface tissue(s)

i.e. cartilage, nucleus pulposus, bone, or spinal N involved

54
Q

if compression decreases pain what tissues are indicated

A

capsule, ligament, or annulus involved

55
Q

if increased pain occurs with compression what tissues are involved

A

joint surface tissue(s)

i.e. cartilage, nucleus pulposus, bone, or spinal N involved

56
Q

what is indicated if both compression and distraction produce pain

A

acute condition

57
Q

what is a dermatome

A

area of skin sensation supplied by a single segmental spinal nerve

considerable overlap

typically creates paresthias

58
Q

what is cutaneous nerve distribution

A

area of skin supplied by peripeheral N

more distinct boundary

typically creates numbness

59
Q

what should you do if during sensory testing both light and sharp touch are within normal limits in the presence of paresthesias

A

use pinwheel to check for hyperpesthesias due to nociplastic P! (increased sensitization of the brain)

60
Q

if sensation of light or sharp touch is diminished in sensory testing what is the next step

A

repeat for incrimination of other spinal nerve or cutaneous nerve pattern

61
Q

what should you test for if light/fine touch sensation is lost and you are concerned about an UMN injury

A

check vibration, 2 pt discrimination, and proprioception

62
Q

what should you test for if there is loss of sharp touch and you are concerned about an UMN injury

A

check temperature and crude touch for possible spinothalmic tract issues

63
Q

what are the levels of results for sensory testing neurological tests

A

0 = absent
1 = diminished
2 = WNL
3 = hyperesthesia

64
Q

what are the levels of results for the DTR or myopic reflex

A

0 = absent
1+ = hyporeflexive; LMN condition
2+ = WNL
3+= hyperrefelxive - large arch but normal dampening; UMN condition or nociplastic pain
4+ = clonus; > 3 beats; UMN condition

65
Q

release of primitive reflex indicates what

A

UMN impairment

66
Q

what are myotomes

A

key muscle or group of muscles innervated by a single spinal nerve

67
Q

what is tension restriction in a dural mobility test

A

inelasticity

pain increases from both ends of nerve being “pulled”

68
Q

inelasticity or inflammation of a nerve may lead to what

A

reproduction of achy or sharp symptoms or paresthias

69
Q

how would you describe the muscle tone of a patient with a LMN injury

A

decreased or flacid

70
Q

how would you describe the muscle tone of a patient with a UMN injury

A

increased/spastic velocity
dependent to resistance; co contractions
synkinesis: UE flexion causes LE flexion

71
Q

bowel/bladder of patient with UMN injury

A

spastic/retentive

72
Q

bowel/bladder of patient with LMN injury

A

incontinence/leakage

73
Q

describe the dermatome/paresthesias of a patient with LMN injury

A

often a single segment diminished

rarely multisegmental

74
Q

describe the dermatome/paresthias of a patient with a UMN injury

A

multi segment diminished with face, extremities, and or trunk

including vibration, temp, and proprioception

75
Q

describe the deep tendon reflexes of patients with UMN vs LMN injuries

A

LMN = hypoactive

UMN = hyperactive

76
Q

describe the myotomes of patients with LMN vs UMN injuries

A

LMN = often single segmental fatiguing weakness; rarely multi

UMN = multi segmental weakness/incoordination/paralysis of face, extremities, or trunk

77
Q

what signs might be present with an UMN injury but not a LMN injury

A

pathological reflexes (i.e. clonus or babinski)

mentation changes

78
Q

describe the superficial reflex in UMN patients vs LMN patients

A

LMN = not present

UMN = hypoactive

79
Q

purposes of a biomechanics exam x3

A

confirm/reject findings
assess for more details in indicated areas
continue to assess for red flags

80
Q

what types of tests may be included in a biomechanical exam x6

A

additional functional testing (as needed)
quantity limited ROM
accessory motion
special tests
MMT and muscle activation after fully assessing joint integrity
palpation

81
Q

describe the additional functional testing that might take place during a biomechanical exam

A

functional movement screen - general application

higher level includes jumping/hopping, agility, and running analysis

82
Q

how would you quantify limited ROM in a BM exam

A

with a goniometer

83
Q

when do you perform an accessory motion test

A

if limited ROM and/or consistent block is present during combined motions

84
Q

how would you go about an accessory motion test

A

asess in neutral or open packed = easier feel (but could also access towards block)

compare both sides/adjacent joints in same position

85
Q

describe the ease/predictability of doing an accessory motion test

A

easier to pick up hypo mobility than hyper

intra-examiner (within) reliability is much greater than inter-examiner (between) reliability

86
Q

what is PPM

A

passive physiological mobility

assess glides with extremity osteokinematics

87
Q

what is PAM

A

passive accessory mobility

assessing glides without osteokinematics

more commonly performed in extremities

88
Q

what is PPIVM

A

passive physiologic intervertebral mobility

assessing glides with spinal osteokinematic

more commonly performed in spine

89
Q

what is PPAIVM

A

passive physiologic accessory intervertebral mobility

assesses glides without osteokinematics (spine)

90
Q

what is indicated with accessory motion and ROM is limited

A

restriction is articular or related to a joint restriction (i.e. capsular shortening or joint restriction)

91
Q

what is indicated if accessory motion is WNL but ROM is limited

A

restriction is extraarticular (i.e. muscle shortening, guarding, or joint hyper mobility/instability)

92
Q

what does accessory motion abnormality indicate

A

indicates improper axis of joint motion and subsequent excessive stress on adjacent tissue

93
Q

describe what a normal axis of motion should be like

A

should never be on the articular surface of a joint

should always be changing due to gliding/rolling

94
Q

describe special tests/why we use them

A

typically more precise than stress tests

may help identify more specific tissues, their integrity, and assess progress

not as “special” as they are thought to be; don’t always get a result/indication

95
Q

how do you choose a special test

A

based on usefulness per research and working dx

composite/cluster testing is more accurate than isolated testing

96
Q

what is a provocative test

A

type of special tests

identify tissues indicated by the reproduction of symptoms during the test

97
Q

describe stability tests

A

assess integrity of non-contractile tissue for 3 things
1- provocation
2-late/empty/soft end feels (i.e. grade I, II, or III strain)
3- segmental play- assessing for excessive linear shearing of vertebra

also perform if excessive ROM and/or inconsistent block noted with combined motion

no immediate symptoms = then hold for 10 sec like with stress tests

98
Q

if pain or laxity occurs with stability tests what is the next step

A

retest with m.activation, closed packed position, corrected posture, or external support

if symptoms and/or laxity improves than a confirmation of joint hyper mobility and a better prognosis

99
Q

what is a muscle length tests

A

passive flexibility of muscles

100
Q

what are anthropometric tests

A

body dimensions with tape measurer

101
Q

describe the usefulness of special tests

A

sensitivity or SNOUT = so good at finding positives that when you get a negative test you can rule that tissue out (good at avoiding false negatives

specificity or SPIN = so good at finding negatives that when the test is positive you can rule the tissue/condition out (good at avoiding false positives)

~ 90% is acceptable level for sensitivity and specificity

102
Q

describe the likelihood ratio of special tests

A

combines sensitivity and specificity

OPTIMAL diagnosis statistic

not affected by condition prevalence

103
Q

what is a positive likelihood ratio

A

likelihood of a positive test when the patient has the condition

the higher the better

large likelihood shift > 10

moderate likelihood shift 5-10

104
Q

what is a negative likelihood test

A

likelihood of a negative test when the patient does not have the condition; the lower the better

large likelihood shift < 0.1

moderate likelihood shift 0.1-0.2

105
Q

what is QUADAS score

A

quality assessment of diagnostic accuracy studies

examines the quality of research

greater than or equal to 10/14 = higher quality studies

106
Q

what is a MMT

A

manual muscle testing

attempting specific muscle testing and grading (0-5)

typically performed in mid range with break test and “don’t let me move you”command

lengthened - passively insufficient position is used to locate milder/grade I strains

107
Q

when would you test strength in a fully lengthened, mid range, and fully shortened positions respectively

A

lengthened = tightens inert components and tests for muscle tears

mid = muscle in strongest position/tests overall power

shortened = weakest position; used to detect palsies, especially if coupled with eccentric contraction

108
Q

describe the hold/force for MMT

A

hold at least 3 sec to better assess neuromuscular adaptation capacity and not maximal strength

force should be smooth, exponential increase to a linear force

109
Q

why is MMT not very reliable or valid

A

it’s subjective with all 4/5 and 5/5 scoring

tends to overestimate strength

especially unreliable with inexperienced users or in the presence of pain or other ligamentous tests

cannot be used to predict function

110
Q

what is MMT not good at

A

finding smaller deficits

111
Q

symptoms upon release of MMT indicate what

A

possible articular issue as glide is released when muscle relaxes

112
Q

multiple planes of weakness at one joint indicates what with MMT

A

possible acute and/or significant injury

113
Q

multiple planes of weakness with MMT indicate what

A

possible CNS issue

114
Q

weakness throughout a range with MMT indicates what

A

possible pathology

115
Q

if there is a weak or painful response to MMT how many times should you repeat testing

A

at least 3

116
Q

with repeated MMT what does improved pain/function indicate

A

inhibited muscle and/or regional independence

117
Q

if there is decreased force with repeated MMT what does that indicate

A

N. Palsy

118
Q

if there is consistent weak force with repeated MMT what does that indicate

A

reconditioned/ torn muscle

119
Q

worse pain/function with repeated MMT indicates what

A

acute injury/irritation

120
Q

what are you assessing and how would you assess muscle activation and endurance

A

often assessing stabilizing, postural and local mm

utilize palpation/observation as able

endurance holds should be solid for 20s

compare bilaterally as a reference

121
Q

what can you assess with palpation in a BM exam

A

temp - warm = acuity, cold = poor circulation

turgor and possible pain - with skin rolling indicates dehydration or nociplastic pain

swelling - watery indicates acuity and thickness/pitting indicates chronicity

122
Q

what does a scratch test look for

A

significant reddening indicating acuity

123
Q

hypertonicity of a muscle indicates

A

inhibited mm that are overworked/protecting

palpation is not reliable on the spine

124
Q

how would you rate circulation with pulses during palpation exam

A

0=absent
1+=diminished
2+=WNL
3+=bounding

125
Q

what does tenderness to palpation indicate (TPP)

A

localizing involved tissue or deformity like a fracture or tear

126
Q

describe TTP grades 0-iV

A

0 = none
1=mild; TTP without grimace/flinching
2=moderate; TTP with grimace/flinching
3=severe; TTP to palpation with withdrawal (jump sign)
4=hypersensitive; withdraws sign to non-noxious stimuli

DPT 730: MSK (14 decks)

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