Physical exam exam 2

What are the two goals of joint motion examination?

Quantify motion and identify involved structures

Define osteokinematics

Movement of long bones that produces motion

What is ROM??

The arc of motion through which a segment moves in a specific plane

Which plane contains flexion and extension movements

Sagittal plane

What are the three cardinal planes of motion?

Sagittal, frontal, transverse

What is degree of freedom (DOF)?

Number of planes a joint can move through

How many DOFs does the glenohumeral joint have?

Three

What are the two factors that determine ROM?

Physiological and accessory motion

What is the difference between active and passive motion?

Active = patient moves; Passive = examiner/equipment move

Which usually has greater ROM, active or passive?

Passive ROM

What structures are examined during PROM?

joint capsule, ligaments, fascia, articular surfaces

Name the four end feels

Soft, firm, hard, empty

Which end feel is associated with two bones meeting?

Hard

Which end-feel may indicate an ACL rupture?

Empty or open

What are the three accessory motions?

Roll, glide, spin

Define roll

New point contacts new point

Define glide

One point contacts multiple new points

Define spin

Rotation around a stationary axis

What is goniometry?

Measurement of joint angles/ROM

What are the three main parts of a goniometer?

Fulcrum, stationary arm, moving arm

What should always be measured first when comparing sides?

Uninvolved side

What information should be documented when recording ROM?

Date, position, motion type, side, joint, ROM, pain

What is joint play?

Motion necessary for full ROM that is not under voluntary control

Why can joint play decrease?

Inflammation, immobilization, restricted motion

What are the three grades of ligament laxity? Describe them.

Grade 1 = pain, no laxity; Grade 2 = some displacement; Grade 3 = open-end feel.

What are the three purposes of strength testing?

Identify deficits, quantify weakness, determine RTP readiness

What three factors can alter muscle strength test results?

Pain, musculotendinous injury, nerve injury.

Which type of testing is preferred for acute injuries?

Break (isometric) tests.

Which type of testing is preferred for non-acute injuries?

Manual muscle tests

What three types of muscle testing exist?

Isometric, isotonic, isokinetic

What is an isometric test?

Strength test with no joint movement

Name one advantage and one disadvantage of isometric testing

Advantage: portable/easy. Disadvantage: position-specific

What type of contractions occur during isotonic testing?

Concentric and eccentric contractions

What is the major advantage of isokinetic testing?

Maximal resistance throughout ROM and objective measurement

Why is manual muscle testing considered subjective?

Results vary among examiners

Describe a break test procedure.

Patient holds position while examiner gradually applies resistance

What does a strong and painless break test indicate?

Normal

What does a strong and painful break test indicate?

Muscle/tendon injury

What does a weak and painless break test indicate?

Nerve injury or rupture

What does a weak and painful break test indicate?

Serious injury such as fracture/dislocation

What is resisted ROM testing

Dynamic muscle testing through ROM using resistance

Define substitutions and compensations.

Substitutions = other muscles help; Compensations = body position changes

What MMT grade corresponds to normal strength?

Grade 5

What grade is "Fair"?

Grade 3+, 3, 3-

What grade is "Trace"?

Grade 1

What grade is "Zero"?

Grade 0

Name three instrumented isometric testing devices

Grip dynamometer, pinch dynamometer, cable tensiometer

What does a grip dynamometer measure?

Grip strength/endurance

What does a pinch dynamometer measure?

Fine motor pinch strength

What is 1RM?

Maximum weight lifted once

Who should not perform a 1RM test?

Children, adolescents, injured athletes

What is 10RM used for?

Untrained individuals and rehabilitation patients

Define isokinetic testing.

Maximum effort against a machine moving at a fixed speed

What is the goal of a neurological examination?

Rule out brain, spinal cord, or peripheral nerve pathology.

What structures make up the CNS?

Brain and spinal cord

What structures make up the PNS?

Cranial nerves and spinal/peripheral nerves

Define a nerve plexus

Interconnection of spinal nerves that forms peripheral nerves

What spinal levels form the brachial plexus?

C5-T1

What spinal levels form the cervical plexus?

C1-C4

Compare UMNL and LMNL

UMNL = brain/spinal cord; LMNL = peripheral nerve/anterior horn injury

What is spasticity?

Muscle stiffening that limits fluid movement

List signs of UMN(Upper Motor Neuron Lesion)

Spasticity, sensory loss, abnormal reflexes, bilateral symptoms, paralysis

List signs of LMNL(Lower Motor Neuron Lesion)

Atrophy, decreased tone, sensory loss, diminished reflexes, unilateral symptoms

What three components are included in a neurological screen?

Sensory, motor, reflexes

What are afferent nerves?

Sensory nerves carrying information to the CNS

What do mechanoreceptors detect?

Touch, pressure, stretch, vibration

What do thermoreceptors detect?

Temperature

What do nociceptors detect?

Pain

Define anesthesia

Lack of sensation

Define paresthesia

Altered sensation

Define hyperesthesia

Hypersensitivity

What is a reflex?

Involuntary response to a stimulus

What three types of reflexes exist?

Deep tendon, superficial, pathological

Which reflexes assess LMNLs?

Deep tendon reflexes

Which reflexes suggest UMNLs

Absent superficial reflexes and positive pathological reflexes

What is the normal reflex grade?

+2

What does reflex grade +4 indicate?

Clonus and UMNL

Name five pathological reflexes

Babinski, Clonus, Chaddock, Oppenheim, Gordon

What is Cranial Nerve I and what is it responsible for?

Olfactory, Smell

What is Cranial Nerve II and what is it responsible for?

Optic, Peripheral vision & pupillary reflex to light

What is Cranial Nerve III and what is it responsible for?

Oculomotor, Pupil size, eyelid movement, and eye movement

What is Cranial Nerve IV and what is it responsible for?

Trochlear, Eye movement

What is Cranial Nerve V and what is it responsible for?

Trigeminal, Jaw movement, teeth clenching, facial sensation

What is Cranial Nerve VI and what is it responsible for?

Abducens, Eye movement

What is Cranial Nerve VII and what is it responsible for?

Facial, Face expressions, and taste

What is Cranial Nerve VIII and what is it responsible for?

Vestibulocochlear, Hearing and balance

What is Cranial Nerve IX and what is it responsible for?

Glossopharyngeal, Taste & gag reflex

What is Cranial Nerve X and

Vagus, Voice quality & gag reflex

What is Cranial Nerve XI and what is it responsible for?

Accessory, Shoulder shrug

What is Cranial Nerve XII and what is it responsible?

Hypoglossal, tongue movement

What is C5 dermatome?

Deltoid and upper lateral arm

What is C7 myotome?

Elbow extension and wrist flexion

What reflex tests C6?

Brachioradialis reflex.

What myotome tests L5?

Great toe extension

What reflex tests S1-S2?

Achilles tendon reflex

Cervical Plexus

C1-C4 with a small distribution coming from C5

Cervical Plexus Dermatome range

C2-C4

What are the myotomes for C1-C2?

Neck Flexors

What is the dermatome for C2

Temporal and occipital regions

What is the dermatome and myotome for C3?

Posterior cheek and lateral neck, Lateral flexors