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PE Skills Musculoskeletal Exam 1
PE Skills Exam 1 Muskuloskeletal
145
Anatomy
Graduate
09/18/2010

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Term
Synarthoidal/Fibrous joints, define and give examples:
Definition
- immovable
- sutures in skull, sternocleidmastoid
- fusions b/w tibia and fibula, and radius and ulna
Term
Amphiarthroidal/Cartilaginous, define and give examples:
Definition
- slightly moveable
- nose
- symphisis pubis
- intervertebral discs
Term
Diarthroidal/Synovial:
Definition
- freely movable
- elbow, knee, finger
- lined by and surrounded by synovium
Term
Synarthroidal, Amphiarthroidal, and Diarthroidal are ____ classifications based on what the joint can do.
Definition
- functional
Term
Fibous, Cartilaginous, and Synovial are ___ classifications.
Definition
- structural
Term
classifications of diarthroidal joints:
Definition
Be Happy Camper So Good Parties
- Ball and socket
- Hinge
- Condyloid aka Ellipsoid
- Saddle
- Gliding
- Pivot
Term
examples and define ball and socket joint:
Definition
- can move along indefinite number of axes
- type of diarthroidal
- hip joint
- glenohumeral joint
Term
Hinge joint, define, give example:
Definition
- can move only in one plane
- elbow
- type of diarthroidal joint
Term
define and give examples of a condyloid joint:
Definition
- rounded end of one bone inserts into the shallow cavity of another bone
- movement allowed in two planes
- carpals to radius
- carpals to metacarpals
Term
give example of Saddle joint:
Definition
- thumb at the carpometacarpal
Term
example of gliding joints:
Definition
- carpals
Term
Pivot joint:
Definition
- atlantoaxial
- radial head on ulna
Term
Inspection/Palpation in Musculoskeletal exam should include:
Definition
- Alighment
- Symmetry
- Size of joint/surrounding structures
- Deformity
Term
Always check to joint above and below the area where pain is.
Definition
Term
goniometer is used for what?
Definition
- measure range of motion of a joint
Term
when walking why would someone slap their feet down?
Definition
Diabetics may have loss of sensation in feet, so they can't feel their feet touch the floor, so they slap them down on the ground so they can hear it
Term
Effusion:
Definition
fluid under the joint
Term
during palpation check this:
Definition
- temperature
- tenderness
- swelling
- effusion
- tenderness
Term
passive ROM is motion performed by the ___.
Definition
- clinician
Term
Active ROM is ___ driven.
Definition
- patient driven
Term
contracture example:
Definition
- hands always flexed down and no matter how hard you pull up the hand stays flexed
Term
number scale of muscle strength:
Definition
No Contractility 0
Slight Contractility, no movement by pt 1
Full ROM, gravity eliminated (passive) 2
Full ROM vs gravity 3
Full ROM vs gravity, some resistance 4
Full ROM vs gravity, full resistance 5
Term
Temperomandibular joint:
Definition
- audible palpable snapping and clicking is OK
- true TMJ dysfunction is accompanied by pain, crepitus, locking, or popping
Term
range of motion of jaw should be about __ to __ cm, or about __ fingers width.
Definition
3 to 6 cm
3 fingers width
Term
lateral movement of jaw should be about __ to __ cm.
Definition
1 to 2 cm
Term
C7
Definition
vertebra prominens
Term
T7
Definition
inferior angles of scapula
Term
T12, L1, L2:
Definition
umbilicus (dermatome of T10)
Term
L4, L5:
Definition
Iliac crests
Term
where is Iliac crest:
Definition
L4, L5
Term
Flexion and extension of the cervical spine should be ___ degrees, lateral bending should be ___ degrees, and lateral rotation should be ___ degrees.
Definition
- 45
- 40
- 70
Term
kyphosis:
Definition
hunch back
Term
lordosis:
Definition
stick out butt, increased concavity of lumbar spine
Term
dowager hump is seen with ___
Definition
osteoporosis
Term
your hammer is useful in diagnosis of ___ ___. Hit the hammer and place the base over the spinous processes of each lumbar segment. The patient will experience severe pain where the fracture is.
Definition
- compression fracture
Term
Thoracic and lumbar spine range of motion, flexion should be __ to __ degrees, extension should be __ degrees, lateral flexion should be __degrees, and rotation should be __ degrees.
Definition
- flexion 75 to 90 degrees
- extension 30 degrees
- lateral bending 35 degrees
- rotation 30 degrees
Term
Supine Straight leg raise test does what:
Definition
- tests for nerve root irration/herniated disc
- tests L4, L5, S1
- could also try this while patient is sitting with legs of table, if it hurts in one position but not in the other, then they might be faking it
Term
positive straight leg test:
Definition
- examiner flexes hip with knee extended
- positive if pain below the knee area when hip extended past 30 degrees
- bending the knee aleviates the pain
Term
Sitting Straight Leg Test and Flip Sign:
Definition
- patient seating leaning slightly foward
- extend leg at knee against resistance
- positive test if patient leans back (flip sign), has radicular pain with extension/ resistance
Term
Bregard Stretch test:
Definition
- patient supine with neck slightly flexed
- examiner holds lower leg/ankle
- LE raised until pain felt, then lower slightly
- briskly dorsiflex foot and internally rotate LE simultaneously
- pain in leg indicates herniated lumbar disc
Term
The Bragard stretch test and straight leg raise test both test what nerve roots:
Definition
L4, L5, S1
Term
Femoral stretch test is also known as the __ __ __.
Definition
- hip extension test
Term
Femoral stretch test:
Definition
- tests L1, L2, L3, maybe L4
- patient prone, extend hip and flex knee, then have them extend hip and knee in air
- positive if pain is in anterior thigh with hip extension
Term
Femoral stretch test:
Definition
- tests L1, L2, L3, maybe L4
- patient prone, extend hip and flex knee, then have them extend hip and knee in air
- positive if pain is in anterior thigh with hip extension
Term
HNP:
Definition
- herniated nucleus pulposus
Term
what are the five muscles that make up the shoulder?
Definition
- supraspinatus
- infraspinatus
- Teres minor
- Subscapularis
- Deltoid
Term
what are the rotator cuff muscles?
Definition
- supraspinatus
- infraspinatus
- teres minor
- subscapularis
Term
Shoulder ROM:
- flexion
- extension
- abduction
- adduction
- internal rotation
- external rotation
Definition
flexion= 180 degrees
extension= 50 degrees
abduction= 180 degrees
adduction= 50 degrees
internal rotation= 90 degrees
external rotation= 90 degrees
Term
which rotator cuff muscles are responsible for external rotation:
Definition
- supraspinatus
- infraspinatus
- teres minor
Term
which rotator cuff muscles are responsible for internal rotation?
Definition
- subscapularis
Term
with rotator cuff there should be no pain when abducting up to 180 degrees, indicators of a cuff tear would be:
Definition
- pain and/or disability between 60 and 120 degrees of abduction
Term
problems brushing hair or buckling bra means there are __ __ problems.
Definition
- rotator cuff
Term
Hawkin's test:
Definition
- flex shoulder and elbow to 90 degrees
- internally rotate the shoulder
- positive if pain in rotator cuff region
Term
O-Brien's active compression test was developed for assessment of _____ joint pathology following a patient's demonstration of what reproduced shoulder pain. O'Brien found it was also good for detecint ___ pathology-
Definition
acromioclavicular
labrum
Term
describe O-Briens test:
Definition
- patient flexes arm to 90degrees with elbow fully extended, and then adduct arm 10 to 15 degrees medial to the sagital plane
- then arm is maximally internally rotated and the patient resists the physician's downward force. Test is repeated in supination.
- this test maximally loads the AC joint and labrum, for maximaly results the patient has to resist the examiner's downward force
Term
Speed's test checks for:
Definition
- biceps tendinitis
- labral pathology
Term
explain speed's test:
Definition
- patient's arm relaxed and by there side, seated
- palpate bicipital groove, hold on to patient' wrist
- have them attempt shoulder flexion while you resist it
Term
Neer Test checks for :
Definition
- rotator cuff integrity
- raise patients arm to 150 degrees of shoulder flexion and internally rotate the arm
- push supraspinatus into antero-inferior subacromial area
- positive test if pain
- also checks serratus anterior integrity and winged scapula
Term
injury to what nerve causes a winged scapula?
Definition
- long thoracic nerve
Term
winged scapula is accentuated by:
Definition
- extending arm or pushing against wall
Term
supraspinatus stress test;
Definition
- abduct to 90 degrees, flex anteriorly to 30 degrees, put thumb to floor (pronate forearm)
- apply mild resistance downward on forearm
- positive test if pain or weakness is elicited
- empty can test
Term
drop arm test, examines what?
Definition
- rotator cuff integrity, specificly the supraspinatus
- passivley abduct shoulder to 90 degrees,tell patient you are going to let go of arm, and they should lower it slowly
- positive if patient cannot lower slowly in a fluid motion
- sign of supraspinatus injury
Term
complete rupture of supraspinatus:
Definition
- most common between ages 55 and 65
- active abduction is very limited
- further abduction accomplished by elevation of scapula and shoulder shrugging or assistance from opposite hand
Term
Impingement syndrome and subacromial bursitis:
Definition
- repetive activity with the arm above horizontal
- compresses structures between the humeral head and coracoacromial arch
Term
AC joint evaluation cross over test:
Definition
- arm horizontally across chest, examiner presses against arm to stress joint
Term
carpel tunnel gives you atrophy of what?
Definition
thenar eminence
Term
volar surface of hand is the __ surface.
Definition
palmar
Term
Swan neck fingers:
Definition
- flexed DIP but not PIP
Term
Boutonneire deformity:
Definition
- flexed PIP but not DIP
Term
mallet finger
Definition
Term
Bouchard's node:
Definition
middle nuckle swelling
Term
Heberden's nodes:
Definition
- swelling of joint right before fingernail (DIP)
Term
rheumatoid nodule:
Definition
between metacarpals
Term
erythemotis:
Definition
red
Term
if a joint is red, swollen, and hot to touch, its probably ___.
Definition
gout
Term
ROM and strength of fingers, hands, and wrists:
Definition
Flexion of fingers at DIPs, PIPs, and MCPs – each  90° (DIPs at about 45°)
Hyperextension of fingers at MCPs – up to 30°
Thumb opposition ability and strength
Finger(s) and thumb adduction and abduction ability and strength
Wrist flexion ( 90°) and extension ( 70°)
Grip ability and strength
Test radial motion ( 20°) and ulnar motion ( 55°) with palms down
Term
Tinel's test:
Definition
- light percussion over flexor retinaculum
- tingling and numbness> positive test for carpel tunnel
- with carpel tunnel, the flexor retinaculum hypertrophys so it compresses nerve
Term
Phalen's test:
Definition
- wrist in acute flexion for 60 seconds, like a reverse prayer position
- also tests for carpel tunnel
- numbness or tingling is positive sign of carpel tunnel
Term
Finklestein's test:
Definition
- tuck thumb in hand and deviate wrist to ulnar side
- pain means positive sign for De Quervain's tenosynovitis
Term
symptoms and causes of De Quervian's Tenosynovitis and what test used to detect this?
Definition
- inflammation of abbductor pollicis longus (drummers, carpenters)
- Finklestein's test, tuck thumb in hand and deviate to ulnar side, pain is positive sign of this conditoin
Term
Trendelenburg test:
Definition
pt stands on one foot, weak hip abductors if pelvis tilts
Term
with knee extended, hip should be able to flex and extend how many degree?
Definition
- flexion 90 degrees
- extension 30 degrees
Term
with knee flexed, hip should be able to flex how many degrees?
Definition
- 120 degrees
Term
Thomas test:
Definition
flex hip when knee if flexed, hip should flex to 120 degrees, can be used to test for flexion contractures
Term
external rotation of hip should be ___. internal rotation of hip should be ___.
Definition
external rotation 45 degrees
internal rotation 40 degrees
Term
Abduction of hip should be __. Adduction of hip should be __.
Definition
- abduction: up to 45 degrees
- adduction: up to 30 degrees
Term
Patrick's test of the ___ is also called ___ test, and it stresses the __ and __ joint.
Definition
- hip
- FABER
- hip
- SI joint
Term
explain Patrick's/FABER test:
Definition
- flexes, abducts, and externally rotate hip to put pressure on hip and SI joint
- positive test= back or butt pain indicative of pelvis problems
- groin pain is more associated with hip joint problems
Term
what maneuvers do you use to evaluate the hips of infants?
Definition
- Barlow and Ortolani maneuvers
Term
how often are the Barlow and Ortolani maneuvers performed?
Definition
- at each pedi visit until age 1
- detects hip dislocation/subluxation
- test one hip at a time
- gentle pressing force
Term
describe the Barlow technique:
Definition
- examiner's thumb on inside of thigh, base of the thumb on the infant's knee
- rest of fingers grip outer thigh with fingertips over trochanter
- ADDUCT THIGH AND APPLY DOWNWARD PRESSURE
Term
describe the Ortolani technique:
Definition
- slowly abduct thigh as axial pressure is maintained, exert pressure in reverse order
Term
so basically Barlow dislocates hip,and Ortolani relocates hip.
Definition
Term
Barlow pushes in and down. Ortolani pushes out and up.
Definition
Term
Allis sign:
Definition
- in infants
- sign of hip dislocation or foreshortened femur
- both knees flexed with feet flat on table
- examiner at infant's feet, assess height of knees
Term
genu valgum:
Definition
knock kneed
Term
genu varum:
Definition
- bow legged
Term
Knee normal range of motion:
Definition
- knee flexion up to 130 degrees
- knee extension up to 15 degrees
Term
Knee effusions: Ballottement
Definition
- rebound sensation as structure floating within a fluid is moved and returns to its original position
- technique: knee extended, downward pressure with one hand on suprapatellar pouch > push patella downward to femur with finger of other hand>if there is tapping or clicking> + effusion
- if positive release deep pressure, but keep light pressure, if patella floats also (+) effusion
Term
genu varum:
Definition
- bow legged
Term
Knee normal range of motion:
Definition
- knee flexion up to 130 degrees
- knee extension up to 15 degrees
Term
Bulge sign:
Definition
- knee extended> milk medial knee upward three times > tap lateral side of patella> + if returning fluid creates bulge in hollow area of medial patella where you just milked
Term
to identify knee stability the patient must ___ for all the tests.
Definition
relax
Term
Varus and Valgus stress tests:
Definition
- test in extension and 30 degree flexion
- femur stabilized with one hand, ankle with other
Term
Varus stress test:
Definition
- force ankle towards midline + internal rotational force
- tests LCL (lateral collateral ligament)
Term
Valgus stress test:
Definition
- force ankle away from midline plus external rotational force
- tests MCL (medial collateral ligament)
Term
anterior and posterior drawer test to identify knee instability :
Definition
- assesses ACL and PCL (anterior and posterior cruciate ligaments)
- patient supine, knee flexed 45 to 90 degrees, foot placed flat on table
- examiner's hand circled around upper tibia with thumbs apart and just proximal to tibial tuberosities, and just distal to joint
- anterior drawer if can pull tibia foward
- posterior drawer is positive and can push tibia back
- positive if movement is greater than 5 cm in either dircetion
Term
Lachman's test determines integrity of the ___.
Definition
ACL
Term
most sensitive test for the ACL that requires the PCL to be intact?
Definition
Lachman's test
Term
Lachman's test technique:
Definition
patient supine, knee flexed 10to 15 degrees
- one hand grasps and stabilizes the thigh, while pulling the tibia anteriorly
- foward translation of the tibial plateau greater than 5 cm= tear in ACL
Term
McMurray test is used to check for what, and describe the technique?
Definition
- meniscal tears
- patient is supine with knees flexed
- examiner encircles femur with one hand and holds the ankle with the other
- fully flex the knee, then externally rotate foot as you extend knee- tests medial meniscus
- fully flex knee, then internally rotate foot while extending the knee, this tests the lateral meniscus
Term
Apley grind test:
Definition
- patient complains of locking or buckling knee, then perform this test
- patient prone with knee flexed at 90 degrees
- examiners hand presses downward on heel, the rotate the heel
Term
examine ankles with sitting, walking, and standing. check medial and lateral malleoli, Achilles tendon, foot and ankle contour, position, size and number of toes.
Definition
Term
pes planus:
Definition
flat feet
Term
pes cavus:
Definition
high instep
Term
pes varus:
Definition
club foot- only lateral side of foot touches ground
Term
pes valgus:
Definition
outward turning of foot with patient walking on medial side of foot
Term
heel pronation:
Definition
- achilles does not run straight down ankle to foot, it deviates laterally
Term
metatarus varus:
Definition
forefoot is deviated medially
Term
metatarsus valgus:
Definition
forefoot is deviated medially
Term
normal range of motion of ankle movements:
Definition
Dorsiflexion to  20°
Plantar flexion to  45°
Ankle inversion to  30°
Ankle eversion to  20°
Ankle adduction to  20°
Ankle abduction to  10°
Flex, extend, fan toes
Term
anterior drawer test for the ankle tests the integrity of ____ ___ ___.
Definition
- anterior talofibular ligament
Term
Hallux valgus:
Definition
- lateral deviation of great toe
- bunion forms due to inflamed bursa formation at pressure point over 1st metatarsal head, medial aspect
Term
Hammer toe:
Definition
- hyperextended MTP with flexed proximal joint
Term
mallet toe:
Definition
DIP flexion deformity
Term
claw toe:
Definition
hyperextended MTP with flexed proximal and distal joints
Term
you strain a __ or ___. you ___ a ligament.
Definition
strain a muscle or tendon
sprain a ligament
Term
strain is stretching or partial tear of muscle or tendon. If there is a complete strain then what happens?
Definition
- rupture
- inability to move joint
- surgical repair required
- usually caused by a sudden stretch when the muscle is in contraction
- more common in older population
Term
Sprain is stretching or partial tear of supporting structures of a joint. these occur in all age groups, caused by sudden trama, graded based on degree of injury and stability of joint. a high ankle sprain may require surgery.
Definition
Term
grades of a sprain:
Definition
Grade I or First Degree
- partial tear
- no instability of joint with stress
- TX: symptomatic
Grade II or Second Degree
- partial tear
- instability noted on stress
- TX: immobilize to protect
Grade III or Third Degree
- complete tear
- complete opening of joint on stress
- TX: immobilize, possibly repair
Term
ankle sprains are mainly ___ injuries.
Definition
inversion
Term
2 major ligaments over lateral aspect of ankle joint:
Definition
- anterior talofibular ligament
- calcaneofibular ligament
Term
anterior talofibular ligament extends anteriorly from the __ __ to the neck of the ___.
Definition
- distal fibula
- talus
Term
calcaneofibular ligament goes from the tip of the __ ___ inferiorly and posteriorly to the ___.
Definition
- lateral malleolus
- calcaneous
Term
most commonly injured ankle ligament:
Definition
anterior talofibular ligament
Term
second most commonly injured ankle ligament:
Definition
- calcaneofibular ligament
Term
what is the minor ligament on the back of the ankle:
Definition
posterior talofibular ligament
Term
what ligament is over the medial portion of the ankle joint?
Definition
deltoid ligament, so you test its integrity by eversion
Term
Achilles tendon rupture:
Definition
More common after age 40
Patients often describe an audible “pop”
Inability to plantar flex
Term
Thomson test:
Definition
patient prone, knee extended, squeeze calf and foot should plantarflex
- absense of plantar flexion is positive test for ruptured achilles tendon
Term
treatment of achilles tendon rupture:
Definition
cast in plantar flexion, or may need surgical repair with casting, long recovery
Term
calcaneal fractures:
Definition
Calcaneus very dense and extremely strong
Most breaks occur 2nd to fall from significant height
Strong association ( 25%) with lumbar spine fracture
compression or burst fracture
Term
leg length is measured from the __ __ __ __ to the __ __ crossing the knee on the __ side.
Definition
- anterior superior iliac spine (ASIS)
- medial malleolus
- medial
Term
arm length is measured from ___ __ to the distal __ ___.
Definition
- acromion process
- ulnar prominence
- circumference is measured at same land mark ilaterally
Term
comparison are necessary to check if epiphysisis is open.
Definition
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