Physical Assessment Quiz 4

Joint Movements

• Flexion: decreases angle between 2 bones (bending your elbow)

• Extension increases the angle between 2 bones (straightening your elbow)

• Hyperextension: extension beyond normal range of motion or normal anatomical position (such as bending the neck backwards sharply).

• Abduction: movement away from the midline of the body (lifting your arm sideways).

• Adduction: movement toward the midline of the body (bringing your arm back down to your side).

• Internal/medial rotation: rotating a body part toward the midline

• External/lateral rotation: rotating a body part away from the midline

• Supination: rotation of the forearm so the palm faces up/anteriorly (holding a bowl of soup)

• Pronation: rotation of the forearm so the palm faces down/posteriorly

• Dorsiflexion: toes/foot move up toward the shin

• Plantar flexion: pointing the toes downward (pressing a gas pedal)

• Inversion: turning the sole of foot inward

• Eversion: turning the sole of foot outward

Tendon vs Ligament

• Tendon: connects muscle to bone

  • helps produce movement

• Ligament: connects bone to bone

  • helps stabilize joints

Major bones & locations

• Radius: forearm bone on the thumb side

• Ulna: forearm bone on the pinky side

• Humerus: upper arm bone

• Scapular: shoulder blade

• Clavicle: collarbone

• Femur: thigh bone

• Tibia: larger, medial lower leg bone

• Fibula: smaller, lateral lower leg bone

• Patella: knee cap

• Iliac crest: superior border of the pelvis

• Acetabulum: socket of the hip, receives the head of the femur

• Greater tubercle: bony prominence of the proximal humerus, associated with shoulder muscles/tendon

• Greater trochanter: larger bony prominence on the upper femur

• TMJ: temporomandibular joint between the mandible & temporal bone. Allows movement involved in chewing & speaking

Fracture vs Dislocation vs Subluxation

• Fracture: break in a bone

• Dislocation: complete displacement of a joint. The articulating surfaces are no longer in normal contact (fully out of joint)

• Subluxation: partial/incomplete displacement of a joint. Some contact between the joint surface remains (partially out of joint)

Intervertebral disc

• located between the vertebrae

• Main parts

  • annulus fibrosis: tough outer ring

  • Nucleus pulposus: soft gelantinous inner portion

  • Herniated/ruptured disc: the inner martial can protrude through a damaged outer ring. If the disc material presses against a nerve root it can cause:

    • pain, numbness, tingling/paresthsia, weakness, symp that may radiate along the affected nerve

SITS/ Rotator Cuff Muscles

• SITS: muscles that help stabilize the shoulder joint

  • S: supraspinatus

  • I: Infraspinatus

  • T: Teres Minor

  • S: Subscapularis

• Head of humorous fits into the glenoid fossa of scapula

• Greater Tubercle of humerus is an important attachment area for rotator cuff muscles

• Acromion process porjects from the scapula & is associated with the clavicle at the acromioclavicular region

Hip Anatomy

• Femoral head: rounded head of the femur

• Acetabulum: socket of the pelvis

• Hip Joint: femoral head fits into the acetabulum

• Greater trochanter: large bony prominence on the proximal femur

Bone/Spinal Terms

• Epiphysis: end portion of a long bone

• Lordosis: exaggerated inward curvature of the spine, especially lumbar region

• Kyphosis: exaggerated posture curvature, especially thoracic spine

• Scoliosis: abnormal lateral curvature of the spine

• Osteoporosis: loss of bone density/mass. Bone becomes weaker & more susceptible to fracture

Hand Disorders & Deformities

• Ulnar Deviation: fingers deviate toward the ulnar/pinky side, commonly associated with rheumatoid arthritis

• Swan-Neck deformity: finger deformity involving

  • Hyperextension of the PIP joint

  • Flexion of the DIP joint

• Boutinniere deformity: flexion of the PIP joint with hyperextension of the DIP joint

• Ganglion cyst: fluid filled cyst associated with a joint or tendon sheath. commonly found around the wrist/hand

• Heberden Nodules: bony enlargement at the DIP joints, associated osteoarthritis

• Bouchard nodules: bony enlargement at the PIP joints, associated with osteoarthritis

• Dupuytren Contracture: thickening/shortening of tissue in the palm. Causes fingers to become flexed toward the palm. It often affects the ring fingers & little fingers

• Epicondylitis: inflammation/overuse injury around the elbow epicondyle

  • tennis elbow: lateral epicondyle

  • golfer’s elbow: medial epicondyle

RA vs OA

Rheumatoid Arthritis

• Inflammation

• autoimmune

• often bilateral/symmetric

• morning stiffness tends to last longer

• common joints: small joints of hands/feet, wrists

• can cause joint deformities

Osteoarthritis

• degenerative

• cartilage wears down

• pain tends to worsen with activities/use

• morning stiffness is usually shorter

• common joints: wieght bearing joints, DIP/PIP. hips & knees

• Heberden & Bouchard nodules may occur

Phalen Test

• used to asses for carpal tunnel syndrome

• positive phalen

  • wrist is flexed

  • symptoms such as numbness/tingling occur, espcially in the median nerve distribution

Tinel Test

• used to asses for carpal tunnel syndrome

• positive tinel

  • tapping over the median nerve at the wrist causes

    • tingling

    • parensthesia

    • pins & needle

Hallux Valgus

• lateral deviation of the big toe

• often associated with a bunion

Plantar Fascitis

• inflammation/irritation of the plantar fascia

• common symptoms:

  • heel/sole pain

  • often worse with the first steps after getting out of bed

Straight leg raising test

• used to assess for irritation of the sciatic nerve/lumbosacral nerve roots

  • often associated with lumbar disc problems

• test

  • pt lies supine

  • leg is raised with knee extended

  • positive finding = reproduction of radiating pain down the leg

Ortolani Maneuver

• used to assess infants for developmental dysplasia of the hip

• positive test: a palpable/audible CLUNK occurs as the femor head is reduced into the acetabulum

Allis Test

• used to assess for possible hip dislocation/leg-length discrepency in infant

• test:

  • infant lies supine

  • knee & hips are flexed

  • compare the height of the knees

• abnormal finding

  • unequal knee heights can indicate hip abnormaillity

Talipes Equinovarus

• club foot

• foot is typically

  • turned inward

  • plantar flexed

Polydactyly vs Syndactyly

Polydactyly: extra fingers or toes

Syndactyly: fingers or toes that are fused together

Spina Bifida Warning Sign

• tuft of hair over a dimple in the midline of the back can be associated with an underlying neural tube defect such as spina bifida

Genu Varum vs Genu Valgum

Genu Varum

• Bow legged

• knee remain apart when ankles are together

Genu Valgum

• Knock kneed

• knees come together while ankles remain apart

Scoliosis

• lateral curvature of the spine

• may be indentified by

  • uneven shoulders

  • uneven hips

  • asymmetry of the back

  • abnormal spinal curvature

Get up & Go test

• used to assess

  • mobility

  • balance

  • gait

  • fall risk

• pt gets up from chairs, walks, then walks back and sits down

Trendelenburg Hip Test

Used to asses hip stability on one leg, the pelvis drops on the oppositw/non-wieght bearing side

• indicated weakness of the hip abductors, epscially gluteus medius on the weight bearing side

CNS

• consists of brain & spinal cord

PNS Peripheral nervous system

• All nerve fibers outside the brain & spinal cord

• 12 pairs of CN

• 31 pairs of spinal nerves

• their branches

Sensory/Afferent

• carries information to the CNA

Motor/Efferent

• carries infomation from the CNA to muscles/glands

Four lobes of the brain

• frontal

  • personality

  • behavior

  • emotions

  • intellectual function

  • voluntary movement

  • broca’s area = motor speech

• Parietal

  • sensation

  • primary sensory cortex

• Temporal

  • hearing

  • language comprehension

  • Wernicke’s area

  • taste/smell fucntion

• occipital

  • vision

Basic Neurological Check

1. LOC

2. Motor Function

3. Pupillary Response

4. Vital signs

5. Glasgow Coma Scale

CN Nerves

• CN 1 Olfactory (smell)

• CN 2 Optic (vision)

• CN 3 Oculomotor ( eye movement & pupil response)

• CN 4 Trochlar (eye movement 6 cardinal points)

• CN 5 Trigeminal (facial sensation & mastication)

• CN 6 Abducens ( lateral eye movement)

• CN 7 Facial (facial movement & Taste)

• CN 8 vestibulocochlear/acoustic (hearing & balance)

• CN 9 Glossopharyngeal (swallowing, gag, posterior tongue taste)

• CN 10 Vagus (swallowing, gag voice parasympathetic factors)

• CN 11 spinal accessory (shoulder shrug, head rotation)

• CN 12 Hypoglossal (tongue movement)

Clonus

• rapid rythmic muscle contractions

• associated with hyperactive reflexes

• sustained clonus is associated with upper motor neuron disease

• normal = no continue movement after muscle is stretched

• abnormal = repeated rythmic contractions occur

Common DTRs

• biceps = C5-C6

  • normal response = flexion of forearm

• Triceps = C7-C8

  • normal response = extension of forearm

• Brachioradialis = C5-C6

  • normal response = flexion & supination

• Patellar/Quadraceps = L2-L4

  • knee jerk

  • normal response = extension of lower leg

• Achilles = L5-S2

  • ankle jerk

  • normal = plantar flexion

Deep Tendon Reflexes

• 0 = no response

• 1+ = diminshed/low normal or requires reinforcement (can be normal)

• 2+ = average/normal

• 3+ = brisker than average, may indicate disease

• 4+ = very brisk/hyperactive with clonus (abnormal)

Sensory Tests

• Stereognosis - ability to recognize an object by touch without looking

  • place object in hand, pt can identify by feeling it

• Graphesthesia- ability to identify a number/letter traced on skin

• Extinction- touch both side of the body simutaneously

  • normal = pt recognized both stimuli

  • abnormal = recognized only one side

• Point location - touch a location & remove stimulus, pt identifies where they were touched.

Reflex Arc

a reflex is:

• involuntary

• rapid

• a protective response

• below concious control

Reflex arc components

• sensory/afferent nerve

• synapse in spinal cord

• motor/efferent nerve

• neuromusclar junction

• muscle

Cerebellum

• motor coordination

• equilibrium

• balance

• posture

• muscle contraction

tests

• rapid alternating movements (palms) RAM

• finger nose to finger

• romberg test

• heel to shin

• tandem walking

• gait assessment

Broca vs Wernicke

• broca’s: frontal lobe

  • controls/mediates motor speech (talking)

• Wernicke: temporal lobe

  • language comprehension (understanding)