-
Pain that is constand and unchanging with activity & worsens at night is an example of
Red Flags (cancer, fracture, infection, etc.)
-
List the steps of the examination in order
- History
- Observation
- Scanning Exam
- AROM & PROM
- Resisted Isometric Movements
- Functional Testing
- Special Testing
- (Reflexes & Cutaneous Distribution)
- Joint Play Movements
- Palpation
-
When do you not need to perform a Scanning Exam?
Definite trauma that explains local symptoms
-
When should you perform the Scanning Exam?
- When the cause of the symptoms are unclear or when there is radiating pain.
- specifically:
- no trauma
- radicular signs
- trauma with radicular signs
- altered sensation in limb
- spinal cord signs
- presents with abnormal patterns
- suspect psychogenic pain
-
Pain direcvtly involving a spinal nerve, a subclass of referred pain
Radicular Pain
-
List the steps in the scanning exam
- AROM & PROM of spine w/ overpressure
- Myotomes
- Dermatomes
- Reflexes
-
Myotomes performed for a minimum of ____ seconds
5
-
List cervical myotome actions and corresponding levels
- Neck Flexion - C1 & 2
- Neck SB - C3
- Shoulder Elevation - C4
- Shoulder Abduction - C5
- Elbow Flexion - C6
- Elbow Extension - C7
- Thumb Extension - C8
- Adduction of hand intrinsics - T1
-
List cervical dermatome areas and respective levels
- Clavicle - C3
- top of shoulder - C4
- distal lateral bicep - C5
- tip of thumb - C6
- tip of 3rd digit - C7
- tip of 5th digit - C8
- distal tricep - T1
- axilla - T2
-
Reflexes: name and level
- Bicep - C5
- Brachioradialis - C6
- Tricep - C7
-
Pain with contraction, active stretch and passive stretch & palpation
Contractile Lesion (yeah I'm sure muscle is fine)
-
For resisted isometrics:
strong and painful = _________
weak and painful = __________
weak and pain free = __________
- 1. local lesion of muscle, tendinitis or 1st/2nd degree strain
- 2. severe injury around joint, fracture, etc.
- 3. nervous system involvement or complete rupture of muscle (though he mentioned it would still hurt, just not increase pain)
-
spin and swing are examples of __________kinematic motion
osteo
-
roll and glide/slide are examples of _____kinematic motion
arthro
-
pull on a long axis of a bone than produces sliding
traction
-
separation of a joint surface at a right angle
distraction
-
3 contraindication of joint mobilizations (stretch techniques is what he lists next to it, but it's under joint mobilization)
- hypermobility
- joint effusion
- inflammation
-
In the acute phase of injury, you would use grade ____ and ____ mobilizations
1 & 2
-
In the subacute stage you would use which joint mobilizations?
1 & 2 for pain relief, 3 & 4 without causing lingering symptoms
-
In the remodeling (chronic) phase, what joint mobes would be appropriate?
3 & 4 for stretch
-
In what direction is a transverse/cross friction massage performed?
Across the fibers desired direction (derp)
-
A cross friction massage assist in organizing and maturation of collagen by:
- maintaining mobility with respect to adjacent tissues
- promoting increased interfiber mobility without longitudinal stress
-
pain and muscle guarding prior to tissue resistance
acute
-
pain with tissue resistance
subacute
-
pain after tissue stretch
chronic/remodeling
-
a wound in muscle or skin closes in about
5-8 days
-
a wound in a tendon or ligament closes in
3-5 weeks
-
muscles active on opening of jaw
lateral pterygoid and if assistance necessary mylohyoid, geniohyoid, digastric
-
muscles active with jaw closing
masseter, temporalis, medial pterygoid
-
Range of active movements at shoulder:
1abduction
2 flexion
3 lateral rotation
4 medial rotation
5 extension
- 1) 170-180
- 2) 160-180
- 3) 80-90
- 4) 60-100
- 5) 50-60
-
loose pack position of TMJ
mouth slightly open
-
loose pack position of shoulder
- 30d horizontal adduction & 55d abduction
- (aka 55d scaption)
-
loose pack position of elbow
90d flexion
-
loose pack position of wrist
neutral
-
capsular pattern in order of greatest limitation (shoulder)
lateral rotation > abduction > medial rotation
-
special test: Neer
forced flexion pain = SS impingement
-
special test: Hawkins-Kennedy
- flex to at least 90, internally rotate & move around
- pain = SS impingement
-
special test: Yocum
- reach across to opposite shoulder and raise elbow to 90d
- pain = SS impingement
-
special test: apprehension
- supine, abduct to 90, then externally rotate, can add fulcrum
- Anterior Instability
-
special test: relocation
- same as apprehension but add post pressure on anterior GH
- Anterior Instability
-
special test: posterior apprehension
- 90d scaption elbow at 90d, horizontal adduction & medial rotation, push through elbow
- Posterior Instability
-
special test: sulcus
- pt. seated/standing, pull on arm below elbow and look for sulcus
- Inferior Instability
-
special test: full can
- SS tear
- 90d scaption
- have pt hold, can add pressure
-
special test: Drop Arm
- SS tears
- uable to sustain 90d abduction, don't just drop them, ease off of support
-
special test: lift-off
- arm medially rotated, hand on back or butt, have them lift hand off
- if can't lift off hand, subscap tear likely
-
special test: dropping for infraspinatus
- elbow at side & bent to 90d, hold actively in as much external rotation as possible
- positive test unable to hold
-
special test: crank
- labral tears
- 160d scaption, elbow bent, pressure through elbow, then rotate external and internally
- look for pain & click
-
special test: SLAP pronated load test
- 90d shoulder abduction, full forearm pronation, maximally externally rotate shoulder
- after max external rotation achieved, resist elbow flexion but maintain pronation
- positive test is deep pain in shoulder
-
What causes thoracic outlet syndrome?
compression of brachial plexus by scalenes and/or pec minor
-
swelling that comes on sono after injury
blood
-
swelling comes on after 8-24 hours
synovial
-
swelling has boggy, spongy feeling
synovial
-
swelling has harder, tense feeling with warmth
blood
-
sweilling is tough & dry
callus
-
swelling characterized by leathery thickening (think stage)
chronic
-
swelling is soft and fluctuating (think stage)
acute
-
-
swelling is thick and slow moving
pitting edema
-
concave/convex rule for shoulder
- head of humerus = convex
- glenoid fossa = concave
-
concave/convex rule humeral ulnar joint
- humerus = convex
- ulna = concave
-
concave/convex rule radiohumeral joint
- radius = convex
- ulna = concave
-
concave/convex rule radiocarpal joint
- carpals = convex
- radius = concave
-
Carpal bones
- Scaphoid, Lunate, Triquetrum, Pisiform
- Trapezium, Trapezoid, Capitate, Hamate
-
The ______ tunnel, formed by flexor retinaculum spanning the carpal gutter, contains ____ tendons & ____ nerve
-
________'s _______ is formed by the pisiform, hamate & pisohamate ligament & contains the __________ nerve
-
Scapulohumeral Rhythm: ______d humeral to ______d scapular motion
120 humeral to 60 scapular
-
Reverse scapulohumeral rhythm means _______ moves more than ________ & suggests ____________
- scapula moves more than the humerus
- suggests frozen shoulder
-
The first ______ mm of opening of the TMJ is _________ motion, then from there to full opening ______ motion
- 10mm
- hinge/rotation
- gliding/sliding
-
flexion of MCP and distal IP
Extension of proximal IP
potential cause: contracture of intrinsic muscles, often seen in RA or after trauma
Swan Neck
-
extension of MCP and Distal IP
Flexion of PIP
potential cause: rupture of the central tendinous slip of the extensor hood: RA or trauma
Boutonniere
-
ulnar deviation of the digits
potential cause: weakening of the capsuloligamentous structures of the MCP and accompanying bowstring effect of the extensor communis tendons
ulnar drift
-
MCP hyperextended
proximal and distal IP are flexed
potential cause: loss of intrinsic musculature of the hand; medial and ulnar nerve palsy
intrinsic minus hand
-
sticking of the tendon in the sheath when trying to flex the finger
potential cause: thickening of the flexor tendon sheath
trigger finger (digital tenovaginitis stenosans)
-
contracture of the palmar fascia, especially of the ring or little finger
dupuytren's contracture
-
distal phalanx rests in a flexed position
rupture or avulsion of extensor tendon where it inserts on the distal phalanx
mallet finger
-
special test: valgus/varus at elbow
elbow at 90d, apply counterpressure to humerus, pressure at distal forearm
-
capsular patter for elbow
flexion more than extension
-
special test: lateral epicondylitis (two methods)
- method one: contraction
- method two: stretch
-
special test: medial epicondylitis
wrist flexor stretch
-
special test: tinel's sign (elbow)
- tap ulnar nerve between olecranon and medial epicondyle
- positive intense tingling > unaffected side
-
special test: elbow flexion test
- stretch ulnar nerve by flexing elbow & extending wrists & holding for 3-5 minutes
- positive is tingling and paresthesia
-
special test: pronator teres syndrome
- elbow at 90d with examiner resisting pronation while patient extends fully
- positive tingling or paresthesia
- medial nerve
-
special test: pinch grip test
- have patient pick up piece of paper tip-to-tip, if they go pulp to pulp positive test
- anterior interosseous nerve
-
special test: froment's sign
- start pulp-to-pulp and if they go tip-to-tip positive sign
- ulnar nerve
-
median nervecompressed by pronator teres
pronator teres has normal strength, but distal innervated musculature can be affected
weakness and paresthesia in the median nerve distribution
pronator syndrome
-
weakness of flexor carpi ulnaris and ulnar half of the flexor digitorum profundus in the forearm, the hypothenar eminence in the hand, the interossei and the third and fourth lumbricals
most obvious & earliest symptom is sensory: pain and paresthesia in the medial elbow & forearm, paresthesia in the ulnar sensory distribution of the hand
cubital tunnel
-
branch of the radial nerve gets compressed as it passes between the 2 heads of the supinator muscle in the canal of Frohse
weakness in wrist extensor muscles, wrist drop
beacause no sensory changes, often get misdiagnosed with tennis elbow
radial tunnel syndrome (post int nerve)
-
special test: thumb ulnar collateral ligament laxity
- extend thumb with valgus stress to MCP joint
- positive is >35d movement
-
special test: grind test (thumb)
- compression and rotation of CMC joint
- positive is pain, indicative of osteoarthritis
-
special test: finkelstein test
- make fist with thumb inside, ulnarly deviate fist
- positive is excruciating pain, as it fucking hurts no matter what
-
special tests: tinel sign at wrist
- tap carpal tunnel
- positive is excess tingling
-
special test: phalen's
- full flexion of wrists
- positive is intense tingling
-
special test: allen test
- open & close hand 5 times, hold closed, then block off both radial and ulnar arteries
- open fist and release arteries one at a time
- test both arteries separately
- check for flushness
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