CMN 574 Unit 2 Musculoskeletal Exam with ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
verified detailed solutions ||\\//|| ||\\//||
Trendelenburg test - correct answer✔✔The patient stands and rises one foot and then the ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
other while the doctor observes the buttocks.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Positive sign is when the buttock drops on the side that the foot is elevated indicating hip
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
abductor weakness on the stance leg side. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Torticollis Findings - correct answer✔✔Chin rotates to the OPPOSITE side of the spasm
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Head tilts toward spasm
||\\//|| ||\\//|| ||\\//||
Torticollis Cause - correct answer✔✔Sternocleidomastoid muscle has been damaged
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
OR ||\\//||
Underlying disease process ||\\//|| ||\\//|| ||\\//||
-congenital deformity of cervical spine ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Tumors of spinal cord or cerebellum; syringomyelia, or RA
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Torticollis Tx - correct answer✔✔PASSIVE stretching effective in up to 97% of all cases
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Congenital Deformities - correct answer✔✔RARE limb deficiencies (esp lower limbs is rare)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
but associated with other congenital probs in femur, tibia, and fibula
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,Also may have extra digits (polydactyly) or absence of brain matter (anencephaly)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
*COMPLETE loss of limb is RARE ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
PARTIAL ABSENCE more common than loss of limb
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Example of congenital limb defect/deformities - correct answer✔✔Congenital longitudinal
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
deficiency of the fibula ||\\//|| ||\\//|| ||\\//||
Polydactyly (extra digits) ||\\//|| ||\\//||
Congenital deformities TX - correct answer✔✔Limb lengthening or contralateral limb
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
shortening
Removal of part of deformed limb ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Prosthetics *early fitting is key ||\\//|| ||\\//|| ||\\//|| ||\\//||
Lower Extremities--> 12 months of age, well tolerated, necessary for balance and walking
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Upper Extremities--> 6 months of age, Mitten type, able to "develop" as child grows
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Deformities of the Extremities - correct answer✔✔Metatarsus Adductus ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Talipes Equinovarus ||\\//||
Developmental ||\\//||
Dysplasia of the Hip ||\\//|| ||\\//|| ||\\//||
,Torticollis
Metatarsus Adductus - correct answer✔✔Congenital foot deformity causing INWARD ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
deviation of the forefoot ||\\//|| ||\\//|| ||\\//||
May be associated with hip dysplasia
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Most FLEXIBLE deformities resolve spontaneously (Caused by positioning in utero)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
RIGID deformity has crease in medial aspect of arch
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Serial casting to correct if cannot reposition past midline
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-may try corrective shoes
||\\//|| ||\\//|| ||\\//||
Talipes Equinovarus - correct answer✔✔(AKA Clubfoot)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Idiopathic, neurogenic, or rt arthrogryposis or Larsen Syndrome ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Check for SPINE anomalies, among others
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Idiopathic clubfoot may be hereditary ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Plantar Flexion of the foot at ankle joint (equinus)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Inversion deformity of the heel (varus) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Medial deviation of the forefoot (adductus) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Talipes Equinovarus TX - correct answer✔✔Preferred
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, -Ponsetti technique (manipulative technique w/ out invasive surgery)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Manipulation and stretching of foo ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Serial Casting ||\\//|| ||\\//||
-1/wk for 6-8wks ||\\//|| ||\\//||
-Night brace req for long-term management
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Rigid and/or resistant to casting
||\\//|| ||\\//|| ||\\//|| ||\\//||
-Surgical release and correction (15-50%) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Femur Anatomy - correct answer✔✔ ||\\//|| ||\\//|| ||\\//|| ||\\//||
Developmental Hip Dysplasia - correct answer✔✔(Abnormal growth or development) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Hip dysplasia= abnormality between the FEMUR and ACETABULUM
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Dislocated hip: femoral head is NOT IN CONTACT with acetabulum ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Subluxatable hip: femoral head may be DISPLACED ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(more common in L hip) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Femur and acetabulum are under developed
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Continues w/ growth pattern, does not correct itself unless dislocation is corrected w/in few
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
weeks of birth ||\\//|| ||\\//||
Diagnosis of Hip Dysplasia - correct answer✔✔Ortolani and Barlow sign ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Ortolani - correct answer✔✔Place long finger over greater trochanter and thumb over inner
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
thigh. Flex hips at 90 degress-slowly ABDUCT from midline, 1 hip at a time. Use gentle
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
pressure to lift greater trochanter forward ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(aBduct to have a baby -named ortolani) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
verified detailed solutions ||\\//|| ||\\//||
Trendelenburg test - correct answer✔✔The patient stands and rises one foot and then the ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
other while the doctor observes the buttocks.
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Positive sign is when the buttock drops on the side that the foot is elevated indicating hip
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
abductor weakness on the stance leg side. ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Torticollis Findings - correct answer✔✔Chin rotates to the OPPOSITE side of the spasm
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Head tilts toward spasm
||\\//|| ||\\//|| ||\\//||
Torticollis Cause - correct answer✔✔Sternocleidomastoid muscle has been damaged
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
OR ||\\//||
Underlying disease process ||\\//|| ||\\//|| ||\\//||
-congenital deformity of cervical spine ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Tumors of spinal cord or cerebellum; syringomyelia, or RA
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Torticollis Tx - correct answer✔✔PASSIVE stretching effective in up to 97% of all cases
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Congenital Deformities - correct answer✔✔RARE limb deficiencies (esp lower limbs is rare)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
but associated with other congenital probs in femur, tibia, and fibula
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
,Also may have extra digits (polydactyly) or absence of brain matter (anencephaly)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
*COMPLETE loss of limb is RARE ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
PARTIAL ABSENCE more common than loss of limb
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Example of congenital limb defect/deformities - correct answer✔✔Congenital longitudinal
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
deficiency of the fibula ||\\//|| ||\\//|| ||\\//||
Polydactyly (extra digits) ||\\//|| ||\\//||
Congenital deformities TX - correct answer✔✔Limb lengthening or contralateral limb
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
shortening
Removal of part of deformed limb ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Prosthetics *early fitting is key ||\\//|| ||\\//|| ||\\//|| ||\\//||
Lower Extremities--> 12 months of age, well tolerated, necessary for balance and walking
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Upper Extremities--> 6 months of age, Mitten type, able to "develop" as child grows
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Deformities of the Extremities - correct answer✔✔Metatarsus Adductus ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Talipes Equinovarus ||\\//||
Developmental ||\\//||
Dysplasia of the Hip ||\\//|| ||\\//|| ||\\//||
,Torticollis
Metatarsus Adductus - correct answer✔✔Congenital foot deformity causing INWARD ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
deviation of the forefoot ||\\//|| ||\\//|| ||\\//||
May be associated with hip dysplasia
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Most FLEXIBLE deformities resolve spontaneously (Caused by positioning in utero)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
RIGID deformity has crease in medial aspect of arch
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Serial casting to correct if cannot reposition past midline
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-may try corrective shoes
||\\//|| ||\\//|| ||\\//||
Talipes Equinovarus - correct answer✔✔(AKA Clubfoot)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Idiopathic, neurogenic, or rt arthrogryposis or Larsen Syndrome ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Check for SPINE anomalies, among others
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Idiopathic clubfoot may be hereditary ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Plantar Flexion of the foot at ankle joint (equinus)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Inversion deformity of the heel (varus) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Medial deviation of the forefoot (adductus) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Talipes Equinovarus TX - correct answer✔✔Preferred
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
, -Ponsetti technique (manipulative technique w/ out invasive surgery)
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Manipulation and stretching of foo ||\\//|| ||\\//|| ||\\//|| ||\\//||
-Serial Casting ||\\//|| ||\\//||
-1/wk for 6-8wks ||\\//|| ||\\//||
-Night brace req for long-term management
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Rigid and/or resistant to casting
||\\//|| ||\\//|| ||\\//|| ||\\//||
-Surgical release and correction (15-50%) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Femur Anatomy - correct answer✔✔ ||\\//|| ||\\//|| ||\\//|| ||\\//||
Developmental Hip Dysplasia - correct answer✔✔(Abnormal growth or development) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Hip dysplasia= abnormality between the FEMUR and ACETABULUM
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Dislocated hip: femoral head is NOT IN CONTACT with acetabulum ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Subluxatable hip: femoral head may be DISPLACED ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(more common in L hip) ||\\//|| ||\\//|| ||\\//|| ||\\//||
Femur and acetabulum are under developed
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Continues w/ growth pattern, does not correct itself unless dislocation is corrected w/in few
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
weeks of birth ||\\//|| ||\\//||
Diagnosis of Hip Dysplasia - correct answer✔✔Ortolani and Barlow sign ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
Ortolani - correct answer✔✔Place long finger over greater trochanter and thumb over inner
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
thigh. Flex hips at 90 degress-slowly ABDUCT from midline, 1 hip at a time. Use gentle
||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
pressure to lift greater trochanter forward ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
(aBduct to have a baby -named ortolani) ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//|| ||\\//||
