2.2.2. SG Physical Exam Flashcards Preview

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Flashcards in 2.2.2. SG Physical Exam Deck (84)
1

5 key aspects of the history

1. Overuse versus Traumatic mechanism of Injury
2. Insidious versus acute onset of pain
3. Presence or absence of swelling
4. Past history or previous injury or surgery
5. Presence of systemic symptoms like fever, weight loss, fatigue, night sweats, etc.

2

Inspection Steps

Begins with patient walking in. Look for changes in gait, arm swing, seating, and other observations can provide clues
Make sure to actually observe the skin of the patient
Also check to see if the joint appears swollen, which is often caused by joint effusion

3

What are joint effusions?

Joint effusions are collections of fluid inside the joint capsule, which is like the plastic bag around the joint. Can vary from obvious redness to swelling to far more subtle

4

First step of palpation exam

Wash hands

5

Last step of palpation exam

Wash hands

6

Two things you need to do when doing palpation portion of exam

1. Need to know the anatomy
2. Check temperature

7

What is the warm cold warm test?

1. Place back of hand on thigh (warm)
2. Place back of hand on kneecap or just medially (cold)
3. Place back of hand on lateral calf (warm)

8

What does Warm-Cold-Warm mean for the Warm cold warm test?

Warm-Cold-Warm means no irritation or inflammation in the joint

9

What does Warm-Warm-Warm mean for the Warm cold warm test?

Warm-warm-warm means something is irritating the joint. Not normal, could be chronic or acute

10

What does Warm-Hot-Warm mean for the Warm cold warm test?

Warm-hot-warm almost always means joint infection, accompanied by swelling, redness

11

Two types of ROM

Active vs. Passive

Active is how much they can do on their own, passive is how much you can do for them

12

What are we looking for with active ROM testing?

Ask patient to describe any pain during that motion, watch for catching and locking and look for any changes bilaterally (usually the same on both sides)

13

Two considerations for the strength-neurological testing

1. Place limb so that the muscle being tested is activated or contracted and then put force on it with the patient resisting in the opposite way

2. When testing nerve innervations, use muscles that are weaker to test if there really is a problem, don’t use muscles that even at a “weak” state are still very strong

14

Steps to the Physical Exam

Inspection
Palpation
ROM
Strength
Special Tests

15

First thing you do when a patient complains of back pain

Check the spine

16

How does cervical innervation differ from lumbar/thoracic vertebrae?

Cervical nerve roots named for the vertebrae below

17

Where does the C5 nerve root exit out of?

Between the C4 and C5 vertebrae

18

C5 nerve Motor

Deltoid, Biceps

19

C5 nerve Reflex

Biceps

20

C5 nerve Sensation

Lateral Arm

21

C6 nerve motor

Wrist Extensors, biceps

22

C6 nerve reflex

Brachioradialis

23

C6 nerve sensation

Thumb/index finger

24

C7 nerve motor

Triceps, wrist flexors

25

C7 nerve reflex

Triceps

26

C7 nerve sensation

Long finger

27

C8 nerve motor

Finger Flexors

28

C8 nerve reflex

None

29

C8 nerve sensation

Ulnar forearm, palmar pinky

30

T1 nerve motor

Finger Abduction

31

T1 nerve reflex

None

32

T1 nerve sensation

Medial elbow

33

Nickname for the nerve C5

Blocker

34

Nickname for the nerve C6

Beggar

35

Nickname for the nerve C7

Kisser

36

Nickname for the nerve C8

Grabber

37

Nickname for the nerve T1

Spock

38

Examination of Cervical Thoracic Spine - Inspection

1. Loss of cervical lordosis

2. Thoracic Kyphosis

3. Skin changes (rash erythema, etc)

39

Examination of Cervical Thoracic Spine - Palpation

Spinous processes
Trapezius muscles
SCM muscles

40

Examination of Cervical Thoracic Spine - ROM

Cervical Flexion
Cervical Extension
Rotation, left and right
Lateral bending left and right

41

Examination of Cervical Thoracic Spine - Strength/Neurovascular

C5 - T1

42

Examination of Cervical Thoracic Spine - Special Tests

Spurling's Maneuver

43

Sperling's Maneuver

1. Have patient laterally bend and rotate to affected side
2. Apply slight axial loading pressure to top of head
3. If not painful, have patient repeat the lateral bending and rotation but add the extension as well. Instruct patient to try and look in the back pocket of your jeans
4. Again apply slight axial loading pressure
5. If the patient experiences pain in the contralateral (opposite side) of the neck or upper extremity, then they have a “Reverse Spurling Sign” caused by the distraction of a cervical nerve root

44

Caudal equina syndrome

Compression of the terminal nerve roots in the spine

45

Inspection for L Spine

Lumbar lordosis
Thoracic Kyphosis
Scoliosis (More than 10 degrees of curvature)
Skin changes (rash, erythema, etc)

46

Palpation part of L Spine exam

Spinous processes
Paraspinous muscles
Sacroiliac joints (SI joints)

47

ROM portion of L spine exam

Spine Flexion
Spine Extension

48

What stress does spine flexion cause?

Spine flexion causes anterior compression between vertebral bodies which causes nucleus pulposus, the goo inside of the intervertebral discs, to get pushed posteriorly. Normal discs don’t do this, but a herniated or ruptured one will, and it will press on the nerve roots with this bulge causing pain

49

Complaint common to flexion abnormalities

Unbearable to bend over and tie my shoes

50

What stress does spine etension cause

Compresses posterior elements of the spine
Normal posterior elements leave enough room between them for the nerve roots to get out unscathed, but abnormal elements like fractures, arthritis or congenital stenosis can, under extension, cause nerve root compression

51

Complaint common to extension abnormalities

Patient will want to be bent forward

52

Palpation portion of L spine exam

Need to distinguish boney vs. non-bony pain (spinous processes vs. paraspinal muscles). Bony means xray, nonbony needs time and fitness

53

What do we order and what are we worried about with someone who has history of cancer

Recurrent cancer, order xrays of the spine

54

What do we order and what are we worried about with someone who has unrelenting nocturnal pain

Cancer or osteoid osteoma. Order xrays for the cancer and CT for the osteoid

55

What do we order and what are we worried about with someone who has unclear injury mechanism

Cancer or an infection. Xrays for the cancer and labs for the infection

56

What do we order and what are we worried about with someone who has constitutional changes like fever, weight loss or night sweats?

Cancer, infection, or rheumatologic disease. Xrays for cancer, labs for the others

57

What do we order and what are we worried about with someone who is over the age of 50?

Cancer, do xrays

58

What do we order and what are we worried about with someone who is younger than 18?

Infection, stressfracture, discitis. Labs for infection, Xrays for others

59

What do we order and what are we worried about with someone who has a history of trauma

Fracture or Nerve root compression, just need xrays

60

What do we order and what are we worried about with someone who has numbness or sensation change in dermatomal distribution?

Cauda Equina Syndrome. Get that person an MRI within 2 hours and neurosurgery TODAY

61

During the exam, if a patient has neurological deficits, what are we worried about?

Nerve root compression. Do Xrays and follow closely for exam progression

62

During the exam, if a patient has saddle sensation changes in the groin or upper thigh, what are we worried about?

Cauda Equina - MRI within 2 hours and neurosurgery TODAY

63

L4 Motor

Tibialis Anterior

64

L4 Reflex

Quads

65

L4 Sensation

Medial Foot ankle

66

L5 Motor

Hallucis longus

67

L5 Reflex

None

68

L5 Sensation

Dorsal ankle/foot

69

S-1 Motor

Peroneals

70

S1 Reflex

Achilles

71

S1 Sensation

Lateral foot/ankle

72

Strength tests for lower spine

Ankle inversion and dorsiflexion for L4

Great toe dorsiflexion for L5

Ankle Eversion for S1

73

Reflex tests for lower spine

Patellar reflex for L4

Achilles reflex for S1

74

Sensation tests for lower spine

Medial Leg/ankle for L4

Dorsum of foot for L5

Lateral leg/ankle for S1

75

Special Tests for the lower spine

Straight leg raise
Patrick's Faber Test
Single Leg Stork

76

Straight leg raise

1. Passively elevates patients leg with knee locked
2a. Pain radiating into the leg at 30 degrees or less suggests neural tension
2b. Pain in the calf at less than 30 degrees also is suggestive of neural tension

77

Patrick's FABER Test

Flexion, ABduction, External Rotation - Looking for pain at SI joint or pain in hip

78

Single Leg Stork Test

1. Patient stands on one leg and extends spine (leans back)
2. Pain in lumbar region on stance suggests spondylolysis
3. Repeat on opposite leg

79

Spondylolysis

Stress fracture of pars intraarticularis

80

Lumbago

Low back pain

81

S1, 2 - "buckle my shoe"

Achilles reflex

82

L3, 4 - "kick the door"

Patellar reflex

83

C5, 6 - "pick up sticks"

Biceps reflex

84

C7, 8 - "lay them straight"

Triceps reflex