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Musculoskeletal for Exam
Terms in this set (71)
Seated Leg Test
Pt is seated on exam table, you lift up the leg, and if the pt leans back--> it is + for a disc problem
Well Leg Test
Pt is laying down, and you are testing for disc herniation in sciatic nerve. You push the UNAFFECTED leg in the air, if there is pain in the affected leg, that is positive.
Straight Leg Test
Pt is laying down, and you are testing for disc herniation. You push the affected leg in the air, if there is pain, that is positive.
Looking at the supraspinatous tendon. Have pt extend arm, and pronate arm so that thumb is facing the ground. Stabilize the arm at the humeral head, and at the wrist. Push down on the arm. If there is pain, that is + for tendonitis or impingement of the tendon.
Looking for Rotator Cuff Tear
Raise pt arm above head and let go of the arm. If it drops to their side, + for rotator cuff
Lift Off Test
Testing for subscapularis dysfunction
Have pt internally rotate their arm and have them push against your hand with their hand. If that causes pain, + for subscapularis dysfunction
Looking for constable knee
Have pt lie down and flex the knee, stabilize the femur and push the tibia posterior and anterior into the femur to check for stability.
Testing for torn ACL. Have pt bend knee, and stabilize the foot. Push the tibia into down and back, if the tibia goes past the knee, + test
Testing for the MCL, LCL
Have pt lay down, and unlock the knee (have it at 30 degree angle), and wiggle it around to check for stability
Testing for menisci tears
Palpate along the joint line, if there is pain, +. Also bounce the knee gently, if there is pain, +.
*Not really specific
Testing with menisci tear
Have pt lay down. Hyper flex the knee, and rotate the knee in that position, pull the knee inward and out, and then fully extend the knee. If you hear a 'pop' or 'click' and pain, that is a + test.
Testing for menisci tear
Have pt lay on stomach. Hyper flex the knee, and rotate the knee in that position pull the knee inward and out, and then fully extend the knee. If you hear 'pop' or 'click' and pain, that is a + test.
involving the joint
not in the join
around the joint
connect bone to bone
connect bone to muscle
flattened fibrous sacs lined w/synovial membrane, contains synovial fluid; common where things rub together
pain that radiates
ex: knee, shoulder
ex: vertebral bodies
ex: skull structures
HPI for all joints
Do OLDCARTS and ask these questions:
Point to the pain
Is pain localized, diffuse, acute, or chronic
Mechanism of injury: when did it occur, did you hear a click or pop?
Is there swelling or discoloration
Has it improved with therapeutic interventions
Red, hot joint? Fever, chills? --> RED FLAG septic joint, gout, osteomyelitis
What % of your dx do you get from the health history?
What joint is most likely to be affected with gout?
Metatarsal pharyngeal (MTP)
What joint is most likely to be affected with osteoarthritis?
DIP: distal interpharyngeal
CMC: carpal metacarpal
With all joints SMART = ROM
S: visual scan or survey of the region
M: motion completed by the pt
A: assisted motion completed by the clinician
R: resisted testing of muscles and tendons
T: tests that are special or "branching"
Scan or Survey
Do joints look appropriate?
Broken skin or rashes?
Muscle tone: appropriate and similar to tone of opposite side?
Palpate unaffected joint first
palpate area surrounding site of pain working towards site:
First observe Active:
What are the limits?
apprehension in movement?
differentiate b/w true strength and ROM limitations vs. limitations due to pain
gently test the limits noted
look for joint instability
look for increased mobility
Resisted testing of muscles and tendons
Move them past the point they stopped in PROM
Any ligamentous stressing of a joint?
Have them hold this place for 5 seconds
Tests that are special or branching
tests that would be more diagnostic
anterior displacement of a vertebrae or the vertebral column in relation to the vertebrae below
chronic, painful degenerative inflammatory arthritis primarily affecting spine and sacroiliac joints
pain, numbness, paresthesia of the C8-T1 region
traumatic or non traumatic
neck pain, limited ROM
Cervical disc injury
worse with tilt to the affected side
numbness or tingling to affected dermatomes
may not have pain or radicular pain
Neck Pain Physical Exam
Inspection: stance, gait, posture, expressions, pain behaviors
Neuro eval: test cranial nerves
Palpate vertebral and paravertebral areas
ROM of Cervical Spine
severe stiffness of the hamstrings causes an inability to straighten the leg when they hip is flexed to 90 degrees
severe neck stiffness causes a pt hips and knees to flex when a pt neck is flexed
low back, buttocks, posterior thigh aching pain, spasm, pain increased with activity or bending, limited motion due to pain
Acute disc herniation
low back to lower leg, sharp pain, shooting or burning pain, paresthesia in leg, pain better with standing; increased with bending or sitting
low back to lower leg; often bilateral, ache, shooting pains, "pins and needles" sensation, increased with walking, specially up incline, decreased with sitting
Signs on Scoliosis
curve in spine
Low Back Physical Exam
Neuro eval: reflexes, sensations of lower extremities, strength
Mobility: sit, lie down, stand up, gait, heel/toe/tandem walk; squat
Straight leg Tests
Rotator Cuff Injury
Cervical Disc Decease
*Always consider that shoulder pain may be referred from either chest or abdomen
Shoulder Pain Physical Exam
Palpate: sternum, clavicle, neck vertebrae, shoulder joint, elbow
AROM: lateral raise (adduction and abduction)
flexion and extension
Internal and External rotation (Apley Scratch test)
Used to assess for humeral head dislocation
Pt lies down and abducts arm with it externally rotated as far as it can go. The examiner stabilizes the humerus and pushes down on the arm. The pt will react or look apprehensive
typically from overuse, or repetitive motion, painful to hold a cup of coffee
Exam: mild edema, ROM retarded by pain, palpation to tendon region is tender, strength may be decreased
Paresthesia in thumb
worse driving or at night
positive shake sign
Exam: Tinel's, Phalen's, their wasting
loss of fat around thumb
Ulnar Tunnel Syndrome
paresthesia in little finger
worse driving or at night
Exam: clawing, Tinel's up to medial elbow, hypothenar wasting
seen in osteoarthritis
B = PIP
H = DIP
see Swan-neck deformity
boutonniere deformity of the thumb
ulnar deviation of metacarpopharyngeal joints
tap the median nerve and if patient experiences pain it is carpal tunnel syndrome
evaluates carpal tunnel syndrome - fully flex wrist and abduct dorsal surfaces of hands together - reproduction of pain, numbness, tingling after 30 to 60 seconds is a positive test
55 or older
isolated tenderness of the patella
tenderness at the head of the fibula
inability to flex to 90 degrees
inability to bear weight immediately and in the ER
unable to transfer weight twice onto each lower limb
type I: stretching, small tears
type II: larger, but incomplete tear
type III: complete tear
Ottawa Ankle Rules
Pt foot is in neutral position, lower leg is stabilized by the examiner with one hand. With the other hand the examiner grasps the heel while the pt foot rests on the anterior aspect of the examiner's arm. An anterior force is applied to the heel while holding the leg fixed. Excessive displacement suggests ligamentous injury
Testing the integrity of the calcaneofibular ligament. Ankle is in neutral position, a gentle inversion force is applied to the affected ankle, and the degree of inversion is observed and compared to uninjured side
Testing for "high" ankle sprain: compress the tibia and fibular above the ankle. Pain in the region of the distal syndesmosis (on top of foot) confirms injury
External rotation stress test
Testing for "high" ankle sprain: you support the lateral fibular and tibia with one hand and gently face external rotation with the other. Pain at the distal syndesmosis confirms injury.
An acute form of inflammation found in the ligament-type tissue stretching across the bottom of the foot. This may lead to heel spurs and/or other severe conditions
Test: Thompson test: pt is lying prone with his knee extended and feet off the table. Examiner squeezes the soleus muscle (calf) on both legs. Both feet should plantar flex, if one doesn't = achilleas rupture
Scan or Survey
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