Quiz 1 Flashcards
Tenosynovitis + example
Inflammation of the synovial sheath of the tendon
ex. tenosynovitis of extensor digitorum longus
Stenosing tenosynovitis + example
Inflammation of the synovial sheath of the tendon such that it narrows and presses on the tendon
ex. stenosing tenosynovitis of extensor hallucis longus
Ganglionic cyst + example
Localized inflammation of the synovial sheath such that it results in a lump under the skin
ex. ganglionic cyst of extensor digitorum longus
Trigger phenomenon
A form of stenosing tenosynovitis where localized swelling of the synovial sheath causes the tendon to jam in the sheath and suddenly let go
ex. trigger phenomenon of flexor digitorum longus
Nerve disorder example
Morton’s neuroma (3rd + 4th metatarsals press on the plantar nerve)
Neurovasular disorders (2)
Raynauds’s
Anterior compartment syndrome
L1 dermatome
Lower back above L2-L3 and lateral buttock to groin
L2 dermatome
Lower back to lateral side at iliac crest, posterior lateral thigh and upper anterior lateral to medial thigh (sling)
L3 dermatome
Lower back, posterior/medial thigh and medial knee, medial upper shin
L4 dermatome
Lateral side of mid to lower posterior thigh, lateral knee, medial anterior shin, medial posterior calf, medial malleolus to anterior big toe
L5 dermatome
Small strip from lateral upper calf, top of the foot and under surface of big, 2nd, 3rd toes
S1 dermatome
Lower lateral border of calf to heel and lateral side of foot to plantar fourth and fifth toes
S2 dermatome
Down centre of posterior leg from buttock to under surface of heel
Bowel and bladder nerves (motor, sensory, main one)
Motor: S2-S4
Sensory: S3-S5
Main: S3
2 types of passive ROM testing
- taking the client’s limb through ROM without their help
- Overpressure after active ROM
Why is overpressure applied and why is it important?
To evaluate the end feel
Helps determine if the joint is normal or pathological
2 types of muscle testing and how they’re recorded
Isometric: strong or weak
Isotonic: graded 0-5
What are isometrics used for?
- Testing myotomes
- Rule out inert tissue and test individual muscle groups
3 normal end feels
Tissue stretch
Soft tissue approx
Bone to bone
Bone to bone
Sudden hard stop, painless
Solid stop, no give
Soft tissue approx
Yielding compression stops movement
Tissue strecth
Hard or firm stop with slight give
5 abnormal end feels
Bone to bone
Springy block
Capsular
Empty
Muscle spasm
Muscle spasm
Sudden hard stop, accompanied by pain “vibrant twang”
Capsular
Like tissue stretch but not where you’d expect it
Bone to bone
Like normal bone to bone but not where you’d expect it
Empty
No mechanical resistance felt by the examiner, but movement impossible due to pain
Springy block
Like tissue stretch but joint has a springy, rebound effect
Capsular pattern
When there is limitation of movement that is proportional and specific to the joint
Non capsular pattern
Limited movement, but does not correspond to the classic pattern for that joint
3 examples of non capsular pattern
Ligamentous adhesion
Internal derangement of a joint
Extra-articular lesion
How long do how hold isometrics for the pelvis?
Only long enough to determine if there is pain
What actions do you do for pelvis isometrics?
Hip adduction/abduction
Hip flexion/extension
Lumbar flexion
L2 myotome
Hip flexion
L3 myotome
Knee extension
L4 myotome
Ankle dorsiflexion
L5 myotome
Big toes extension
S1 myotome
Ankle eversion or hip extension
S1 S1 myotome
Knee flexion
What are isotonics used for? How>
Used for muscle testing
Resistance is applied to a limb as patient moves through ROM
3 types of reflexes
Superficial
Deep tendon/muscle stretch
Pathologic
Umbilicus type of reflex + nerve root
Superficial reflex
Upper: T7-T9
Lower: T11-T12
Pathologic reflex example + what is signifies
Babinski - upper motor neuron lesion
Babinski
Position: supine or sitting with knee straight and supported
Test action: stabilize tib/fib and draw the end of the hammer from lateral heel, up the side of the foot across the ball of the foot to the plantar surface or the first MTP area
Normal response - toes curl
Positive response - big toe extends, other abduct
Simple segmental defintion
Impulse comes from the periphery, into the spinal cord and back out to the periphery, without going to the higher up centers
4 considerations while testing muscle
- Complete relaxation
- Midrange position
- Adequate stretch
- Facilitation if reflexes are
Reflex grades
0 - absent
1- diminished
2 - normal
3 - exaggerated
4 - clonus
Upper motor neuron lesion findings
Increased tone
Hyperreflexia
Reduced or absent superficial reflexes
Positive Babinski
Positive hoffman sign
Normal EMG
Weakness in muscles below lesion
Lower motor neuron lesion findings
Decreased tone
Decreased reflexes
Fasciculation
Fibrillation
Abnormal EMG
Weakness and pronounced atrophy of involved muscles
4 types of swelling
Synovial
Fluid
Pitting
Longstanding soft tisse
Synovial
Boggy
Fluid
Soft and mobile
Pitting
Thick, slow moving, leaves indent
Longstanding soft tissue
Tough/leathery
L3-L4 reflex
Patellar reflex
L4-L5 reflex
Tibialis posterior
L5-S1 reflex
Medial hamstring
S1-S2
Lateral hamstring
Achilles
Extensor digitorum brevis
Spinal stenosis
Narrowing of the spinal canal causing compression of the cauda equina
Spinal stenosis symptoms
Pain in lumbar spine with radiation to extremity
Paraesthesia of lower extremities
Symptoms increase with extension and walking, decrease with flexion
May affect bowel and bladder
Arthritis of facet joints symptoms
Sharp pain on same side with rotation, side flexion, extension
Pulling sensation on opposite side
No pain with isometrics
Tenderness on palpation
Positive lumbar kemps
Spondylolisthesis
Bilateral defect of pars interarticularis with forward slippage of a vertebral body and transverse processes on vertebra below
Spondylolisthesis Grade symptoms
Grade I: localized back pain
Grade II + III: Localized and radiating pain along dermatome and paraesthesia. Varrying degrees of functional impairment, B/B problems
Concealed Spondylolisthesis
X-ray in supine: everything looks good
X-ray in standing: it shows up (unstable segment)
Nerve root impingement signs/symptoms
Positive SLR, PKB test, valsalva, slump tests
Weakness of affected myotomes
Paraethesia of affected dermatomes
Diminished reflexes of affected nerve root
Altered posture
Osteophytes
Bony protrusion from vertebral body - constant back pain
Lumbar capsular pattern
Side flexion and rotation equally limited, extension
How to evaluates peripheral joints in lumbar scan
- Squat test or AROM of each joint
- PSIS or gillet’s
- Sacral sulcus
3 instances you wouldn’t use the squat test
Pregnancy
Obesity
Poor balance
Elderly
Obvious lower extremity joint problems
Lumbar scan fill-ins
Goniometry
Passive extension in prone
Isometrics of lumbar spine
Isotonics (rarely done)
Local ST, SP, temp testing
SLR test
Position: supine
Action: medially rotates and adducts the hip, then passively flexes the hip, keeping the hip medially rotated and adducted and the knee straight until the patient complains of pain or tightness. Slowly lets the hip extend passively until there is no pain or tightness. Then passively dorsiflexes the ankle then has the client flex their neck to see if pain returns
PR: pain radiates down leg on that side L4-S3 dermatome
Indicates: Nerve root impingement L4-S3
SLR test 0-35 degrees and 35-70 degrees
0-35: SI joint pathology
35-70: Dural impingement/nerve root
PKB test
Position: prone
Action: Examiner passively flexes client’s knee so their heel is touching their butt, hold for 45 seconds
PR: reproduction of symptoms along L2 or L3 or L4 or femoral nerve root
Indicates: Nerve root impingement of L2 or L3 or L4 or femoral nerve root
What needs to be ruled out for SLR and PKB test?
SLR: hamstring pain/tightness and SI joint pathology
PKB: rec fem tighteness and SI joint pathology
PKB dural stretch degrees
80-100
Valsalva maneuver
Indicates: increased intrathecal pressure due to space occupying lesions
Position: sitting
Action: instruct patient to take a breath, hold it, and then bear down as if evacuating the bowels
PR: increase symptoms in lower extremity or lower back
Slump test
Position: sitting with hands behind back and chin up
Action: Ask patient to slump while examiner holds chin and head erect. If no symptoms, apply overpressure through neck or thoracic spine. If no symptoms, extend one of the patient’s knees. If no symptoms, passively dorsiflex patient’s ankle. If symptoms are reproduced, add neck extension at to see if symptoms decrease. (this confirms positive response)
PR: Reproduction of patient’s symptoms along affected dermatome
Indicates: Dural or nerve root impingement
Lumbar kemp’s
Position: standing
Action: Examiner stands behind patient and passively rotates, side flexes, and extends the patients spine with one hand, while stabilizing the opposite pelvis with the other hand. Apply downward pressure through shoulders using both hands
PR: local pain on the side that is rotated, side flexed and extended
Indicates: Facet joint sprain
If a patient states that sitting, coughing, sneezing results in leg pain, what structure is likely compressing the nerve root?
Disc protrusion (can also be a tumour)
Scoliosis (named after?)
Curvature of the spine, named after the convexity
Spinal stenosis vs. nerve root impingement
Spinal stenosis: symptoms are aggravated by extension/relieved by flexion
NRI: opposite
Lordosis
Anterior curvature of the spine
Kyphosis
Posterior curvature of the spine
Structural vs non-structural scoliosis
Functional: curve disappears on flexion
Structural: Curve is visible on flexion
Gibbus deformity
Sharp, angulated kyphosis
Effect of flexion in spinal stenosis vs. disc protrusion
Spinal stenosis: reduces pain because the cord stretches, narrows + fits in canal with less pressure
Disc protrusion: Increase pain because it forces disc material posteriorly, where nerve roots are located, causing pressure on nerve roots
2 structures aggravated by lumbar lordosis
Anterior longitudinal ligament
Facet joints
Purpose of scan
To determine if symptoms the patient is experiencing is due to a pathology in the lumbar spine, peripheral joints, or both
Landmarks for spinal flexion measurements
Whole spine: C7-S1
Thoracic: C7-T12
Lumbar: T12-S1
Grade 0
Zero
No contraction palpated or visible
Grade 1
Trace
Evidence of slight contractility but no joint movement
Grade 2-
Poor -
Initiates motion w/o gravity
Grade 2
Poor
Complete ROM w/o gravity
Grade 2 +
Poor +
Initiates motion against grvaity
Grade 3-
Fair -
Incomplete ROm against gravity
Grade 3
Fair
Complete ROM against gravity
Grade 3 +
Fair +
Complete ROM against gravity and minimal resistance
