Quiz #1: Intro & Shoulder Flashcards
What are the 11 Principles of Examination?
- test the uninvolved side first
- active mm first , then passive, then resisted iso.
- painful mm are last
- apply pressure with care
- repeat or sustain mm if history indicates
- do resisted isometric mm in resting position
- with passive and ligamentous testing, both the degree and quality (end feel) of opening are important
- with ligamentous testing, repeat with increasing stress
- with myotome (groups of muscles supplied by the single nerve root) contractions must be held for 5 seconds
- warn of possible exacerbations
- refer if necessary
What are the 5 elements of patient/client management?
- Examination
- Evaluation
- Diagnosis
- Prognosis
- Intervention
Define contractile, nervous and inert tissues
Contractile: includes muscles, their tendons, and their attachments into bone
Nervous: nerves and their associated sheaths
Inert: include all structures not considered contractile or neurological such as, joint capsules, ligaments, bursae, blood vessels, cartilage and dura mater.
What are the 3 classic normal end feels? Explain.
Bone-to-bone or hard: unyielding sensation that is painless
Soft tissue approximation or soft: yielding compression that stops further mm due to compression of soft tissue
Tissue stretch or firm: springy or firm type of mm with a slight give.
What are the 5 classic abnormal end feels?
- Muscle spasm: painful mm and end feel is sudden and hard.
- Capsular: hard capsular has thick quality to it and a soft capsular has a boggy feel to it.
- Bony block: restriction occurs before the end of the ROM
- Empty: the ROM is stopped by the patient due to pain
- Springy block: occurs when you wouldn’t expect it to, usually in joints with Menisci
- Laxity: hyper mobility
What is the grading scale?
5: normal: max resistance applied by the examiner
4: good: mod resistance
3: fair: against gravity-no resistance
2: poor: gravity minimal
1: trace: evidence of muscle contraction
0: zero: no contraction
What are the 4 joints of the shoulder?
Glenohumeral
Sternoclavicular
Acromioclavicular
Scapularthoracic - functional joint
What type of joint is the Glenohumeral? And what is the capsular pattern?
Synovial ball and socket
Lateral rotation, abduction, medial rotation
What type of joint is the sternoclavicular?
Synovial joint, saddle shaped joint surface
What type of joint is the acromioclavicular joint?
Synovial
What type of joint is the Scapulothoracic?
Considered a functional rather than an anatomical joint.
What muscles are being tested during MMT of shoulder flexion? What nerve?
Anterior Deltoid- Axillary nerve (C5,C6)
Coracobrachialis- Musculocutaneous (C5,C6,C7)
What muscles are being tested during MMT of shoulder extension? What nerve?
Latissimus Dorsi- Thoracodorsal (Long Subscapular
Posterior Deltoid- Axillary
Teres Major- Subscapular
What muscles are being tested during MMT of shoulder scaption? What nerve?
Anterior Deltoid- Axillary
Middle Deltoid- Axillary
Supraspinatus- Suprascapular
What muscles are being tested during MMT of shoulder abduction? What nerve?
Middle Deltoid- Axillary
Supraspinatus- Suprascapular
What muscles are being tested during MMT of shoulder horizontal abduction? What nerve?
Posterior Deltoid- Axillary
What muscles are being tested during MMT of shoulder horizontal adduction? What nerve?
Pectoralis Major- Lateral Pectoral and Medial Pectoral (C5, C6)
What muscles are being tested during MMT of shoulder external rotation? What nerve?
Infraspinatus- Suprascapular
Teres Minor- Axillary
What muscles are being tested during MMT of shoulder internal rotation? What nerve?
Subscapularis- Subscapular
What muscles are being tested during MMT of scapular ABD and upward rotation? What nerve?
Serratus Anterior- Long thoracic
What muscles are being tested during MMT of scapular elevation? What nerve?
Upper trapezius- Accessory, Cervical Spinal (C3, C4)
What muscles are being tested during MMT of scapular adduction? What nerve?
Middle Trapezius- Accessory
Rhomboid Major- Dorsal Scapular
What muscles are being tested during MMT of scapular depression and ADD? What nerve?
Lower Trapezius- Accessory
What muscles are being tested during MMT of scapular ADD and downward rotation? What nerve?
Rhomboid Major- Dorsal Scapular
Rhomboid Minor- Dorsal Scapular
What muscles are being tested during MMT of scapular depression? What nerve?
Latissiumus Dorsi- Thoracodorsal (Long Subscapular)
What are the “Red Flags” in exam indicating need for medical consultation?
- severe unremitting pain
- pain unaffected by meds or position
- severe pain with no history of injury
- severe spasm
- psychological overlay
What should be noted when patient is performing active movement?
- when/where during each mm the onset of pain occurs
- whether the mm increases the intensity and quality of pain
- reaction patient has to pain
- amount of observable restriction
- pattern of mm
- rhythm and quality of mm
- mm of associated joints
- willingness of patient to move the part
- any limitations and it’s nature
What should be noted with a patient when they are going through passive movements?
- when/where during each mm the pain begins
- whether the mm increases the intensity and quality of pain
- the pattern of limitation of mm
- the end feel of mm
- the mm of associated joints
- the ROM available
Define Capsular Pattern
When the joint capsule is affected there will be pattern of proportional limitation specific to each joint of the body.
Define Noncapsular pattern
A limitation that exists but does not follow the classic capsular pattern for that particular joint
What are the 4 classic patterns seen in lesions of inert tissue?
- Pain-free, full ROM= no lesion
- Pain and limited ROM in every direction= entire joint is affected! indicating arthritis or capsulitis
- Pain and excessive or limited ROM in some directions= lesion of inert tissue such as ligamentous sprain or local capsular pattern lesion
- Pain-free, limited ROM= often of abnormal bone-on-bone type, usually indicating symptomless arthritis
What type of tissue would be affected: restricted and painful, same direction?
Non contractile tissue affected (inert or capsular)
What type of tissue would be affected: restricted and painful, opposite direction?
Contractile tissue affected (muscle tissue)
Define Validity
The degree to which an instrument measures what it is purported to measure; the extent to which it fulfills it’s purpose.
What are the 4 main types of validity?
Face validity
Content validity
Criterion-related validity
Construct validity
Define Reliability
Refers to the amount of consistency btw successive measurements of the same variable on the same subject under the same conditions
Define Intrarater reliability
The degree to which one person can replicate the measurement he/she obtains
Define interater reliability
The degree to which multiple testers can obtain measurements that agree
What does “gonia” and “metron” stand for?
Gonia- angle
Metron- measure
Define Arthrokinematics
Refers to the mm of joint surfaces such as, slides, spins and rolls
Define Osteokinematics
Refers to the mm of the shaft of the bone rather than the joint surface
What are some factors that affect a persons ROM?
Age: in most cases there is some degree of decreased ROM in all joints with age
Gender: in most cases females have more flexibility
Hypermobility vs. Hypomobility
Define Active Insufficiency
Inability for a muscle to exert enough tension to shorten sufficiently to complete ROM in all joints simultaneously.
Define Passive Insufficiency
Inability for a muscle to stretch enough to complete full ROM in all joints simultaneously.
Crosses 2 or more joints
Define Prime mover/Agonist
Muscle primarily responsible for the mm
Define Antagonist
Muscle or muscle group that opposes the prime mover/agonist
Define Synergist
Muscle or muscle group that works with the agonist to produce the desired mm.
Ex: knee ext
Agonist: quads
Antagonist: hams
Synergist: TFL
What are the 4 possible findings on resisted mm?
- Strong and Painless= no lesion
- Strong and Painfull= minor lesion
- Weak and Painless= interruption of nerve supply or complete rupture of tendon or muscle
- Weak and Painful: partial tendon/muscle rupture or pain inhibition due to serious pathological condition
Convex/Concave Rule: Sternoclavicular Joint
Elevation/depression: Convex clavicle moves on concave Manubrium in opposite direction of lateral end of clavicle
Protraction/Retraction: Concave clavicle moves on concave Manubrium in same direction as lateral end of clavicle
Osteokinematics of GH joint?
3 degrees of freedom
Flex/ext
ABD/add
Med/lat rotation
Osteokinematics of the sternoclavicular joint?
3 degrees of freedom
Elevation/depression
Protraction/retraction
Ant/post rotation
Osteokinematics of acromioclavicular joint?
3 degrees of freedom
Up/downward rotation
Tilting (tipping)
Protraction/retraction
Osteokinematics of Scapulothoracic joint?
Scapular elevation/depression
Up/downward rotation
Ant/post tilting
Pro/retraction
What is normal ROM for shoulder flexion, extension, ABD, medial (internal) rotation, and lateral (external) rotation?
Flex: 0-180* Ext: 0-60* ABD: 0-180* IR: 0-70* ER: 0-90*