Week 1 Flashcards
Outline of a Musculoskeletal Assessment
- History: Verbal and Written
- Observation
- Examination: ROM, Muscle Testing, Special Testing, Joint Play,
Neurological Tests - Palpation
- Diagnostic Imaging
Factors to add in a Health History Form
- Demographics: name, address, contact info etc
- Personal Info: Hobbies, work, sports
- Past Medical History
- Family Medical History
- Medications
- Presenting Symptom/Condition: Location of pain etc.
- Aggregating Factors
- Relieving Factors
- Concurrent Problems
- Previous to and/or imaging
- Goals for treatment
- Acknowledgment of the the above info is correct
Benefits of Verbal Subjective History
- Allows the clinician to focus on areas of importance from the written history
- Allows the clinician to “get a feel” for the patients personality
- Allows the clinician to ask quart ions about the patient’s condition that the patient may not have thought of. Do not lead the patient but do ask closed ended questions
- Observe body posture, facial expressions, tension level etc.
Things to look for in Observation
- General Appearance: Deformities, swelling, body shape,
Emotional state - Posture (Using Plumb line): *Arches
* Head Position
* Spinal Curves
* Location of shoulders
* Position of hands/knees
* Position of the scapulas
What does Pes Cavus mean?
High Arches
What does Pes Planus mean?
Fallen Arches
What is AROM?
Patient moves on their own to the end range of the joint being tested
Allows the clinician to see the patients willingness and ability move as well as provide info on where pain begins during movement and behaviour of pain
What is PROM?
The therapist passively moves the supported limb with no active contraction of muscle from the patient
Allows the clinician to feel the actual ROM of the joint and the type of end feel
2 Types of Muscle Testing
- General strength testing: Kendall muscle grading
2. Specific Strength Testing: Isometric muscle grading
Kendall Muscle Grading Benefits:
- Provides in for on muscle strength in relation to joint range
- Must have full passive ROM
- Muscles are strongest physiologically when lengthened
- Muscles are weakest physiologically when shortened
- Muscles can produce most force in mid range
Isometric Muscle Testing
- Tests contractile structures, bone and bursar by compression
- No joint movement should occur
- Just enough resistance to reproduce symptoms “don’t let me move
You” - Provides info on direction and amount of force needed to reproduce
Symptoms
Why use Special Tests
- To test specific structures
- Unique to each body area
- Used to confirm or disconfirm a diagnosis
4 Types of Special Tests
- Ischemic Tests
- Stability Tests
- Provocative Tests
- Combined movement tests, quadrants
Types of Neurological Tests
Myotomes/Key Muscle Testing
Dermatomes
Reflexes
Neural Tension Tests
Cutaneous Distribution
What are Myotomes?
Muscles which are supplied by a single segmental level
What is Key Muscle Testing?
Muscles which are most representative of given segment
Procedure for Myotomes:
Performed in the shortened position and held in a contraction for 6-10 seconds.
Positive Findings: Fading or progressive weakness with repeated
Contractions indicating a neuromuscular lesion
*Characteristics of muscle weakness will have no fading but consistent weakness with repeated contractions
What’s a Dermatome?
An area of skin supplied by a single nerve root
Used to evaluate the nerve conductivity to the brain for sensation
What’s the procedure for using Dermatomes
The area of interest is tested with sharp and soft sensation
Positive Finding: Altered or decreased sensation
What are Reflexes?
To evaluate the mono-synaptic reflex arc involving both afferent and efferent nerves
Biceps Brachii Reflex Nerves
C5 - C6
Brachioradialis Reflex Nerves
C5 - C6
Triceps Reflex Nerves
C7 - C8
Patella Reflex Nerves
L3 - L4
Hamstrings Reflex Nerves
Medial: L5 - S1
Lateral: S1 - S2
Achilles Reflex Nerves
S1 - S2
Reflex Grading System
0 = Absent
1 = Diminished: Hypo-Reflexia
2 = Normal/Average
3 = Exaggerated
4 = Clonus: Hyper-Reflexia
What is Hypo-Reflexia?
A lower motor neurone lesion with involvement of a nerve root or peripheral nerve
What is Hyper-Reflexia?
An upper motor neuron lesion
What is Upper Motor Neuron Testing and what are 3 main tests
Indicates a loss of inhibition from the CNS
- Hoffman’s Reflex
- Oppenheimer Test
- Babinski Test
What’s the Hoffman’s Reflex Test?
Flicking the finger nail of the index, middle or ring finger
*Positive Test: Flexion of the distal phalanx of the thumb and/or
Index finger and/or middle finger
What is the Oppenheimer Test?
Application of a noxious stimulus to the tibial crest or stroking of anteromedial tibial surface
- Positive Test: Toes fan upwards
- Negative Test: Toes curl
What is the Babinski Test?
Application of a noxious stimulus to the sole of the foot or stroking the lateral aspect of the foot
- Positive Test: Toes fan upwards
- Negative Test: Toes Curl
Purpose of Joint Play and how to do it
Used to assess the accessory movement of a joint. Accessory movement is when a joint isn’t under voluntary control but is necessary for full, painless ROM.
Done in Open Packed Position
Joint dysfunction signifies a loss of accessory motion
Palpation
Always done last to not irritate the area
Palpation the structures suspected of being injured for tenderness
X-Rays
Calcium absorbs the X-ray therefore deficiencies show up as opaque
Primarily useful to detect pathology of the skeletal system
Can also be used to detect gallstones, kidney stones, pneumonia, lung cancer, pulmonary edema, bowel obstruction
Not useful in imaging soft tissue such as brain and muscle
What is a Bone Scan
A nuclear scanning using radiopharmaceuticals taken up by the osteoblast cells
*Used for stress fractures, bone cancer, bone infections and bone abnormalities
What’s an Arthrogram?
Images of a joint post injection of a contrast medium.
*Used for rotator cuff tears, tendon abnormalities
What are contraindications for Arthrogram Testing?
Allergic to Latex, Local Anesthesia or contrast medium
What’s a CT or CAT scan?
Computer processed combination of many X-ray images taken at different angles to produce a cross section image
A moderate to high radiation diagnostic technique
*Used for braving infarction (tissue death due to lack of oxygen), Tumors, calcifications, pulmonary embolism, fracture, ligament injuries, dislocations, haemorrhages
What’s an MRI?
Magnetic Resonance Imaging
Utilizes magnetic fields and radio waves
*Uses for brain, cardiovascular, musculoskeletal
What are contraindications for an MRI?
Cardiac pacemakers
Shrapnel
Metallic Foreign Bodies in the eyes
Cochlear Implants
Purpose of a Musculoskeletal Assessment
- Rule out red flags
- Identify Contraindications and precautions to treatment
- Develop a working diagnosis
What is a normal end feel
1) Soft tissue approximation
2) bone on bone
3) soft tissue stretch (most common)
What is an abnormal end feel
1) bone on bone
2) mm spasm
3) capsular
4) springy block
5) empty (too much pain/mm guarding)
