Musculoskeletal

What type of joint is a fibrous or synarthroses?

Sutures of the skull, immovable

What type of joint is a cartilaginous or amphiarthrosis?

Vertebral bodies of the spine (slightly moveable), ribs

What type of joint is a synovial or diarthroses?

freely moveable

Which type of synovial joint has a wide range of rotary motion with rounded convex surface articulating with concave cuplike cavity?

Spheroidal (shoulder/hip); ball and socket

Which type of synovial joint has motion in one plane, is flat/planar/or slightly curved allowing only a gliding motion?

Hinge (flexion/extension), (elbow/IP joints of hand and foot)

Which type of synovial joint has movement of two articulating surfaces not dissociable, allowing for flexion or extension, rotation and motion in the coronal plane?

Condylar (knee/jaw)

What is the order for the physical exam?

Inspection, Palpation, Range of motions, Strength, Neurovascular status, Stability, Special tests

What must you ALWAYS be during the exam?

systematic

What are techniques for the physical exam?

direct attention to function as well as structure, visualize the underlying anatomy, recall key elements of history

What part of the exam includes: gait, position/posture, symmetry, discoloration of skin or joints, tumors, deformity?

Inspection

What part of the exam includes tenderness or swelling, muscle tone or crepitus, temperature change, tumor (evaluation), inflammation?

Palpation

What could be noted with a hot temperature change?

Inflammation (gout/arthritis), infection

What could be noted with a cold temperature change?

Vascular compromise

What part of the physical exam includes AROM and PROM?

Range of motion

In which range of motion does the patient do the moving?

Active

In which range of motion does the examiner do the moving and assess for crepitus?

Passive

Which ROM is completed first?

Active!!! ALWAYS

What is the grading system for range of motion?

Manual muscle strength testing

What is a 0/5 for the MMT?

No evidence of contractility

What is a 1/5 for the MMT?

Slight contractility, no movement

What is a 2/5 for the MMT?

FROM (function range of motion), gravity eliminated

What is a 3/5 for the MMT?

FROM with gravity

What is a 4/5 for the MMT?

FROM with gravity and some resistance

What is a 5/5 for the MMT?

FROM against gravity, full resistance

What is the most active joint in the body?

TMJ

What could you see with inspection of the TMJ?

swelling or redness

What is the inability to open mouth due to pain

Trismus

When examining the upper extremities, what position should the patient be?

Seated

What bony prominences do you palpate for the upper extremities?

SC joints, clavicle, AC joints, bicipital groove, scapulae, olecranon processes, epicondyles, joints of wrists and fingers

What ROM do you test for shoulder?

Flexion, extension, abduction, adduction, external and internal rotation

What ROM do you test for elbow?

Flexion, extension, pronate, supinate

What ROM do you test for wrist?

Flexion, extension, ulnar and radial deviation

How do you test for ROM of hands?

Extend and spread fingers then make a first

What are fine muscle tremors?

Fasciculation

Where is the subacromial bursa?

Under the deltoid

What bony landmarks do you palpate for the shoulder?

Acromion process, clavicle (distal tip), A/C joint, bicipital groove and tendon, greater tubercle of the humerus, coracoid process of scapula

How many degrees can you abduct the arms w/out scapular motion? with?

90 degrees; 180 degrees

How many degrees is shoulder flexion?

170-180

How many degrees is shoulder extension?

60

How many degrees is shoulder abduction?

180

How many degrees is shoulder external rotation?

90 degrees

How many degrees is shoulder internal rotation?

70

During inspection how should the shoulder be to palpate medial, lateral epicondyles and the olecranon process?

Flexed to 70 degrees

Which way are your palms during supination?

Palms side up

Which way are your palms during pronation?

Palms side down

What landmarks do you palpate for the wrist?

Distal radius and ulna, anatomical snuff box, dorsal surface (with thumbs)

What landmarks do you palpate for the hand?

8 carpal bones, 5 metacarpals (compress the MCP joint)

What landmarks do you palpate for the fingers?

Proximal, middle, and distal phalanges

What position is the patient in during examination of the lower extremities?

Supine and seated

What bony prominences are you palpating for the lower extremities?

Iliac crest, greater trochanter, patella, suprapatellar pouch, tibial plateau, femoral epicondyles, lateral/medial malleoli of ankles, MTP and IP joints of toes

What soft tissue do you palpate for the lower extremities?

Muscles of thigh, lower leg, popliteal fossa, knee joint space, achilles tendon

What is the phase when the foot is on the ground and bears weight (foot flat, midstance)?

Stance

What is the phase when the foot moves forward and does not bear weight (heel strike and push-off)?

Swing

What are you observing for when examining the hip?

Width of the base, shift of the pelvis, flexion of knee

What are you inspecting the lumbar spine for?

slight lordosis, symmetry of leg length, anterior and posterior surfaces for muscle atrophy and bruising

What do you palpate on the anterior surface of the hip?

Iliac crest, iliac tubercle, anterior iliac spine

What do you palpate on the posterior surface of the hip?

Posterior superior iliac spine, greater trochanter, ischial tuberosity, sciatic nerve

What ROM do you test for hips?

Flexion, Extension, Adduction, abduction, internal rotation, external rotation

What is active examination for the hip?

Patient flexes knee to chest

What is passive examination for the hip?

Examiner internally and externally rotates the hip

What are you observing in the knee while seeing gait?

Alignment and contour of the knee, atrophy of the quadriceps, loss of normal hollows around the patella

How should the patient be positioned while palpating the knee?

Sitting on the edge of the table

What ROM do you test for knees?

flexion and extension while sitting, internal and external rotation (rotate the foot medially and laterally)

What is the degree of flexion for knees?

130

What is the degree of extension for knees?

0

What is the degree of external rotation for knees?

30

What is the degree of internal rotation for knees?

20

What are you looking for when observing ankle, feet, toes?

Deformities, nodules, swelling, calluses, corns

What are you palpating on ankles, feet, toes?

Anterior aspect of ankle joint, achilles tendon, heel and plantar surface, metatarsophalangeal joint, compress metatarsal forefoot, exert pressure proximal

What ROM do you test for ankle, feet, and toes?

Dorsiflexion and plantarflexion, inversion and eversion of the ankle, flexion and extension of the toes

What do you palpate for the cervical spine?

Spinous processes (C7 most prominent), paravertebral, SCM, trapezius

What is the degree of extension of C-spine?

55

What is the degree of flexion of C-spine?

45

What is the degree of rotation of C-spine?

70

What is the degree of lateral bend of C-spine?

40

What ROM do you test for thoracic and lumbar spine?

Flexion, extension, lateral bend, rotation (patient’s pelvic must be stabilized for all EXCEPT flexion)

How is the SI joint identified?

Dimple over the posterior superior iliac spine

How is flexion tested and how many degrees is it for thoracic and lumbar spine?

Patient bends forward to touch their toes; 85

How is extension tested and how many degrees is it for thoracic and lumbar spine?

Hands on iliac spine for support and have patient bend backwards as far as possible; 20

How is lateral bending tested and how many degrees is it for thoracic and lumbar spine?

stabilize hips and patient run a hand down their leg; 30

How is rotation tested and how many degrees is it for thoracic and lumbar spine?

Stabilize hips and patient rotate; 45