Musculo-Skeletal Evaluation

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Author:
son850
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170994
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Musculo-Skeletal Evaluation
Updated:
2012-10-08 15:16:37
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Biomedicine
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Biomedicine
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  1. 1. Test Asymptomatic Side First, unless bilateral movement is required
    2. Any movements which are painful are performed Last
    3. Active movements are performed before Passive movements
    4. At completion of an examination, the examiner must Warn the patient their symptoms may be worsened as a result of the examination
    General Rules for Performing of Ortho / Neuro Tests
  2. This type of pain is sharp, stabbing, electric pain.
    Neurologic Pain
  3. This type of Neurologic Pain is the condition of the Nerve Roots.
    • Radicular / Radiculitis / Radiculopathy
    • i.e. L4 Radiculoapathy, C5 Radiculopathy
  4. This type of Neurologic Pain is the condition of Peripheral Nerves.
    • Neuralogic / Neuritis / Neuropathy
    • i.e. Femoral Neuropathy, Ulnar Neuropathy
  5. This type of pain is soft, dull, aching.
    Muscular Pain
  6. This type of pain is deep and cannot be located.
    Osseous Pain
  7. This type of pain is throbbing / pulsating.
    Vascular Pain
  8. What is the term for alteration of feel / touch / sensation?
    Dysesthesia
  9. What is the term for no feel / touch / sensation?
    Anesthesia
  10. What is the term for increased feel / touch / sensation?
    Hyperesthesia
  11. What is the term for decreased feel / touch / sensation?
    Hypoesthesia
  12. What is the term for altered feel / touch / sensation (like ants crawling into skin)?
    Paraesthesia
  13. What is the term for alteration in pain sensitivity?
    Algesia
  14. What is the term for no pain sensitivity?
    Analgesia
  15. What is the term for increased pain sensitivity?
    Hyperalgesia
  16. What is the term for decreased pain sensitivity?
    Hypoalgesia
  17. This device measures muscle strength.
    • Dynamometer
  18. How is muscle strength graded?
    • 5 - Normal (complete range of motion, against gravity with resistance)
    • 4 - Good (complete range of motion, against gravity with some resistance)
    • 3 - Fair (complete range of motion, against gravity only)
    • 2 - Poor (complere range of motion, with gravity eliminated, but in the perpendicular plane there is contractility)
    • 1 - Trace (evidence of slight contractility but no joint motion
    • 0 - Zero (no evidence of contractility)
  19. What is MRS?
    Motor Deep Tendon Reflex Sensation
  20. What are other terms used for Posterior Nerve Root?
    • Sensory
    • Dorsal
    • Afferent
  21. What are other terms used for Anterior Nerve Root?
    • Motor
    • Ventral
    • Efferent
  22. What is the breakdown of the 31 pairs of spinal nerves?
    •   8 Cervical
    • 12 Thoracic
    •   5 Lumbar
    •   5 Sacral
    •   1 Coccygeal
  23. A ligamentous injury, pain aggrevated upon passive movement.
    Sprain
  24. Musculocutaneous Injury, pain upon resisted range of motion
    Strain
  25. If Passive ROM pain > Resisted pain, what type of injury is this?
    Sprain
  26. If Resisted pain > Passive ROM pain, what type of injury is this?
    Strain
  27. In cases of Strain, what meridian(s) are affected in Dosiflexion? Plantar flexion? Eversion? Inversion?
    • Dorsiflexion - ST
    • Plantar Flexion - KI / UB
    • Eversion - GB
    • Inversion - SP / LR
  28. In cases of Sprain, what meridian(s) are affected in Dosiflexion? Plantar flexion? Eversion? Inversion?
    • Dorsiflexion - KI / UB
    • Plantar Flexion - ST
    • Eversion - SP / LR
    • Inversion - GB
  29. What is the term for the condition of lateral curvature of the spine?
    • Scoliosis (diagnosis of scoliosis is > 35o)
  30. When performing Adam's Positions / Test, if patient has a curve while standing and goes while bent over, what condition is this?
    • Functional Scoliosis
  31. When performing Adam's Positions / Test, if patient has a curve while standing and curve while bent over, what condition is this?
    • Structural Scoliosis
  32. In the Spinal Percussion test, if pain is found what is that due to? if there is paraspinal pain what it that due to?
    • Pain on spin - Bone pathology, Disc herniation
    • Paraspinal Pain (pain lateral to spine, medial to scapula) - Strain of that muscle
  33. If there is radiating pain when performing the test for Space Occupying Lesions, what it be due to?
    • Tumor of Spine
    • Hematoma
    • Disc Herniation
  34. Please describe the Valsalva Maneuver.
    • Patient puts thumb in mouth and blows out / Bearing down stimulating bowel movement
    • (+) if there is Radiating Pain
  35. Please describe the Triad of Dejerine.
    • Patient is questioned regarding pain while coughing, sneezing, or during a bowel movement
    • (+) Radiating Pain
  36. Please describe Naffzigger's Test.
    • Digitally compress patients jugular veins for up to 45 seconds, then have them cough.  Patient should feel a stuffy head.
    • (+) Radiating Pain
  37. Please describe Milgram's Test.
    • Have patient lay supine, raise and hold legs off the ground 3-6" and hold for 30 seconds
    • (+) Radiating Pain
    • *patients with weak abdominal or lumbar paraspinal spasm may not be able to perform this test
  38. What is the test performed the determine whether to keep a patient or refer them out?
    • Heel Walk / Toe Walk
    • Support forward stretched arms while they walk on their heel (tests L5 nerve root)
    • Support forward stretched arms while they walk on their tippy toes (test S1 nerve root)
    • (+) unable to perform the test
    • *If patient cannot doe both, they are considered a surgical case
  39. Using resisted movements to test motor function, what are the nerve(s) responsible when testing Iliopsoas?
    L1-2 primarily
  40. Using resisted movements to test motor function, what are the nerve(s) responsible when testing Adductors of the Hip?
    L3 primarily
  41. Using resisted movements to test motor function, what are the nerve(s) responsible when testing Tibialis Anterior?
    L4 primarily
  42. Using resisted movements to test motor function, what are the nerve(s) responsible when testing Extensor Hallucis (big toe)?
    L5 primarily
  43. Using resisted movements to test motor function, what are the nerve(s) responsible when testing Peroneus?
    S1 primarily
  44. What is the ROM for flexion of the Lumbopelvic region?
    80o
  45. What is the ROM for extension of the Lumbopelvic region?
    20o-30o
  46. What is the ROM for lateral flexion of the Lumbopelvic region?
    35o
  47. What is the ROM for rotation of the Lumbopelvic region?
    45o
  48. Which nerve roots are associated with the Lumbar Plexus?
    L1-L4 Nerve Roots
  49. Which nerve roots are associated with the Sacral Plexus?
    L4-S4 Nerve Roots
  50. What is the function of the Sciatic Nerve of the Sacral Plexus?
    Supplies muscles of the posterior thigh and all muscles of the lower leg and foot
  51. Which Intervertebral Disc (IVD) is most commonly damaged?
    • L5
    • *IVD's act as shock absorbers
  52. Which nerve is affected at the site of Protrusion 1? Protrusion 2?
    • Protrusion 1: L5 Nerve Compression
    • Protrusion 2: S1 Nerve Compression
  53. What are the nerve(s) responsible when testing Patellar?
    L4 Primary
  54. What are the nerve(s) responsible when testing Medial Hamstrings?
    L5 primary
  55. What are the nerve(s) responsible when testing Achilles?
    S1 Primary
  56. What is the image study for Disc Herniation?
    • 1. MRI
    • 2. CT Scan (patient cannot have MRI if metal is in their body)
  57. What are the different types of Disc Herniation?
  58. How does the practitioner determine whether a Disc Herniation is lateral or medial to a nerve root?
  59. Please describe the Straight Leg Raise (SLR).
    • Elevate symptomatic leg with knee extended until patient reports pain or knee flexion occurs.
    • Note the angle.
    • (+) radiating pain down the extremity past knee indicating sciatic nerve / nerve root involvement
  60. When performing SLR, if pain is found between 0o-35o, what possible problem(s) does the patient have?
    • Ipsilateral SI (same side sacroiliac) or Hip Problems
    • Severe Lumbar muscle spasms
  61. When performing SLR, if pain is found between 35o-70o, what possible problem(s) does the patient have?
    Lumbar Radiculopathy
  62. When performing SLR, if pain is found over 70o, what possible problem(s) does the patient have?
    • Ipsilateral Hamstring
    • Contralateral SI joint
  63. Please describe Braggard's test.
    • postive SLR findings
    • lower the leg until there is no pain
    • dorsiflex foot
    • (+) exacerbation of leg pain
  64. Please describe the Well Leg Raise (WLR) test?
    • performed on asymptomatic side
    • (+) exacerbation of pain on symptomatic leg
  65. SLR (+) finding
    Braggard's (+) finding
    WLR (+) finding
    What condition does this patient have?
    Lumbar Radiculopathy
  66. SLR (+)
    Braggard's (+)
    WLR (-)
    What condition does this patient have?
    Lumbar Neuropathy
  67. Please describe Lasegue's Differential.
    • Perform SLR
    • Flex Knee to reduce sciatic nerve tension
    • (+) relief of pain upon flexion
  68. Please describe Minor's Sign.
    • Observe patient as they get up from a seated position.
    • (+) patient uses arms to push off chair or knees & jackknife body over legs
  69. Please describe Bechterew's Test.
    • Have patient extend one knee
    • Then the other
    • Then both together
    • (+) increasing pain or inability to extend knee due to pain
    • Indications: Lumbar Radiculopathy
    • *If the symptomatic leg has pain, it may be Lumbar Neuropathy
  70. Please describe Kemp's Test.
    • Patient seated
    • Perform lateral flexion of waist with ipsilateral rotation and extension
    • Asympotmatic side first
    • (+) increasing pain in lower back & leg
    • Indications: Lumbar Radiculopathy
    • Perform same test again but with patient standing
    • (+) increase in local pain
    • Indications: Facet syndrome
  71. Please describe the Belt Test.
    • "bend over" test
    • Then, "bend over" test with back supported by practitioner
    • (+) decrease of pain upon support: SI / Hip problem
    • No change in pain / increased pain: Lumbar / Lumbo-sacral problems
  72. Please describe the Nachlas test.
    • Heel-to-Buttock
    • (+) if patient points to problem area
  73. Please describe Ely's Sign.
    • Nachlas + "hip up"
    • Indications: Tighness in Rectus Femoris / Tensor Fascia Lata
  74. Please describe the Femoral Nerve Traction Test.
    • Prone positions
    • Extend leg back
    • (+) Pain radiating down the anterior thigh
    • Indications: Femoral Neuropathy
  75. The Femoral Triangle is bounded by which anatomical structures?
  76. What are the degress of Active Hip Normal ROM's?
    • Flexion (knee flex): 120o
    • Flexion (knee ext): 80o-90o
    • Extension: 15o
    • Abduction: 50o
    • Adduction: 30o
    • Internal Rotation: 40o
    • External Rotation: 60o
  77. Please describe the Thomas test.
    • Patient supine
    • Flex knee, push against chest
    • (+) other legs thigh is off the table
    • Indications: contracture of hip flexors including iliopsoas, TFL, ITB, and rectus femoris
  78. Please describe the Anvil test?
    • Raise affected leg off table
    • Strike calcaneous firmly with fist
    • (+) pain in the hip region or along leg
    • Indications: Fracture of Femoral Neck
  79. What does FABER stand for?
    • Flexion
    • ABduction
    • External Rotation
  80. Please describe FABER / Patrick's test.
    • Patient supine
    • Flex knee, foot lies flat on table, practitioner compresses into the hip joint
    • Cross leg so ankle rests on opposing knee, push knee down into the ground while stablizing opposing ASIS
    • (+) inability to perform motions or pain at hip
    • Indication: Hip joint problem
  81. Please describe Ober's Test.
    • Patient lays on side
    • Hold illeum donw with on hand while taking the thigh of the upper leg into flexion, abduct, then extend to neutral position
    • Lower the leg slowly to midline
    • (+) inability to adduct the hip back to neutral position
    • Indications: ITB Spasm
  82. Please describe Trendelenburg's Test.
    • Patient stands & asked to flex knee towards chest
    • Observe gluteal fold on flexed side
    • (+) downward deviation of gluteal fold or Hip of flexed leg
    • Indications: weakness of Gluteus Medius
  83. Please describe Yeoman's Test.
    • Perform Nachlas + extending the thigh and adding pressure on ipsilateral SI joint
    • (+) deep SI pain
    • Indications: SI Sprain
  84. Please describe Hibb's Test.
    • Patient is prone
    • Flex knee
    • The lower leg acts as a lever to internally rotate the hip
    • (+) SI or hip pain
    • Indications: Hip or SI joint problem
  85. What is the Piriformis Stretch Test.
    • Hibb's + practitioner stablizes the opposite SI Joint & additional pressure to internally rotate leg
    • (+) exacerbation of sciatic symptoms with radiating pain down the leg
    • Indications: Piriformis Syndrome

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