Christina Spring 26 > MSK Lab 2 > Flashcards

MSK Lab 2 Flashcards

(106 cards)

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1
Q

young < 30

A

ligament sprain or muscle strain

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2
Q

middle age 30-60

A

most prevalent

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3
Q

older >60

A

spondylosis or spinal stenosis

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4
Q

radiation of symptoms bilaterally

A

myelopathy
central dysfunction

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5
Q

radiation of symptoms unilaterally

A

radiculopathy
peripheral dysfunction

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6
Q

prescence of cough or sneeze

A

disc pathology

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7
Q

What are 3 mandatory questions with pts w/ neck pain

A

any dizziness (vertigo), blackouts, drop attacks?

any hx of RA, other inflammatory arthritis, tx w/ systemic steroids?

any neuro symptoms in legs?

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8
Q

what are the 5 D’s and 3 N’s?

A
  • Dizziness, drop attacks, diplopia, dysarthria, dysphagia
  • Ataxic gait
  • Nausea, numbness, nystagmus
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9
Q

Any dizziness (vertigo), blackouts or “drop” attacks?

A

Vertebral basilar artery insufficiency (VBI)
5 D’s and 3 N’s

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10
Q

Any history of RA, other inflammatory arthritis, or treatment w/ systemic steroids?

A

CV instability or ligamentous insufficiency

note: c-spine clearing needed if yes

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11
Q

Any neurological symptoms in the legs?

A

Cervical myelopathy or some form of spinal cord compression

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12
Q

if Pt has gradual onset of neck pain do you need to do canadian c spine rules?

A

no

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13
Q

64 y/o MVA do you do canadian c spine?

A

no wasn’t given speed not enough info

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14
Q

what cervical spine clearing tests must be cleared before doing anything if indicated!

A

transverse ligament
alar ligaments
vertebral basilar arteries

*do if MOI,trauma, instability in ligaments

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15
Q

how many test do you need to do to clear cervical spine?

A

1 or more for each structure!

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16
Q

What test is for tranverse ligament and AA joint stability?

A

modified sharp purser *

supine lift off

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17
Q

Modified Sharp Purser (1º test)

purpose

A

assess integrity of transverse ligament and AA joint stability

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18
Q

Modified Sharp Purser (1º test)

how to perform?

A

Pt is seated w/ PT standing on pt’s side

Pt asked to perform active CV neck flexion (ie. chin nod down) and then relate any serious S&S including hearing or feeling a ‘clunk’

PT then stabilizes C2 SP w/ pincer or key grip w/ 1 hand and provides posterior force w/ opposite hand

*after tip head ask pt if any of same symptoms

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19
Q

what is a + Modified Sharp Purser (1º test)

A

(+) test = S&S are reduced (relocation test)

Immediate referral to pt’s physician for clearance before beginning any PT treatment

*S&S include 5 D’s and 3 N’s

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20
Q

Supine Lift-off (2º test to confirm as needed)

purpose

A

assess integrity of transverse ligament and AA joint stability

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21
Q

Supine Lift-off (2º test to confirm as needed)

procedure

A

Pt is supine w/ PT at pt’s head

PT places both index fingers horizontally along C1 lamina while supporting base of pt’s skull w/ remaining fingers

PT shears occiput and C1 in anterior direction

Immediate neck flexion should occur

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22
Q

what is a + supine lift off

A

(+) test = excessive upper cervical mobility suggesting ligamentous laxity or damage

Ex: anterior movement of occiput and C1 w/ no commiserate movement of C2 and below)

Immediate referral to pt’s physician for clearance before beginning any PT treatment

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23
Q

if pt has instability in AA joint what do you see?

A

with neck flexion, AA joint dislocates and pt reports feeling lump in throat/ symptoms

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24
Q

Pt reports feeling better with modified sharp purser test when relocated C1 back onto C2 what does this mean?

A

positive!

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25
supine lift off is it better for guarding
yes!
26
alar ligament test is for what.
assess integrity of alar ligaments AND OA joint stability
27
how many OA joints?
2 so test both sides! :)
28
in atlas ligament testing: if sidebend pt head to right where should you feel SP that indicate alar ligaments intact?
left!
29
atlar testing procedure
Pt is seated or supine w/ PT near pt’s head PT places 1 hand on C2 SP using pincer grip while using other hand to grip top of pt’s head PT then performs either passive CV L and R SB Can also use L and R rotation Movement of C2 SP should be felt immediately Ex: movement to R tightens L alar ligament (should feel L side of C2 move into PT’s finger)
30
what is a + atlar ligament test?
(+) test – immediate movement of C2 SP into PT’s fingers NOT felt suggesting ligamentous laxity or damage Immediate referral to pt’s physician for clearance before beginning any PT treatment
31
VBI screen purpose
Purpose: assess integrity and function of vertebral basilar artery
32
VBI procedure
Pt is seated or supine w/ PT holding pt’s head PT passively extends PT’s head and ask them to pick a spot on the ceiling/wall and count back from 10 keeping their eyes open PT passively rotates PT’s head to L and repeats same commands, followed by rotation to R If no symptoms are present in cardinal planes then the process is repeated in combined motions - Extension w/ L and R rotation
33
what is a + VBI screen?
(+) test = presence of 5 D’s or 3 N’s, particularly nystagmus, facial numbness, slurred speech, dizziness, diplopia in any of the testing positions Immediate referral to pt’s physician for clearance before beginning any PT treatment
34
VBI order of testing
extension --> rotation --> rot + ext if shows positive in any position ur done!! STOP DONT CONTINUE
35
When do you clear the cervical spine?
trauma or condition
36
When do you NOT need to clear the cervical spine?
no hx of trauma (need to ask) gradual onset no medical hx to suggest instability or VBI none of conditions (RA, inflammatroy arthritis, txt with steroids)
37
two decisions to make clear the spine? scanning exam?
clear the spine before scanning if chose to
38
before cervical spine exam
clear the spine scan exam if appropriate
39
craniovertebral AROM different from lower cervical ROM
Upper cervical C0-C1 C1-C2
40
OA motions
f/e
41
CV AROM includes
seated AROM +/- OP CV flexion CV extenesion
42
lower cervical AROM
normal flex/ext SB ROT Quadrant testing*
43
if you measure ROM what do you measure and how
both sides! use gonio only for rotation
44
if - for all cardinal planes for lower cervical AROM
quadrant testing
45
Pt doesnt have full ROM and has pain do you OP? do you do anything else?
no! but measure ROM and compare to other side
46
Pt doesnt have full ROM but NO pain what do you do?
OP measure ROM with OP
47
if pt has AROM deficits what could be causing the decreased motion?
muscle tight joint capsule could be hypomobile so do PROM
48
when do you do PROM
only for deficits we saw!
49
what does PROM tell us?
more range: muscle no change: joint
50
if move head and doesnt have change in symptoms
prob stuck - mobility deficits
51
cervical muscle strength MMT what position to test in
resisted isometric strength in NEUTRAL position not lengthened!
52
cervical muscle strength MMT what are we looking for?
pain and strength
53
cervical muscle strength MMT flexion
tests key mm for C1-C2 and CN XI
54
cervical muscle strength MMT L/R SB
tests key mm for C3 and CN XI
55
L/R rotation tests what key muscles
C2
56
UE AROM: for a joint specific exam can just do above and below joint
t spine and shoulder
57
how to overpressure ER?
hands behind head push back
58
how to OP IR ?
hands behind back take hand away from back
59
when is muscle length testing indicated?
limitation in ROM b/c could be mms or joints (motion loss) asymmetry (atrophy,hypertrophy)
60
upper trap muscle length testing indication
SB ROM limited
61
when to muscle length test levator scapulae
rotation and flexion decreased b/c are posteriorly oriented muscle
62
when to muscle length test SCM
SB rotation extension anteriorly oriented
63
when to muscle test scalenes?
64
how to test UT muscle length
Pt is supine PT maximally flexes pt’s head, then contralaterally SB w/ ipsilateral rotation PT then depresses ipsilateral shoulder
65
UT normal length
~45º of rotation w/ soft barrier at end range
66
what is decreased UT mm length
<45º of rotation and/or hard barrier at end range
67
mm length how to test levator scapulae
Pt is supine PT maximally flexes pt’s head, then contralaterally rotates w/ contralateral SB PT then depresses ipsilateral shoulder
68
normal mm length for levator scapulae
~45º of rotation w/ soft barrier at end range
69
what does decrease mm length for levator scapulae mean?
TTP at mm. insertion and/or <45º of rotation
70
how to test mm length for SCM
Pt is supine w/ head supported PT contralaterally SBs pt’s neck w/ extension PT then stabilizes ipsilateral shoulder and rotates neck ipsilaterally
71
what is normal mm length for SCM
~equal ROM bilaterally
72
what is decrease mm length. SCM
unequal ROM bilaterally w/ or w/o TTP and hypertonicity
73
how to test muscle length scalenes
Pt is supine w/ head supported PT extends and contralaterally SBs pt’s neck while stabilizing shoulder PT then stabilizes ipsilateral shoulder
74
what is normal muscle length scalenes
Normal mm. length = ~45º of SB ROM
75
what is decrease mm length scalenes
<45º of SB ROM w/ or w/o TTP and hypertonicity
76
joint mobility -OA opening on R and L
Opening on R --> push R PT performs CV flexion w/ L to R sideglide Opening on L --> push L PT performs CV flexion w/ R to L sideglide
77
joint mobility OA how to assess
lift flex and push on one side one hand stays still other glides push down 45 degree angle
78
joint mobility OA - closing R and L
Closing on R PT performs CV extension w/ R to L sideglide Closing on L PT performs CV extension w/ L to R sideglide *access normal, hypermobile, hypomobile at each segment + PAIN
79
Joint Mobility – AA
L/R rotation PT flexes mid-lower c-spine to ‘take up slack’ PT rotates to L followed by R *access normal, hypermobile, hypomobile at each segment
80
joint mobility - PA springing (C2-T1)
Prone CPAs Prone R and L UPAs
81
when do you do prone CPAs
on everyone thumbs on or around SP C2-T1
82
when do you do prone R and L UPAs?
only if sided neck pain cant recreate w/ CPA
83
where is TP in relation to SP for cervical
same level
84
joint mobility side glides C2-T1 side glides in flexion
PT flexes neck up to segment being assessed Side glides L to R to open R side Side glides R to L to open L side Repeats actions at each segment
85
Joint Mobility – Side glides (C2-T1) extension
PT extends neck up to segment being assessed Side glides L to R to close L side Side glides R to L to close R side Repeats actions at each segment
86
when is side glides indicated?
flexion or extension limitation opening vs closing restrictions
87
Special Tests include
compression and distraction Spurlings Test Cranio-Cervical Flexion Test (CCFT) Neck Flexor Endurance Test Cervical Flexion-Rotation Test (CFRT) Shoulder Abduction Test
88
how to do side glides where do you put the pressure
find articular pillar --> put 2nd MCP on facet joint articular pillar: find base of skull. First bump is SP articular pillar and TP are same spot
89
cervical compression and distraction procedure
Can perform in supine or sitting PT stands behind pt, hands on top of head (compression) or below mastoid process (distraction) Maintain pressure 5-8 sec Gradually release pressure Look for symptom Δ’s “Are your symptoms better, worse or the same w/ this pressure?” Symptom location is important to clarify
90
spurlings test purpose
Compresses foramina to test for cervical radiculopathy
91
spurlings test procedure
Pt is seated w/ PT standing behind pt PT askes pt to SB head and then applies an inferior force (towards floor) for 5-8 sec Test is repeated on opposite side
92
+ spurlings test
(+) test = reproduction of symptoms into ipsilateral UE High specificity, low sensitivity (ie. not a good screening test)
93
cervical radiculopathy CPR Wainner
C-spine rotation to painful side <60 deg (+) Spurling test (+) ULLT #1 (+) cervical distraction test (ie. relieves symptoms) 4 tests = 90% likelihood of cervical radiculopathy 3 tests = 65% likelihood of cervical radiculopathy
94
Cranio-Cervical Flexion Test (CCFT) purpose
Assesses activation and endurance of deep cervical neck flexors
95
if have closing restriction do you have to do both side glides?
no just extension
96
Cranio-Cervical Flexion Test (CCFT) procedure
Pt is supine in hooklying position w/ head and neck in neutral (use a folded towel behind head) A biofeedback cuff of BP cuff is placed under lordotic curve of c-spine Cuff is inflated to 20 mmHg Pt then asked to gently nod their head for 10 sec in a sufficient amount to ↑ pressure to 22 mmHg Pt then rests for 10 sec and repeats process 4 more times adding 2 mmHg each time (last rep is at 30 mmHg) w/ 10 sec of rest in b/t each rep Test ends when pt is no longer able to maintain desired pressure x 10 sec hold
97
what JPA do you do on everyone?
side glides and CPA
98
what are the 2 scores for cranio cervical flexion test
Activation score = max pressure achieved and held for 10 sec Performance index = max pressure achieved and held for 10 sec x # of reps that max pressure was maintained for 10 sec (up to 10 repetitions)
99
neck flexor endurance test purpose
Assesses for neck flexor endurance and motor control
100
neck flexor endurance test procedure
Pt is supine in hooklying position Pt is asked to tuck chin and lift head off table ~2.5 cm (1 inch) while maintaining chin tuck Test ends when pt is no longer able to maintain chin tuck
101
neck flexor endurance test + for men vs women
(+) test for men = <38.9 sec (+) test for women = <29.4 sec
102
Cervical Flexion-Rotation Test (CFRT) purpose
Assesses for presence of cervicogenic HA Both a ROM and symptom provocation test
103
Cervical Flexion-Rotation Test (CFRT) procedure
Pt is supine w/ PT at pt’s head, resting symptoms are noted Pt is asked to maximally flex their head and hold that position PT then applies pressure throughout full rotation to both side and notes any △’s in symptoms
104
cervical flexion rotation test + test
(+) test = rotation ROM loss to 1 side >10º compared to opposite side and/OR reproduction/exacerbation of pt’s symptoms
105
shoulder abduction test purpose
Assess for presence of radicular symptoms
106
shoulder abduction test procedure
Pt is seated and asked to place hand of affected limb on top of head
Christina Spring 26
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