Skill Check 2 Flashcards
What should you observe of the upper quadrant
- Position (symmetry)
- Carrying angle of arms
- General posture
- Thoracic spine position
- Cervical spine position
Where to palpate olecranon process
– Proximal end of the ulna
– Elbow flexion moves the olecranon process out of the fossa making it easier to palpate
Where to palpate olecranon fossa
Palpated with the elbow slightly flexed
Where to palpate triceps tendon insertion
Palpated at insertion to olecranon process, fully extend elbow
Where to palpate medial epicondyle
Found on the medial side of the distal end of the humerus
Where to palpate medial supracondylar ridge
Palpate proximally from the medial epicondyle, move into flexion to feel ridge
Where to palpate lateral epicondyle
-Located lateral to the olecranon process
– Smaller and less well defined than the medial epicondyle
-put into elbow flexion
Where to palpate lateral supracondylar ridge
-Longer and better defined than the medial side
– Proximal to the lateral epicondyle, slide upwards
-put into flexion and move into extension to feel ridge
Where to palpate the ulnar nerve
Palpate the groove between the medial epicondyle and the olecranon process
Where to palpate ulnar head
Where to palpate radial head
-Flex elbow to 90°
– Feel radial head approximately 1-2 cm distal to the
lateral epicondyle and confirm with pronation/
supination
Where to palpate radio-humeral joint
Extend elbow fully and palpate the posterolateral
dimple
Where to palpate radial collateral ligament
Rope like, passes from the lateral epicondyle to the lateral side of the annular ligament of the radius
Where to palpate ulnar collateral ligament
Fan shaped ligament, passes from the medial epicondyle to the trochlear notch of the ulna
– Palpated directly for tenderness
Where to palpate radial collateral ligament
Where to palpate annular ligament
Flexion/extension and pronation/supination
Where to palpate ulnar-humeral joint
Flexion/extension
Where to palpate cubital fossa
What are the borders and contents of the cubital fossa
– Borders
* Lateral border: brachioradialis
* Medial border: pronator teres
* Superior border: line joining the two epicondyles
– Contents
* Biceps brachii tendon
* Brachial artery
* Median nerve
T or F: Hand should be flexed when palpating carpals
T
Where to palpate trapezium
-on thumb posterior side
- At the base of the 1st metacarpal bone, just distal to the scaphoid
– Tubercle of the trapezium lies anteriorly at the base of the thenar
eminence
Where to palpate trapezoid
-next to trapezium on posterior side
– At the base of the 2nd metacarpal bone on the dorsum of the hand
Where to palpate hamate
-Hook palpated just distal and radial to the pisiform on palmar aspect
– Found at the base of the 4th and 5th metacarpal
Where to palpate capitate
-directly down from digits 3 (posterior)
- Depression just proximal to the base of the 3rd metacarpal bone on the dorsum of the wrist
Where to palpate triquetrum
-posterior side by capitate/slightly below
- Radially deviate wrist and palpate just distal to the ulnar styloid process
Where to palpate pisiform
hook on palmar medial side below and attached to the top of triquetrum (anterior)
Where to palpate lunate
right below capitate (posterior)
Where to palpate scaphoid
large and on palmar side right by lunate and below trapezium
Where to find guyon tunnel and what is its role
– Between pisiform and hook of hamate
– Passage of ulnar nerve and ulnar artery to the hand
Where to palpate ulnar styloid process
Ulnar deviate
Where to palpate radial styloid process
Make into snuff box (radial styloid)
Where to palpate distal radioulnar joint
Where to palpate Lister’s tubercle
Flexion/extend wrist
Name the 4 wrist flexor forearm pronator muscles and how you would palpate them
-In full forearm supination and elbow extension,
place opposite hand over the forearm with the
thenar eminence over the medial epicondyle
– Allow the fingers to spread over the forearm
* Pronator teres: thumb
* Flexor carpi radialis: index finger
* Palmaris longus: middle finger
* Flexor carpi ulnaris: ring finger
What are the 3 wrist extensor muscles and where to palpate them
– Brachioradialis: lateral supracondylar ridge to distal lateral radius at the styloid process (functionally elbow flexor)
– Extensor carpi radialis longus: radial supracondylar ridge to the base 2nd MC
– Extensor carpi radialis brevis: lateral epicondyle to the base of the 3rd MC
Where to palpate flexor retinaculum
-Carpal tunnel area
– Attached laterally to the tubercle of scaphoid and tubercle of trapezium
– Attached medially to pisiform and hook of hamate
Name the extensor muscle group (7) and where to find them
Where to find abductor pollicis longus
Thumb abduction resistance
Where to palpate flexor carpi ulnaris and function
– Resist wrist flexion and ulnar deviation
– Feel the tendon as it attaches to the pisiform and then proceeds on to the hamate bone as the pisihamate and pisometacarpal ligament
Where to palpate hypothenar eminence and name the 3 muscles involved
– Abductor digiti minimi (superficial)
– Opponens digiti (middle)
– Flexor digiti minimi (deep)
Where to palpate ulnar artery
– Just lateral to the flexor carpi ulnaris in the wrist
Where to palpate radial artery
Just lateral to flexor carpi radialis in wrist
Where to palpate thenar eminence and the 3 muscles involved
– Abductor pollicis brevis (superficial)
– Opponens pollicis (middle)
– Flexor pollicis brevis (deep)
Where to palpate anatomic snuff box and its 2 borders
What actions can be performed at elbow and forearm
-Flexion
-Extension
-Pronation
-Supination
What actions can be performed at the wrist
-Flexion
-Extension
-Pronation
-Supination
-Radial/ulnar deviation
Radial vs Ulnar Deviation
How to measure ROM with supination and pronation for forearm/wrist
Have them hold a pen in hand sideways get them to twist arm either way measuring with the goniometer where the ben goes
NOTE: PROM -> have their arm lie on corner of bed, twist the arm and push the goniometer with your thumb
How to measure ROM for ulnar/radial deviation
Line up goniometer with the top of the hand and move the hand left and right
How to measure myotome for C5
Have patient raise both arms to 90 degrees and press down
How to measure myotome C6
Assess:
1) biceps brachii: have elbows flexed at 90 degrees and supinated. Ask patient to resist force applied
2) Wrist extensors: place pronated forearm on table, have their fist closed and apply a force against half extended wrist
How to measure myotome C7
Assess:
1) triceps brachii: Flex patients elbow to 90 degrees and perform resisted extension
2) wrist flexors: place supinated forearm on table, have their fist closed and apply a force against have flexed wrist
How to measure myotome C8
Assess the abductor pollicis brevis by have the patients arm on its side, pinky side down, with wrist at edge of table and ask patient to resist thumb adduction
How to measure myotome T1
Assess the first dorsal interosseus by separating the last 3 digits and apply an adduction force against the index finger
How to test the slump test
-Tests extensibility of dura (Slow gentle progressive “winding up” of dura).
-Patient seated at side of bed with feet unsupported and hands clasped behind back.
-Test is performed actively with input to patient.
-Normal responses include central T8-9 pain when neck flexion is added.
-Most patients will be unable to completely straighten knee because of stretch in posterior thigh and knee area.
Thoracic flexion : Ask patient to slump or “sag in the middle” but do not allow pelvis to rotate backwards.
Neck flexion: “Chin to chest” (with gentle hold).
Knee extension (asymptomatic side first, ankle stays relaxed).
Record angle of knee extension and any symptoms produced.
- have arm and hand on neck
How to perform passive neck flexion
Without chin tuck = lower l-spine
How to perform upper limb tension test
Flex neck away from arm (lateral)
How to test cranial nerve 1 (olfactory)
1) Have eyes closed
2) Test smell in one nostril at a time using non-irritants (coffee, lemon, mint)
How to test cranial nerve 2 (optic)
- Check pupil size and symmetry
- Assess visual field by having one finger on each hand in place where only one eye sees one finger. Move fingers and ask which side the fingers are moving on (right or left)
How to test cranial nerve 3 (oculomotor)
- Pupillary light reflex: bring light from side to eye and shine light in the eye to assess constriction
- Assess eye movement (inferior oblique, superior, medial and inferior rectus) by drawing the letter “H” -> only do one eye at a time and head must be stationary
- Accommodation reflex: Move fingers close to nose until it becomes blurry (patient should be cross eyed)
How to test cranial nerve 4 (trochlear)
Assess eye movement using the letter H while head is stationary and they follow finger with one eye (superior oblique muscle)
T or F: Cranial nerves 3, 4, and 6 can be assessed together using the H movement with one eye
T
How to test cranial nerve 5 (trigeminal) motor
Ask patient to:
1. Clench teeth
2. Protrude jaw
3. Protrude jaw and move side to side
4. Jaw reflex (using reflex hammer)
How to test cranial nerve 5 (trigeminal) sensory
Make sure to assess both sides of face separately, but test using pin prick/light tough on the:
1. Ophthalmic branch (blue)
2. Maxillary branch (red)
3. Mandibular branch (yellow)
How to test cranial nerve 6 (abducens)
Lateral rectus muscle, but using letter H with head stationary and one eye at a time like 3 and 4 cranial; nerves
How to test cranial nerve 7 (facial) motor
- Lift brows
- Close eyes tightly
- Show teeth
- Frown
- Whistle
- Smile
How to test cranial nerve 7 (facial) sensory
Test each side of tongue separately by applying sugar or salt to anterior 2/3 of tongue
NOTE: Dampen q-tip and have them drink water between each taste
How to test cranial nerve 8 (vestibulochlear)
Vestibular: Test balance and check for nystagmus
Cochlear: Test hearing by rubbing on side of ears with fingers
How to test cranial nerve 9 (glossopharyngeal) motor
- Check ability to swallow
- Test gag reflex by pressing q-tip to back of throat on posterior pharynx
How to test cranial nerve 9 (glossopharyngeal) sensory
Test each side of tongue and place sugar or salt on q-tip on posterior 1/3
NOTE: Make sure they drink water in between and dampen q-tip to pick up sugar or salt
How to test cranial nerve 10 (vagus)
Motor:
1. Gag Reflex: Touch one side of posterior pharynx with tongue depressor or q-tip (test each side separately)
2. Palatal reflex: Touch one side of uvula at time and it should elevate OR ask to say “ahhhhh” and if deviation = abnormality
NOTE: Sensory is tested with the other tasting ones with salt/sugar
How to test cranial nerve 11 (accessory)
- Examine muscle bulk
- Assess trap via resisted shoulder elevation
- Assess SCM via resisted cervical rotation
How to test cranial nerve 12 (hypoglossal)
- Assess tongue movements (protrude and retract)
- Push tongue against cheek and apply resistance to outside of cheek
- Ask to say “la,t,d”
NOTE: Jaw and tongue deviate TOWARDS affected side while uvula deviates AWAY from affected side
How to palpate iliac crests
Place hands on side of hip and will feel the shelf
How to palpate ASIS (anterior superior iliac spine)
Come down anteriorly off iliac crests and it lies in the same vertical plane as symphysis pubis and horizontal plane as PSIS and S2 (most prominent bone on the front)
How to palpate AIIS (anterior inferior iliac spine)
Approximately two thumb widths below and slightly medial to ASIS:
Resist extension and hand on top of ankle and ask to kick out against hand -> rectus femoris muscle is what will pop up
How to palpate pubic tubercles
NOTE: Should feel hard bone and its really low
How to palpate the greater trochanter
It is level with center of hip joint, confirm with hip internal/external rotation (should feel where hip joint turns on side of hip)
How to palpate L4/L5 and spinous processes
Find the 2 PSIS posteriorly and run across = S2 then move up thumb lengths to find L5/L4 NOTE: big space between S1 and L5 so count 2 thumb lengths for this space
-L5 often small, short and deep
-L4 is large and ridged sagitally
How to palpate lumbar transverse processes
The lie level with interspace between spinous processes and are large at L3 than they are at lower or upper L-spine
NOTE: You want to find L4/L5 and move 2 thumb lengths over and dig gradually in a circular motion deeper and deeper until you feel a bony prominence
How to palpate articular facets
Lie on either side of the lower 1/3 of the L-spine spinous process. Facets lie 3-5 cm below surface of skin so dig deep
How to palpate PSIS (posterior superior iliac spine)
2 bony landmarks on each side of spine that corresponds directly to S2 (directly under dimples at S2 level)
How to palpate PIIS
2 thumb lengths lower and 1 thumb length lateral from PSIS (will feel sensitive)
NOTE: At S2 level so will palpate at upper level of buttock
How to palpate sacral sulcus
Between psis and s2
How to palpate sacrococcygeal joint
How to palpate ischial tuberosities
Go up hamstring with heel of hand until you feel a bony shelf (will be on butt)
How to palpate adductor longus
confirm with resisted adduction but this muscle in abduction has a distinct ridge running from symphysis pubis to mid-thigh
How to palpate adductor magnus
Uses resisted adduction and extension (inserts distally to adductor tubercle)
-Will be just below adductor longus
How to palpate sartorius
Palpate inferior to ASIS and determine through resisted hip flexion, abduction, or external rotation
How to palpate gracillis
Palpate a few cm distal to pubic insertion on medial surface and confirm with resisted adduction
How to palpate rectus femoris
Start palpation below AIIS until insertion at quadriceps tendon and confirm by asking client to perform isometric quadricep contraction (resisted extension)
How to palpate inguinal ligament
Found from ASIS to superior tubercle. Palpate medial to ASIS
How to palpate quadratus lumborum
Attaches from 12th rib to L1-L5 attaches to transverse processes (so palpate around there) until you get to iliac crest
How to palpate piriformis
Find PSIS and find ischial tuberosity (in between two is the sciatic nerve) find the greater trochanter and the piriformis will be in between the sciatic nerve, the shelf and the greater trochanter
How to palpate hamstrings
- Find the inferior aspect of the ischial tuberosity and then drop directly distal off of it and you will be on the common proximal attachment of the hamstring group.
- Place your hand on the posterior thigh between the buttocks and knee, and ask the partner to flex the knee, holding the foot off the table, exploring mass and width as hamstrings contract. Locate the ischial tuberosity, slide fingertips distally in. and strum across the large solid tendon of the hamstrings. (Make sure they active flex)
How to palpate sacrotuberous ligament
Lies near the highest point of the butt and attaches from lateral border of sacrum to ischial tuberosity
What are the 3 borders of the femoral triangle
What are the 3 contents of the femoral triangle
How to palpate the femoral triangle
Palpate the inguinal ligament, the sartorius, and the adductor longus muscles
How to palpate the sciatic nerve
What 4 movements does the L-spine do
- Flexion
- Extension
- Rotation
- Side Bending
How to measure extension L-Spine
Have clients arms crossed, apply hands to side of hip and support lower back
How to measure flexion L-Spine
Have arms crossed and apply hands to arms on front and back
Measuring tape: put on s2 and mark line 15 cm above and then measure in flexion
How to measure rotation L-Spine
Have clients arms crossed and support both sides (1 lower hand and 1 upper hand)
How to measure side bending L-Spine
Support both sides with hands (1 lower hand and 1 upper hand)
What are the 6 movements of the hip
- Flexion
- Extension
- IR
- ER
- Abd
- Add
Abduction/Adduction for hip with and without gravity and strength
Have leg fully extended
With gravity: Side lying
Without: Lying supine
Strength: Apply pressure on abduction/adduction
Extension for hip with and without gravity and strength
With: Have lying prone with leg slightly bent (foot on shoulder and hand on hip )
Without: Side lying
Strength: Apply resistance to extension
Flexion for hip with and without gravity and strength
With: Have lying supine with leg slightly bent
Without: Side lying
Strength: Apply pressure against flexion
ER/IR with and without gravity
With: Side lying -> cross one leg and have leg on bottom push up for external rotation at knee, then have legs on side with knees touching and have upper leg push out for internal rotation at knee
Without: Lift leg up supporting ankle and one hand under knee and have rotate in (external) and out (internal) (laying supine) -> 90 degrees
NOTE: MAKE SURE TO HAVE BED AT LINE OF DRIVE WITH ARM FOR HIP (HAVE BED AT LEVEL WITH ARM TO HELP GENERATE FORCE)
Different classifications of levels of assistance
What is measured on the 4 + 1 assessment
When to use one-person pivot transfers and the 3 types
Note: Wont have to do mechanical transfer
When to use 2-person side by side transfer and the 4 types
NOTE: Wont perform 2 person transfers on skills check
What are 3 important things to consider for evert repositioning task
How to cue the patient to reposition themselves in a wheelchair
How to assist a patient reposition themselves in a wheelchair
How to perform one person pivot transfer (supervision vs assistance)
Supervision:
1. Cue client to get at 45 degree angle with bed and have them apply their brakes
2. Instruct client to remove foot plates and have swing the foot rest farthest away from the bed out of the way
3. Instruct client to put arms on arm rest, lean forward and push themselves out of wheel chair and into standing
4. Instruct to pivot back facing bed and have one hand on wheel chair arm rest and then put one hand behind to feel the bed and use arm and wheel chair arm to lower
Minimal Assistance:
1. Therapist applies brakes and aligns at 45 degree angle with bed
2. Place transfer belt around client
3. Remove foot rests and foot plates
4. Place transfer disc under clients feet
5. Therapist puts knees around clients knees
6. Instruct client to move head over shoulder towards movement and ask client to place hands on therapists hips
7. Therapist grabs transfer belt and moves up on 1,2,3 stand
8. turn client to bed ask to place hands on bed and say 1,2,3 sit and client sits down
How to perform a slide board transfer
REMEMBER 1/3 RULE
1. Position client at 45 degree angle and put on brakes and transfer belt
2. Remove foot rests and arm rest between client and bed
3. Ask client to lean away from be gently so you can slide transfer board under the butt closest to bed (press the board down and into the seat away from clients skin)
4. Instruct client to place hand on board but away from edge so fingers do not get crushed
5. Cue client to user upper body to move themselves along the board during the transfer
6. Therapist puts knees around patients knees and hands on transfer belt and moves client to bed
How to perform rolling in bed and lie to sit transfer
- reposition bed to align with waist and remove bed rails that are needed for task
- Instruct client to bend far knee placing foot on bed
- Have client grab bed rail with opposite arm and have them raise arm above head (dont have to do this second part)
- Place hands on scapula and waist and ask to roll on 1,2,3
- Lower arm rail
- Have client bend both knees and line them on edge of bed and brace arm that was on rail on the bed on the bed
- Therapist supports shoulder girdle with one hand and other hand on waist and on 1,2,3 sit bring client into seated position
- Make sure to move client forward if feet are not in contact with ground
How to perform a sit to lie transfer
- Ask client to shift up the bed to ensure head hits pillow
- Ask client to place hands on bed while therapist swings feet onto bed (1,2,3 lie)
- Client should be positioned in supine
- Ensure bed rails and call bell are in place and client is comfortable
Name 16 things to look for in posterior posture assessment (upper body)
Name 16 things to look for in posterior posture assessment (lower body)
Name 12 things to look for in lateral posture assessment (upper and lower body)
Name 10 upper and 11 lower body things to look at in anterior posture assessment
Describe how to measure the pelvic angle using a goniometer
How to perform distraction test and why
Measures for cervical radiculopathy
How to perform sperling test and why
See if it reproduces symptoms by compressing nerve root
Purpose of a slump test
To test the dura and can wind up system by plantar flexing and wind down system by lifting head up. Test is positive if it produces typical symptoms. If neck extension doesn’t get rid of pain = hamstring
Purpose of passive neck flexion test
It can diagnose spinal disorders in meningitis if it reproduces typical pain
The ULTT1 purpose
To check for cervical radiculopathy. If it produces typical symptoms then thats what it is. Cervical radiculopathy is when a nerve in the cervical region is irritated causing pain.
What are the fitts & posner 3 stages of motor learning and purpose
Helps require a skill or retain old skills lost by impairments
What is the different levels of assistance in lifts and transfers
What is the 4 + 1 assessment and purpose
Determines level of independence for transferring
How to classify supervised and 1-person pivot transfers
How to classify 2-person side by side and two-person pivot transfer
Name 5 types of impaired postural alignments
If muscles are short and tight we want to
Stretch them
If muscles are weak and elongated we want to
Strengthen them
Go through these case studies
What are the 9 balance domains (systems framework
Go over the different types of loading for FITT
FITT for strength
Fitt for aerobic exercise
Fitt for flexibility training
Fitt for posture
