wk 4- musculoskeletal Flashcards
principles of MSK
the 4 domains.
Domain A- person centred approaches
B- Assessment, investigations and diagnosis
C- condition management, interventions and prevention
D- service and professional development
what is the process of determining a diagnosis with a patient in general terms
use knowledge about other cases and the patients history to find a clinical prediction by comparing what is similar and not similar between the cases and the symptoms/history. if sinister differential diagnosis are yet to be eliminated or where no clinical test powerful enough to confirm a condition, then a highly sensitive/specific investigations are required.
- clinical prediction
- clinical tests
- investigations
indications of MSK 4
joint pain
regional or general pain or stiffness
muscle weakness or injury
systematic problems
common MSK conditions
rare MSK conditions
signals/symptoms that indicate the need for specialists
signals/symptoms that indicate the need for specialists
signals/symptoms that indicate the need for specialists
how to screen red flags
- musculoskeletal history
- symptoms from joint or soft tissue
- chronic or acute
- always exclude a potential systemic disease
aims of musculoskeletal assessment 5
- Identify site of the primary problem
- Identify secondary problems and relate them to the primary problem
- Identify the cause of the primary problem e.g. poor posture
- Devise an appropriate treatment plan based on the assessment data
- Monitor the progress of the condition using subsequent assessment
where is the location of the COG and how much
55% of body height which is anterior to S2 vertebra
determinants of gait 9
- Pelvic rotation
- Pelvic tilting
- Lateral displacement of
the body - Knee flexion
- Knee mechanism
- Ankle mechanism
- Trunk, neck, arm swing
what determines pelvic oblique tilt and what does the tilt do for the COG and gait
The magnitude of tilt is controlled by the hip abductors on the stance side.
- Pelvis tilt reduces the apex of the
COG trajectory - Pelvis tilt introduces the need for
knee flexion during swing (so the foot
can clear the ground)
position of a body part in the 3 planes, what directions are they in
Sagittal Plane
ØMedial vs lateral (towards vs away from midline)
* Frontal Plane
ØAnterior vs posterior (in front vs behind)
* Transverse Plane
ØDistal vs proximal (away vs towards centre)* Dorsal vs plantar (foot)
joint motion in the planes what movements occur (4 planes)
Sagittal Plane
ØFlexion
ØExtension
§Dorsiflexion
§Plantarflexion
Frontal plane
ØThigh & leg
§Abduction & adduction
ØFoot
§Inversion & eversion
- Transverse plane
ØThigh & leg
§Internal and external rotation
ØFoot
§Adduction & abduction - Triplanar motion
ØPronation
§Dorsiflexion, eversion, abduction
ØSupination
§Plantarflexion, inversion, adduction
position of a joint in the planes
Sagittal Plane
ØHip & thigh
§Extended & flexed
ØFoot
§Dorsiflexed & plantarflexed
Frontal Plane
ØHip & thigh
§Abducted & adducted
ØFoot
§Inverted & everted
deformities in these planes
Sagittal Plane
ØEquinus deformity if part is in plantarflexed position
ØExtensus deformity if part is in dorsiflexed position
- Frontal Plane
ØVarus & valgus - Transverse Plane
ØAdductus & abductus
what is equinus
Limitation of normal ankle joint dorsiflexion with the STJ in its neutral position
* Can be present with the knee joint flexed or extended
* Gastrocnemius muscle originates above the knee joint
* Origin of the soleus in below the knee joint
* Clinically differentiate tightness of two structures
what is varus
inverted position of one part relative to the next
* Positional or structural deformity
* Example
ØForefoot varus, where the forefoot is invertedin relation to the rearfoot
what is valgus
algus position is an everted position of one part relative to the next
* Positional or structural deformity
* Example
ØForefoot valgus, where the forefoot is evertedin relation to the rearfoot
knee positions 4
- Genu Varum (bow legged) - outward leg in relation to thigh
- Genu Valgum (knock kneed) - knees touch and thighs angled inwards
- Genu Recurvatum- knee hyperextension, bends backwards
- Flexed deformity- inability to straighten the knee
explain joint axes
oints of the foot function like hinges
* All joint motion occurs perpendicular to the joint axis (the pin)
* The arm of the hinge moves in the plane of motion
* The axis of motion or joint axis can be parallel to the
* Transverse and sagittal planes
* Motion in the frontal plane
* Transverse and frontal planes
* Motion in the sagittal plane
* Sagittal and frontal planes
* Motion in the transverse plane
what is open/closed kinetic chain motion and what is kinetic and kinematics briefly
- Joint motion can occur in non weight bearing
ØOpen kinetic chain motion (OKC)* Or weight bearing
ØClosed kinetic chain motion (CKC)* Kinetics
ØUnderstanding the forces of movement* Kinematics
ØThe understanding of movement
process of muscolosletal assessment 7 steps
General observation
* Specific joint observation
* Palpation
* Examination of movement
* Muscle assessment
* Special tests
* Further investigation
what body parts do you do a non weightbearing examination on
- Hip
- Knee
- Ankle and rearfoot
- Midtarsal
- MTPJ’s
- Digits
- Alignment
assessment of joints include 4 things
- Signs of inflammation
ØErythema, heat, pain , swelling & loss of function
ØPain - Characteristics
ØRange and direction of motion
ØWarm up of muscles, ligaments and synovial fluid - Range of motion (ROM)ØMeasured versus observed
ØCompared to normal
ØDirection of motion (DOM)
ØSymmetry of motion (SOM)
ØQuality of motion (QOM) - Dislocation and subluxation
classifying muscles
Local stabilizers maintain low continuous activation in all joint
positions and become inhibited when dysfunctional (e.g. VMO)
uGlobal stabilizers are activated in specific directions of joint
movement and tend to become long and weak with dysfunction
(e.g. gluteus medius)
uGlobal mobilisers produce joint movement in specific directions
and become short and overactive when dysfunctional (e.g.
hamstrings)
