NURO 528 AHA MUSCULOSKELETAL |151 QUESTIONS AND ANSWERS 2024(DIAGRAMS INCLUDED).

tendon Connects muscle to bone tendons: origin Proximal Greater mass More stable (usually not the part being moved) tendon: insertion Distal Less mass Greater motion (this bone is moved by the motion) axial skeleton Head = skull Neck = hyoid bone and cervical vertebra Trunk = ribs, sternum, vertebrae, and sacrum appenduicular skeleton Shoulder, collar, pelvic, arms and legs. LIMBS ligaments Connect bone to bone cartilage A connective tissue that is more flexible than bone and that protects the ends of bones and keeps them from rubbing together. cartilage in the skeleton changes as the body grows The younger a person is, the greater the contribution of cartilage. The bones of a newborn are soft and flexible because they are mostly composed of cartilage. Joints: Pivot Pivot joints are uniaxial and allow for rotation only. One bone rotates within a sleeve or ring formed by the other bone. An example is the atlantoaxial joint, which allows for rotation of the head. Joints: Hinge permit flexion and extension only. Joints: Saddle The convex surface of one bone sits in the concave surfact of another. All movement is possible, but rotation is limited (carpal-metacarpal joint of the thumb) Joints: Plane Plane joints permit gliding and sliding movement (between toes) Joints: Ball and Socket Ball like head of one bone fits into the socket of another, which allows movement in three planes of motion (shoulder & hip joints) They allow for the most movement of any type of joint (flexion/extenison, abduction/adduction, medial/lateral rotation, circumduction). Joints: Condyloid wrist knuckle biaxial movement cervical and lumbar areas of the spine have a concave lordosis curve thoracic and sacral areas have a convex curve kyposis curve 1° curves: thoracic and sacral Develop during the fetal period Characterized by an anterior to posterior vertebral body height difference 2° curves: cervical and lumbar They become obvious and more developed during infancy. An anterior to posterior intra-vertebral disc height difference causes these curves. The cervical curve develops when an infant begins raising his head. The lumbar curve develops when a child begins to push up the upper part of the body and more so when he begins to stand and walk. spinous and transverse processes sites of muscle attachments Extrinsic muscles of back Made up of the superficial and intermediate groups Produce and control limb and respiratory movements Intrinsic muscles of back extend trunk and maintain posture Includes muscles from the deep group Act on the vertebral column, producing its movements and maintaining posture Passive palpation Provider is manipulating the joint. Provider is palpating how the joint feels. Active Palpation Provider is palpating the joint while the patient moves it through its range of motion. Provider is looking for crepitus, popping, tracking issues, etc. i.e. assessing TMJ Active ROM Is movement initiated and completed by the athlete without assistance. Passive ROM provider moves body part. Patient must relax muscles. Active ROM (AROM) Activating contractile elements of limb or joint (muscles, tendons, nerves) Stressing noncontractile components (bones, ligaments, menisci) Determining which component is affected or limiting ROM not immediately possible Passive ROM (PROM) Testing only noncontractile components of joint passive ROM was greater than active ROM provider able to get a higher degree than when pt does it on own PROM AROM suspect muscular weakness or tissue lesion The problem is either with the muscle or the nerve supplying the muscle. By removing the stress on these components during passive ROM, we achieved greater ROM. PROM = AROM This suggests the problem is within the joint. Such is the case with frozen shoulder syndrome, dislocations, and fractures. In most cases, you only need to test active ROM because... Passive ROM only necessary if active ROM is limited Have the patient do moves that put the joint through its entire ROM. E.g., rotating the joint wrist, ankle, shoulder, elbow not the neck Muscle strength: 0 No muscle contraction is detected visually or with palpation. Muscle strength: 1 A trace of muscle contraction is detected visually or with palpation, but no movement of the joint is achieved. Muscle strength: 2 Patient is actively able to move the muscle when gravity is removed. ex. pt laying can flex/extend knee but when sitting up right the leg is hanging off bed and now cannot lift Muscle strength: 3 active movement against gravity but not against resistance Muscle strength: 4 active movement against gravity and some resistance Muscle strength: 5 Patient is able to actively move against and overcome resistance applied by examiner (normal muscle strength). Orthopedic Tests Purpose: pinpoint specific nature of an MS injury By isolating specific structures By eliciting pain By identifying laxity Orthopedic Test process take joint through specific motions to determine - If joint is moving correctly -- If specific movements cause pain It is most important to understand the mechanics of each test. Make sure you can identify what structures are being stressed or moved, palpated straight leg raise test test often performed to determine whether a patient with low back pain has an underlying herniated disk Tests for nerve root irritation lift leg up past 45 degrees and dorsiflex leg Lasègue Sign/Straight-Leg-Raising Sign Pain in the distribution of nerve root when a patient extended in the supine position raises the leg gently; suggests lumbar disk disease. Lasègue Sign SLR of more than 30° Tests for pain in affected or unaffected leg Indicates L4, L5, or S1 nerve root irritation or herniation Bragard Sign like a passive SLR Bragard Sign Positive radiating pain in posterior thigh When patient feels pain, slightly lower leg, dorsiflex foot, and internally rotate leg. Pain below the knee at less than 70° indicates herniated nucleus pulposus at L5 or S1. Femoral Stress Test Conducted in the prone position Patient raises affected leg by extending hip. Pain to anterior thigh indicates nerve root irritation, usually at L1, L2, or L3. **done for anterior thigh pain Low Back Pain Red Flags Consider immediate referral or consultation for --Bowel or bladder dysfunction or significant change -- New onset of incontinence with low back pain --New onset of retention with low back pain Saddle paresthesia Lower extremity weakness -New onset -Onset over time after back injury Back or lower extremity muscle atrophy - Indicates nerve damage Saddle paresthesias numbness/tingling in the perineal region. Indicative of cauda equina syndrome Abnormal sensation, tingling, or numbness in saddle area McMurray test Meniscal Tear With patient supine and knee internally and externally rotated during range of motion Note where pain, grinding, or limited extension occurs. click and pop with pain when ROM conducted hyperflex and rotate Anterior and posterior drawer Knee at 90 degrees - stabilize foot/ankle and pull/push lower leg forward/backward by knee, + laxity (compare) anterior and posterior drawer test ACL and PCL anterior and posterior drawer test purpose Use these tests to identify anterior and posterior cruciate ligament instability. Due to overstretching Due to complete avulsion or tearing ACL normally resists posterior displacement of femur on tibia. PCL normally resists anterior displacement of femur on tibia. varus and valgus stress tests LCL/MCL instability holding knee and moving foot side to side varus and valgus stress tests Tests for damage to medial or lateral collateral ligaments Valgus moves femur medially to test medial collateral ligament. Varus moves femur laterally to test lateral collateral ligament. put slight 30 degress and move knee side to side Ballottement Test/ Patella Tap Palpate patella downward against femur Listen for a clicking sound test for fluid in knee Can do with or without milking fluid