Class 1 (1/7/21)

Question 1

Synovial joint

Answer 1

1. Tendon - joins muscle to bone.
2. Ligament - joins bone to bone.
3. Muscle.
4. Synovial fluid - lubricates the joint.
5. Synovial membrane - produces synovial fluid.
6. Hyaline cartilage - shock absorber, reduces friction.
7. Fibrous joint capsule.

Question 2

Bursa

Answer 2

Bursa - small fluid-filled sac and provides cushion between structures such as bones and tendons or muscles around joint. It reduces friction around the bones and allows free movement.
Bursitis - inflammation of bursa.

Question 3

Muscles

Answer 3

1. Striated - voluntary or skeletal. Attached to bones, responsible for muscular movements.
2. Smooth - found in the walls of hollow internal organs such as blood vessels, GI tract, bladder, uterus. It is under autonomic nervous system.
3. Cardiac - cardiac muscle cells are located in the walls of the heart, appear striated but involuntary.

Question 4

Sprain vs. strain

Answer 4

Sprain - injury of the bands of tissue that connect two bones together (ligaments).
Strain - injury of the muscle or to the bands of tissue that attaches muscle to the bone (tendon).

Question 5

Rickets

Answer 5

Also called osteomalacia.
Softening and weakening of bones in children, usually due to inadequate vitamin D.
Symptoms: delayed growth, bow legs, weakness, pain in the spine, pelvis and legs.

Question 6

Components of musculoskeletal exam

IPRSSGN

Answer 6

1. Inspection
2. Palpation (bony landmarks & related joint and soft tissue structures)
3. Range of motion (passive, active, resisted)
4. Strength assessment
5. Special test/maneuver
6. Gait analysis
7. Neurovascular tests

Question 7

Musculoskeletal findings

Answer 7

1. Abnormal posture
2. Pain or tenderness with palpation
3. Pain or tenderness with movement
4. Limited ROM
5. Joint contractures
6. Weakness
7. Atrophy
8. Asymmetry
9. Sign of inflammation
10. Edema
11. Altered gait pattern

Question 8

Signs of inflammation and and arthritis

Answer 8

1. Swelling (palpable swelling may involve: (1) the synovial membrane, which can feel boggy or doughy; (2) effusion from excess synovial fluid within the joint space; or (3) soft-tissue structures such as bursae, tendons, and tendon sheaths).
2. Warmth (use the backs of your fingers to compare the involved joint with its unaffected contralateral joint, or with nearby tissues if both joints are involved).
3. Tenderness (identify the specific anatomic structure that is tender. Trauma may also cause tenderness).
4. Redness (redness of the overlying skin is the least common sign of inflammation near the joints).

Question 9

Assessing musculoskeletal pain

SOCRATES

Answer 9

1. Site 2. Onset 3. Character 4. Radiation
2. Associated factors 6. Timing (frequency, duration, periodicity) 7. Exacerbating features (exercise, etc)
3. Severity

Question 10

Inspection

Answer 10

1. Asymmetry
2. Deformity
3. Edema/swelling
4. Hematoma
5. Contracture
6. Atrophy

Question 11

Contracture

Answer 11

A conditioning of shortening and hardening of muscles, tendons, or other tissues, often leading to deformity and rigidity of joints.

Question 12

Palpation

Answer 12

1. Pain/tenderness
2. Edema/effusion
3. Local spasm
4. Laxity
5. Heat/warmth

Question 13

Range of motion (ROM)

Answer 13

Passive ROM
Active ROM
Resisted ROM

Question 14

Knee ROM

Answer 14

1. Completely straight knee = 0°
2. Flexion (bending)
3. Extension (straightening)
4. Rotations (inward and outward)

Question 15

Elbow ROM

Answer 15

1. Flexion
2. Extension = 0°
3. Supination = 90°
4. Pronation = 90°

Question 16

Shoulder ROM

Answer 16

1. Forward flexion = 180°
2. Abduction = 150°
3. Adduction = 50°
4. Extension = 45-60°
5. Lateral rotation = 90°
6. Medial rotation = 90°

Question 17

Strength assessment

Answer 17

Grade, description
0 = no contraction
1 = flicker or trace of contraction
2 = active movement with gravity eliminated
3 = active movement against gravity
4 = active movement against gravity and resistance
5 = normal power

Question 18

Muscles of rotator cuff

SItS

Answer 18

S = supraspinatus
I = infraspinatus
t = teres minor
S = subscapularis

Question 19

Rotator cuff injury

Answer 19

1. Common in throwing and racket sports, painters and carpenters due to repeated overhead motion.
2. Dull ache deep pain in shoulder worse with sleeping on involved side.
3. difficulty in combing hair and reaching behind back.
4. Arm weakness.

Question 20

Empty can test/ supraspinatus test

Answer 20

1. Patient’s arm should be elevated to 90°, with elbow extended, full internal rotation, and pronation of the forearm.
2. This results in thumbs down position, as if pouring down the liquid out of the can.
3. Therapists stabilizes the shoulder while applying a downward force to the arm; the patient tries to resist.
   Positive(+): if patient experiences pain or weakness with resistance; indicates a tear in supraspinatus tendon or muscle.

Question 21

Drop arm test/ supraspinatus test

Answer 21

1. If there is a tear in supraspinatus, the patient is unable to lower the affected arm slowly and smoothly from a position of 90° of abduction.

Question 22

Infraspinatus test

Answer 22

1. Patient should be standing, with the arm in neutral position and the elbow flexed to 90°.
2. The therapist will apply a medially directed force to the arm while the patient is instructed to resist.
   Positive (+): Pain or weakness when resistance is applied.

Question 23

Torticollis

Answer 23

1. It is a stiff neck due to muscle spasm (lateral flexion contracture of cervical spine).
2. Sternocleidomastoid or trapezius muscles can be involved.

Question 24

Thoracic Outlet Syndrome

Answer 24

1. It is an umbrella term that encompasses three related syndromes that involve compression of the nerves or blood vessels in the lower neck and upper chest area and cause pain in the arm, shoulder, and neck and numbness in fingers.
2. Thoracic outlet is the space between the clavicle and the 1st rib.
3. Causes: trauma, repetitive injuries, sports injuries.

Thoracic outlet syndrome occur when blood vessels or nerves in the space between your collarbone (clavicle) and your first rib (thoracic outlet) are compressed. This can cause pain in your shoulders and neck and numbness in your fingers, or impaired circulation to the extremities.

Question 25

Adson's test

Answer 25

1. Patient in either sitting or standing with their elbow in full extension. 2. The arm of the standing (or seated) patient is abducted 30 degrees at the shoulder and maximally extended. 3. The radial pulse is palpated and the examiner grasps the patient's wrist. 4. The patient then extends neck and turns the head toward the symptomatic shoulder and is asked to take a deep breath and hold it. 5. The quality of the radial pulse is evaluated in comparison to the pulse taken while the arm is resting at the patient's side. Positive(+): The test is positive if there is a marked decrease, or disappearance, of the radial pulse. It is important to check the patient's radial pulse on the other arm to recognize the patient's normal pulse.

Question 26

Subscapularis test

Answer 26

1. The patient is asked to place their dorsum of hand behind their back. 2. The ability to actively lift the dorsum of the hand off the back constitutes a normal lift-off test. 3. Inability to move the dorsum off the back constitutes an abnormal lift-off test and indicates subscapularis rupture or dysfunction.