NPTE MSK review

Thumb biomechanics:

Flexion (radial adduction)

extension (radial abduction)

Palmar adduction

Palmar abduction

Flexion: same, ulnar glide

extension: same, radial glide

adduction: opposite, volar/anterior

abduction: opposite, dorsal/posterior

Grades of mobs

Grade one: small amplitude beginning of range

II: large amplitude within range

III: large amplitude from middle to end of range

IV: small amplitude at limit of range and into resistance

V: small, fast at limit of range

Example of firm end feel

shoulder flexion

example of soft end feel

elbow flexion

what is a firm end feel?

capsular/ligamentous stretching

what is a soft end feel?

soft tissue approximating together

what is a boggy end feel?

edema/swelling

what is a rubbery end feel?

muscle spasm

what is a springy end feel?

meniscal displacement

How would you increase flexion at C5/6? extension?

PA glide at C5 to increase flexion and PA glide at C6 to increase extension

How would you increase rotation at C5/6?

PA glide at left C5 or R C6

right rotation: right side closing and left side opening

right side bend: right side opening and left side closing

coupled motions in cervical, thoracic, lumbar spines

cervical/thoracic: rotation and side bending are in the same direction (R side bend and R rotation)

lumbar: side bend and rotation are in opposite directions (r side bend and L rotation)

Lumbopelvic rhythm:

flexion:

extension (from flexed position):

flexion: L spine does 70-60 degrees of flexion, then pelvis rotates anteriorly, then hips flex

extension: hips extend, pelvis moves posteriorly, and spine extends

AC joint tests

cross arm adduction test (horizontal adduction test), resisted extension, painful arc (pain between 170-180 deg), paxinos sign, AC shear test

Paxinos sign

-examiner's thumb placed posterolateral aspect of acromion and index and middle fingers paced superior to mid-clavicle

-thumb applies an anterosuperior pressure and index middle applies an inferior pressure

+=pain at the AC joint

AC shear test

squeeze over deltoid muscle

subacromial impingement tests

hawkins kennedy, infraspinatus resisted test, painful arc (60-120), yocum test, neer test, empty can test (jobe test), scapular assistance test

yocum test

modified hawkins kennedy, PT elevates elbow while pts hand is on opposite shoulder

neer test

passive shoulder elevation in scapular plane with IR

RC pathology tests

hornblower sign, ER lag, belly press, lift off, drop arm, infraspinatus resisted

hornblower sign

resisted ER at 90/90 for infraspinatus

SLAP tests

active compression/obriens test, biceps load II, anterior slide, compression rotation, pain provocation (mimori) test

obriens test

more pain with IR and no pain with ER

biceps load II

pain with resisted elbow flexion

anterior slide test

pain or clicking in deep shoulder

compression rotation test

apply axial compression load with ER and IR

memori/pain provocation test

pain worse in pronated is positive test

biceps tendonitis test

yergasons, speed test

yergasons

resisted supination and ER

speeds test

popeyes sign

biceps tendon rupture

anterior instability tests

anterior apprehension test and relocation test

relocation test

after apprehension test, PT stabilizes GHJ posteriorly and the shoulder reduces in apprehension

posterior instability tests

jerk test (posterior-inferior labral), posterior apprehension test

jerk test

sudden jerk with shoulder flexion 90 and IR

TOS tests

adsons, halstead, roos, wright, military brace test

adsons test

rotate toward testing side, ER and extend shoulder and check pulse

halstead maneuver

applying downward traction on test shoulder

wright test

military brace test (costoclavicular syndrome test)

find radial pulse

cubital tunnel special tests

Tinels sign, pinch grib, pressure provocation test, flexion compression test, elbow flexion test

pinch grip

pinch index to thumb (cannot pinch tip to tip--indicates entrapment of AI nerve between pronator teres)

pressure provocation test

flexion compression test

pressure provocation: pressure on ulnar nerve at cubital tunnel --> flexion compression test is the same but add elbow flexion/shoulder abd 90/ER

elbow flexion test

elbow fully flexed with wrist extended and shoulder abducted to 90

Elbow ligament injury tests

valgus, varus tests

moving valgus

moving valgus test

move elbow from flexion to extension (30 deg)

elbow pain should increase within arc of 120 and 70 deg of flexion if +

pronator teres syndrome test

identifies median nerve entrapment

lateral epicondylitis test

cozen test

mill test

maudsley test

cozen test

resisted wrist extension

mill test

passive stretching of the wrist extensors

maudsley test

resisted 3rd digit extension (distal to PIP)

medial epicondylitis test

stretching wrist flexors

CTS tests

carpal compression test, tinels sign, flick maneuver, sensory testing, phalens test, reverse phalens test

carpal compression test

pressure over median nerve in carpal tunnel

flick maneuver

shaking hands helps the symptoms of CTS

median nerve sensory distribution

reverse phalens test

TFCC tests

supination lift test, TFCC press test, ulnar fovea sign

supination lift test

TFCC press test

pushing up from a chair on hand rests

ulnar fovea sign

compression of TFCC in supination

scaphoid fx test

snuff box palpation, thumb grind test (axial load)

watson test

scaphoid shift test --> passive wrist ulnar deviation and slight extension --> press scaphoid --> bring into RD and slight flexion

for scaphoid instability

murphy sign

3rd MCP head appears same height as others in a fist

dequervians tenosynovitis tests

finkelsteins, WHAT test

WHAT test

highest sensitivity for DQT

max flexion of wrist and extend and abduct thumb with increasing abduction resistance from therapist to thumb

modified allens test

for vascular compromise

open and close fingers and make a fist while compressing arteries and letting go one at a time

Brunnel-Littler Test

Purpose: Intrinsic Muscle Tightness

Method: Pt is sitting with metacarpophalangeal joint in slight extension. PT moves the PIP joint into flexion

Positive Test: PIP joint does not flex with metocarpholageal joint in slight extension.

harness zancolli test

tight retinacular test

froments sign

grip paper between thumb and finger--> need to utilize flexor pollicus instead of adductor pollicus

wartenberg sign

cannot adduct little finger back into neutral position

craigs test

for femoral anteversion:

<8 deg is retroversion, >15 degrees is anteversion

Hip ERs

piriformis, OI, gemellus (inferior and superior), quadratus femoris, obturaror externus, glute max

Hip IRs

glute min and TFL

Hip abductors

TFL and glute med

hip adductors

adductor magnus, longus, brevis, gracilis, pectineus

hip extensors

glute max and hamstrings

hip flexors

pectineus, RF, psoas (major and minor), iliacus

SLR biases:

Sciatic

tibial

sural

common peroneal

nerve root/disc prolapse

sciatic: extension and DF

tibial: extension, DF, eversion

sural: extension, DF, inversion

common peroneal: extension, PF, inversion

nerve root/prolapse: crossed SLR

Superior gluteal nerve

glute med, glute min, TFL

inferior gluteal nerve

glute max

piriformis innervation

anterior rami of S1 and S2

obturator nerve (anterior)

adductor longus and brevis, gracilis

obturaror nerve (posterior)

obturator externus, adductor magnus

sciatic nerve innervates

hamstring muscles, adductor magnus, and most muscles in leg and foot

femoral nerve

rect fem, sartorius, iliacus, pectineus, quads

tibial nerve (from sciatic) innervates

gastroc, soleus, plantaris, popliteus, tib post, FHL, FDL

tibial nerve branches

lateral and medial plantar nerves

medial plantar nerve

FHB, lubrical 1, FDB, abductor hallicus

lateral plantar nerve

plantar interossei, dorsal interossei, quadratus plantae, abductor digiti minimi, lubricals 3-4, adductor hallicus

leg and foot sensory

deep peroneal nerve: between 1st and 2nd toes

SF peroneal nerve: dorsum of foot except for between 1st and 2nd toes, AL part of lower leg

tibial nerve: lower posterolateral leg, heel and foot

saphenous nerve: medial leg/foot

Forefoot varus:

compensation for it?

first MT (medial border) is higher than fifth MT (lateral border) (inversion)

compensation is RF valgus --> low arch

Forefoot valgus

Lateral border is higher than medial border (eversion)

compensation: RF varus (supination/high arch)

HU joint and HR joint kinematics

HU joint: concave ulna moves on convex humerus (open chain), same direction

same with HR joint (concave radius moves on convex humerus in open chain).

thompson test

Achilles tendon rupture--prone, knee extended, squeeze calf looking for PF of ankle

Anterior Drawer Test

hip 45 deg flexion, knee 90 deg flexion for ACL tear

Post tib tendon dysfunction is associated with

Hindfoot valgus and forefoot abduction

loss of strength when grasping a cup, but less difficulty holding onto a pencil. Which nerve is likely affected?

ulnar

ulnar nerve is primarily power grips (spherical/cylindrical), requiring both radial and ulnar sides of hand, thumb.

median nerve controls flexion of radial digits and would be involved in both power and precision (pencil grip, lateral and digital prehension) with thumb to hold smaller objects.

Hand of Benediction

median nerve injury--only digits 4 and 5 flex completely

Froments sign

identifies ulnar nerve dysfunction

thumb wants to flex instead of adduct to keep paper