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PT9112 > Skills Check 3 > Flashcards

Skills Check 3 Flashcards

1
Q

How to palpate tendon (patellar ligament) -> superior and inferior

A

Palpate along length of insertion from patella to tibial tubercle
-Palpate on medial and lateral sides of depression

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2
Q

How to palpate tibial tubercle

A

Partner seated, knee flexed. Locate patella and move down 3-4 inches inferior and will feel a bony prominece

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3
Q

Apex of patella

A

Inferior pole of patella

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4
Q

Base of patella

A

Superior pole of patella

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5
Q

How to palpate patella

A

Have knee slightly flexed and note position of patella in terms of base, apex, and medial/lateral aspect

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6
Q

How to palpate suprapatellar bursa

A

-Extends 3 finger breadths over superior patellar pole

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7
Q

How to palpate tibial platea

A

Knee flexed to 90 degrees. Place thumbs on either side of patella. move into joint space and continue moving medially until you reach bony prominence.

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8
Q

How to palpate medial tibial condyle

A

Lies immediately inferior to tibial plateau and provides attachment for pes anserine

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9
Q

How to palpate femoral condyles

A

Supine with knee fully extended. Locate sides of patella. Shift patella medially and slide off of it onto lateral condyle. Palpate medial condyle in same way but shift patella laterally.

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10
Q

How to palpate femoral epicondyles

A

Partner seated with knee flexed. Locate patella. Slide directly laterally from patella. return to patella and slide medially for other epicondyle.

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11
Q

How to palpate adductor tubercle

A

Partner seated. Knee flexed. Locate medial epicondyle of femur. Slide superiorly along medial side of femur and you can feel the bone drop off (abductor magnus is here).perform resisted adduction

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12
Q

How to palpate medial coronary ligament

A

Medial to patellar tendon on superior surface of tibial plateau (knee should be flexed at 90 degrees and tibia externally rotated)

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13
Q

How to palpate medial collateral ligament

A

2-3 cm wide passing from medial femur epicondyle to medial tibial condyle

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14
Q

How to palpate pes anserine

A

Locate tibial tuberosity. Slide medially one inch and then do resisted knee flexion.

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15
Q

Palpate Lateral tubercle of tibia (Gerdy’s Tubercle)

A

On anterolateral aspect of tibia immediately below lateral tibial plateau and lateral to tibial tuberosity
-Distal attachment of IT band
-resisted hip flexion

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16
Q

How to palpate head of fibula

A

Easier to palpate with knee flexed and tibia internally rotated. Slide fingers laterally 3-4 inches. (can also have prone and follow the bicep femoris tendon)

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17
Q

How to palpate lateral collateral ligament

A

-Passes from fibular head to lateral femoral condyle
-Cross leg and let it fall into abduction and ER, palpate the LCL as a rope-like structure

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18
Q

How to palpate trochlear groove

A

Superiorly above patella, lateral will be more prominent (better to have knee flexed)

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19
Q

How to palpate lateral coronary ligament

A

Palpate on tibial plateau with the knee in flexion and IR

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20
Q

How to palpate iliopatellar fibers

A

Palpate posterolateral ridge of the base of the patella (fibers go to it band from base of patella)

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21
Q

How to palpate hamstring tendons and muscle belly

A

In prone lying with knee slightly flexed and resisted knee flexion

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22
Q

How to palpate popliteal fossa

A

Contains superficial to deep: tibial nerve, popliteal vein and popliteal artery

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23
Q

How to palpate menisci

A

Have knee flexed. Place thumb superior to tibial plateau in joint spaces between femur and tibia. Grasp leg with hand and rotate either medially or laterally. The menisci will push against the thumb

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24
Q

How to palpate quadriceps

A

have sitting leg on edge of bed and do resisted extension (vastus lateralis -> knee internal rotation; medialis -> knee external rotation, rectus femoris just middle in extension and vastus intermedius is underneath rectus femoris

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25
Q

How to palpate fib long/brev

A

Have partner side lying. Place finger at head of fibula and another at lateral malleolus. They are located between these too marks. Lay fingers between these landmarks and have them evert then relax foot . Can perform resisted eversion.

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26
Q

How to palpate tib ant/post

A

Partner supine. Locate shaft of tibia and slide off it laterally onto tibialis anterior. Ask partner to dorsiflex ankle and palpate. Follow to medial side of foot as it disappears into medial cuneiform. Can perform resisted dorsiflexion. CANNOT palpate tib post.

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27
Q

How to palpate hamstrings

A

Lying prone and feel for tendons and do resisted flexion

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28
Q

How to palpate popliteus

A

lateral condyle to proximal tibia (prone)…have lying prone with knee flexed. Access tibial tuberosity and sliding medially around the tibia to the posterior surface of its shaft. Also does knee flexion

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29
Q

How to palpate gastrocnemius

A

calfs (resisted knee flexion will give two heads (prone)…have partner lying prone and bend the knee to 90 degrees . Isolate soleus from gastroc by having partner gently plantar flexor against resistance (soleus should get thick

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30
Q

How to palpate plantaris

A

Have partner prone knee flexed and locate fibular head. Move thumb medial into popliteal space between gastroc heads. With thumb between gastroc heads slowly sink into tissue of the posterior knee.

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31
Q

How to palpate soleus

A

Bend knee and then resisted plantar flexion (lower leg near ankle and up to calf) (prone)

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32
Q

How to palpate flexor digitorum longus and hallucis

A

resisted flexion of toes (prone)
-Hallucis is big toe
Locate medial malleolous and slide posteriorly and proximally into space between posterior shaft of tibia and calcaneal tendon. Difficult to isolate specific tendons. Have partner invert foot.

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33
Q

How to palpate extensor digitorum longus and hallucis

A

resisted extension of toes (prone)

-Ask partner to extend their toes and palpate along the tendons to the ankles

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34
Q

How to palpate tibia/fibula articulation

A

find fibula head but will be difficult (superior) will also be inferior articulation near the ankle

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35
Q

how to palpate patella mobility

A

Move patella around

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36
Q

How to palpate tibia rotation

A

Have lying supine and have knee flexed and relaxed, one hand supporting calf and the other on the Achilles-> rotate the Achilles each way to test for tibia rotation

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37
Q

How to measure flexion/extension ROM

A

Have in supine (for extension put cloth under hip) can measure hyperextension also)

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38
Q

How to test screw home mechanism

A

Flex leg supporting calf and performing tibial rotation (externally) -> externally rotate knee and pull leg back into extension slowly letting go of tibial rotation

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39
Q

Medial Malleolus

A

Partner in seated or supine and palpate distal end of tibia. Will feel protrusion. It is the attachment site for thed eltoid ligaments (anterior tibiofibular, tibionavicular, tibiocalcaneal, and posterior tibiotalar ligament)

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40
Q

Sustentaculum Tali

A

Slide 2-2.5 cm directly below medial malleoulus. Attachment site for spring ligament and tib post. Invert to soften tissues

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41
Q

Navicular Head/Tubersity and navicular

A

Partner seated or in supine. Approx 4 cm distal to sustentaculum tali on medial aspect of foot. For navicular locate base of first metatarsal and move proximally across surface of cuneiform.

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42
Q

1st mt/1st cuneiform joint

A

Cornfirm by testing tib ant (resisted dorsiflexion)

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43
Q

Navicular/1st cuneiform joint

A

Just distal to navicular tuberosity

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44
Q

1st MTP joint

A

Locate proximal end of 1st phalanx as it articulates with distal end of the 1st metatarsal

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45
Q

How to palpate talus (head, trochlea, and medial tubercle)

A

Head of Talus: Partner supine or seated with ankle in neutral position. Locate navicular tubercle. Slide proximally off tubercle to head of talus. Head may feel like a depression compared to tubercle. Passively invert (navicular tubercle becomes more prominent) and evert (talar head becomes more prominent) foot to distinguish between the two.

Trochlea of talus: Partner supine and passively invert and PFF. Draw a line that connect the malleoli and drop inferiorly off center of line looking for bony prominence. Will be more prominent near lateral malleolus

Medial tubercle: Partner supine. Locate medial malleolus. Slide posteriorly off malleolus at 45 degree angle to locate medial tubercle. Passively dorsiflex and plantarflex ankle (tubercle should slide around malleolus)

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46
Q

Tib post palpation

A

Across sustentaculum tali and partly inserting into navicular. Resist ankle plantarflexion and inversion

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47
Q

Palpate spring ligament

A

Goes from surface of sustentaculum tali to navicular . Can passively invert foot to soften tissue to loacate sustentaculum tali.

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48
Q

How to palpate tom dick and a very nervous harry

A
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49
Q

Lateral malleolus palpation

A

Find lateral bony prominence on lateral side of foot. Provides attachment for ATFL, CFL, and PTFL.

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50
Q

How to palpate medial, middle and lateral cuneiforms

A

Partner seated or supine. Locate base of first metatarsal. Glide proximally to skinny ditch of first tarsometatarsal joint. Continue proximally onto surface of medial cuneiform. Slide laterally from medial cuneiform along dorsal surface of foot and explore middle and lateral cuneiforms.

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51
Q

How to palpate 5th metatarsal

A

Palpate along shaft of 5th metatarsal base. The base is the styloid process and is the insertion for peroneus brevis. Could do resisted eversion to confirm.

52
Q

how to palpate cuboid

A

Proximal to base of 5th metatarsal. There will be a depression on lateral aspect for passage of peroneus longus. Also can draw imaginary line from tuberosity of 5th metatarsal to lateral malleolus. Cuboid is half an inch from tuberosity.

53
Q

Calcaneus

A

Partner seated or in supine. Walk fingers distally from malleoli down to heel.

54
Q

Calcaneocuboid joint

A

Approx 2cm proximal to styloid process of 5th metatarsal on lateral and dorsal aspect of base of foot. Can twist foot in opposite directions to feel the movement. If not on it there wont be any movement.

55
Q

Peroneal tubercle

A

Immediately below the lateral malleolus and it separates the 2 peroneal tendons

56
Q

How to palpate ATFL

A

Move anterior from lateral malleolus to lateral aspect of talus neck. Plantarflex and invert slightly

57
Q

How to palpate CFL

A

Move from lateral malleolus inferiorly and posterior to calcaneus just behind peroneal tubercle. Have slight inversion.

58
Q

How to palpate PTFL

A

Runs horizontally between medial insertion posteriorly on talus to lateral malleolus posteriorly

59
Q

How to palpate sinus tarsi

A

Depression seen laterally when foot is plantarflexed and inverted. Formed by interlocking of talus and calcaneus.

60
Q

Deltoid ligament

A

Partner supine or seated. Locate medial malleolus and sustentaculum tali. Place finger between these points and strum horizontally to isolate fibers of ligament. Slide distally from medial malleolus at 45 degree angle and palpate its angled fibers to define anterior and posterior aspects.

61
Q

Peroneus/Fibularis longus and brevis tendons

A

Behind lateral malleolus with peroneus brevis lying closer to malleolus

62
Q

How to palpate inferior tibio-fibular joint

A

Palpate anteriorly coming around lateral malleolus to depression between medial and lateral malleolus. (Sinus tarsi region)

63
Q

How to palpate achilles tendon

A

Dorsiflex the ankle to place achilles tendon under some stretch to palpate more accurately. Palpate for tenderness and thickness

64
Q

Retrocalcaneal bursa palpation

A

Lies between achilles tendon and calcanous

65
Q

Calcaneal bursa palpation

A

Partner seated or supine. Ankle in neutral position and locate achilles/calcaneal tendon. Follow it distally until it merges into calcaneus. Gently squeeze the skin posterior to tendon and this is where the bursae is (bursae is not palpable in health people)

66
Q

Tib ant on foot

A

Inserts into medial cuneiform bone and base of 1st metatarsal. Confirm with resisted dorsiflexion and inversion. Tib ant on leg = have supine and locate shaft of tib and slide off it laterally onto tib ant. Ask partner to dorsiflex his ankle and palpate belly down the leg. Itll disappear at medial cuneiform

67
Q

Extensor hallucis longus on foot palpation

A

Inserts into base of distal phalanx. Confirm with resisted big toe extension. Palpate tendon running along top of foot toward the ankle.

68
Q

Extensor digitorum longus

A

have supine. Do resisted toe extension and follow the tendons towards the ankle (D2-5)

69
Q

How to palpate dorsal pedis artery

A

Lies lateral to EHL and medial to first tendon of EDL.

70
Q

Flexor digitorum longus and hallucis

A

Partner supine or side lying. Locate medial malleolus. Slide off malleolus posteriorly into space between posterior shaft of tibia and calcaneal tendon. Have partner do resisted toe flexion as well as you can invert their foot to follow tendon around ankle and to underside of foot

71
Q

how to palpate tibia and fibula articulation

A

Do top and bottom of leg try and rotate opposite ways to feel the movement

72
Q

Talocrural (ankle) joint palpation

A

Find depression on front of ankle on lateral side by malleolus and have invert and plantarflex foot (will connect tibia fibula and talus)

73
Q

Subtalar joint palpation

A

Articulation between the talus and calcaneus. Go to back of heel having partner lie spine and bend calcaneus down

74
Q

Abd/Add resistance and ROM of foot

A

REsistance: Sit on edge of bed and have pillow under thigh to offload gastroc. Have hand on foot and under hel and move side to side. Should be 30-50 egreees (abd) and add is half of abd.

75
Q

Plantar/Dorsiflexion resistance and ROM of foot

A

Have pillow under thigh and have foot hanging off bed in supine. Grasp calcaneus and support top of ankle for dosiflexion have arm go up toes and trie and do resistance. For plantar have hand on top of foot and on ankle and do resistance that way.

ROM: Place axis inferior to lateral malleolus. Have stationary arm in parralel with fibula and moveable arm parallel to sole of heel at 90 degrees then dorsiflex (20 degrees) and plantarflex (50 degrees)

76
Q

Inversion/Eversion resistance and ROM of foot

A

ROM: Use paper and hard flat glas to measure andlge and draw angles on paper. (can also place goni at ankle joint with foot off bed and have it run 180 degrees and then invert and evert

Resistance: Stabilize ankle and do resisted inversion and eversion (show patient movement first)

77
Q

Flexion /Extension of big toe resistance and ROM

A

Resistance: Have foot on bed and do resisted extension and flexion of big toe.
ROM. Have stationary arm parallel to first metatarsal and have moveable arm parallel to proximal phalanx (180 degrees) then flex and extend. Place axis on MTP joint (flex =45, ext = 70)

78
Q

How to test myotome L2

A

Hip flex with knee bent and bring hip to 90 degrees (pull down on hip for resistance for 5 seconds) put leg on shoulder

79
Q

How to test myotome L3

A

Quadricep have arm under knee and one on top of ankle and have them try to kick up on hand

80
Q

How to test myotome L4

A

Hand under ankle and other on top of foot try and move out of 90 degree dorsiflexion (stand at end of bed and align elbow with foot (90 degree arm bend.)

81
Q

how to test myotome L5

A

Hold top of foot and try to resist pushing down on big toe

82
Q

How to test myotome S1

A

Hand on top of ankle and have plantar flex, try and pull the foot up (have arm and elbow and hand straight above (hold foot from side)

83
Q

How to test myotome S2

A

Have knee flexed try and pull leg down and straighten it… hand on top of quad and just beneath calf

84
Q

How to palpate C-spine

A

C-spine: Ask for any change (not any pain)
-Make sure no muscle tone
1) Find obturator process
2) Go down to next bump should be c2 and push on each c spine level and ask for any change (light force-> mid force -> more force…go all the way down to C7
3) Can identify if quality or quantity is compromised

85
Q

How to palpate L-spine

A

1) Make gun and then bunny and combine together
2) Place gun and bunny at L5 to expose hypothenar eminence and apply pressure and ask for any change…go up to L1 (remember to compare each vertebrae as you go up
3) Push down on L-Spine
Instead of gun bunny: open up dominate hand then with non dominate grab use 3 fingers that arent index or thumb to grab onto webbing of dominate hand then close fists

86
Q

What are the 3 neurodynamic tests of the lower extremities

A

1) Slump
2) SLR
3) Prone knee bend

87
Q

How to perform slump

A

Ask any change with every movement in upper trunk and lower trunk
-raise leg and have foot dorsiflex asking (to wind up)
If have change have lower leg have them look up to unwind (if head movement improves it = dura…if still feel it after unwinding = muscular component like hamstrings)
-perform on both legs

88
Q

How to perform SLR

A

L4, L5, S1 tested as it measures sciatic and hamstrings (place one hand behind ankle and one hand on lower thigh and ask for any change going through), turn body have way through to move leg in line of drive (should be around 70-80 degrees = normal)
-Can apply dorsiflexion to see if any change also so were winding up nervous system = sciatic issue not hamstring, also could use adduction and medial rotation as leg is raised to wind up
-perform on both legs

89
Q

How to perform prone knee bend and what is alternate if can’t bend knee

A

Targets Quads (rec fem) and femoral nerve = L3 nerve root. Ask for any change all the way through the movement. Can do passive hip flexion if they cant bend knee
-do on both legs

90
Q

Describe the gait cycle

A
91
Q

What to watch for in gait analysis

A
92
Q

What is an appropriate gait sped

A

1 m/s

93
Q

How to perform 6-minute walk test

A
94
Q

How to perform a 10 m walk test

A
95
Q

how to perform a dual-task gait test

A

Ask them to walk and remember a 5-digit number and report after they have finished walking

96
Q

What to look for in pathological gait

A

Same as what you would look for in gait analysis look for gait deviations and potential impairments of all joint areas going from top to bottom. Have them walk and repeat as many times as you can.

97
Q

Go over how to fit and use a cane, including sit-to-stand, stand-to-sit, 4-point, 2-point, 3-point, modified 4 and 2 point walks, and your spotting (how would you teach a client)

A

Fit: Wrist crease

Sit-to-Stand: Scoot forward on chair have feet below knees, lean forward, and push off
**Don’t use gait aid as support to stand up (crutches is an exception to standing)
**With no arms on chair can have them move sideways to use back of chair to get off
**Have cane (single) in hand while trying to get out of chair to minimize risk of balance loss

Stand-to-Sit: Have them turn around and push legs against back of chair, reach over with unsupported hand to reach chair then life cane up and reach with other hand onto chair for support and sit down

Types of movements:
4-Point: Left cane - Right foot - Right cane - Left foot
2-Point: Left cane and right foot - Right cane and left foot
3-Point: Both canes - single foot (only weight bearing foot is used)
Modified 4-point: cane- step -step 1 cane)
Modified 2-point: cane and opposite leg - then other leg (1 cane)
**Watch quad canes for narrowness and width, want proper quad cane to have narrow side on unaffected side

Spotting: Stand on affected side of person (opposite of cane)

REMEMBER:
-Screw in the cane once adjsuted
-Cane always goes on unaffected side, but if they just have general balance issues and no affected side they can pick and choose (usually be dominant side)

98
Q

Go over how to fit and use crutches, including sit-to-stand, stand-to-sit, 4-point, 2-point, 3-point, 3-1point, and your spotting (how would you teach a client)

A

Fit: have at wrist line and have 3 inches from axilla when leaning

REMEMBER: Instruct them to not have it in their armpits but rather lower closer to ribs area

Sit-to-Stand: Use cane arms in one hand as leverage to stand up (if non-weight bearing put foot straight out and get it out of way and push off bed with other hand that isnt on crutches)

Stand-to-Sit: Line up back of legs with chair or bed. Have them combine canes into one hand and then use free hand to grab onto bed…put crutches off to side and use other hand to get on bed.

Spotting: When walking stand behind them on corner of affected side. When sitting again stand on affected side.

Types of movements
4-point: same as cane (balance impairment)
2- Point: same as cane (balnce impairment)
3-point: both crutches - 1 weight bearing foot (non-weight bearing on 1 leg)
3-1 Point (light weight bearing): both crutches and affected leg - unaffected leg (partial weight bearing on affected leg)

99
Q

Go over how to fit and use standard walker, including sit-to-stand, stand-to-sit, WAT, 50% WAT, Feather WAT, Non-weight bearing, and PWB (how would you teach a client)

A

Fit: At wrist crease line (for people who had knee replacements)

Sit-to-stand: Don’t grab walker use the chair and then grab walker make sure walker is not tight to the person but a little way away from body….get feet underneath knees, lean forward, have hands on side of chair (besides you) and push off (if chair doesn’t have arms have patient sit sideways = only use sometimes)

Stand-to-Sit: Have turn around so back of legs touch chair and have them use arms to get back down (instruct to reach back for chair one hand at a time)

Spotting: along side them to make sure they arent putting walker out too far but if walking too fast stand behind them

Movement:
WAT: Walker - sore leg - good leg (at first bring 2 feet together and as progress you can start to displace feet slightly (little bit passed one another) but do not walk PAST the walker

50% WAT: Unweight affected leg so they don’t have 100% load

Feather weight bearing: Rest one foot stretched in front of other and get to standing (sit to stand) and walking should also be the same as egg (as much pressure on that leg as you would use to not crack an egg -> better than non-weight bearing because of functionality and restoring gait pattern and helps with balance

Non-weightbearing: Leg is not on floor during sit to stand and walking

PWB (protective weight bearing): weight bearing as tolerated with a gait aid

100
Q

Go over how to fit and use wheeled walker, including sit-to-stand, stand-to-sit, WAT, movement (how would you teach a client)

A

Fit: Wrist crease

Sit-To-Stand: Same as others and don’t use device to get up (brakes need to be engaged at all times when doing sit to stands = push down to break or hold while pushing up….use brakes on these when walking when going down the hill or if it is slippery)

Stand-to-sit: Line legs up with back of chair. Make sure brakes are on. Have them reach back one arm at a time and sit.

Spotting: Stand beside them to make sure walker isnt going out too far. If walking too fast stand behind them.

Movement: Normal gait and must be full weight baring to use so they should be walking normally

101
Q

How to teach a patient to ascend stairs with mobility aid

A

Have transfer belt on and get foot close to stairs as possible
Up-> foot goes first then crutches, stand on side behind
Down-> crutches then foot…stand in front on hand on transfer belt and other on top of shoulder (without rail)

ALWAYS use rail if present whether good or bad side….put both crutches under both arms and use rail….foot up then crutches (up)….crutches then foot (down)-> stand on side away from rail when using that

PWB: same as without rail

4-arm crutches: to go up or down with rail…same thing but hold the crutches in a T with long end pointing to stairs when down and away from stairs when up

102
Q

How to teach a patient to descend stairs with a mobility aid

A

Have transfer belt on and get foot close to stairs as possible
Up-> foot goes first then crutches, stand on side behind
Down-> crutches then foot…stand in front on hand on transfer belt and other on top of shoulder (without rail)

ALWAYS use rail if present whether good or bad side….put both crutches under both arms and use rail….foot up then crutches (up)….crutches then foot (down)-> stand on side away from rail when using that

PWB: same as without rail

4-arm crutches: to go up or down with rail…same thing but hold the crutches in a T with long end pointing to stairs when down and away from stairs when up

103
Q
A

Wed have to know if there are any upper impairments. Since it is easier to get around we should use crutches and a 3 point gait. We want them to get out of bed how they want but they should be able to do both ways even if other way hurts. Make sure their bad foot does not touch the ground. Then educate them how to get up with crutches. Make sure crutches are not underarms to prevent brachial plexus damage. Make sure to stand behind them on unaffected corner and teach them where to place the crutches. How to move with. Don’t do massive swing threw and correct posture. Can use standard walker as well depends on their needs and if their environment has stairs or take public transportation. Clean and maintenance of crutches is important

104
Q
A

Standard walker because in acute care and had major surgery-> acute care, use 3-1 and step to the foot. Sit-to-stand, maintenance, how to walk with walker (make sure it doesn’t get too far out front), how to get out of bed by applying light weight bearing on foot. For 50% WAT you want to describe it as you stand that is 50% so when you take a step to not use 100% you want to use your arms to help limit the load on that foot). Make sure to always adjust bed when going from sit-to-stand. Put injured leg up and have them stand up. Check height of walker and if it doesn’t fit have them sit down and readjust. In positioning have hand on hips of opposite side of where you are then other hand on front side running from front of body under arm. Use shoulder to prevent falling forwards(usually need 2 people). Have transfer belt on

105
Q
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106
Q

Differentiate 4-point, 3-point and 2-point gait pattern

A
107
Q

What is a 3-1 gait pattern

A
108
Q

How to differentiate between ambulatory aids to choose (WAT vs not WAT)

A
109
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110
Q
A

Write something for this

111
Q

Active movement gives

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112
Q

PROM gives

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113
Q

Resisted movement gives

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114
Q

Capsular pattern vs non-capsular pattern

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115
Q

Regional interdependence

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116
Q

What are myotomes and how do they help us

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117
Q

What are deep tendon reflexes and how do they help us

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118
Q

Difference between dura and nerve root pain

A
119
Q

Solve the case study

A

Write something

120
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121
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122
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123
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124
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125
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126
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127
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PT9112 (10 decks)

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