311: Exam 6

abduction

movement away from midline (lifting arm to side)

adduction

movement toward midline

pronation

palm down

supination

palm up (holding ‘soup’)

inversion

sole of foot turns inward

eversion

sole turns outward

flexion

bending a joint, reducing the angle between bones

extension

straightening a joint, increasing the angle between bones

circumduction

circular movement of a limb or joint

protraction

moving forward (pushing jaw out)

retraction

pulling back

elevation

lifting (shrugging shoulders)

depression

lowering (relaxing shoulders)

temporomandibular joint (TMJ)

location: jaw; between temporal bone and mandibular

function: movement of jaw (chewing, talking)

spinal curvatures: lordosis

exaggerated lumbar curve

spinal curvature: kyphosis

exaggerated thoracic curve (hunchback)

vertebra count

cervical: 7, thoracic: 12, lumbar: 5, sacral: 5 (fused)

brain & spinal cord functions

medulla: autonomic functions (breathing, HR)

cerebral cortex: higher functions (thought, memory, voluntary movement)

cerebellum: coordination, balance

spinal cord: signal relay between brain & body

muscle strength grading (0-5)

0: no movement

1: flicker

2: active w/o gravity

3: active against gravity

4: against some resistance

5: normal strength

reflex grading (0-4+)

0: no response (hyporeflexia)

1+: diminished

2+: normal

3+: brisk

4: hyperactive w/ clonus (hyperreflexia)

golfer’s elbow

medial epicondylitis- pain inside elbow

assessment: pain with resisted flexion

tennis’s elbow

lateral epicondylitis- pain outside elbow

assessment: pain with resisted extension

reflexes by level

biceps: C5-C6

triceps: C7-C8

quadriceps (patellar): L2-L4 - knee extension

achilles: S1-S2 - plantar flexsion

kinesthesia

sense of movement

dysdiadochokinesia

inability to perform rapid alternating movements

SBAR communication

S: situation- what’s happening now?

B: background- relevant history

A: assessment- what you think is going on

R: recommendation- what’s needed

DTRs (deep tendon reflexes)

why test: assess spinal cord and nerve function

if absent: reinforce, retest

arthritis

symmetrical, autoimmune, joint swelling, deformity.

gout

sudden, painful, red joints (usually big toe), uric acid

posturing: decerebrate

arms extended- brainstem damage

posturing: decorticate

arms flexed- damage above brainstem

landmark dermatomes

c6: thumb, t4: nipple, t10: umbilicus, l4: knee, s1: lateral foot

anosmia

loss of smell

anisocoria

unequal pupils

graphesthesia

recognizing writing on skin

stereognosis

identify object by touch

functional assessment

ADLs (bathing, dressing), IADLs (cooking, shopping), mobility

spasticity

increased tone

flaccidity

no tone

atrophy

muscle wasting

clonus

rhythmic contractions

movement issues

tic: involuntary movement (facial)

tremor: rhythmic shaking

vertigo: spinning sensation

bursa vs. joint

• fluid-filled sac- reduces friction

• connects bones, allows movement

vertebra/disc functions

• structural support, protect spinal cord

• shock absorption, movement

• herniated disc sign: radiating pain, weakness, numbness

bone issues

osteoporosis- low bone density, fragile

osteopenia- milder bone loss

fracture signs- pain, swelling, bruising, deformity

carpal tunnel tests

Tinel’s: tapping median nerve- tingling

phanel’s: flex wrists- symptoms after - 1min

peripheral neuropathy

nerve damage (common in diabetes)

hypoalgesia

decreased pain sensitivity

hyperalgesia

increased pain sensitivity

analgesia

no pain sensation

I Olfactory: smell

test with scents

II optic: vision

Snellen, visual fields

III, IV, VI oculomotor, trochlear, abducens

eye movement- EOMs, PERRLA

VII facial

facial movement- smile, puff cheeks

IX glossopharyngeal, XII hypoglossal

swallowing, tongue movement- say ‘ah’ tongue midline