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MSK > UNIT 1 > Flashcards

UNIT 1 Flashcards

1
Q

how to tell a mechanical from a non mechanical prob

A

a mechanical prob, the px is modified by movement or rest, non mechanical prob is constant

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2
Q

If we are not able to reproduce the px, we may have to

A

refer them out

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3
Q

ICF model

A

health cond to body structure and function to participation rest to activity limitation then personal and env factors

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4
Q

4 main parts to what we do (new pt)

A

examination -collect data
assessment - interpret data
intervention - develop and implement plan
assessment - reeval

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5
Q

What is 2 compartment thinking

A

we need to be open to the idea that not everything will fit in to a cookie cutter scenario (brick wall vs permeable wall)

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6
Q

A pos response to your tx indicates that your hypothesis was ___

A

correct

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7
Q

2 common errors with clinical reasoning

A

over emphasising findings to help support one hypothosis

ignorning findings that don’t support your hypothesis

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8
Q

SINSS

A 
severity
irritability
nature
stage
stability
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9
Q

What is the severity part of SINSS

A

your assessment of the intensity (min, mod max)

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10
Q

what is the irritability part of the SINSS

A

amt of activity needed to cause sx
severity of sx
time it takes to subside sx

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11
Q

What is nature

A

structure that is causing the issue

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12
Q

what is stage

A

acute, subacute, chronic

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13
Q

what is stability

A

better or worse (ease of disturbance)

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14
Q

acute is what time frame

A

less than 30 days (inflammatory phase)

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15
Q

sub acute is what time frame

A

30 days to 6 mos

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16
Q

chronic is what time frame

A

after 6 mos

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17
Q

proliferation stage is associated with what phase

A

sub acute

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18
Q

a physical finding

A

sign

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19
Q

problem reported by pt

A

sx

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20
Q

what is clearing a jt

A

you have to check above and below the joint that is causing the prob, do passive over pressure and testing of all 3, then place a single check mark over the joint on the body chart to indicate cleared

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21
Q

P1

A

primary complant

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22
Q

C

A

constant

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23
Q

I

A

intermittant

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24
Q

/////

A

numbness or tingling

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25
Q

a sign found on an objective exam that reproduces sx (px)

A

comparable sign

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26
Q

D vs S

A

deep vs superficial

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27
Q

our focus in the subjective exam

A

to find all of the behavior and characteristics of their issue and sx

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28
Q

BTS

A

back to sleep

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29
Q

HBH

A

hand behind head

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30
Q

HBB

A

hand behind back

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31
Q

HF

A

horizontal flexion

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32
Q 
red flags
(many children will fall down without loving care NN)
A 
Malaise
Chills/fever
Wt change
Fatigue
Dizziness
Weakness
Lightheadedness
Cough
N/V
Numbness tingling
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33
Q

px that occurs before any resistance is felt, you would do what grades of joint mobs

A

1 or 2

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34
Q

If px doesn’t increase when resistance is felt, you should be ok doing a grade

A

3 or 4

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35
Q

what is the closing part of our exam

A

“is there anything you can think of you need to share that I haven’t asked about”

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36
Q

when should you have 3-4 hypotheses formulated

A

after your subjective exam

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37
Q

4 catagories to guide you to the extent of your tests/exams

A

px, ROM, overpressure feel, sustainability

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38
Q

3 stages of intervention

A

1 - to relieve the primary issue (ex: px)
2 - relieve the movement issue
3 - aid with global issues

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39
Q

when should you test pxfull mvmts

A

at the very last, or not at all (depends on scenario)

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40
Q

AROM tests what type of tissue

A

both contractile and inert (focus is on contractile)

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41
Q

PROM tests what type of tissue

A

inert only

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42
Q

what is PAM

A

Passive accessory movement (mobs)

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43
Q

PAMs test what kind of motion

A

arthrokinematics (mvmt within joint articulation)

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44
Q

resisted motion tests, test what type of tissue

A

contractile

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45
Q

how are resisted motion tests and MMT different

A

resisted motion tests do not test strength

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46
Q

in order for resisted motion test to really be effective, pt MUST be in ____ position

A

resting

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47
Q

Scale for resisted motion testing

A

strong and painless
strong and painfull
weak and painless
weak and painful

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48
Q

if the resisted motion test is strong and painless, this indicates that it is not ____ tissue

A

contractile (contractile would be painful)

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49
Q

If the resisted motion test is strong and painful, this indicates that it is probably ____ tissue that is effected

A

contractile (like a strain)

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50
Q

If the resisted motion test is weak and painless, this indicates that the problem is probably

A

neuro

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51
Q

if the resisted motion test is weak and painful

A

serious contractile issue or even possible fx

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52
Q

explain how we test dermatomes

A

light touch sensation

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53
Q

What is DTR

A

deep tendon reflex (with reflex hammer)

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54
Q

what is the segment for achilles reflex

A

S1

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55
Q

segment for hamstring reflex

A

L5

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56
Q

segment for patellar reflex

A

L4

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57
Q

Scale for reflexes grading

A 
0 nothing
1 hypo 
2 normal
3 hyper
4 clonus
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58
Q

hyporeflex would indicate

A

peripheral issue

59
Q

hyper reflexive indicates

A

systemic issue (cortex, spinal cord)

60
Q

order of your obj eval

A 
OPAPP
RMLNF
SC
observe, palpate, arom, prom, pam
resisted testing, mmt, length test, neuro, functional
special tests, clear
61
Q

when does discharge planning start

A

day 1

62
Q

what 4 main factors need to be considered when determining a prognosis

A

demographics
disease factors
bio-behavioral factors
other med conditions

63
Q

how many nocioceptors are in art cart

A

none

64
Q

2 functions of rectus femoris

A

knee ext, hip flexion

65
Q

origin of rf

A

A I I S

66
Q

actions of adductor longus

A

adducts hip, IR hip, flexes hip

67
Q

actions of TFL

A

FBI

68
Q

glut min and med actions

A

FBI

69
Q

glut max axns

A

EEEswings (extends hip, extends knee, externally rotates hip, abduction and adduction)

70
Q

O and I for glut min and med

A

ilulm to greater trochanter

71
Q

O and I for glut max

A

illum, sacrum and coccyx

to the gluteal tuberosity and the IT band

72
Q

explain muscle length test for gastroc

A

start with them in seated pos on table
goni measure dorsi
(below lat malleolus, 5th meta, fib head)
the have them extend knee and remeasure, if second measurement is a smaller number they are tight

73
Q

explain Thomas test

A

you have pt at end of table (like they were going to sit on it) you guide them back to a supine position as you keep your hand at lumbar spine

as you stabalize tightly as ASIS and PSIS you have them grab behind their opposing knee and have them hold it as you let testing leg drop. if they can reach all the way to table with testing leg, iliopsoas is not tight. if leg reaches table but knee extends then the tight muscle is the RF, If you can abd the leg and get more depth then TFL is the prob

74
Q

how do we grossly test labrums

A

compression

75
Q

before we palpate muscle tissue, what should we have pts do to ensure we are on the correct structure

A

have them contract the muscle

76
Q

list inert tissue

A

bone, capsule, lig, bursa, fascia (anything but muscle)

77
Q

unwilling to move vs unable to move

A

unwilling -dt px

unable - dt tissue immobility

78
Q

AROM tests

A

contractile tissue and lets you see their response to the movement

79
Q

list the abnormal end feels

A

empty, spasm, springy, capsular

80
Q

what is a capsular pattern

A

a predictable loss of function that goes along with OA or degneration (look up the specific motions)

81
Q

px before end feel is usually what stage

A

acute inflammation

82
Q

px right at resistnace would correspond with what stage

A

subacute

83
Q

if there is no px even after resistance, this would make you think

A

there is no inflammation

84
Q

px felt with AROM and PROM with mvmt in agonist direction of muscle would make you think

A

inert tissue

85
Q

essentially, contractile tissue should not experience px with _____ROM

A

PROM

86
Q

px felt when going opp direction of the muscle (PROM AND AROM) would make you think

A

contractile tissue - stretch

87
Q

if you are extending the hip in PROM and there is px in the hip flexors, what tissue is this

A

contractile

88
Q

with PROM, if px is felt and you are not stretching the antagonist, then the issue is probably inert tissue

A

correct

89
Q

myotomes (8)

A 
L2 - hip flexion
L3 - knee ext
L4 - dorsi and inversion
L5 - toe ext
S1 - peroneals
S2 toe flexion
S1 and S2 together - knee flexion and hip ext
90
Q

L3 dermatome location

A

medial lower thigh

91
Q

L4 dermatome location

A

medial lower calf

92
Q

L5 dermatome

A

top of foot

93
Q

S1 dermatome

A

peroneals

94
Q

S2 dermatome

A

behind knee

95
Q

hip flexion corresponds with

A

L2

96
Q

knee extension corresponds with

A

L3

97
Q

Dorsi flexion corresponds with

A

L4

98
Q

toe ext corresponds with

A

L5

99
Q

peroneals correspond with

A

S1

100
Q

toe flexion corresponds with

A

S2

101
Q

L5 dermatome is where

A

top of foot

102
Q

S1 dermatome is where

A

peroneals

103
Q

S2 dermatome is where

A

behind the knee

104
Q

L3 dermatome is where

A

low medial thigh

105
Q

L4 dermatome is where

A

medial calf

106
Q

pronated posture suggests what muscle is elongated

A

tib. posterior

107
Q

supinated posture suggests that what is elongated

A

peroneals (tib post is shortened)

108
Q

TF angle should be

A

170-175

109
Q

if TF angle is greater than 180

A

genu varum (bow leg)

110
Q

if TF angle is less than 170

A

genu valgus

111
Q

angle from asis, patella and tibial tuberosity

A

Q angle

112
Q

what is super tight in genu recurvatum

A

quads (and gastroc will be too)

113
Q

if a person has a flexed knee posture, what is tight

A

post capsule (quads will be weak)

114
Q

with ant pelvic tilt, quads are

A

quads are tight

gluts are weak

115
Q

with post pelvic tilt what is tight

A

hams are tight

116
Q

ant pelvic tilt, ____ are tight

A

quads and hip flexors

117
Q

ant pelvic tilt ____ are tight

A

quads and hip flexors

118
Q

ant pelvic tilt _____ are tight

A

quads and hip flexors

119
Q

decreased lumbar curve indicates tight

A

hams (post pelvic tilt)

120
Q

in addition to tight quads, with ant pelvic tilt, what 2 muscle groups are weak

A

hams and abs

121
Q

speed of ossilation of mobs

A

2-3 oscillations per sec or 30 sec)

122
Q

absolute contraindications for joint mobs

A 
Malignancy – especially bone
Tuberculosis – acts like severe OA
Osteomyelitis – bone inf
Osteoporosis
Fracture
Ligamentous rupture (eg Alar ligament)
Disc prolapse with nerve root compression
123
Q

the assessment of joint mobility we do (scale 0-6), what findings would we not want to do joint mobs and why

A

4, 5, 6 we typically don’t do mobs on unless they have px (these are hyper mobile)

124
Q

difference btwn grade 1 and grade 2 mob

A

both are before resistance
There is only one difference between a Grade 2 oscillation and a Grade I: Grade 2 amplitude is large and a Grade I amplitude is small.

125
Q

so grades 1 and ___ are small ossilations and grade 2 and ____ are large ones

A

1 and 4 = small

2 and 3 = large

126
Q

why might you want to do a grade V

A

to “snap” adhesions or alter/move structures in the joint

127
Q

small, slowly adapting mechanoreceptors, found in the superficial joint capsule. They provide information concerning the static position of the joint, and contribute to regulation of postural muscle tone; kinesthetic sense; direction and speed of movement, and regulation of muscle tone (describes what type of mechanoreceptor)

A

type 1

128
Q

medium sized, rapidly adapting mechanoreceptors, found in the deeper layers of the joint capsule. They fire only on quick changes in movement (i.e. are dynamic), providing information about acceleration and deceleration of joint movement (i.e. the change in speed of movement) (describes what type of mechanoreceptor)

A

type 2

129
Q

dynamic/inhibitive mechanoreceptors are type

A

3

130
Q

non adapting px receptors are type

A

4

131
Q

we want to stimulate these receptor types with standard joint mobs

A

1 and 2

132
Q

in the stress/strain curve, grade 1 and 2 joint mobs are where on the graph

A

elastic

133
Q

in the stress/strain curve, grade 3 and 4 joint mobs are where on graph

A

plastic

134
Q

the only time you might do joint mobs on a hypermobile joint is to tx

A

px

135
Q

after a grade III or IV joint mob, _____ should be done to optimize mobility in the joint

A

exercise

136
Q

What is post pred value

A

High PPV: indicates a (+) test is a strong predictor of the disorder“True positives (likely hood they actually have the pathology)

137
Q

you want sensitivity closest to

A

1.0

138
Q

sensitivity tests

A

Test’s ability to detect patients who actually have the disorder as indicated by a reference standard

139
Q

specificity tests

A

Test’s ability to detect patients who actually do not have the disorder as indicated by a reference standard

140
Q

spin snout

if specificity is high (rule in) and the test you do is pos, the likely hood that they have it is

A

very high

141
Q

spin snout

if specificity is low and the test you do is pos, the likleyhood they have it is

A

unclear

142
Q

most widely used imaging

A

xray

143
Q

explain grading scale for PAM assessment

A 
0/6  = there is no motion between the two articulating surfaces.    Mobilization/manipulation is not indicated because the joint is ankylosed. 
1/6 =  there is considerable limitation in the excursion between the two joint surfaces. 
2/6 =  there is slight limitation in the excursion between the two joint surfaces. 
3/6 =  the amount of movement between the joint surfaces is normal.
4/6 =  there is a slight increase in the excursion between the two joint surfaces. The patient should be treated with stabilization and postural re-education. Taping and bracing may also be used. 
5/6 =   there is a considerable increase in the excursion between the two joint surfaces. Treatment is similar to that listed in 4/6.
6/6 =   The joint is unstable.

MSK (10 decks)

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