Musculoskeletal NPTE Prep
108 terms by scottie2fit
Distal Radial/Ulnar Convex/Concave Convex/Concave Rule
Radius on Ulnar: concave on convex
Proximal Radial/Ulnar Convex/Concave Convex/Concave Rule
Radius on Ulnar: convex on concave
Sternocalvicular Elevation Convex/Concave Convex/Concave Rule
Clavicle on Sternum; convex on concave
Sternocalvicular pro/retraction Convex/Concave Convex/Concave Rule
Clavicle on Sternum; concave on convex
Acromioclavicular Convex/Concave Convex/Concave Rule
scapula on clavicle; concave on convex
Stern terno ocla clavicul icula ar Open Open//Clos losed Pack ack
Open pen: arm at side; ide; Closed: max elevation
Glenoh enohum umer era al Open Open//Clos losed Pack ack
Open pen: 55-7 55-70 0 abd & 30 horiz orizon onta tall add; dd; Closed: max abd & ER
Hip Open/Closed Pack
Open: 30 flex/abd and slight ER; Closed: (ligamentous: full ext, abd, & IR); bony: 90 flex and slight ER/ABD
Knee Open/Closed Pack
Open: 25° flex; Closed: full ext & ER
Talocrural Open/Closed Pack
Open: mid in/eversion and 10° PF; Closed: full DF
Subtalar Open/Closed Pack
Open: 10° PF; Closed: full DF
Lower Cervical Capsular Patterns
limitation of all but flexion
Upper Ce Cervical Ca Capsular Pa Patterns
occi ccipitoatlantal (f (flex > ext); Atlantoaxial (limitation of rotation)
Glenohumeral Capsular Patterns
ER > ABD > IR
Elbow Capsular Patterns
Flex > Ext
Wrist Capsular Patterns
limitation flex = ext
Finger Capsular Patterns
flex > ext
T Spine Capsular Patterns
rot > ext > flex
L Spine Capsular Patterns
marked/equal limitation of SB and rot; ext > flex
Hip Capsular Patterns
limitation flex/IR; no or little limitation in add and ER
Knee Capsular Patterns
flexion grossly limited
Talocrural Capsular Patterns
PF > DF
Tenodesis Grip
wrist ext to passively flex fingers
Requirements for Full Elevation (6)
scapular stabilization, Inferior glide of humerus, ER of humerus, rotation of clavicle on sternum, scapular ABD & ER of AC joint, & straightening of thoracic kyphosis
Proximal tib-fib Convex/Concave Rule
Fib head concave on convex; head moves anteriorly/inferiorly plus IR with PF
Femoral Head Angle of Inclination
Normal: 115-125; Coxa Valga: >125; Coxa Vara: <115
Femoral Head Ante/Retroversion
Normal: 10-15° anteversion (or IR in Craig's Test). more IR = more anteversion, while less IR or more ER = retroversion)
Iliofemoral Ligament
aka "Y"; AIIS to anterior intertrochateric line; taut in ext/ER (Strongest ligament)
Ischiofemoral Ligament
ischium to greater trochanter; taut with IR, ABD, and Ext.
Medial Meniscus Attachments
MCL and semimembranous; moves half as much as lateral meniscus
Knee ROM during Walking
15°, almost pure rolling (gliding later in movement)
Screw Home Mechanism of Knee
Open Chain: Tibial ER at terminal extension. Closed Chain: femoral IR at terminal ext.
Subtalar Open Chain Pro/Supination
Pronation: Calcaneus Eversion, Forefoot DF/ABD; Supination: Calcaneus Inversion, Forefoot PF/ADD
Subtalar Closed Chain Pro/Supination
Pronation: Talus PF/ADD, Calcaneus Eversion; Supination: Talus DF/ABD, Calcaneus Inversion
DJD/OA Symptoms
Pain/stiffness upon rising, eases over 3-5 hrs, worsens with repetitive activity, constant soreness,
Facet Joint Dysfunction Symptoms
Stiffness upon rising, eases within hour, loss of motion with pain, certain mvmts sharp pain, stationary positions worsen and mvmt in pain free range reduce symptoms
Discal w/ nerve root compression Symptoms
No pain in reclined or semireclined positions; increasing pain with increasing weight bearing, (shooting, burning, stabbing)
Spinal Stenosis Symptoms
Pain related to position (worse in ext, better in flex), walking brings on symptoms and make take hours to relieve
Claudication Symptoms
pain in all spinal positions, brought on by exertion, promptly improves with rest (1-5 mins), usually numbness and diminished peripheral pulses
Shoulder Posterior Internal Impingement Test
tests impingement b/w RC and posterior glenoid or greater tuberosity; pt supine, then passively move shoulder to 90° ABD, max ER, 15-20° horizontal add; + is reproduction of pain in post. shoulder
Adson's Test
TOS; compression b/w anterior & middle scalene; PT adducts and extends arm (so behind back) while pt rots/extends head toward side being tested.
Costoclavicular Syndrome Test
aka Military Brace; TOS; compression b/w clavicle & 1st rib; pt assumes a "military brace" position by adducting and retracting scapulae (active from pt).
Wright Test
aka hyperabduction; TOS; compression b/w pec minor & ribs; horizontally abducting/ER arm maximally, with head rot opposite (& deep breath)
Roos Test
TOS: open/close hand for 3 mins
ULTT 1
tests median nerve
ULLT 3
Tests Radial nerve
ULTT 4
tests ulnar nerve
Pronator Teres Syndrome Test
tests median nerve entrapment; pt sitting with elbow 90° flex; resist forearm pronation/elbow extension; reproduces symptoms
Finkelstein's Test
tests de Quervain's tenosynovitis (adductor pollicis longus/extensor pollicis brevis); thumb within fist, passively ulnar deviation (compare to other side because typically painful)
Bunnel-Littler Test
tests tightness surrounding MCP joints; compare PIP flexion with MCP in ext or flexion (if tight in both, capsular, if more PIP flex with MCP flex, intrinsic tightness)
Froment's Sign
Ulnar nerve dysfunction; pt pinches paper b/w 1st/2nd digit as PT tried to pull out; if thumb IP flexion, indicates compensation for weak adductor pollicis
Phalen's
max wrist flexion, against each other, for 1 min
Apley Test
differentiate meniscus vs ligamentous; pt prone, knee flexed 90°, & PT knee on pt thigh to stabilize, test IR/ER: w/ knee distraction (ligamentous) or w/ compression (meniscus)
Q-Angle
Normal 13° for men & 18° for women
Noble Compression Test
test distal ITB friction syndrome; pt supine, hip 45°, knee 90°, apply pressure to lateral femoral epicondyle and pt extend knee; + is pain over lateral epicondyle, ~30° common
Quadrant Test
Intervertebral foramen vs facet dysfunction in L spine; for foramen pt SB, ROT, and EXT to painful side, facet SB to painful side and ROT/ext contralateral
Gillet's Test
SIJ dysfunction; pt standing, PT place 1 thumb just under PSIS of test leg and other mid sacrum at same level, pt flex hip and should see PSIS move inferiorly
Gaenslen's Test
SIJ dysfunction; pt side-lying with bottom leg fully flexed hip/knee, and PT passively extends top leg, placing stress on SIJ.
Goldthwait's test
differentiate b/w lumbar and SI pain; pt supine, with PT fingers b/w lumbar spinous process, then use other hand to perform SLR, if pain prior to palpable lumbar mvmt, likely SI pain
DJD/OA
loss of cartilage & hypertrophy of subchondral bone in weight bearing joints, PT: joint protection, improve mechanics, & aerobic capacity
Ankylosing Spondylitis
Rheumatoid condition; mid/LBP <4th decade of life, increasing kyphosis of T and C spines, decreased lordosis of L spine; PT: flexibility exercises for trunk, aerobic conditioning, and breathing strategies
Gout
uric acid elevation, deposition in joints (typically knee and great toe); PT injury prevention/reduction in involved joints and early recognition
RA
chronic systemic disorder, typically symmetrical pattern (hands, wrists, elbows, shoulders, knees, and feet); typically see ulnar drift in MCP and PIP (DIPs spared); PT: joint protection, improved joint mechanics, aerobic conditioning
Osteomalacia
declacification due to low Vit D
Osteochondritis Dissecans
separation of articular cartilage from underlying bone; PT: joint protection, flexibility/strengthening
Myofascial Pain Syndrome
trigger points [focal irritability within muscle (palpable taut band)]; hypothesized onset from sudden overload, over stretch, and/or repetitive/sustained muscle activities; PT: normal joint motion, manual therapy (soft tissue work, cyrotherapy, manual pressure for desensitization, strength training)
Tendonosis/Tendonopathy
typically called tendonitis though typically not much inflammation
Bursitis
Inflammation of bursa secondary to overuse, trauma, gout, or infection
Paget's Disease
etiology largely unknown, thought linked to viral infection with abnormal osteoclastic/blastic activity, can lead to stenosis, facet arthopathy, & possible spinal fracture
Structural vs Functional Scoliosis
Structural has rotational component, functional does not; <25° conservative PT, 25-40° spinal orthoses; >45° indicates surgery
Hill-Sachs Leison
compression fracture of posterior humeral head
Bankart's Leison
avulsion of anteroinferior capsule and ligaments associated with glenoid rim (requires surgery)
Volkmann's Ischemia
commonly seen with supracondylar Fx. and post dislocation, damage to brachial artery, ant interosseous br. of median nn, insufficient arterial perfusion and venous stasis results in ischemia, edema and compartment syndrome, degeneration of musculature
Boutonniere Deformity
Tear of central slip of extensor hood at the PIP level; ext of MCP and DIP w/ flex of PIP
Swan Neck Deformity
contracture of intrinsic muscles w/ dorsal sublux of lateral extensor tendons; flex of MCP and DIP w/ ext of PIP
Ape Hand Deformity
from median nerve dysfunction, wasting of thenar, 1st digit moves dorsally
Mallet Finger
rupture/avulsion of extensor tendon at insertion in distal phalanx; usually from trauma/forceful flexion of DIP; seen as flexion of DIP
Gamekeeper's Thumb
sprain/rupture of ulnar collateral ligament of MCP at 1st digit; frequently during skiing falls (pole into thumb); immobilized for 6 wks
Boxer's Fracture
fracture of neck of 5th MC; commonly from punching, casted 2-4 weeks,
Jersey Finger
sprain/avulsion at insertion of FDP at distal phalanx from forceful hyperextension of DIP with PIP and MCP flexion; inability to flex DIP
Legg-Calve Perthes Disease
idiopathic necrosis of femoral head in young boys>girls; characterized by psoatic limp (ER, flex, add)
Slipped Capital Femoral Epiphysis
fracture through growth plate @femoral head, males>females, ~1113 yrs old; limits hip ABD, flex, IR
Genu Valgum/Varum
Normal: 6°; excessive varum (medial tibial torsion/"bowlegs") & valgum (lateral tibial torsion/"knock knees")
Equinus
PF'ed foot; compensation includes subtalar/midtarsal pronation
Charcot-Marie-Tooth Disease
peroneal muscular atrophy that affects motor/sensory nerves; PT focus on maintaining ADLs while disease progresses
Bicycle test of van Gelderen
differ stenosis from claudication; pt bicycles, when pain comes on, increased flexion would decrease stenosis pain, and rest could relieve claudication symptoms
Hoover Test
test for malingering; pt supine while PT cup both calcaneouses & pt asked to active straight leg raise. Should sense downward pressure on contralateral side.
CT Imaging
Advantages: bone, soft tissue, & blood vessels; (not as good for soft tissue as MRIs)
MRI
Advantages: no radiation, and good for all structures, especially soft tissue. T1- fat brighter & T2 fluid is brighter
Pes Planus
flat feet
Genu Recurvatum
hyperextended knees; may be caused by ↑ PF
Contraindications for Aquatic Therapy
incontinence, kidney disease, severe cardiac/respiratory dysfunction, severe PVD, large open wounds, bleeding, infections (water or airborne)
Heel Strike Muscles
Eccentric Quad control of min knee flexion, and eccentric ankle dorsiflexors, extensors for controlled PF
Foot Flat/Loading Response Muscles
calves to eccentrically control tibial forward progression
Midstance Muscles
Hip/knee/ankle extensors all active to resist gravity; hip ABD active to stabilize hip in single limb support
Heel Off Muscles
peak PF force
Acceleration/Initial Swing
brief quad activation (though silent by mid swing); and hip flexors
Mid Swing
foot clearance achieved w/ DF, hip/knee flexors
Deceleration
Hamstrings active to decelerate the limb & DF active to prepare for heel strike
Pelvic Motion During Gait
pelvis rotates anteriorly on unsupported extremity side; and moves anteriorly during mid swing; transverse movements, side to side following support limb
Mean Cadence/Speed
113 steps/min & 1.4 m/s or 3 mi/hour
Gait: ↑ forward trunk lean
weak quadriceps or hip/knee flexor contractures
Antalgic Gait
Stance time shortened on painful limb & uninvolved limb limb has ↓ step length
Muscle Spindle
throughout muscle belly; about muscle length = help to control posture
Golgi Tendon Organ
on tendons about tension;
Painful Arc
pain btw 60-120° ABD; non-capsular pathology
Ottawa knee rules
a pt post acute knee trauma should be referred for radiographs if any of the following 5 criteria are present: age ≥55, tenderness at fibular head/patella, inability to flex knee >90°, inability to weight-bear for 4 steps.
Heterotrophic Ossification
deposition of calcium in ms typically after injury/nerve damage Tx: Maintaining available ROM, avoid "vigorous" stretching, & achieve/maintain "optimal wheelchair positioning"
