Unit 2 DOCS Flashcards
Describe how to perform the Thomas test and how you interpret the findings
Testing for hip flexor tightness
Place pt supine (check for excessive lordosis)
Flex hip on unaffected side, bringing knee to chest (ask pt to hold)
Check affected hip for flexion
Affected leg comes off table = positive
Describe how to perform the Ober test and how you interpret the findings
Testing for tightness of IT band, gluteus medius and minimus
Lay pt on their side with affected hip up.
While pushing the iliac crest inferiorly, hold the ankle and passively abduct and extend the hip.
Align ankle on same plane as greater trochanter.
Leg stays abducted = positive
Knee moves inward toward exam table = negative
Describe how to perform the FABER test and how you interpret the findings
Testing for various impingements, iolopsoas, or sacroiliac involvement
Place pt supine.
Passively move leg of affected hip into flexion, abduction, external rotation (create figure 4 with foot over opposite knee)
Gently lower knee toward table
Pain or limited motion = positive
Describe how to perform the Trendelenburg test and how you interpret the findings
Testing for hip abductor stability, gluteus medius strength
Ask pt to stand squarely to assess normal hip alignment
Ask pt to stand on one foot for 30 seconds while maintaining alignment
Pelvis falls > 2cm = positive
Name at least 5 skin lesion characteristics
Morphology
Size
Configuration
Shape
Distribution
Location
Texture
Color
What are the steps of the Strain/Counterstrain technique?
Diagnose SD
Find counterstrain point
Tell pt tenderness is 10/10
Place pt in position that reduces pain to 0/10
Hold for 90 seconds
Slowly return to neutral
Recheck counterstrain point
Describe the different techniques of Strain/Counterstrain
Time defined - hold for 90 seconds
Release defined - hold until physician feels a release (pulsating/”let go”/etc)
What are the steps of a hip joint exam?
Inspect gait
Palpate anterior and posterior landmarks
Palpate inguinal ligament and bursas
Assess ROM
Perform special maneuvers
What are the neuromuscular maturity signs looked for on an APGAR test?
Posture
Square window (wrist)
Arm recoil
Popliteal angle
Scarf sign
Heel to ear
What are the physical maturity signs looked for on an APGAR test?
Skin
Lanugo
Plantar surface crease
Breast
Eye/ear
Genitals
If the patient presents with pronation of the foot (dorsal flexion, eversion, and abduction), you suspect the fibular is in what position?
What test would you use to check?
Anterior to the femur
Anterior drawer test
If the patient presents with supination of the foot (plantar flexion, inversion, adduction), you suspect the fibular is in what position?
What test would you use to check?
Posterior to the femur
Posterior drawer test
What is the treatment position of the MCL/medial meniscus counterstrain point?
Moderate knee flexion, internal rotation, and slight adduction of
the tibia
What is the treatment position of the LCL/lateral meniscus counterstrain point?
Moderate knee flexion, slight abduction, internal or external
rotation of the tibia. May require ankle dorsiflexion and eversion
What is the treatment position of the popliteus counterstrain point?
Slight flexion of the knee with internal rotation of the tibia
What is the treatment position of the gastrocnemius counterstrain point?
Marked plantar flexion of the ankle with knee flexion
What is the treatment position of the ACL counterstrain point?
Place an object/pillow under the distal femur to create a fulcrum. Apply a shearing force by moving the proximal tibia posteriorly on the femur
Note: Classic Jones treatment
What are the Ottawa knee rules?
55+
Tenderness at head of fibula
Patellar tenderness
Inability to flex knee >90 degrees
Inability to bear weight
Explain the difference between the Anterior Drawer Test and the Lachman test
The ADT is done by laying pt supine with hip at 45 degrees and knee at 90 degrees, then pulling knee forward with sudden jerk
Lachman test is done by laying pt supine with knee bent ~20 degree angle and slight external rotation of the hip, then pulling knee firmly and keeping thigh stable
What are the 12 systems of the Objective section?
Constitutional (vital signs, general appearance)
Eyes
ENT
CV
Resp/Pulm
GI
GU
MSK
Derm
Neuro
Psych
Heme/Immuno/Lymph
Outline the proponents of an APGAR score and their point systems
Appearance - (0 - blue or pale body, body pink, face blue), (1 - body pink, extremities blue), (2 - completely pink)
Pulse (0 - absent), (1 - < 100), (2 - >100)
Grimace - (0 - no response), (1 - grimace), (2 - cough/sneeze)
Activity (0 - limp), (1 - some flexion), (2 - active motion)
Respiratory (0 - absent), (1 - slow, irregular), (2 - good, crying)
List the special tests done on a newborn
Rooting reflex
Sucking reflex
Palmar grasp reflex
Plantar reflexes (Plantar grasp & Babinski)
Stepping reflex
Galant reflex (baby curves toward stroke on paraspinal region)
Asymmetric tonic neck reflex (limbs extend whichever way baby faces)
Moro (sudden drop = abduction & extension then adduction & flexion)
Pathogenesis and clinical presentation of Legg-Calve-Perthes disease
Idiopathic avascular necrosis of proximal femoral epiphysis
Presents with painless limp, intermittent hip, knee, groin, thigh pain, Trendelenburg gait - loss of ABIR
Pt presents with bilateral pain around groin and thigh, tenderness of hips. Foot is turned outward and has Trendelenburg gait. What is the mechanism causing these symptoms?
Slipped Capital Femoral Epiphysis
Metaphysis translates anterior and externally rotated (causing outward foot)
Epiphysis remains in acetabulum and lies posterior/inferior to metaphysis
What are the three mechanisms by which a Trendelenburg Gait can be caused?
Failure of the fulcrum (LCP, dysplasia, dislocation)
Failure of the lever (g. troch avulsion, neck of femur mutation)
Failure of effort (L5 radiculopathy, S. Gluteal n damage, G medius and minimus damage/abscess)
What are the physical signs and tests done on newborns to check for hip dysplasia or dislocation?
Physical signs: asymmetrical gluteal skin folds, short leg
Tests: Ortolani “click” test, telescoping
HVLA is a ________ method using ____-amplitude, _____-velocity thrusting
Direct
Low
High
List the indications for HVLA
SD that results in loss of motion causing asymmetry in articulation
The muscles of the anterior arm are innervated by
Musculocutaneous and Radial nerves
What is the difference in function between the brachialis and the biceps brachii
Brachialis flexes the forearm
Biceps brachii supinates the forearm and flexes in the supine position
List the sites where the ulnar nerve can become impinged
Axilla
Struthers window
Cubital tunnel
Dionne’s canal
What are the terminations of the Median Antebrachial v
Median cephalic v and median basilic v
List the contents of the Cubital Fossa
Lateral to Medial - TAN
Tendon of Biceps Brachii
Artery, Brachial
Nerve, Median
What are the boundaries of the Cubital Fossa
Superior: Imaginary border between epicondyle and humerus
Medial: Pronator teres
Lateral: Brachioradialis m
Floor: Brachialis
What is a positive bicipital reflex indicative of?
Confirms the integrity of the musculocutaneous nerve (C5-C6)
Describe a normal response when testing the bicipital myotatic reflex in the cubital fossa
An involuntary contraction of the biceps, felt as a momentary tensed tendon, usually with a brief jerk-like flexion of the elbow
A positive response is the normal response
What is an excessive, diminished or prolonged (hung) bicipital reflex indicative of?
A central or peripheral nervous system disease or metabolic disorder (e.g. thyroid disease)
Shoulder counterstrain of Levator Scapulae
Dr ipsilateral
Rotate pt head away
IR, ABD
Shoulder counterstrain Supraspinatus
Supine
Flex/hold elbow/forearm
F ABD ER
Shoulder counterstrain Infraspinatus (upper)
Supine
F shoulder 90-120 degrees
ABD, ER/IR
Shoulder counterstrain infraspinatus (lower)
Lat recumbent CS side up
F shoulder 135-150 degrees
ABD, ER/IR
Shoulder counterstrain subscapularis
Supine, Dr. Ipsilateral
E shoulder, IR
Shoulder counterstrain pectoralis minor
Supine, Dr contralateral
Adduct arm across chest
Pull shoulder ant/inf
