Exam 5 Terminology - PAP 580

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  1. Abduction
    movement of a limb away from the midline or axis of the body
  2. Active ROM
    the range of movement through which a patient can actively (without assistance) move a joint using the adjacent muscles
  3. Acute gouty arthritis
    An abrupt gouty attack, which may be precipitated by overeating, alcohol, surgery, emotional stress, infection, antibiotics, insulin. Crushing pain of a joint–most often the great toe–which is swollen, hot, shiny
  4. Adduction
    the movement of a limb toward the midline or axis of the body
  5. Adhesive capsulitis
    a shoulder condition characterized by stiffness, pain, and limited range of motion. It most often occurs in midlife and may be associated with shoulder surgery or injury. Also called frozen shoulder
  6. Anterior/Posterior Drawer sign
    In a knee examination, abnormal forward or backward sliding of the tibia with respect to the femur indicating laxity or tear of the anterior (forward slide) or posterior (backward slide) cruciate ligament of the knee. 
  7. Apley's scratch test
    a method for assessing the range of motion of the shoulders. The patient is asked to scratch his or her back while reaching over the head with one hand and behind the back with the other hand. The test requires abduction and lateral rotation of one shoulder and adduction and medial rotation of the other shoulder.
  8. Apley’s compression/distraction
    used to evaluate individuals for problems in the meniscus of the knee, the patient lays prone (face-down) on an examination table and flexes their knee to a ninety degree angle. The examiner then places his or her own knee across the posterior aspect of the patient's thigh. The tibia is then compressed onto the knee joint while being externally rotated. If this maneuver produces pain, this constitutes a "positive Apley test" and damage to the meniscus is likely.
  9. Arthralgias
    Severe pain in a joint
  10. Balloon sign
    Place the thumb and index finger of your right hand on each side of the patella; with the left hand, compress the suprapatellar pouch against the femur. Feel for fluid entering (or ballooning into) the spaces next to the patella under your right thumb and index finger.
  11. Bulge sign
    With knee extended, place the left hand above the knee and apply pressure on the suprapatellar pouch, displacing or "milking" fluid downward. Stroke downward on the medial aspect of the knee and apply pressure to force fluid into the lateral area. Tap the knee just behind the lateral margin of the patella with the right hand.
  12. Bursa (pl -ae)
    a fibrous sac between certain tendons and the bones beneath them. Lined with a synovial membrane that secretes synovial fluid, the bursa acts as a small cushion that allows the tendon to move over the bone as it contracts and relaxes
  13. Carpal tunnel syndrome
    a disorder caused by compression at the wrist of the median nerve supplying the hand, causing numbness and tingling, in particular the thumb and first three fingers
  14. Cartilage
    A tough, elastic connective tissue found in the joints, outer ear, nose, larynx, and other parts of the body.
  15. Condylar joint
    ellipsoidal joint; one in which an ovoid head of one bone moves in an elliptical cavity of another, permitting all movements except axial rotation.
  16. Crossover test
    Test for the acromioclavicular joint. Palpate and compare both joints for swelling or tenderness. Adduct the patient's arm across the chest, sometimes called the "crossover test".
  17. Diffuse
    spread out
  18. Drop-arm sign
    Ask the patient to fully abduct the arm to shoulder level (or up to 90°) and lower it slowly. Note that the abduction above the shoulder level, from 90° to 120°, reflects action of the deltoid muscle.
  19. Empty can test
    Suprasinatus strength - Elevate the arms to 90° and internally rotate the arms with the thumbs pointing down, as if emptying a can. Ask the patient to resist as you place downward pressure on the arms.
  20. Epicondylitis
    A painful and sometimes disabling inflammation of the muscle and surrounding tissues of the elbow caused by repeated stress and strain on the forearm near the lateral epicondyle of the humerus. (Tennis Elbow)
  21. Eversion
    a turning outward or inside out, such as a turning of the foot outward at the ankle
  22. Extension
    a "straightening" movement allowed by certain joints of the skeleton that increases the angle between two adjoining bones, such as extending the leg, which increases the posterior angle between the femur and the tibia
  23. External rotation
    turning outwardly or away from the midline of the body, such as when a leg is externally rotated with the toes turned outward or away from the body's midline
  24. Fibromyalgia syndrome
    Widespread musculoskeletal pain and tender points. Mechanism may involve aberrant pain signaling and amplification.
  25. Finkelstein’s test
    Test the thumb function if there is wrist pain by asking the patient to grasp the thumb against the palm and then move the wrist toward the midline in ulnar deviation.
  26. Flexion
    a position that is made possible by the joint angle decreasing
  27. Forearm supination
    Flex the patient's forearm to 90° at the elbow and pronate the patient's wrist. Provide resistance when the patient supinates the forearm.
  28. Hand grip strength
    Test hand grip strength by asking the patient to grasp your second and third fingers. This tests function of wrist joints, the finger flexors, and the intrinsic muscles and joints of the hand.
  29. Hawkin’s impingement sign
    Flex the patient’s shoulder and elbow to  90° with the palm facing down. Then, with one hand on the forearm and one on the arm, rotate the arm internally. This compresses the greater tuberosity against the coracoacromial ligament. 
  30. Hinge joint
    a synovial joint that allows movement in only one plane, forward and backward. Examples are the elbow and the interphalangeal joints of the fingers. The jaw is primarily a hinge joint but it can also move somewhat from side to side. The knee and ankle joints are hinge joints that also allow some rotary movement. Called also ginglymus.
  31. Inflammatory
    Characterized or caused by inflammation. Symptoms include tenderness, warmth, or redness. May also include fever or chills.
  32. Infraspinatus strength
    Ask the patient to place the arms at the side and flex the elbows to 90° with the thumbs turned up. Provide resistance as the patient presses the forearms outward.
  33. Internal rotation
    the turning of a limb about its axis of rotation toward the midline of the body.
  34. Inversion
    A frontal plane movement of the foot, where the plantar surface is tilted to face the midline of the body or the medial sagittal plane; the axis of motion lies on the sagittal and transverse planes; a fixed inverted position is referred to as a varus deformity
  35. Joint capsule
    the saclike envelope enclosing the cavity of a synovial joint.
  36. Lachman test
    Place the knee in 15° of flexion and external rotation. Grasp the distal femur on the lateral side with one hand and the proximal tibia on the medial side with the other. With the thumb of the tibial hand on the joint line, simultaneously pull the tibia forward and the femur back. Estimate the degree of forward excursion.
  37. Ligaments
    fibrous tissue that connects bones to other bones 
  38. Localized
    Confined to a small area
  39. McMurray's Test
    With the patient supine, grasp the heel and flex the knee. Cup your other hand over the knee joint with fingers and thumb along the medial joint line. From the heel, externally rotate the lower, then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time, slowly extend the lower leg in external rotation. The same maneuver with internal rotation of the foot stresses the lateral meniscus. If a click is felt or heard at the joint line during flexion and extension of the knee, or if tenderness is noted along the joint line, further assess the meniscus for a posterior tear.
  40. Mechanism of injury
    (MOI) series of events leading up to or causing the pain or trauma
  41. Monoarticular Joint Pain
    Joint pain that is localized and involves only one joint. Pain in one joint suggests injury, monarticular arthritis, possible tendinitis, or bursitis. Lateral hip pain near the greater trochanter suggests trochanteric bursitis.
  42. Polyarticular Joint Pain
    Joint pain involving several joints.
  43. Myalgias
    Muscular pain or tenderness, especially when diffuse and nonspecific
  44. Neer’s impingement sign
    Press on the scapula to prevent scapular motion with one hand, and raise the patient’s arm with the other. This compresses the greater tuberosity of the humerus against the acromion. 
  45. Noninflammatory
    Joint pain without inflammation
  46. Opposition 
    Movement of the thumb. To test opposition, or movements of the thumb across the palm, ask the patient to touch the thumb to each of the other fingertips.
  47. Osteoarthritis
    Degeneration and progressive loss of cartilage within the joints, damage to underlying bone, and formation of new bone at the margins of the cartilage
  48. Passive ROM
    the moving of a joint through its range of motion without exertion by the subject usually done by an examiner who moves the person's body part manually
  49. Patellofemoral grinding test
    With the patient supine and the knee extended, compress the patella against the underlying femur, and gently move it medially and laterally, assessing for crepitus and pain. Ask the patient to tighten the quadriceps as the patella moves distally in the trochlear groove. Check for a smooth sliding motion. 
  50. Pattern of involvement
    Does the joint pain migrate from joint to joint, or steadily spreads from one joint to multiple joints. Is the involvement symmetric? Migratory pattern of spread is seen in rheumatic fever or gonococcal arthritis; progressive additive pattern with symmetric involvement, in rheumatoid arthritis.
  51. Phalen's test/sign
    Test Phalen’s sign for median nerve compression by asking the patient to hold the wrists in flexion for 60 seconds. Alternatively, ask the patient to press the backs of both hands together to form right angles. These maneuvers compress the median nerve.
  52. Plantar fasciitis
    Bone spurs may be present on the calcaneus. Focal heel tenderness on palpation of the plantar fascia suggests plantar fasciitis, seen in prolonged standing or heel-strike exercise and also in rheumatoid arthritis, gout.
  53. Polymyalgia Rheumatica
    A disease of unclear etiology in people older than 50, especially women; overlaps with giant cell arteritis
  54. Prepatellar bursitis
    Swelling over the patella suggests prepatellar bursitis.
  55. Pronation
    Arms at side, elbows bent 90°, "Turn your palms down."
  56. Range of motion  
    The arc of measurable joint movement in a single plane. There are two phases to range of motion: active (by the patient) and passive (by the examiner).
  57. Rheumatoid arthritis
    Chronic inflammation of synovial membranes with secondary erosion of adjacent cartilage and bone, and damage to ligaments and tendons
  58. Sciatica
    Shooting pain below the knee, commonly into the lateral leg (L5) or posterior calf (S1); typically accompanies low back pain. Patients report associated paresthesias and weakness. Bending, sneezing, coughing, straining during bowel movements often worsen pain.
  59. Scoliosis
    In scoliosis, there is lateral and rotatory curvature of the spine to bring the head back to midline. Scoliosis often becomes evident during adolescence, before symptoms appear. Deformity of the thorax on forward bending, especially differences in height of the scapulae, also unequal leg length
  60. Spheroidal joint
    (ball-and-socket joint) a synovial joint in which the rounded or spheroidal surface of one bone (the “ball”) moves within a cup-shaped depression (the “socket”) on another bone, allowing greater freedom of movement than any other type of joint. Called also polyaxial or spheroidal joint.
  61. Supination
    "Turn your palms up, as if carrying a bowl of soup."
  62. Synovial fluid
    viscous lubricating fluid secreted by the synovial membrane which lines the synovial cavity
  63. Systemic
    pertaining to the whole body rather than to a localized area or regional part of the body
  64. Tendons
    A band of tough, inelastic fibrous tissue that connects a muscle with its bony attachment.
  65. Thumb abduction test
    Test thumb abduction by asking the patient to raise the thumb straight up as you apply downward resistance.
  66. Tinel’s test
    Test Tinel’s sign for median nerve compression by tapping lightly over the course of the median nerve in the carpal tunnel.
  67. Trochanteric bursitis
    Lateral hip pain near the greater trochanter suggests trochanteric bursitis.
  68. Valgus Stress test
    (Abduction Stress Test) With the patient supine and the knee slightly flexed, move the thigh about 30° laterally to the side of the table. Place one hand against the lateral knee to stabilize the femur and the other hand around the medial ankle. Push medial against the knee and pull laterally at the ankle to open the knee joint on the medial side.
  69. Varus Stress Test
    (Adduction Stress Test) With the patient supine and the knee slightly flexed place one hand against the medial surface of the knee and the other around the lateral ankle. Push laterally against the knee and pull medially at the ankle to open the knee joint on the lateral side.
  70. Amyotrophic lateral sclerosis
    A chronic, progressive disease marked by gradual degeneration of the nerve cells in the central nervous system that control voluntary muscle movement. The disorder causes muscle weakness and atrophy and usually results in death. Also called Lou Gehrig's disease.
  71. Asterixis
    motor disturbance marked by intermittent lapses of an assumed posture as a result of intermittency of sustained contraction of groups of muscles (liver disease, uremia, hypercapnia). Ask patient to “stop traffic”.
  72. Ataxia
    a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum. (Greek for "lack of order")
  73. Atrophy
    partial or complete wasting away of a part of the body. Causes of atrophy include mutations (which can destroy the gene to build up the organ), poor nourishment, poor circulation, loss of hormonal support, loss of nerve supply to the target organ, disuse or lack of exercise or disease intrinsic to the tissue itself.
  74. Clonus
    rhythmic oscillations between flexion and extension (Greek for "violent, confused motion")
  75. Cortical Stroke
    • Caused by a lesion in the cerebral cortex.
    • Motor findings: Chronic contralateral corticospinal-type weakness and spasticity. Flexion is stronger than extension in the arm, plantar flexion is stronger than dorsiflexion in the foot, and the leg is externally rotated at the hip.
    • Sensory findings: Contralateral sensory loss in the limbs and trunk on the same side as the motor deficits
  76. Dermatomal distribution
    Follows the dermatome pattern on the skin, suggests herpes zoster, vasculitis
  77. Dermatomes
    A dermatome is the band of skin innervated by the sensory root of a single spinal nerve.
  78. Discriminative sensations
    Several additional techniques test the ability of the sensory cortex to correlate, analyze, and interpret sensations. Because discriminative sensations depend on touch and position sense, they are useful only when these sensations are either intact or only slightly impaired. eg: stereognosis, number identification (graphesthesia), two-point discrimination
  79. Dysarthria
    a defect in the muscular control of the speech apparatus (lips, tongue, palate, or pharynx). Words may be nasal, slurred, or indistinct, but the central symbolic aspect of language remains intact. Causes include motor lesions of the central or peripheral nervous system, parkinsonism, and cerebellar disease.
  80. Dysdiadochokinesis
    Inability to perform rapid alternating movements. A clinical manifestation of cerebellar dysfunction/lesion.
  81. Dysesthesias
    distorted sensations in response to a normal stimulus. Occurs with spinal cord injury, other neurological disorders, and with shingles.
  82. Extinction
    Simultaneously stimulate corresponding areas on both sides of the body. Ask where the patient feels your touch. Normally both stimuli are felt.
  83. Fasciculations
    Involuntary twitching of muscles
  84. Finger-to-nose test
    Ask the patient to touch your index finger and then his or her nose alternately several times. Move your finger about so that the patient has to alter directions and extend the arm fully to reach it. Observe the accuracy and smoothness of movements, and watch for any tremor. Normally the patient's movements are smooth and accurate.
  85. Flaccidity
    quality of lack of tone of muscular or vascular organ or tissue
  86. Gait Testing
    • Walk across the room or down the hall, then turn, and come back. Observe posture, balance, swing-ing of the arms, and movements of the legs. Normally balance is easy, the arms swing at the sides, and turns are accomplished smoothly.
    • Walk heel-to-toe in a straight line— a pattern called tandem walking.
    • Walk on the toes, then on the heels—sensitive tests, respectively, for plantar flexion and dorsiflexion of the ankles, as well as for balance.
    • Hop in place on each foot in turn (if the patient is not too ill). Hopping involves the proximal muscles of the legs as well as the distal ones and requires both good position sense and normal cerebellar function.
    • Do a shallow knee bend, first on one leg, then on the other. Support the patient’s elbow if you think the patient is in danger of falling.
    • Rising from a sitting position without arm support and stepping up on a sturdy stool are more suitable tests than hopping or knee bends when patients are old or less robust.
  87. Types of Gait abnormalities
    • Spastic Hemiparesis, Scissors Gait, Steppage Gait, Parkinsonian Gait, Cerebellar Ataxia, Sensory Ataxia
    • Caused by:
    • Inadequate muscle strength in the hip, knee, or ankle to flex
    • Inadequate sensation in the foot to send message to brain
    • Inadequate muscle strength to support the body
    • Inability to relax the muscles of the leg to transfer weight
    • Disorders of the cerebellum (which coordinates muscle contraction and relaxation)
  88. Spastic Hemiparesis
    Seen in corticospinal tract lesion in stroke, causing poor control of flexor muscles during swing phase. Affected arm is flexed, immobile, and held close to the side, with elbow, wrists, and interphalangeal joints flexed. Affected leg extensors spastic; ankle plantar-flexed and inverted. Patients may drag toe, circle leg stiffly outward and forward (circumduction), or lean trunk to contralateral side to clear affected leg during walking.
  89. Scissors Gait
    Seen in spinal cord disease, causing bilateral lower extremity spasticity, including adductor spasm, and abnormal proprioception. Gait is stiff. Patients advance each leg slowly, and the thighs tend to cross forward on each other at each step. Steps are short. Patients appear to be walking through water. Scissoring is seen in all spasticity disorders, most commonly cerebral palsy.
  90. Steppage Gait
    Seen in foot drop, usually secondary to peripheral motor unit disease. Patients either drag the feet or lift them high, with knees flexed, and bring them down with a slap onto the floor, thus appearing to be walking up stairs. They cannot walk on their heels. The steppage gait may involve one or both legs. Tibialis anterior and toe extensors are weak.
  91. Parkinsonian Gait
    Seen in the basal-ganglia defects of Parkinson disease. Posture is stooped, with flexion of head, arms, hips, and knees. Patients are slow getting started. Steps are short and shuffling, with involuntary hastening (festination). Arm swings are decreased, and patients turn around stiffly—“all in one piece.” Postural control is poor (retropulsion).
  92. Cerebellar Ataxia
    Seen in disease of the cerebellum or associated tracts. Gait is staggering, unsteady, and wide based, with exaggerated difficulty on turns. Patients cannot stand steadily with feet together, whether eyes are open or closed. Other cerebellar signs are present such as dysmetria, nystagmus, and intention tremor.
  93. Sensory Ataxia
    Seen in loss of position sense in the legs (with polyneuropathy or posterior column damage). Gait is unsteady and wide based (with feet wide apart). Patients throw their feet forward and outward and bring them down, first on the heels and then on the toes, with a double tapping sound. They watch the ground for guidance when walking. With eyes closed, they cannot stand steadily with feet together (positive Romberg sign), and the staggering gait worsens.
  94. Glove and stocking distribution
    suggests sensory loss of a polyneuropathy; diabetes, vitamin B12 or folate deficiency, alcohol, or intoxications (heavy metals, industrial chemicals or medications). All sensation in the hand is lost. Repetitive testing in a proximal direction reveals a gradual change to normal sensation at the wrist. This pattern fits neither a peripheral nerve nor a dermatome. Hyperventilation would also include peri-oral paresthesia
  95. Graphesthesia
    When motor impairment, arthritis, or other conditions prevent the patient from manipulating an object well enough to identify it, test the ability to identify numbers. With the blunt end of a pen or pencil, draw a large number in the patient’s palm. A normal person can identify most such numbers.
  96. Guillain-Barre syndrome
    Progressive subacute onset of distal lower extremity weakness (peripheral demyelinating disease, typically in an ascending pattern, with both motor and sensory deficits)
  97. Heel-to-shin test
    Ask the patient to place one heel on the opposite knee, and then run it down the shin to the big toe. Note the smoothness and accuracy of the movements. Repetition with the patient’s eyes closed tests for position sense. Repeat on the other side.
  98. Hemiparesis
    Slight paralysis or weakness affecting one side of the body
  99. Hemiplegia
    Paralysis affecting only one side of the body.
  100. Hypertrophy
    A nontumorous enlargement of an organ or a tissue as a result of an increase in the size rather than the number of constituent cells. (Muscle bulk)
  101. Hypotonia
    A condition in which there is diminution or loss of muscular tonicity, resulting in stretching of the muscles beyond their normal limits.
  102. Intention tremor
    Intention tremors, absent at rest, appear with movement and often get worse as the target gets closer. Causes include disorders of cerebellar pathways, as in multiple sclerosis, or any other disease of the cerebellum.  Trauma, tumor, stroke.
  103. Involuntary movements
    Watch for involuntary movements such as tremors, tics, or fasciculations. Note their location, quality, rate, rhythm, and amplitude, and their relation to posture, activity, fatigue, emotion, and other factors.
  104. Loss of consciousness (LOC)
    a state of complete or partial unawareness or lack of response to sensory stimuli as a result of hypoxia caused by respiratory insufficiency or shock; from metabolic or chemical brain depressants such as drugs, poisons, ketones, or electrolyte imbalance; or from a form of brain pathologic condition such as trauma, seizures, cerebrovascular insult, brain tumor, or infection. Various degrees of unconsciousness can occur during stupor, fugue, catalepsy, and dream states
  105. Loss of sensation
    When pain sensation is diminished or absent, as in diabetic neuropathy, neuropathic ulcers may develop at pressure points on the feet. Although often deep, infected, and indolent, they are painless. Underlying osteomyelitis and amputation may ensue. Early detection of loss of sensation using a nylon filament is the standard of care in diabetes.
  106. Meningeal signs
    • Upon completion the neurologic examination, check for facial asymmetry and asymmetries in motor, sensory, and reflex function. Test for meningeal signs if indicated. Neck mobility, Brudzinski’s sign (as you flex the neck, watch the hips and knees for flexion), Kernig’s sign (flex the leg at the hip and knee, then straighten – should not be painful)
    • Meningeal signs suggest meningitis, subarachnoid hemorrhage.
  107. Myasthenia gravis
    an autoimmune disease that causes muscle weakness, affects the neuromuscular junction, interrupting the communication between nerve and muscle, and thereby causing weakness. A person with MG may have difficulty moving their eyes, walking, speaking clearly, swallowing, and even breathing, depending on the severity and distribution of weakness. Increased weakness with exertion, and improvement with rest, is a characteristic feature of MG.
  108. Near Syncope
    The patient hears external noise or voices throughout the episode, feels light-headed or weak, but fails to actually lose consciousness is consistent with near syncope or presyncope
  109. Nystagmus
    Rhythmic, oscillating motions of the eyes are called nystagmus. The to-and-fro motion is generally involuntary. Vertical nystagmus occurs much less frequently than horizontal nystagmus and is often, but not necessarily, a sign of serious brain damage. Nystagmus can be a normal physiological response or a result of a pathologic problem.
  110. Opposing resistance
    Test muscle strength by asking the patient to actively resist your movement. Remember that a muscle is strongest when shortest, and weakest when longest.
  111. Paraplegia
    Complete paralysis of the lower half of the body including both legs, usually caused by damage to the spinal cord
  112. Paresis
    slight or incomplete paralysis
  113. Paresthesias
    subjective sensations without obvious stimulus, experienced as numbness, tingling, “pins and needles”. May be caused by compression of a nerve, hyperventilation, or underlying disorders of the brain or spinal cord.
  114. Peripheral paresthesias
    can be caused by entrapment syndromes, metabolic disturbances, trauma, inflammation, connective tissue diseases, toxins, hereditary conditions, malignancies, nutritional deficiencies and miscellaneous conditions
  115. Parkinson’s disease
    Low-frequency unilateral resting tremor, rigidity, and bradykinesia. Also loss of smell and dysarthria.
  116. Resting tremor
    May decrease or disappear with movement, eg Parkinson's
  117. Passive stretch
    When a normal muscle with an intact nerve supply is relaxed voluntarily, it maintains a slight residual tension known as muscle tone. This can be assessed best by feeling the muscle’s resistance to passive stretch. Persuade the patient to relax. Take one hand with yours and, while supporting the elbow, flex and extend the patient’s fingers, wrist, and elbow, and put the shoulder through a moderate range of motion. With practice, these actions can be combined into a single smooth movement. On each side, note muscle tone—the resistance offered to your movements. Tense patients may show increased resistance.
  118. Past pointing
    Cerebellar disease causes incoordination that worsens with eyes closed. If present, this suggests loss of position sense. Repetitive and consistent deviation to one side, referred to as past pointing, worse with the eyes closed, suggests cerebellar or vestibular disease.
  119. Patterns of testing
    Because sensory testing quickly fatigues many patients, producing unreliable results, conduct the examination as efficiently as possible. Pay special attention to those areas where there are symptoms such as numbness or pain, where there are motor or reflex abnormalities that suggest a lesion of the spinal cord or peripheral nervous system, and where there are trophic changes, such as absent or excessive sweating, atrophic skin, or cutaneous ulceration. Repeat testing at another time is often required to confirm abnormalities.
  120. Point localization
    Briefly touch a point on the patient’s skin. Then ask the patient to open both eyes and point to the place touched. Normally a person can do so accurately. This test, together with the test for extinction, is especially useful on the trunk and the legs.
  121. Point-to-point movements
    Finger-to-nose test, and Heel-to-shin test
  122. Presyncope
    symptoms of feeling faint, light-headed, or weak, but without actual loss of consciousness. Sometimes called near syncope
  123. Pronator drift
    The patient should stand for 20 to 30 seconds with both arms straight forward, palms up, and with eyes closed. A person who cannot stand may be tested for a pronator drift in the sitting position. In either case, a normal person can hold this arm position well.
  124. Quadriplegia
    paralysis of all four limbs
  125. Rapid alternating movements
    • Arms: Show the patient how to strike one hand on the thigh, raise the hand, turn it over, and then strike the back of the hand down on the same place. Urge the patient to repeat these alternating movements as rapidly as possible. Observe the speed, rhythm, and smoothness of the movements. Repeat with the other hand. The non-dominant hand often performs somewhat less well. Show the patient how to tap the distal joint of the thumb with the tip of the index finger, again as rapidly as possible. Again, observe the speed, rhythm, and smoothness of the movements. The nondominant side often performs less well.
    • Legs: Ask the patient to tap your hand as quickly as possible with the ball of each foot in turn. Note any slowness or awkwardness. The feet normally perform less well than the hands.
  126. Restless legs syndrome
    Present in 6% to 12% of the U.S. population. An unpleasant sensation in the legs, especially at night, that gets worse during rest and improves with activity.
  127. Rigidity
    Caused by a lesion in the basal ganglia system. Increased resistance that persists throughout the movement arc, independent of rate of movement, is called lead-pipe rigidity. With flexion and extension of the wrist or forearm, a superimposed rachetlike jerkiness is called cogwheel rigidity. Commonly caused by Parkinson's.
  128. Romberg test
    This is mainly a test of position sense. The patient should first stand with feet together and eyes open and then close both eyes for 30 to 60 seconds without support. Note the patient’s ability to maintain an upright posture. Normally only minimal swaying occurs.
  129. Seizure
    A paroxysmal episode, caused by abnormal electrical conduction in the brain, resulting in the abrupt onset of transient neurologic symptoms such as involuntary muscle movements, sensory disturbances and altered consciousness. Also called convulsion.
  130. Sensory mapping
    Meticulous sensory mapping helps to establish the level of spinal cord lesion and to determine whether a more peripheral lesion is in a nerve root, a major peripheral nerve, or one of its branches.
  131. Spasticity
    a form of muscular hypertonicity with increased resistance to stretch. It usually involves the flexors of the arms and the extensors of the legs
  132. Stance
    The Romberg Test and Test for Pronator Drift
  133. Stereognosis
    The perception of the form of an object by means of touch.
  134. Straight-leg raise
    (Lumbosacral Radiculopathy) If the patient has low back pain with nerve pain that radiates down the leg, commonly called sciatica if in the S1 distribution, test straight-leg raising on each side in turn. Place the patient in the supine position. Raise the patient’s relaxed and straightened leg, flexing the leg at the hip, then dorsiflex the foot. Some examiners first raise the patient’s leg with the knee flexed, then extend the leg. Assess the degree of elevation at which pain occurs, the quality and distribution of the pain, and the effects of dorsiflexion. Tightness or discomfort in the buttocks or hamstrings is common during these maneuvers; do not interpret this as “radiating pain” or a positive test.
  135. Syncope
    • sudden, brief loss of consciousness and postural tone with spontaneous, complete recovery
    • caused by reflex-mediated (vasovagal), orthostatic hypotension, neurologic disease, medication-induced, cardiac related, or due to unknown cause
  136. syncope alarm symptoms
    personal or family history of heart disease or sudden death, associated chest pain or dyspnea, exertional syncope, syncope while supine, absence of nausea, vomiting, palpitations or other prodrome (suspicious for arrhythmia), associated diplopia, dysarthria, vertigo or facial numbness (suspicious for TIA)
  137. prodrome
    An early symptom indicating the onset of an attack or disease
  138. Tics
    Tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Causes include Tourette’s syndrome and drugs such as phenothiazines and amphetamines.
  139. Tremors
    rhythmic oscillatory movements, which may be roughly subdivided into three groups: resting (or static) tremors, action (postural) tremors, and intention tremors.
  140. Trigeminal neuralgia
    Isolated facial sensory loss from peripheral nerve disorders
  141. Trophic changes
    changes resulting from interruption of nerve supply, eg: absent or excessive sweating, atrophic skin, or cutaneous ulceration.
  142. Two-point discrimination
    Using the two ends of an opened paper clip, or the sides of two pins, touch a finger pad in two places simultaneously. Alternate the double stimulus irregularly with a one-point touch. Be careful not to cause pain.
  143. Vasovagal syncope
    the most common cause of fainting. A reflex of the involuntary nervous system that causes the heart to slow down (bradycardia) and blood vessels in the legs to dilate. As a result, the heart puts out less blood, the blood pressure drops, and what blood is circulating tends to go into the legs rather than to the head, resulting in syncope. Causes include environmental factors, emotional factors, physical factors, or illness.
  144. Winging of the scapula
    When the shoulder muscles seem weak or atrophic, look for winging. Ask the patient to extend both arms and push against your hand or against a wall. Observe the scapulae. Normally they lie close to the thorax. In very thin but normal people, the scapulae may appear "winged" even when the musculature is intact.
  145. Cerebral vascular accident
    sudden death of brain cells in a localized area due to inadequate blood flow
  146. Peripheral neuropathy
    a wide range of disorders in which the nerves outside of the brain and spinal cord—peripheral nerves—have been damaged. Peripheral neuropathy may also be referred to as peripheral neuritis, or if many nerves are involved, the terms polyneuropathy or polyneuritis may be used - common in diabetics
  147. Rotator cuff injuries
    Rotator Cuff Tendinitis (Impingement Syndrome), Rotator Cuff Tears
  148. Transient ischemic attack
    often described as a mini-stroke. Unlike a stroke, however, the symptoms can disappear within a few minutes. TIAs and strokes are both caused by a disruption of the blood flow to the brain. In TIAs and most strokes, this disruption is caused by a blood clot blocking one of the blood vessels leading to the brain. The blockage produces symptoms such as sudden weakness or numbness on one side of the body, sudden dimming or loss of vision, and difficulty speaking or understanding speech. If the symptoms are caused by a TIA, they last less than 24 hours and do not cause brain damage. Stroke-associated symptoms, on the other hand, do not go away and may cause brain damage or death. TIAs can serve as an early warning sign of stroke and require immediate medical attention
  149. Aneurysm
    a sac formed by localized dilatation of the wall of an artery, a vein, or the heart
  150. Anosmia
    lack of the sense of smell. It may also refer to a decreased sense of smell.
  151. Anterior cruciate
    a strong band that arises from the posterior middle part of the lateral condyle of the femur, passes anteriorly and inferiorly between the condyles, and is attached to the depression in front of the intercondylar eminence of the tibia
  152. Aphasia
    condition characterized by either partial or total loss of the ability to communicate verbally or using written words. A person with aphasia may have difficulty speaking, reading, writing, recognizing the names of objects, or understanding what other people have said. Aphasia is caused by a brain injury, as may occur during a traumatic accident or when the brain is deprived of oxygen during a stroke. It may also be caused by a brain tumor, a disease such as Alzheimer's, or an infection, like encephalitis. Aphasia may be temporary or permanent. Aphasia does not include speech impediments caused by loss of muscle control.
  153. Articulation
    a joint or place of junction between two different parts or objects.
  154. Babinski's reflex
    dorsiflexion of the big toe on stimulation of the sole, occurring in lesions of the pyramidal tract, although a normal reflex in infants.
  155. Bouchard's nodes
    cartilaginous and bony enlargements of the proximal interphalangeal joints of the fingers in degenerative joint disease.
  156. Cauda equina syndrome
    A condition caused by compression of multiple lumbosacral nerve roots in the spinal canal due to an abrupt prolapse of the lumbar disk. CES is a medical emergency characterized by bilateral sciatica in the lower back and upper buttocks, saddle anesthesia, urinary retention, bowel dysfunction
  157. Cord compression
    an abnormal and often serious condition resulting from pressure on the spinal cord. The symptoms range from temporary numbness of an extremity to permanent tetraplegia, depending on the cause, severity, and location of the pressure. Causes include spinal fracture, vertebral dislocation, tumor, hemorrhage, and edema associated with contusion (herniated disk, spondylolisthesis)
  158. Corticospinal tract
    A tract of nerve cells that carries motor commands from the brain to the spinal cord
  159. Costochondritis
    inflammation at the junction of a rib and its cartilage
  160. Crepitus
    the grating sound of two ends of a broken bone rubbing together
  161. Deep tendon reflex
    a brisk contraction of a muscle in response to a sudden stretch induced by a sharp tap by a finger or rubber hammer on the tendon of insertion of the muscle. Absence of the reflex may be caused by damage to the muscle, peripheral nerve, nerve roots, or spinal cord at that level. A hyperactive reflex may indicate disease of the pyramidal tract above the level of the reflex arc being tested. Generalized hyperactivity of DTRs may be caused by hyperthyroidism. Kinds of DTRs include Achilles tendon reflex, biceps reflex, brachioradialis reflex, patellar reflex, and triceps reflex. Also called myostatic reflex, tendon reflex
  162. Dysphagia
    Difficulty in swallowing
  163. Ecchymosis
    The passage of blood from ruptured blood vessels into subcutaneous tissue, marked by a purple discoloration of the skin. (A bruise)
  164. Effusion
    escape of a fluid into a part; exudation or transudation
  165. Facet joints
    the articulations of the vertebral column
  166. Fascia
    a sheet or band of fibrous tissue such as lies deep to the skin or invests muscles and various body organs
  167. Fibrous joints
    a type of synarthrosis in which the bones are united by continuous intervening fibrous tissue
  168. Heberden's nodes
    small hard nodules, usually at the distal interphalangeal joints of the fingers, formed by calcific spurs of the articular cartilage and associated with osteoarthritis.
  169. Herniated disc
    protrusion of a degenerated or fragmented intervertebral disc into the intervertebral foramen with potential compression of a nerve root or into the spinal canal with potential compression of the cauda equina in the lumbar region or the spinal cord at higher levels characterized by disruption of the annular fibrosis
  170. Hyaline cartilage
    a flexible semitransparent substance with an opalescent tint, composed of a basophilic, fibril-containing substance with cavities in which the chondrocytes occur
  171. Incontinence
    inability to control excretory functions (bladder control or bowel movements)
  172. Ipsilateral
    situated on or affecting the same side
  173. Joint effusion
    increased fluid in synovial cavity of a joint
  174. Kyphosis
    extreme curvature of the upper back also known as a hunchback
  175. Lordosis
    An abnormal forward curvature of the spine in the lumbar region. Also called hollow back, saddle back.
  176. Meniscus
    flattened crescent-shaped pieces of cartilage inside the knee joint (one medial, one lateral), wedged between the articular surfaces (condyles) of the femur and the tibia and thickest around their convexity towards the outside of the joint. Act as shock absorbers and increase joint stability
  177. Metastasis
    transfer of disease from one organ or part of the body to another not directly connected with it, due either to transfer of pathogenic microorganisms or to transfer of cells; all malignant tumors are capable of metastasizing.
  178. Muscle atrophy
    loss of muscle bulk, secondary to imposed inactivity, neurological dysfunction, reduced vascular perfusion, fibrosis or specific disease
  179. Myopathy
    any disease of muscle
  180. Parietal
    • of or pertaining to the walls of a cavity.
    • pertaining to or located near the parietal bone.
  181. Pectus excavatum
    An abnormality of the chest in which the sternum (breastbone) sinks inward; sometimes called "funnel chest."
  182. Polyneuropathy
    neuropathy of several peripheral nerves simultaneously
  183. Popliteal
    pertaining to the area behind the knee
  184. Posterior cruciate
    the strong fibrous cord that extends from the posterior intercondylar area of the tibia to the anterior part of the lateral surface of the medial condyle of the femur
  185. Postural hypotension
    an abnormal decrease in blood pressure when a person stands up. This may lead to fainting.
  186. Radiculopathy
    disease of the nerve roots
  187. Reflexes
    an involuntary stereotypical response that may involve as few as two neurons, one afferent (sensory) and one efferent (motor), across a single synapse. The deep tendon reflexes in the arms and legs are such monosynaptic reflexes. They illustrate the simplest unit of sensory and motor function. Other reflexes are polysynaptic, involving interneurons interposed between sensory and motor neurons.
  188. Reinforcement
    If the patient’s reflexes are symmetrically diminished or absent, use reinforcement, a technique involving isometric contraction of other muscles for up to 10 seconds that may increase reflex activity. In testing arm reflexes, for example, ask the patient to clench his or her teeth or to squeeze one thigh with the opposite hand. If leg reflexes are diminished or absent, reinforce them by asking the patient to lock fingers and pull one hand against the other (Jendrassik maneuver). Tell the patient to pull just before you strike the tendon.
  189. Sensory perception
    the conscious recognition and interpretation of sensory stimuli that serve as a basis for understanding, learning, and knowing or for motivating a particular action or reaction.
  190. Resting tremor
    tremor occurring in a relaxed and supported limb or other bodily part; it is sometimes abnormal, as in parkinsonism
  191. action (postural) tremor
    Appear when the affected part is actively maintaining a posture; may worsen with intention, eg Hyperthyroidism, Anxiety, Fatigue, Essential tremor
  192. Rotator cuff
    a musculotendinous structure about the capsule of the shoulder joint, formed by the inserting fibers of the supraspinatus, infraspinatus, teres minor, and subscapularis muscles, which blend with the capsule and provide mobility and strength to the shoulder joint.
  193. Spastic paraplegia
    a form of partial paralysis mainly affecting older people. It is accompanied by irritability and spastic contractions of the leg muscles.
  194. Spina bifida
    a serious birth abnormality in which the spinal cord is malformed and lacks its usual protective skeletal and soft tissue coverings
  195. Spinothalamic tract
    a group of nerve fibers in the lateral funiculus of the spinal cord that arise in the opposite gray matter and ascend to the thalamus, carrying the sensory impulses activated by pain and temperature.
  196. Spondylolisthesis
    Forward displacement of one of the lower lumbar vertebrae over the vertebra below it or over the sacrum.
  197. Step-off deformity
    one spinous process seems unusually prominent (or recessed) in relation to the one above it
  198. Sternocleidomastoid
    pertaining to the sternum, clavicle, and mastoid process
  199. Superficial reflex
    any withdrawal reflex elicited by noxious or tactile stimulation of the skin, cornea, or mucous membrane, including the corneal reflex, pharyngeal reflex, cremasteric reflex, etc.
  200. Synovial joint
    a joint that permits more or less free motion, the union of the bony elements being surrounded by an articular capsule enclosing a cavity lined by synovial membrane.
  201. Tandem walking
    Walk heel-to-toe in a straight line
  202. Torticollis
    a type of movement disorder in which the muscles controlling the neck cause sustained twisting or frequent jerking (wry neck)
  203. Upper motor neuron
    A motor neuron whose cell body is located in the motor area of the cerebral cortex and whose processes connect with motor nuclei in the brainstem or the anterior horn of the spinal cord.
  204. Valgus
    bent out, twisted; denoting a deformity in which the angulation is away from the midline of the body
  205. Varus
    bent inward; denoting a deformity in which the angulation of the part is toward the midline of the body
  206. Vasovagal
    Relating to or involving blood vessels and the vagus nerve
  207. Regions of the brain
    4 regions: cerebrum, diencephalon, brainstem, cerebellum
  208. Gray matter
    aggregations of neuronal cell bodies
  209. White matter
    neuronal axons coated with myelin
  210. Peripheral nerves
    31 pairs of nerves that attach to the spinal cord: 8 cervical, 12 thoracic, 5 lumbar, 5 sacral, 1 coccygeal
  211. anterior (ventral) root
    containing motor fibers
  212. posterior (dorsal) root
    containing sensory fibers
  213. jamais vu
    meaning "never seen" phenomenon of experiencing a situation that one recognizes in some fashion, but that nonetheless seems very unfamiliar
  214. Déjà vu
    meaning "already seen", refers to the experience of feeling sure that one has witnessed or experienced a new situation previously
  215. Tonic
    seizure characterized by tonic but not clonic contractions. Continuous tension or contraction of muscles, as a convulsion or spasm
  216. Clonic
    seizure in which there are generalized clonic (clonus) contractions without a preceding tonic phase
  217. Absence
    A common form of childhood epilepsy characterized by episodic arrest of sensation and voluntary activity caused by transient loss of contact with the environment - eg brief staring spell, minimal motor manifestations (Absence attack, absence seizure, petit mal epilepsy)
  218. Drop attacks
    a form of transient ischemic attack in which a brief interruption of cerebral blood flow causes a person to fall to the floor without losing consciousness. The fall may be caused by a disrupted sense of balance or decreased leg muscle tone. Weakness of the leg muscles or a hip or knee joint dysfunction may be a contributing factor
  219. Myoclonus
    an abrupt spasm or twitch of a muscle or muscles, occurring in some neurological diseases. (Generally happens when falling asleep, especially if overtired.)
  220. Postictal
    pertaining to the period following a seizure or convulsion, altered state of consciousness after an epileptic seizure
  221. Cranial Nerve I
    • Olfactory
    • Smell
    • Very little localizing information can be obtained from testing the sense of smell. This part of the exam is often omitted, unless there is a reported history suggesting head trauma or toxic inhalation.
  222. Cranial Nerve II
    • Optic
    • Visual acuity, visual fields and ocular fundi
    • The initial change in the ophthalmoscopic examination in a patient with increased intracranial pressure is the loss of pulsations of the retinal vessels. This is followed by blurring of the optic disc margin and possibly retinal hemorrhages.
  223. Cranial Nerves II,III
    • Optic, Oculomotor
    • Pupillary reactions
    • Anisocoria is a neurological term indicating that one pupil is larger than another. Ptosis is the lagging of an eyelid. It has 2 distinct etiologies. Sympathetics going to the eye innervate Muller's muscle, a small muscle that elevates the eyelid. The III cranial nerve also innervates a much larger muscle that elevates the eye lid - the levator palpebrae. Thus, disruption of either will cause ptosis.
  224. Cranial Nerves III,IV,VI
    • Oculomotor, Trochlear, Abducent
    • Extra ocular movements, including opening of the eyes
    • The limitation of movement of both eyes in one direction is called a conjugate lesion or gaze palsy, and is indicative of a central lesion. Disconjugate lesions, where the eyes are not restricted in the same direction or if only one eye is restricted, are due to more peripheral disruptions - cranial nerve nuclei, cranial nerves or neuromuscular junctions. Ethanol and barbiturates (recreational or therapeutic) are the most common cause of gaze-evoked nystagmus. Downbeat nystagmus (including a rapid component) may indicate a lesion compressing on the cervicomedullary junction such as a meningioma or chordoma.
  225. Cranial Nerve V
    • Trigeminal
    • Facial sensation, movements of the jaw, and corneal reflexes
    • Some clinicians omit the corneal reflex unless there is sensory loss on the face as per history or examination, or if cranial nerve palsies are present at the pontine level.
  226. Cranial Nerve VII
    • Facial
    • Facial movements and gustation
    • When the whole side of the face is paralyzed the lesion is peripheral. When the forehead is spared on the side of the paralysis, the lesion is central (e.g., stroke). This is because a portion of the VII cranial nerve nucleus innervating the forehead receives input from both cerebral hemispheres.
  227. Cranial Nerve VIII
    • Vestibulochochlear
    • Hearing and balance
    • Because of the extensive bilateral connections of the auditory system, the only way to have an ipsilateral hearing loss is to have a peripheral lesion, i.e. at the cranial nerve nucleus or more peripherally. Bilateral hearing loss from a single lesion is invariably due to one located centrally.
  228. Cranial Nerves IX,X
    • Glossopharyneal, Vagus
    • Swallowing, elevation of the palate, gag reflex and gustation
    • Some clinicians omit testing for the gag reflex unless there is dysarthria or dysphagia present by history or examination, or if cranial nerve palsies are present at the medullary level. Roughly 20% of normal individuals have a minimal or absent gag reflex.
  229. Cranial Nerves V,VII,X,XII
    • Trigeminal, Facial, Vagus, Hypoglossal
    • Voice and speech
    • Dysarthria and dysphagia are due to incoordination and weakness of the muscles innervated by the nucleus ambiguous via the IX and X cranial nerves. The severity of the dysarthria or dysphagia is different for single versus bilateral central lesions. Central lesions produce a strained, strangled voice quality, while peripheral lesions produce a hoarse, breathy and nasal voice.
  230. Cranial Nerve XI
    • Accessory
    • Shrugging the shoulders and turning the head
    • Peripheral lesions produce ipsilateral sternocleidomastoid (SCM) weakness and ipsilateral trapezius weakness. Central lesions produce ipsilateral SCM weakness and contralateral trapezius weakness, because of differing sources of cerebral innervation.
  231. Cranial Nerve XII
    • Hypoglossal
    • Movement and protrusion of tongue
    • The tongue will deviate towards the side of a peripheral lesion, and to the opposite side of a central lesion.
  232. Syringomyelia
    a central fluid-filled cavity of the cervical spinal cord may affect the crossing spinothalamic tracts, and so lead to bilateral deficits of pain and temperature sensation in the upper extremities
  233. Gait alarm symptoms
    sudden onset, fever, incontinence, visual loss, arm weakness, saddle anesthesia (numbness in the buttocks and groin area) – may indicate spinal cord abscess or metastasis, stroke
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Exam 5 Terminology - PAP 580
2014-04-14 18:54:03
Physical Assessment

Musculoskeletal and Nervous System Terms Exam 5
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