Week 10 - musculoskeletal and neuro Flashcards
Pronator Drift test is one of the most sensitive tests for
upper extremity weakness
Abnormal finding with pronator drift
arms drop down very quickly
What can a positive Straight Leg Raise test (Laségue Test) indicate?
when there is pain, the test is positive and can indicate HERNIATED lumbar disc and nerve irritation/pressure
Phalen’s Sign
Inverted prayer - there should be no pain or discomfort (assesses for carpel tunnel)
Positive Tinel’s Sign
Pain when tapping medial nerve (assesses for carpel tunnel)
What is the #1 predictor of falls in the elderly?
history of falls!
What is the only movable joint in the head?
temperomandibular joint (TMJ) Can move vertically, laterally, protrusion (in/out)
Alexander technique
through voice and gentle touch, participants led through movements to improve posture during sitting, standing, and walking
Traeger Therapy
goal is to provide deep relaxation and increase mobility
Feldenkrais technique
Participants are led by verbal suggestion through an exploratory movement process
Focuses on improving functional awareness and expanding the repertoire of movement patterns
Neuro health history ?’s
Hx of seizure disorder, TIA, stroke, fainting, blackouts, meningitis, alcoholism, myasthenia gravis, multiple sclerosis, mental health dysfunction
Romberg test
stand w/ feet together, close eyes. Slight swaying is normal.
Falling can occur in PTs w/ MS, drunk, loss of vestibular function
Tandem walking
PT walks in straight line, heel to toe (accentuates gait problems)
increased touch sensation
hyperesthesia
reduced touch sensation
hypoesthesia
absent touch sensation
anesthesia
Stereognosis (evaluates cortical sensory function)
place a familiar object in the patient’s palm (e.g. paper clip) ask PT to identify it
Graphesthesia (evaluates cortical sensory function)
trace a # on PT’s palm w/ a blunt object (e.g. finger) and ask PT to identify number
inability to identify objects correctly
astereognosis
headache history- what are signs of increased ICP
pain worse in the AM on awakening & pain precipitated by straining/sneezing
Cogwheel rigidity
small, regular jerks during rotating movements of wrist and hand (parkinson’s)
indicative of UPPER motor neuron lesions (from strokes, tumors)
hyperreflexia
indicative of LOWER motor neuron lesions (from spinal cord injury)
hyporeflexia
Stroke recognition FAST
F- face (ask person to smile, look for droopiness)
A-arms (raise both arms, does one drift)
S- speech (is speech slurred?)
T-time (call 911 if you observe these signs!)
What’s always the 1st step when there’s a musculoskeletal injury?
compare L and R for symmetry
Phalen and Tinel tests can test for
carpel tunnel syndrome
Bulge and ballottement tests look for
effusion in the knee joint
McMurray test assesses for
meniscus tears in the knee
The Thomas Test is used to identify
flexion contracture of the hip
The Drawer test is for
knee injury
Trendelenberg test is for
hip disease (lift one leg and see if you tip to side)
When doing an assessment of the spine of an older adult, you can expect to see which variation?
Kyphosis (hunchback)
fasciculation
involuntary twitching
tremors
involuntary contractions of muscles
atony
lack of tone or strength
spasticity
muscle tone is hypertonic so the muscles are stiff and movements awkward
Post hip replacement, which assessment technique should you avoid?
adduction (could cause fake hip to dislocate)
1,200 mg of calcium
recommended daily amt to consume for bone health
What 3 functions are assessed on the glasgow coma scale?
verbal response, eye opening, and motor response
15: best
3 or less: totally unresponsive
Innervation of the arm roughly correlates with which parts of the spinal cord?
C5 to T1
Innervation of the chest correlates with:
T1 to T8
Innervation of the abdomen corresponds with
T9 to T12
Innervation of the legs corresponds with
L1 to S1
When discussing care for a patient with back pain, the nurse should particularly alert the assistant to watch for
bowel/bladder incontinence (can occur with spinal cord injury at any level)
Cluster headache
pain is usually on one side of head with lacrimation and nasal congestion
Tension headache
typically mild or moderate, often bilateral, “pressing” or “tightening” pain (not sharp)
Crepitation
dry, crackling sound or sensation that occurs with joint movement
Muscle strength grading
● 0 = no evidence of contractility
● 1 = slight evidence of contractility
● 2 = ROM with gravity eliminated
● 3 = ROM with gravity
● 4 = ROM against gravity with some resistance
● 5 = ROM against gravity with full resistance
common symptoms associated with neuro system include
headace, weakness, blurred vision, impaired motor function, and impaired speech
Clinical situations that require urgent communication of neurological assessment findings include
a change in LOC,
pupillary reaction, and
verbal or motor response.
Cranial nerves 1, 2, 3:
○ I: Olfactory - smell
○ II: Optic - visual acuity, visual fields, ocular fundi, pupillary reactions
○ III: Oculomotor - pupillary reactions, extraocular movements (including opening of the eyes)
Cranial nerves 4, 5, 6
○ IV: Trochlear - extraocular movements
○ V: Trigeminal - facial sensation, movements of the jaw, corneal reflexes, voice and speech
○ VI: Abducens - extraocular movements
Cranial nerves 7, 8, 9
○ VII: Facial - facial movements and gustation, voice and speech
○ VIII: Vestibulocochlear - hearing and balance
○ IX: Glossopharyngeal - swallowing, elevation of the palate, gag reflex, gustation
Cranial nerves 10, 11, 12
○ X: Vagus - swallowing, elevation of the palate, gag reflex, gustation, voice and speech
○ XI: Accessory - shrugging shoulders and turning head
○ XII: Hypoglossal - movement and protrusion of tongue, voice and speech
Cerebellar function
movement, coordination, balance
Grading scale of Deep tendon reflexes (DTRs)
● 0 - no response ● 1+ - diminished, low normal ● 2+ - average, normal ● 3+ - brisker than average, high normal ● 4+ - hyperactive with clonus
Clonus
repeated muscular movements (jerking)
Intention tremor
absent at rest and increases with movement
babinski reflex
toes should fan out when testing plantar reflex
migraine aura
indicates either cortical or brainstem dysfunction
migraine headaces
typically last 4-72 hours and are accompanied by at least one of the following: nausea, vomiting, phonophobia, or photophobia
the PT with a head injury and increasing ICP is likely to have which assessment findings?
decreased LOC and sluggish pupil
