PD 3 - MSK Part 1

You can use this in cases of muscle mass and swelling?
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Terms in this set (84)
You can use this in cases of muscle mass and swelling?
Measure Girth
Most mobile portion of the spine
7 bones supporting a 10-15lb head
Cervical Spine
Rotation of C spine is at C1-C2 while Lateral Bending occurs at (_)
C2-C7
Flexion and extension of the C spine occurs primarily between the (_) and (_)
skull
C1
Torticollis can be due to a (_) issue
C spine
Image: Torticollis can be due to a (_) issue
Forward Flexion of C spine is (_) degrees
45
Hyperextension of C spine is (_) degrees
55
Lateral Bending of C spine is (_) degrees
40
Rotation of C spine is (_) degrees
70
Name of test + What it tests for?

Ask patient to rotate and extend the neck to one side. Apply gentle axial load.
Pain (cervical radiculopathy) on ipsilateral side is a positive test.
Spurling Test;

nerve root compression
Name of test + What it tests for? An electrical shock that travels down the spine and into the extremities when flexing the neck with chin down toward the chest.Lhermitte's Sign; *Dorsal column dysfunction. -MS and myelopathy*Name of test + What it tests for? Patient lies supine, assess for resting symptoms, then apply a distraction/traction force. Assess for change. A positive test is indicated when symptoms improve or resolve.Distraction Test; *nerve root compression*Name of test + What it tests for? With the patient sitting ask the patient to "bear down" . Increased radicular pain would indicate a positive test.Valsalva Test; *nerve root compression*Name of test + What it tests for? With the patient in the sitting position. Apply gentle axial load. Pain (cervical radiculopathy) on IPSILATERAL side is a positive test.Compression Test (first part of Spurling's test); *nerve root compression*What three tests are used to evaluate for Thoracic Outlet Syndrome?Adson's Wright RoosName of test + What does it test for? With the patient in the seated position, locate the RADIAL PULSE and have the patient turn his or her chin towards the AFFECTED shoulder. Ask the patient then to EXTEND his or her head while the examiner EXTERNALLY rotates and EXTENDS the patient's shoulder. Next, instruct the patient to take a deep breath and hold it. A positive test is indicated when there is a reduction in the radial pulse. If negative repeat to the opposite side.Adson's Maneuver; *interscalene compression, subclavian/brachial plexus* (aka TOS)This test for Thoracic Outlet Syndrome is *low specificity*Adson's ManeuverName of test + What does it test for? Progressively HYPER ABDUCT and EXTERNALLY rotate affected arm. Positive - diminished pulse or paresthesias.Wright Test; *interscalene compression, subclavian/ brachial plexus or TOS*Name of test + What does it test for? Both shoulders abducted and externally rotated 90° with elbows flexed 90°, open and close hands for 3 minutes.Roos Test; *interscalene compression, subclavian/brachial plexus* (TOS)This test for thoracic outlet syndrome is *very sensitive, non specific*Roos TestIliac Crests lie at what level vertebrae?L4What must we do throughout assessment of ROM of the Thoracic and Lumbar Spine?Stabilize hipsName of test + What does it test for? With the patient standing as the patient to stand on one leg. The level of the patient's hips should remain level or slightly rise with normal hip abductor strength. Positive test = pelvis drops on opposite side of standing leg (indicates weakness on the side of the patient's standing leg).Trendelenburg Test; *hip aBudctor strength* (glut medius)Name of test + What does it test for? With the patient seated, passively raise the leg by lifting and extending knee. Try and distract the patient. Positive test is indicated when the patient leans back or reports pain.Straight Leg Raise; *lumbar disc herniation/ radiculopathy/sciatic tension* (if they do not try and lean back or do not report pain the likely of sciatic tension is low)Name of test + What does it test for? With the patient supine passively raise the leg until the knee bends or the patient reports pain in the buttock or back.Straight Leg Raise; *lumbar disc herniation/radiculopathy/sciatic tension* A positive *contralateral* SLR (symptoms reproduced in opposite leg) is indicative of a *lumbar disc herniation*.This test is used to evaluate for long-tract spinal cord involvement.Babinski TestWhat would a *positive* Babinski Test look like?Great toe extends and lesser toes fan outwardWhat is a *normal* Babinsi test?Curling of the toesThis test is used to evaluate for disc herniation or radiculopathy of lumbar spineMilgram's TestName of test + What does it test for? With the patient supine ask the patient to raise both feet 2 inches in the air with their legs in the in the extended position for 30 seconds. Pain in the patient's lower back/ affected leg or inability to lift leg/s indicates a positive test.Milgram's Test; *lumbar disc herniation*Name of test + What does it test for? With the patient supine ask the patient to raise one leg extended while placing your hand underneath the opposite foot, the patient should apply pressure on the opposite foot (calcaneus) for natural leverage. You will feel a downward pressure on your hand. A positive test indicates no pressure felt on your hand and the patient is not trying to lift the "affected" leg.Hoover Test; Perform right after SLR. Evaluates *malingering* if a pt states he/she cannot raise their leg (paresis).PE: Scapular winging, trauma. Possible Dx?Serratus anterior or trapezius dysfunctionPE: Seizure and inability to passively or actively rotate affected arm externally. Possible Dx?Posterior shoulder dislocationPE: Pain radiating below elbow; decreased cervical ROM. Possible Dx?Cervical disc diseaseShoulder pain in throwing athletes; anterior glenohumeral joint pain. Possible Dx?Glenohumeral joint instabilityPain or "clunking" sound with overhead motion. Possible Dx?Labral disorderNighttime shoulder pain. Possible Dx?Impingement/Rotator Cuff TearGeneralized ligamentous laxityMultidirectional instabilityPerform (_) ROM prior to (_) ROMActive PassiveWhat nerve?: Wrist & Thumb EXTENSIONRadial n.What nerve? Little finger ABDUCTIONUlnar n.What nerve? Thumb PINCH, OPPOSITION, ABDUCTIONMedian n.What nerve? (motor exam) DeltoidAxillary n.What nerve? (motor exam) BicepsMuculocutaneousWhat nerve? Sensation of *dorsal web space between thumb and index finger*?Radial n.What nerve? Sensation of *distal ulnar aspect - little finger*Ulnar n.What nerve? Sensation of *distal radial aspect - index finger*Median n.What nerve? Sensation of *lateral arm - deltoid patch on upper arm*Axillary n.What nerve? Sensation of *lateral forearm*Musculocutaneous n.Name of test + What does it evaluate? The patient is instructed to attempt to "scratch" or touch the opposite scapula behind their back. Both via external rotation/abduction and internal rotation/adduction.Apley Scratch Test; *shoulder range of motion*Name of test + What does it evaluate? The patient is instructed to attempt to touch behind the opposite shoulder, crossing over the body. Pain at AC joint on affected side indicates positive test.Cross Over Test; *AC joint pain/arthrosis* (Pain at AC joint on affected side is indicative of AC joint pain and a positive test).Name of test + What does it evaluate? With the patient standing pronate the arm at the wrist and apply forward flexion. Pain = Positive.Neer Test; *rotator cuff tear/impingement* (positive test is pain on maneuver, indicating compression of the greater tuberosity against the anterior acromion causing discomfort)Name of test + What does it evaluate? With the patient standing flex the shoulder to 90°, flex elbow to 90, and then internally rotate the arm. Pain = Positive.Hawkin's Test; *rotator cuff tear/impingement (reinforces Neer)* (positive test is pain on maneuver, indicating compression of the greater tuberosity against the anterior acromion causing discomfort)Name of test + What does it evaluate? With the patient standing and the shoulder at 90° of abduction, 30° of forward flexion and the thumb down apply downward pressure against resistance. Positive test = weakness on affected side.Empty Can Test; *rotator cuff tear (supraspinatus)*Name of test + What does it evaluate? With the patient standing passively abduct the patient's arm to 90° ask them to slowly lower to their waist.Drop-Arm Test; *rotator cuff tear (supraspinatus)* (positive test = patient's arm "drops" due to inability to slowly lower arm, or pain)Name of test + What does it evaluate? With the patient standing ask them to externally rotate (starting at 30°) against resistance with arm at side and elbow 90°. Positive test if patient is unable to resist, with or without pain.Infraspinatous Test *infraspinatus/teres minor rotator cuff tears*Name of test + What does it evaluate? With the patient seated or standing ask the patient to place their hand behind their back (palm facing out) and lift off their back against resistance. Positive test = pain or inability to do maneuver.Lift Off Test; *subscapularis tendon tear/ rotator cuff tear*Name of test + What does it evaluate? With the patient seated or supine and the shoulder in the neutral position at 90° of abduction apply gentle anterior pressure to the humerus and externally rotate the arm.Apprehension Test; *anterior glenohumeral instability*Name of test + What does it evaluate? 90° of Forward Flexion, Internal Rotation, then ADduct 30° with resisted Forward Flexion. Pain or pop indicates = positive test.O'Briens Test; *SLAP tear*Name of test + What does it evaluate? Throwing position, continue to Externally rotate. Pain is positive for Anterior Instability. / Posterior force on Humeral Head alleviates pain. *Labral tear/ Instability*Apprehension/Relocation; *labral tear/instability* (glenohumeral joint)Name of test + What does it evaluate? With the patient in the supine position and his/her arm externally rotated at 90° forward flexion push into the Glenoid then translate Anterior and Posterior. Motion indicates Instability in that direction.Load and Shift; *labral tear/instability* (glenohumeral joint)Name of test + What does it evaluate? With the patient standing or seated flex the patient's elbow to 90° with the thumb up, have the patient actively supinate and flex the forearm as you resist them.Yerguson Test; *proximal biceps tendonitis*Name of test + What does it evaluate? With the patient standing or seated flex the patient's elbow to 20-30° with the forearm in supination and the arm in 60° of flexion, have the patient resist you with forward flexion as you palpate the biceps anteriorlySpeed Test; *proximal biceps tendonitis*What does this test evaluate? Downward pressure of the arm with the shoulder in forward flexion to 120° and palpate the scapula; scapula stays against chest wallSerratis AnteriorWhat does this test evaluate? Hands on hips and push forward against the elbow from behind; palpate the vertebral border of the scapula, should remain against chest wallRhomboidNormal Carrying Angle of elbow?5-15 degreesMuscles controlling elbow flexion?Biceps brachii, Brachialis, BrachioradialisMuscles controlling elbow extension?Triceps brachii, AnconeusMuscles controlling elbow supination?Supinator, Biceps brachiiMuscles controlling elbow pronation?Pronator Teres, Pronator QuadratusAKA medial epicondylitis?Golfer's ElbowAKA lateral epicondylitis?Tennis ElbowFinkelstein test tests for what?DeQuervain TenosynovitisPhalen's and Tinel's Tests assess for what?Carpal Tunnel Syndrome (distribution of median n.)Froment Test evaluates for what?Ulnar Palsy/Adductor Pollicis WeaknessEvaluate for stenosising tenosynovitis of the *1st dorsal compartment, APL & EPB* =Finkelstein TestAsk the patient to pinch a piece of paper between the thumb and index fingertip while you apply tension to the other side of the paper =Froment SignOcclude radial and ulnar arteries then open up one of them and make sure they reperfuse with colorAllen TestAt PIPs; associated with OABouchard's NodesAt DIPs; associated with OAHeberdan's NodesSymmetric deformities in PIP, MCP and wrist with ulnar deviation suggests what?RAFibrous tissue thickening causing contracture (fixed flexion) of MP, PIP, rarely DIPDupuytren's ContracturePIP hyperextension with DIP flexion (can be associated with RA or trauma)Swan Neck DeformitiesPIP flexion with DIP extensionBoutonniere Deformities; associated with RA or trauma