NPTE MSK review

first class lever

The fulcrum is positioned between the effort and resistance

in the middle

head on first vertebrae nodding yes

see saw

second class lever

resistance lies between the applied force and the fulcrum

heel raise closed chain

wheel barrel

third class lever

the effort lies closer to the axis than the force of resistance

most muscles- biceps brachii, knee flex

convex on concave

roll and slide in opposite directions

concave on convex

roll and slide in the same direction

convex concave rule in the spine

first 2 vertebrae the convex rule opp is in effect

in the rest of the vertebrae it is the concave rule same is in effect

fingers/ metacarpals and toes concave convex

distal is concave moving on proximal convex

wrist flex ext concave convex rule

scaphoid, capitate, lunate and triquetrum all convex on concave

trapezoid is concave on convex

radioulnar convex concave pronation supination

radius moving

distal- convex on concave

proximal concave on convex

radius moving on humerus concave convex

concave on convex same

sternoclavicular joint concave convex sternum moving

elevation depression- convex on concave opp

protractor retraction- concave on convex same

AC joint concave convex rule

all mm concave on convex same

subtalor concave convex-

navicular and cuneiforms moving- concave on convex

cuboid calcaneus- convex on concave- inversion eversion

talocural talus moving

convex on concave

shoulder joint weakness

most vonerable in the inferior capsule

cortical humeral lig

renioforces biceps tendon

main pathological bursa of shoulder

subacrominal bursa

ratio of glenohumeral to sacpulothroacic movement

2:1

requirements of elevation of the shoulder

scapular stabilization

inferior guide of humerus

ER of humeral head

scap abd and lateral rotation of acromioclavicular joint

straightening of thoracic kyphosis

annular ligament

thick fibrous ring attached to medial ulna and encircles radial head

protects radial head in semi flexed- unstable

stability of the elbow joint

the trochlea of radius and trochlear notch of ulna make it stable

biomechanics of elbow

ulna pronates during ext

ulna supinates during flex

ulna proximally glides medial during ext and lateral during flex

CMC joint of thumb

saddle joint

trapezium-

medial lateral- convex

anterior posterior- concave

arcaded popliteal lig

y shaped lig

fib head to intercondular area of the tibia

strengthens posterior lateral capsule

knee meniscus

medial- C shaped and large

lateral O shaped and small

function of meniscus

deepens fossa

shock absorber

increased congruency of tibia and femur

stability provider

lubrication provider

improves wt distribution

movement of meniscus

medial meniscus moves in flex with semimemernosis and ACL posteriorly

and anteriorly with meniscopatealar lig in ext

lateral moves posteriorly popliteius and anteriorly with menicuspatellar lig

screw home mechanism

5 degrees of tibial er at end range ext open chain

closed chain IR of femur

proximal tibial fibular joint

dorsiflex- fib head glides superiorly ad posteriorly and ER of shaft

talocural joint

- Hinge type, synovial joint

- Distal tibia, fibular form mortise for trochlea of talus

- primary motions are dorsiflexion (more stable) and plantar flexion (less stable)

DF PF

subtalor joint

posterior talocalcaneal articulation-

anterior posterior convex

medial lateral- concave

windlass mechanism

Tightening of the plantar fascia during dorsiflexion, thus shortening the longitudinal arch

causes supination of the calcaneus and inversions of the subtalor joint creating a rigid lever for push off

look up biomechanics of subtalor joint

uncinate joints in C spine

limit lateral flex due to artery

C3-C7

rule of 3 with ribs

T1-3 are at the level

T4-6 are 1/2 below

T7-9 are 1 full level below

T 10 is a full level

T 11 is 1/2 a level

T12 is level

Alar lig

attaches dens to occipital condyles

limits flex and opp side bending and rotation

anterior longitudinal lig

limits ext

posterior longitudinal lig

limits flex

ligamentum flavum

limits flex

interspinous lig

limits flex and rotation

supraspinus lig

limits flex

vertebral artery test

Patient supine with head supported on table (follow the progression)

1.- Extend head and neck for 30 sec. if no change in symptoms, progress to next step

2.- Extend head and neck with rotation left, then right for 30 seconds, if no change in symptoms progress to next step

3.- With head being cradled off table, extend head and neck for 30 seconds. If no change in symptoms, progress to next step

4.- With head being cradled off table, extend head and neck with rotation left for 30 seconds, and then right

(+) TEST: dizziness, visual distribuances, disorientation, blurred speech, nausea/vomiting

quadrant test for cervical spine- spurlings test

determine if the pts is having cervical radiculopathy

put pt in ext rotation and same side side bend with over pressure

distraction test

Patient supine and head is passively distracted

(+) TEST: finding:

- A decrease in symptoms in neck (facet dysfunction)

- A decrease in upper limb pain (neurological condition)

gillet test

SI joint dysfunction

standing on one leg

if PSIS moves then ok if no then not ok

SI joint dysfunciton tests

distraction test

thigh thrust

gaenslen test

sacral thrust

compression test

shoulder impingement test

neers test

Hawkins kennedy test

painfull arch

rotator cuff test

supraspinatus mmt

infraspinatus mmt

drop arm test

ER lag sign

IR lag sign

horn blowers sign

instability of shoulder tests

sulcus sign

anterior aprehensión test, relocation test, anterior drawer

jerk test- posterior instability

AC joint test

horizontal add test

pains sign

palpation of AC joint

elbow tests

MCL and LCL tears- valgus and varus stress tests, moving valgus stress test

cubital tunnel syndrome- pressure provocation test

tingles sign

elbow flexion test

wrist ligament tests

ligamentous instability- scafoid shift test- Watsons

thumb ulnar colateral lig test

test for tight reticular lig

lunatetriquetral ballottement test

tests for wrist tendons and muscles

finkelstine test

eichhoffs test

Jersey finger sign

tunnel ;Littler test

jersey finger

A rupture of the flexor digitorum profundus tendon from the distal phalanx because of the rapid extension of the finger while actively flexed.

neuro tests for hand and wrist

tinels

phalen's test

reverse phalens

carpal compression test

circulation tests for hands

allens test

digital blood flow nail bed compression

hip muscle length tests

obers-

Thomas test

SLR

ells test

piriformis test

hip pathology tests

FABAR/ Patrick test

FADIR

Scour test

trendelenbruge sign

hip OA tests combs

increased pain with squat

lateral hip pain with active hip flex

+ scour test

pain with active hip ext

pasive IR <25 degrees

knee tests

1) Lachman Test - ACL

2) Anterior Drawer Test - ACL

3) Valgus Test - MCL

4) Varus Test - LCL

meniscus tests

mcmurrarys

Thessaly test

appleys compression test

joint line tenderness

patellar instability tests

patellar apprehension test

patellar tilt test

IT band test

nobles compression

lig tests for ankle

anterior drawer

talar tilt

squeeze test for legs for syndusomsis injury

Syndesmosis instability/pain tests le

kleiger test

DF ER strest test

squeeze test

foot and ankle tests

Thomas test- achilles rupture

windlass- plantar fascitis

tinels

morton neuroma

cervical special tests

-Vertebral Artery Test

-Transverse ligament test

sharps perser

alar lig test

-Foraminal compression (Spurling's test)

-Maximum cervical compression test

-Distraction test

-Shoulder Abduction test

-Lhermitte's sign

-TOS tests

-ULTT

cervicogenic head ache test

flexion rotation test

lhermittes sign

Patient seated or supine, patient actively/passively flexes head toward chest.

Positive sign is sharp electric shock like sensation down the spine into the extremities indicating multiple sclerosis, myelopathy, or other demyelinating cord lesions

upper c spine instability tests

alar lig test

sharp purser

cervical radiculopathy tests

spurlings test- compression

maximal cervical compression

distraction

shoulder abd test

thoracic spine special tests

Rib springing

Thoracic springing

Lumbar spine ST

slump test

SLR test

femoral nerve traction test

valsalva menuever

prone instability test PIT

quadrant test

aberrent movement test

bicycle test

crossed SLR

schober test

SI joint septal tests

gillets test

thigh thrust

gaenslen test

long siting test

goldthwaits test

sidelying compression test

SI distraction test

cervical rotation

rotation R

both facets move L

R move down and anterior

L move up and posterior

Lumbar rotation

R rotation

separation at the R and approximation at the L

coupled movements in C spine

for C2-C7 rotation and SB are in the same direction

for C1 occiput- they rotate in the Opp direction when SB occurs

lumbopelvic rythm

lumbar spine first goes through 60-70 degrees of flex before pelvis will rotate anteriorly and then hip flex

during ext hips ext first then spine follows

nutation

flex of sacrum and posterior rotation of ilium

counternutation

ext of sacrum and anterior rotation of ilium

GH instability tests

anterior-

apprehension

relocation

posterior-

Jerk test

sulcus sign

sub acromial impingement

hawkins kennedy

neer

painfull arch

empty can

rotator cuff pathology

drop arm test

ER lag sign

infraspinatus mmt

hornblower sign

IR lag sign

AC joints test

horizontal add

pacinos sign

SLAP tests

active compression/ obrien test

biceps load 2 test

anterior slide test

compression rotation test

yergasons test

speeds test

thoracic outlet syndrome tests

adson test

roos

ankylosing spondylitis

marie strûmpell disease, rheumatoid spondylitis, bechterews disease

inflammatory disorder

initial onset in mid to low back usually before 4th decade of life

men 3x more likely

kyphosis of c spine and T spine

decreased lordosis of L spine

Psoriatic arthritis

related to psoriasis- inflammatory disorder

joints of digits and joints of axial skeleton

RA

rheumatoid arthritis

autoimmune disorder

hand feet C spine

ra factor, ACPA

2-4x woman

osteomalacia

Vitamin D deficiency

decalcification of bones

bursitis

inflammation of bursa

pain with rest

PROM and AROM limited use to pain

CRPS types

type 1- triggered by injury to tissue but no nerve damage

type 2 has nerve damage

pagets disease

osteitis deformans

results in spinal stenosis, facet arthopathy and posible spinal fx

torticollis

spasm or tightness of SCM

SCM- side bend towards and rotate away

traumatic shoulder instability

TUBS

Traumatic

Unidirectional

Bankart lesion (torn labrum)

surgery most likely

usually anterior inferior dislocation

abd with forceful ER

atraumatic shoulder instability

AMBRI atraumatic multidirectional bilateral rehabilitation inferior capsular shift

glenoid labrum post op precautions

avoid 90/ 90 position for 12 weeks post surgery for labrum

sling for 3-4 weeks

after 6 weeks sports specific training can be done

12-16 weeks for full fitness make take place

compression areas for thoracic outlet syndrome

superior thoracic outlet

scalenes triangle

clavicle and first rib

pec minor and thoracic wall

tests for TOS

Adsons, Roos, Wrights, costaclavicular test

impingement syndrome

tests- Hawkins Kenedy, painful arch, infraspinatus mmt

tx-

restore posture

functional training for proprioception and coordination

joint movement restriction addressed