NPTE PREP: MSK basics (reading module 0)

First-digit adduction (ADD) roll direction

Dorsal

First-digit flexion (FLX) and extension (EXT) mechanics

Concave on convex; roll and slide in the same direction.

First-digit abduction (ABD) and adduction (ADD) mechanics

Convex on concave; roll and slide in opposite directions.

Resting (loose-packed) position characteristics

Minimal surface contact and maximal joint play; used for joint mobilizations.

Closed-packed position characteristics

Maximum surface contact and tension; do not perform joint mobilizations.

Mobilization grade choice for pain or muscle guarding

Grade I or II mobilizations.

Mobilization grade choice when no pain is present

Grade III or IV mobilizations.

Grade I mobilization

Slow, small-amplitude motion at the beginning of range.

Grade II mobilization

Slow, large-amplitude motion within range but not reaching limit.

Grade III mobilization

Slow, large-amplitude motion in middle to end of available range.

Grade IV mobilization

Slow, small-amplitude motion at limit, stressed into tissue resistance.

Grade V mobilization

High-velocity, small-amplitude thrust at limit of available range.

Normal hard end feel cause and example

Bone or cartilage; example is elbow extension.

Normal soft end feel cause and example

Soft tissue approximation; example is elbow flexion.

Normal firm end feel cause and example

Capsular and ligamentous stretching; example is shoulder flexion.

Pathological hard end feel cause

Heterotopic ossification (HO) or abnormal bony obstruction.

Pathological boggy end feel cause

Edema or joint swelling.

Pathological springy end feel cause

Meniscal displacement.

Pathological rubbery end feel cause

Muscle spasm.

Pathological firm end feel with decreased elasticity cause

Fibrosis of soft tissues.

Pathological empty end feel cause

Muscle guarding or pain.

C1 dermatome location

Vertex of skull

C2 dermatome location

Temple, forehead, occiput

C3 dermatome location

Entire neck, posterior cheek, temporal area, prolongation forward under mandible

C4 dermatome location

Shoulder area, clavicular area, upper scapular area

C5 dermatome location

Deltoid area, anterior aspect of entire arm to base of thumb

C6 dermatome location

Anterior arm, radial side of hand to thumb and index finger

C7 dermatome location

Lateral arm and forearm to index, long, and ring fingers

C8 dermatome location

Medial arm and forearm to long, ring, and little fingers

T1 dermatome location

Medial side of forearm to base of little finger

T2 dermatome location

Medial side of upper arm to medial elbow, pectoral and midscapular areas

T3-T6 dermatome location

Upper thorax

T5-T7 dermatome location

Costal margin

T8-T12 dermatome location

Abdomen and lumbar region

L1 dermatome location

Back, over trochanter and groin

L2 dermatome location

Back, front of thigh to knee

L3 dermatome location

Back, upper buttock, anterior thigh and knee, medial lower leg

L4 dermatome location

Medial buttock, lateral thigh, medial leg, dorsum of foot, big toe

L5 dermatome location

Buttock, posterior and lateral thigh, lateral aspect of leg, dorsum of foot, medial half of sole, first, second, and third toes

S1 dermatome location

Buttock, thigh, and leg posterior

S2 dermatome location

Buttock, thigh, and leg posterior

S3 dermatome location

Groin, medial thigh to knee

S4 dermatome location

Perineum, genitals, lower sacrum

C1-C2 myotome movement

Cervical flexion

C3 myotome movement

Cervical side flexion

C4 myotome movement

Scapular elevation

C5 myotome movement

Shoulder abduction

C6 myotome movement

Elbow flexion and wrist extension

C7 myotome movement

Elbow extension and wrist flexion

C8 myotome movement

Thumb extension

T1 myotome movement

Finger abduction

L1-L2 myotome movement

Hip flexion

L3 myotome movement

Knee extension

L4 myotome movement

Ankle dorsiflexion

L5 myotome movement

Big toe extension

S1 myotome movement

Ankle eversion and plantarflexion, hip extension

S2 myotome movement

Knee flexion

S3 myotome movement

No specific test action; intrinsic foot muscles (except abductor hallucis)

Corneal reflex description

Involuntary blinking in response to corneal stimulation.

Corneal reflex pathway (afferent/efferent)

Afferent: Ophthalmic branch (V1) of trigeminal nerve

Efferent: Facial nerve (CN VII).

Abdominal reflex (T7-T12) description

Contraction of superficial abdominal muscles when stroking the abdomen lightly from lateral to medial.

Abdominal reflex asymmetry significance

Usually signifies an upper motor neuron (UMN) lesion on the absent side.

Cremasteric reflex (L1-L2) description

Contraction of cremaster muscle pulling up scrotum/testis after stroking same-side superior/inner thigh.

Cremasteric reflex absence cause

Spinal cord injury (SCI) and corticospinal lesions.

Plantar reflex (S1-S2, Tibial nerve) normal response

Plantarflexion of toes when stroking the lateral sole of the foot.

Babinski sign (abnormal plantar reflex) description and meaning

Dorsiflexion of great toe and fanning of toes; indicates corticospinal/UMN lesion.

Anal reflex description and pathway

Contraction of external anal sphincter upon stroking perianal skin; mediated by pudendal nerve (S2-S4).

Bulbocavernosus reflex description

Anal sphincter contraction from squeezing glans penis or tugging Foley catheter (S2-S4).

Bulbocavernosus reflex clinical significance

First reflex to return after SCI; indicates the body is out of spinal shock.

DTR grading scale:

0 = No Response, always abnormal

1+ = Slight reflex, present but depressed, low normal

2+ = Normal, typical reflex

3+ = Brisk reflex, possibly but not necessarily abnormal

4+ = Very brisk reflex, abnormal, clonus

Biceps reflex spinal roots

C5-C6

Brachioradialis reflex spinal roots

C5-C6

Triceps reflex spinal roots

C7-C8

Patellar reflex spinal roots

L2-L4

Achilles Tendon reflex spinal roots

S1-S2

Hamstrings reflex spinal roots

L5-S2