PTRS 703 midterm - lab material

Hip flexion normative value

120

Hip extension normative value

20

Hip abduction normative value

45

Hip adduction normative value

30

Hip internal rotation normative value

45

Hip external rotation normative value

45

Knee flexion normative value

135

Knee extension normative value

0

Ankle/talocrural dorsiflexion normative value

20

Ankle/talocrural plantar flexion normative value

50

Ankle/tarsal inversion normative value

35

Ankle/tarsal eversion normative value

15

Subtalar inversion normative value

5

Subtalar eversion normative value

5

Great toe flexion normative value

45

Great toe extension normative value

70

Thoracolumbar spine flexion normative value

10cm

Thoracolumbar spine extension normative value

5cm

Thoracolumbar spine lateral flexion normative value

35

Thoracolumbar spine rotation normative value

45

Lumbar spine flexion normative value

6.5cm

Lumbar spine extension normative value

1.5cm

Hip extension end-feel

firm

Hip flexion end-feel

soft or firm

Hip abduction end-feel

firm

Hip adduction end-feel

firm

Hip internal rotation end-feel

firm

Hip external rotation end-feel

firm

Knee flexion end-feel

soft or firm

Knee extension end-feel

firm

Ankle/talocrural dorsiflexion end-feel

firm

Ankle/talocrural plantar flexion end-feel

firm

Ankle/tarsal inversion end-feel

firm

Ankle/tarsal eversion end-feel

firm

Subtalar inversion end-feel

firm

Subtalar eversion end-feel

firm or hard

Great toe flexion end-feel

firm

Great toe extension end-feel

firm

ALL lumbar + thoracic spine end-feels are...

firm

Hip flexion ROM

supine

stationary arm: midline of pelvis

fulcrum: greater trochanter

moving arm: lateral epicondyle

Hip extension ROM

prone

stationary arm: midline of pelvis

fulcrum: greater trochanter

moving arm: lateral epicondyle

Hip abduction ROM

supine

stationary arm: between ASISes

fulcrum: ipsilateral ASIS

moving arm: center of patella

Hip adduction ROM

supine

stationary arm: between ASISes

fulcrum: ipsilateral ASIS

moving arm: center of patella

Hip internal rotation ROM

seated

stationary arm: perpendicular to floor

fulcrum: center of patella

moving arm: talocrural joint (between malleoli)

Hip external rotation ROM

seated

stationary arm: perpendicular to floor

fulcrum: center of patella

moving arm: talocrural joint (between malleoli)

Knee flexion ROM

supine

stationary arm: greater trochanter

fulcrum: lateral epicondyle

moving arm: lateral malleolus

Knee extension ROM

supine, ankle supported

stationary arm: greater trochanter

fulcrum: lateral epicondyle

moving arm: lateral malleolus

Ankle/talocrural dorsiflexion ROM

seated

stationary arm: lateral epicondyle

fulcrum: lateral malleolus

moving arm: parallel to 5th metatarsal

Ankle/talocrural plantar flexion ROM

seated

stationary arm: lateral epicondyle

fulcrum: lateral malleolus

moving arm: parallel to 5th metatarsal

Ankle/tarsal inversion ROM

seated

stationary arm: tibial tuberosity

fulcrum: talocrural joint (between malleoli)

moving arm: 2nd metatarsal

Ankle/tarsal eversion ROM

seated

stationary arm: tibial tuberosity

fulcrum: talocrural joint (between malleoli)

moving arm: 2nd metatarsal

Subtalar inversion ROM

** passive + active!

prone, feet off table

stationary arm: middle of gastrocnemius/calf

fulcrum: posterior talocrural joint (between malleoli)

moving arm: middle of calcaneus

Subtalar eversion ROM

prone, feet off table

stationary arm: middle of gastrocnemius/calf

fulcrum: posterior talocrural joint (between malleoli)

moving arm: middle of calcaneus

Great toe flexion ROM

supine, feet off table

stationary arm: 1st metatarsal

fulcrum: 1st MTP joint

moving arm: 1st phalange

Great toe extension ROM

supine, feet off table

stationary arm: 1st metatarsal

fulcrum: 1st MTP joint

moving arm: 1st phalange

Thoracolumbar flexion ROM (tape measure)

standing

superior point: C7

inferior point: S2/PSIS

measure cm from C7-S2, flex trunk, measure difference (longer)

Thoracolumbar extension ROM (tape measure)

standing

superior point: C7

inferior point: S2/PSIS

measure cm from C7-S2, extend trunk, measure difference (shorter)

Thoracolumbar lateral flexion ROM (goniometer)

standing

stationary arm: perpendicular to floor

fulcrum: S2 (between PSISes)

moving arm: C7

Thoracolumbar rotation ROM (goniometer)

seated

stationary arm: iliac crests

fulcrum: center of head

moving arm: acromion processes

Lumbar flexion ROM (tape measure)

standing

superior point: T12 (end of ribs)

inferior point: S2/PSIS

measure from T12-S2, flex trunk, measure difference (longer)

Lumbar extension (tape measure)

standing

superior point: T12 (end of ribs)

inferior point: S2/PSIS

measure from T12-S2, extend trunk, measure difference (shorter)

Dermatome testing procedure

1) Gather materials

2) Explain the test to the patient

3) Let the patient feel what the light touch will feel like

4) Position your patient appropriately (area exposed and comfortable) BEFORE

starting the procedure

5) Ask the patient to say "yes" when the cotton ball is felt and if it feels different from

side to side

6) Ask the patient to close the eyes

7) Conduct light touch sensation with short and light strokes in the appropriate region

and with equal pressure applied bilaterally (avoid moving the body part)

8) Test each level bilaterally before moving on to the next level

9) Avoid touching the patient (e.g., to reposition arms or legs) while testing sensation

10) Document your findings

Myotome testing procedure

1) Explain the test to the patient (** "maximal test!")

2) Position patient appropriately to test the correct muscle (a mechanical advantage

may be desired)

3) Test the myotome with maximal resistance for 5-6 seconds

4) Test each level bilaterally before moving on to the next level

5) Document your findings

Reflex testing procedure

1) Gather materials

2) Explain the test to the patient

3) Let the patient feel what the tap of the hammer will feel like

4) Position your patient appropriately (be sure to fully support a limb if appropriate)

5) Ask the patient to RELAX before you test the reflex

6) Test the reflex in the appropriate region with equal pressure applied bilaterally. Tap 3 times for each reflex or until a response is elicited.

7) Test each level bilaterally before moving on to the next level

8) If no reflex is elicited, try doing it again while the patient is performing a Jendrassik maneuver for the LE (or clenched jaw for UE)

9) Document your findings

How do you introduce myotome testing in a segmental neuro exam?

Is it okay with you if I test the strength of some of your muscles?

This test will be a maximal test, so the pressure I will apply will feel fairly strong to you. I ask that you withstand this pressure and don't let me move you for around 5 seconds. How does that sound?

Introduce the specific test next.

How do you introduce reflex testing in the segmental neuro exam?

Next I need to test some of your muscle reflexes by giving you a tap with this hammer. Is that okay with you?

Okay, how about I show you how the reflex hammer will feel. Do you mind holding your hand out for me? Please relax your hand as much as you can.

hit the hammer on palm of hand a few times

Okay now let's get started... (explain the specific reflex you will be testing)."

What is the patient's position for a lower segmental neuro exam?

supine

L1 Dermatome

Groin

L2 dermatome

Anterior proximal thigh

L3 dermatome

Medial knee

L4 dermatome

Lateral knee

L5 dermatome

dorsum of foot

S1 dermatome

Lateral foot (over fifth metatarsal)

S2 dermatome

Medial aspect of heel (where heel goes into the arch of the foot)

L2 myotome

Hip Flexion

L2 myotome muscle

Psoas

L3 myotome

Knee extension

L3 myotome muscle

Quadriceps

L4 myotome

dorsiflexion + inversion

L4 myotome muscle

Anterior tibialis

L5 myotome

Toe extension

L5 myotome muscle

Extensor hallucis longus

S1 myotome

Foot Eversion

S1 myotome muscle

Peroneals

S2 myotome

toe flexion

S2 myotome muscle

Flexor digitorum longus

L3 reflex test

patellar tendon

L5 reflex test

medial hamstring tendon

S1 reflex test

achilles tendon