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Musculoskeletal NPTE Prep

108 terms by scottie2fit

Distal Radial/Ulnar Convex/Concave


Rule

Radius on Ulnar: concave on convex

Proximal Radial/Ulnar
Convex/Concave Rule

Radius on Ulnar: convex on concave

Sternocalvicular Elevation
Convex/Concave Rule

Clavicle on Sternum; convex on


concave

Sternocalvicular pro/retraction
Convex/Concave Rule

Clavicle on Sternum; concave on


convex

Acromioclavicular Convex/Concave
Rule

scapula on clavicle; concave on


convex

Sternoclavicular Open/Closed Pack

Open: arm at side;


Closed: max elevation

Glenohumeral Open/Closed Pack

Open: 55-70 abd & 30 horizontal add;


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 Cervical Capsular Patterns

occipitoatlantal (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"