Exam 3 - Musculoskeletal Flashcards
1
Q
How many vertebrae?
A
Vertebrae are 33 connecting bones stacked in a vertical column.
2
Q
How many cervical vertebrae are there in humans?
A
There are 7 cervical vertebrae.
3
Q
How many thoracic vertebrae are there in humans?
A
There are 12 thoracic vertebrae.
4
Q
How many lumbar vertebrae are there in humans?
A
There are 5 lumbar vertebrae.
5
Q
How many sacral vertebrae are there in humans?
A
There are 5 sacral vertebrae.
6
Q
How many coccygeal vertebrae are there in humans?
A
There are 3 to 4 coccygeal vertebrae.
7
Q
What is the significance of the spinous processes of C7 and T1?
A
They are prominent at the base of the neck.
8
Q
Where is the inferior angle of the scapula located?
A
It is normally at the level of the interspace between T7 and T8.
9
Q
What does the imaginary line connecting the highest points on each iliac crest indicate?
A
It crosses L4.
10
Q
What does the imaginary line joining two symmetric dimples overlie?
A
It crosses the sacrum.
11
Q
What does the lateral view of the vertebral column show?
A
It shows four curves, forming a double-S shape.
12
Q
What are the characteristics of the cervical and lumbar curves?
A
They are concave (inward or anterior).
13
Q
What are the characteristics of the thoracic and sacrococcygeal curves?
A
They are convex.
14
Q
What is the first step in the order of a musculoskeletal exam?
A
Inspection.
15
Q
What should be noted during inspection?
A
Size and contour of the joint; skin and tissues over joints for color, swelling, and any masses or deformity.
16
Q
What is the second step in the order of a musculoskeletal exam?
A
Palpation.
17
Q
What should be palpated during the exam?
A
Each joint, including skin for temperature, muscles, bony articulations, and area of joint capsule.
18
Q
What should be done if tenderness occurs during palpation?
A
Localize to specific anatomic structures.
19
Q
What is assessed during the range of motion (ROM) step?
A
Active voluntary ROM is assessed while stabilizing the body area proximal to that being moved.
20
Q
What should be done if a limitation in ROM is observed?
A
Gently use passive ROM.
21
Q
What is the focus of muscle testing in a musculoskeletal exam?
A
Test strength of prime mover muscle groups for each joint.
22
Q
How is muscle strength assessed?
A
Ask the person to flex and hold as you apply opposing force.
23
Q
What should muscle strength be like during testing?
A
It should be equal bilaterally and should fully resist opposing force.
24
Q
What scale is used to report muscle strength results?
A
A standardized grading scale from 0 to 5.
25
What should be inspected in the cervical spine?
Inspect alignment of head and neck. The spine should be straight and head erect.
26
What should be palpated in the cervical spine?
Palpate spinous processes and sternomastoid, trapezius, and paravertebral muscles. They should feel firm, with no muscle spasm or tenderness.
27
What tests the integrity of cranial nerve XI in the cervical spine?
Repeat motions while applying opposing force. The person normally can maintain flexion against full resistance.
28
What should be observed in the cervical spine examination?
Observe for limitation of motion and/or reported pain.
29
What should be inspected in the shoulder examination?
Inspect and compare both shoulders posteriorly and anteriorly. Do not attempt if you suspect neck trauma.
30
What to do if a person reports shoulder pain?
Ask him/her to point to the spot with the hand of the unaffected side. Shoulder pain may be from local causes or referred pain which could be potentially serious.
31
How to assess muscle strength and ROM in the shoulder?
While standing in front of the person, palpate both shoulders, noting any muscular spasm or atrophy, swelling, heat, or tenderness. Use a methodical method to assess muscle strength and ROM.
32
What does a shoulder shrug test?
Shoulder shrug also tests the integrity of cranial nerve XI, spinal accessory nerve.
33
What should be inspected in the elbow?
Inspect size and contour of elbow in both flexed & extended positions. Look for deformity, redness, or swelling.
34
What should be palpated in the elbow examination?
Palpate elbow flexed about 70 degrees and relaxed. Use stabilizing technique to support extremity during assessment.
35
What should be assessed in the elbow?
Test ROM and assess muscle strength.
36
What should be inspected in the wrist and hand?
Inspect hands and wrists on dorsal and palmar sides. Note position, contour, and shape; normally no swelling or redness, deformity, or nodules are present.
37
What to do during palpation of the wrist and hand?
Palpate each joint in wrist and hands. Perform ROM and assess muscle strength.
38
How to test for Carpal Tunnel Syndrome?
Perform Phalen test—acute flexion of wrist produces numbness and burning if positive. Perform Tinel sign test—percussion of median nerve produces burning & tingling if positive.
39
What should be inspected in the hip examination?
Inspect hip joint together with spine later in examination as person stands; note symmetric levels of iliac crests, gluteal folds, and equally sized buttocks.
40
What indicates functional hip motion?
Smooth, even gait reflects equal leg lengths and functional hip motion.
41
What should be palpated in the hip examination?
Help person into supine position and palpate hip joints; joints should feel stable and symmetric, with no tenderness or crepitation.
42
What should be assessed in the hip?
Assess ROM. Limitation of abduction of hip while supine is most common motion dysfunction found in hip disease.
43
What should be inspected in the knee examination?
Person should remain supine with legs extended. Inspect lower leg alignment, knee shape, and contour.
44
What to check for in the quadriceps muscle?
Check quadriceps muscle in anterior thigh for any atrophy.
45
What should be performed to assess the knee?
Perform ROM to assess for any limitation or presence of pain.
46
How to enhance palpation of the knee?
Enhance palpation with knee in supine position; start high on anterior thigh above patella.
47
What to do if swelling is observed in the knee?
Test for bulge sign and ballottement of patella to distinguish soft-tissue swelling or increased fluid in joint.
48
What test is performed if a meniscal tear is suspected?
Perform McMurray’s test. An audible click on examination is positive for presence of tear.
49
What should be inspected in the ankle and foot?
Inspect while person is sitting and when standing & walking. Compare both feet, noting contour of joints; foot should align with long axis of lower leg.
50
What indicates proper weight-bearing in the foot?
Weight-bearing should fall on middle of foot; most feet have a longitudinal arch, but this can vary normally from 'flat feet' to high instep.
51
What should be noted about the toes during inspection?
Toes should point straight forward and lie flat; note locations of calluses or bursal reactions as they reveal areas of abnormal friction.
52
What should be done during palpation of the ankle and foot?
Palpate metatarsophalangeal joints between your thumb on dorsum and fingers on plantar surface.
53
What should be assessed in the ankle and foot?
Perform ROM to assess for any limitation or presence of pain. Assess muscle strength by asking person to maintain dorsiflexion and plantar flexion against your resistance.
54
What should be inspected in the spine examination?
Person should be standing, draped in gown open at back. Inspect and note if spine is straight.
55
What should be noted about the spinal curves?
From side, note normal convex thoracic curve and concave lumbar curve. Kyphosis: Enhanced thoracic curve typically seen in aging people. Lordosis: Pronounced lumbar curve seen in obese people.
56
What should be palpated in the spine?
Palpate spinous processes; normally straight and not tender. Palpate paravertebral muscles; should feel firm with no tenderness or spasm.
57
How to check ROM of the spine?
Ask person to touch toes; look for flexion of 75 to 90 degrees, and smoothness & symmetry of movement.
58
What happens to the lumbar curve during toe touching?
Concave lumbar curve should disappear with this motion; back should have single convex C-shaped curve.
59
What to do if spinal curvature is suspected?
Mark a dot on each spinous process; when person resumes standing, dots should form a straight vertical line.
60
What ROM checks should be performed on the spine?
Stabilize pelvis with your hands; check ROM. Bend sideways: lateral bending of 35 degrees. Bend backward: hyperextension of 30 degrees. Twist shoulders to one side, then the other: rotation of 30 degrees, bilaterally.
61
What do these maneuvers reveal?
These maneuvers reveal gross restrictions only; movement is still possible even if some spinal fusion has occurred.
62
What final tests should be performed on the spine?
Finally, ask person to walk on his or her toes for a few steps, then return walking on heels.
63
What is the purpose of Straight Leg Raising or Lasègue’s Test?
These maneuvers reproduce back and leg pain & may confirm presence of herniated nucleus pulposus.
64
What normally happens during straight leg raising with the knee extended?
It normally produces no pain.
65
How is the Straight Leg Raising test performed?
Raise affected leg just short of point where it produces pain; then dorsiflex foot.
66
What indicates a positive result in the Straight Leg Raising test?
Test positive if it reproduces sciatic pain; if lifting affected leg reproduces sciatic pain, it confirms presence of herniated nucleus pulposus.
67
What should be done with the unaffected leg during the Straight Leg Raising test?
Raise unaffected leg leaving other leg flat; inquire about involved side.
68
When should you measure leg length discrepancy?
Perform this measurement if you need to determine whether one leg is shorter than the other.
69
How do you measure true leg length?
Measure between fixed points, from anterior iliac spine to medial malleolus, crossing medial side of knee.
70
What does it indicate if leg length measurements are equal or within 1 cm?
It indicates no true bone discrepancy.
71
What are expected postural changes during pregnancy?
Progressive lordosis, anterior cervical flexion toward third trimester, kyphosis, and slumped shoulders.
72
What gait characteristic is noted when pregnancy is at term?
A protuberant abdomen & relaxed mobility in joints create a characteristic 'waddling' gait.
73
What is Ortolani’s sign used for?
It is used for infants to check for congenital dislocation.
74
What does the Phalen test indicate?
Acute flexion of wrist produces numbness and burning if positive.
75
What does the Tinel sign test indicate?
Percussion of median nerve produces burning & tingling if positive.
76
What does McMurray's Test assess?
It assesses for meniscal tear.
77
What does the Thessaly test assess?
It assesses for meniscal tear.
78
What does the Anterior Drawer Test assess?
It assesses the Anterior Cruciate Ligament.
79
What does the Posterior Drawer Test assess?
It assesses the Posterior Cruciate Ligament.
80
How should infants be examined?
Examine fully undressed and lying on back; maintain temperature.
81
What should be noted in infants' feet and legs?
Note any positional deformities and the relationship of forefoot to hindfoot.
82
What is tibial torsion?
It is a twisting of the tibia.
83
What is the Allis test used for?
It is used to check for hip dislocation.
84
What does the Trendelenburg sign check for?
It checks progressively for subluxation of the hip.
85
What is the purpose of inspecting and palpating the Temporomandibular Joint (TMJ)?
To assess for audible and palpable snap or click, muscle contraction, and jaw movement.
86
What does the TMJ exam include?
Open mouth, partially open mouth, protrude jaw, stick out lower jaw.
87
What is the nucleus pulposus?
It is the disk center composed of soft, semifluid, mucoid material.
88
What motions does the vertebral column perform?
Flexion, extension, abduction, and rotation.
