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Clinical skills 1 Flashcards

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1
Q

What are the 5 basics of consent?

A
  1. Explain to patient what is going to happen and why
  2. Explain the benefits and risks
  3. Alternatives and option to withdraw consent
  4. Ask the patient if they understand or if there are any questions
  5. Ask for consent to proceed
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2
Q

What are red flags?

A

Red flags are signs and symptoms that raise suspicion of a serious pathology.

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3
Q

Identify 3-5 red flags

A
  1. Severe pain
  2. Deformity
  3. Night pain
  4. History of cancer
  5. Neurological signs
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4
Q

What are contraindications?

A

Contraindications are signs, symptomsor clinical conditions where the practitioner would NOT treat the patient.

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5
Q

List 5-7 contraindications

A
  1. Trauma/instability
  2. Bone weakening
  3. Serious neurological or vascular pathology
  4. Clinical features of a serious illness
  5. Inability to establish a working diagnosis
  6. Excessive pain
  7. Informed consent is not able to be given by the patient
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6
Q

What are 4 serious pathologies?

A

Cauda Equina syndrome, fracture, malignancy, infection

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7
Q

Name all the bondy landmarks of the shoulder complex (including the joints)

A

Sternoclavicular
Acromioclavicular
Glenohumeral joint
Scapulothoracic
Coracoid process
Acromion
Humeral head
Clavicle
Lesser & greater tubercle of humerus
Bicipital (intertubercular) groove

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8
Q

Name all the anterior axioappendicular muscles of the shoulder

A

Pec major
Pec minor
Subclavious
Serratus anterior

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9
Q

What are the attachments, nerve supply, and action of Pectoralis major?

A

PA - medial clavicle, sternum
DA - lateral lip of intertubercular groove
N/S - medial & lateral pectoral nerve
A - adducts and medially rotates GH joint.

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10
Q

What are the attachments, nerve supply, and action of Pectoralis minor?

A

PA - ribs 3-5
DA - coracoid process of scapula
A - protracts & stabilises scapula
N/S - medial pectoral nerve

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11
Q

What are the attachments, nerve supply, and action of Serratus anterior?

A

PA - ribs 1-8
DA - anterior surface of medial scapular border
A - protracts, superiorly rotates & stabilises scapula
N/S - long thoracic nerve

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12
Q

Name all the posterior axioappendicular muscles of the shoulder

A

Trapezius
Latissimus dorsi
Levator scapulae
Rhomboid major & minor

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13
Q

What are the attachments, nerve supply, and action of the Trapezius?

A

PA - skull, nuchal ligament, C7-T12 SPs
DA - lateral clavicle, acromion, spine of scapula
A - elevates, depresses, retracts & superiorly rotates scapula
N/S - Accessory nerve

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14
Q

What are the attachments, nerve supply, and action of the latissimus dorsi?

A

PA - T7-T12 SPs, thoracolumbar fascia, iliac crest
DA - floor of intertubercular groove of humerus
A - extends, adducts & medially rotates GH joint
N/S - thoracodorsal nerve

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15
Q

What are the attachments, nerve supply, and action of Levator scapulae?

A

PA - C1-C4 transverse processes
DA - superior medial border of scapula
A - elevates & inferiorly rotates scapula
N/S - dorsal scapular nerve

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16
Q

What are the attachments, nerve supply, and action of Rhomboid major & minor?

A

PA - nuchal ligament, C7-T1 SPs
DA - medial scapula border
A - retracts & inferiorly rotates scapula & stabilises it
N/S - dorsal scapular nerve

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17
Q

Name all the scapulohumeral intrinsic shoulder muscles (including rotator cuff)

A

Deltoid
Teres major
Teres minor
Supraspinatus
Infraspinatus
Subscapularis

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18
Q

What is the attachment, nerve supply, and action of the deltoid?

A

PA - lateral clavicle, acromion, spine of scapula
DA - deltoid tuberosity
A - abducts (middle); flexes/medially rotates (anterior); extends/laterally rotates (posterior)
N/S - axillary nerve

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19
Q

What is the attachment, nerve supply, and action of teres major?

A

PA - inferior angle of scapula
DA - medial lip of intertubercular groove
A - adducts & medially rotates GH joint
N/S - lower subscapular nerve

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20
Q

What is the attachment, nerve supply, and action of supraspinatus?

A

PA - supraspinous fossa
DA - superior facet of greater tubercle
A - initiates abduction of GH joint & stabilises it
N/S - suprascapular nerve

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21
Q

What is the attachment, nerve supply, and action of infraspinatus?

A

PA - infraspinous fossa
DA - middle facet of greater tubercle
A - laterally rotates & stabilises GH joint
N/S - suprascapular nerve

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22
Q

What is the attachment, nerve supply, and action of teres minor?

A

PA - lateral border of scapula
DA - inferior facet of greater tubercle
A - laterally rotates & stabilises scapula
N/S - axillary nerve

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23
Q

What is the attachment, nerve supply, and action of subscapularis?

A

PA - subscapula fossa
DA - lesser tubercle of humerous
A - medially rotates & stabilises GH joint
N/S - upper & lower subscapular nerve

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24
Q

Name all the arm muscles

A

Biceps brachii
Brachialis
Coracobrachialis
Triceps brachii
Aconeus

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25
What are the attachments, nerve supply, and actions of the biceps brachii?
PA - long head - supraglenoid tubercle short head - coracoid process of scapula DA - radial tuberosity A - supinates forearm, & flexes elbow (when supinated); short head resists GH dislocation N/S - musculocutaneous nerve
26
What are the attachments, nerve supply, and actions of the brachialis?
PA - distal half of anterior humerus DA - ulnar tuberosity A - flexes elbow joint in all positions N/S - musculocutanous
27
What are the attachments, nerve supply, and actions of the coracobrachialis?
PA - coracoid process of scapula DA - medial humerus A - flexes and adducts N/S - musculocutaneous
28
What are the attachments, nerve supply, and actions of the triceps brachii?
PA - Long head: infraglenoid tubercle Lateral head: post. humerus (above radial groove) Medial head: post. humerus (below radial groove) DA - olecranon process A - extends elbow; long head resits GH dislocation N/S - radial nerve
29
What are the attachments, nerve supply, and actions of the aconeous?
PA - lateral epicondyle DA - olecranon A - extends elbow N/S - radial
30
List the components of observational, regional and functional screening
Observation (swelling, bruising, reddness) Functional movements/activities of daily living Gait Posture Cervical spine motion Upper extrem. Lumbar/thoracic motion Thoracic cage Lower extrem.
31
State the 3 types of barriers when testing certain structures
Physiological barrier - tests movement of active and passive structures (muscles) Elastic barrier - tests movement ligaments, joint capsule, PROM, joint play in passive structures Anatomical barrier - the theoretical limit before tissue damage occurs
32
What is Active Range of Motion? What movements do we assess for the shoulder joint?
AROM assesses the muscles within the physiologic barrier. Allows for the assessment of ROM control, pain, and the patient's willingness to perform specific movements. Movements: Flex/ext, abd/add, int/ext rotation, horizontal flex/ext, elevation/depression, protraction/retraction
33
What is Passive Range of Motion? Movements are the same as AROM.
PROM is where the practitioner performs the movement while the patient is completely relaxed. This assesses the ligaments and joint capsules to identify any hypo/hyper-mobility of joints, pain, and the patient's ability to perform assisted movements.
34
How many times do we repeat PROM for?
2-3 times, ensuring we ask the patient pain and comfort levels
35
What is joint play?
Joint play assesses the subtle, involuntary movements of joints (gliding, sliding, rotations) that the patient cannot perform themselves.
36
What is resisted isometric testing?
Practitioner provides force to the movement as the patient resists for at least 5 seconds.
37
Which muscles produce abduction of the GH joint?
Deltoid, supraspinatus
38
Which muscles produce external rotation of GH?
Deltoid, infraspinatus, teres minor
39
Which muscles produce extension of GH?
Deltoid, lat dorsi
40
Which muscles produce adduction of GH?
Lat dorsi, pec major, teres major
41
Which muscles produce internal rotation of GH?
Pec minor, subscapularis, teres major
42
Which muscles produce flexion of GH?
Deltoid
43
Which muscles produce horizontal flexion?
Pec major, anterior deltoid
44
Which mucles produce horizontal extension?
Deltoid, posterior rotator cuff muscles
45
What are orthopedic tests?
A biomechanical stress test to highlight points of restriction or excessive strain.
46
What is sensitivity and specificity?
Sensitivity - individuals HAVE the condition, and test POSITIVE Specificity - individuals who DON'T have condition and test NEGATIVE
47
What is an apprehension & relocation orthopedic test for the GH joint? What is a positive finding? What conditions do they test for?
Apprehension test: Practitioner laterally rotates patient's arm while in 90° flexion. Positive finding - excessive movement of humeral head Indicates if patient has anterior glenohumeral instability or a labral tear. Relocation test: Test only continues if the patient tests positive for those conditions. Practitioner applies gentle compression on upper humerus while doing lateral rotation to manually relocate/relieve the pain. Positive finding - apprehension pain is relieved
48
What is the infraspinatus orthopedic muscle test? What is a positive finding?
Patient's elbow is at 90° and medially rotates while practitioner applies force so the patient can resist. Positive finding - inability to resist indicates infraspinatus pathology
49
What is the lift off orthopedic test? What is a positive finding?
Patient places their arm behind their back at 90° and resists extension force from practitioner. Positive finding - inability to lift hand, and/or any pain/weakness indicates subscapularis pathology
50
What is the Hawkin's kennedy orthopedic test? What is a positive finding?
Patient forward flexes the arm to 90° and medially rotates the shoulder Positive finding - pain when patient performs this test. Indicates subacromial pain syndrome.
51
What is the Neer's orthopedic test? What is a positive finding?
Patient arm is passively moved into GH flexion in forward position, with the arm in internal rotation. Positive finding - pain producing movement Indicates subacromial pain syndrome
52
What is the empty can test? What is a positive finding?
Patient abducts both arms to 90° horizontally. Arms facing downwards as the practitioner resists abduction. Positive finding - pain or weakness when doing movement Indicates supraspinatus pathology or subacromial pain syndrome.
53
What are the 4 therapeutic mechanisms?
1. Decrease pain 2. Promote mobility and movement 3. Support tissue healing and collagen remodelling 4. Promote fluid drainage
54
What are the minor/transient reactions of osteopathic treatment?
Headache, tiredness, muscle tenderness, short-term stiffness or soreness
55
What are the moderate/substantive reactions of osteopathic treatment?
Medium-long term pain or loss of function, peripheral nerve injury
56
What are the major/serious reactions of osteopathic treatment?
Fracture, dislocation, rupture of tendon, ligament or muscle
57
What are the indications of soft tissue techniques?
Hypertonic tissues Tender or painful tissues Shortened muscles/tissue Poor circulation in muscles/tissue Stress or tension in patient
58
Name the 7 types of soft tissue techniques
Cross fibre kneading Longitudinal Inhibition Myofascial release Effluerage Stretching
59
How long do you perform a soft tissue technique?
All is performed for 60-90 seconds or untill a tissue texture change, except for stretching (15-30 seconds)
60
What are the 4 tests in a neurological exam?
1. Reflex testing 2. Motor testing - tone, strength 3. Sensory testing - pain/temp, light touch, vibration, proprioception 5. Coordination - point-point coordination
61
State the myotomes of the upper limb
C4 - Shoulder elevation C5 - Shoulder abduction C6 - Elbow flexion, wrist extension C7 - Elbow extension C8 - Finger flexion T1 - Finger abd/add
62
What can you observe when looking at the elbow region?
Inflammation - redness/swelling Bruising Scars Cuts Skin conditions Skin infection
63
What are the 4 types of elbow alignments?
1. Normal carrying angle 2. Excessive cubitus valgus 3. Cubitus varus 4. Gun stock deformity
64
What movements are available to assess AROM of the elbow?
Flexion (135-145°), extension (0-5°) , supination and pronation (80-90°)
65
What movements does the practitioner perform PROM for the patient?
Flexion (135-145°), extension (0-5°) , supination and pronation (80-90°)
66
Identify all the bony landmarks when palpating the elbow?
Medial epicondyle Medial supracondylar ridge Olecranon Olecranon fossa Ulna Lateral epicondyle Lateral supracondylar ridge Radial head Radius
67
Name all the anterior forearm muscles (superficial)
Pronator teres Flexor carpi radialis Palmaris longus Flexor carpi ulnaris Flexor digitorum superficialis
68
What are the attachments, and action of the pronator teres?
PA - medial epicondyle, coranoid process DA - lateral surface of radius A - pronates forearm, flexes elbow
69
What are the attachments and actions of the flexor carpi radialis?
PA - medial epicondyle of humerus DA - base of 2nd metacarpal A - flexes and radially deviates wrist
70
What are the attachments and actions of the flexor carpi ulnaris?
PA - medial epicondyle DA - pisiform, hook of hamate, base of anterior 5th metacarpal A - flexors and ulnar deviates the wrist
71
What are the attachments and actions of the flexor digitorum superficialis?
PA - medial epicondyle DA - middle phalanges 2-5 A - flexes the PIP & MCP joints of digits 2–5
72
Name all the lateral soft tissues of the elbow
Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Lateral collateral ligament
73
Name all the posterior forearm muscles (superficial)
Brachioradialis Extensor carpi radialis longus Extensor carpi radialis brevis Extensor digitorum Extensor digiti minimi Extensor carpi ulnaris
74
What are the attachments and actions of the brachioradialis?
PA - lateral supracondylar ridge DA - lateral distal radius A - flexes elbow in a mid-prone position
75
What are the attachments and actions of the extensor carpi radialis longus?
PA - lateral supracondylar ridge DA - base of 2nd metacarpal A - extends and radially deviates wrist
76
What are the attachments and actions of the extensor carpi radialis brevis?
PA - lateral epicondyle DA - base of 3rd metacarpal A - extends and radially deviates wrist
77
What are the attachments and actions of extensor digitorum?
PA - lateral epicondyle DA - posterior digits 2-5 A - extends digits 2–5 at MCP & IP joints
78
What are the attachments and actions of the extensor digiti minimi?
PA - lateral epicondyle DA - posterior 5th digit A - extends the 5th digit at the IP & MCP joints
79
What are the attachments and actions of extensor ulnaris?
PA - lateral epicondyle DA - base of 5th metacarpal A - extends & ulnar deviates wrist
80
What are the 3 joint play techniques of the elbow?
1. Traction of elbow, can be on a long-axis (radiohumeral joint) or short axis/flexed (humeroulnar) 2. Medial and lateral gapping 3. AP/PA glide/shear
81
What movements are tested using resisted isometric testing on the elbow & wrist.
Elbow flexion and extension at 90°, pronation/supination, wrist flexion/extension
82
How long do you hold a resisted isometric test for, and how many times do you repeat it?
Hold for 5 seconds, repeat 2-3 times
83
What is the valgus and varus orthopedic stress test?
Both test for any ligament sprains/ruptures. The valgus stress test assesses the medial collateral ligament, and the varus stress test assesses the lateral collateral ligament. (they require the same movemnents as medial and lateral gapping, but at 20-30° elbow flexion)
84
What is the Cozen's orthopedic test of the elbow?
Tests for lateral epicondyalgia. The arm is positioned in a pronated positioned, radially deviated as the patient extends resistance, practitioner provides force over the wrist.
85
What is the Maudsley's orthopedic test for elbow?
Tests for lateral epicondylalgia where the patient resists extension of the 3rd digit.
86
What is Tinel's orthopedic test of the elbow?
Tests the ulnar nerve at the medial side of the elbow. Practitioner repeatedly taps the ulnar nerve to see if patient experiences a tingling sensation.
87
What are the passive articulations for the elbow?
Flexion Extension Supination Pronation
88
What are the joint play articulations for the elbow?
Traction: Humeralulnar and radiohumeral Medial and Lateral gapping PA/AP shear radial head
89
What are the 4 soft tissue techniques for the elbow?
Cross fiber kneading Longitudinal Inhibition Forearm stretch - flexors & extensors
90
What are the 5 rehabilitation exercises for the elbow/arm?
Forearm Extensor Stretch (Static) Forearm Flexor Stretch (Static) Biceps Stretch (Static) Triceps Stretch (Static) Pronation/Supination with stick/Band (Dynamic)
91
Name all the carpal bones. Which ones are the proximal and distal row?
Prox. Scaphoid Lunate Triquetrum Pisiform Dist. Trapezium Trapezoid Capitate Hamate
92
Name the rest of the bony landmarks of the hand
Metacarpals Metacarpohalangeal joints Phalanges Proximal and distal interphalangeal joints
93
What are the borders of the anatomical snuff box?
Anterior (radial) border: Extensor pollicis brevis Abductor pollicis longus Posterior (ulnar) border: Extensor pollicis longus Floor: Scaphoid and trapezium bones Radial artery Roof: Skin and fascia Superficial branch of radial nerve passes superficial to the space
94
What are the dorsal soft tissues of the hand? (posterior)
Extensor pollicis brevis Abductor pollicis longus Extensor carpi radialis longus/brevis Extensor pollicis longus Extensor digitorum Extensor indicis Extendsor digiti minimi Extensor carpi ulnaris
95
What are the palmar soft tissues of the hand? (anterior)
Flexor carpi ulnaris Ulnar tunnel Palmaris longus Carpal tunnel Flexor carpi radialis Radial artery
96
What can you look for when observing the wrist/hand?
Skin Scars, Deformity Swelling Colour changs Nail changes
97
What are the AROM/PROm movements of the wrist/hand?
Pro/sup Wrist flex/ext Radial & ulnar deviation Thumb flex/ext Thumb abd/add Finger flex/ext Finer abd/add Opposition of thumb
98
What are the joint play movements of the wrist/hand?
Shear distal radioulnar joint PA/AP shear/glide of carpal bone rows PA/AP shear/glide of individual carpal bones Shear metacarpals 1st CMC/IP joint, 2nd-5th MCP/PIP/DIPs: - Traction - Rotation - Shearing
99
What are the resisted isometric testing movements for the wrist/hand?
Distal radioulnar joint – pro/sup Wrist – flexion/extension, radial/ulnar deviation Thumb – flex/ext, abd/add, opposition Finger(s) – flex/ext, abd/adduction
100
What is the phalen's orthopedic test? What is a positive finding?
Patient flexes their wrists together for 30 seconds. PF - paraesthesia in fingers innervated by the median nervel; tests for carpal tunnel
101
What is the carpal compression test?
Practitioner applies pressure over the median nerve in the carpal tunnel for 30 seconds PF - paraesthesia in fingers innervated by the median nervel; tests for carpal tunnel
102
What is tinel's sign at the wrist orthopedic test?
Practitioner taps over the carpal tunnel at the wrist 3-5 times. PF - paraesthesia in fingers innervated by the median nervel; tests for carpal tunnel
103
What is the hand elevation orthopedic test?
Patient elevates hands overhead with wrist flexion for no longer than 2 mins PF - paraesthesia in fingers innervated by the median nervel; tests for carpal tunnel
104
What are the passive articulation techniques for the wrist?
Flexion, extension, radial/ulnar deviation, pronation/supination
105
What are the passive articulation techniques for the metacarpophalangeals?
Flexion, extension, abduction, adduction
106
What are the passive articulation techniques for the interphalangeals?
Flexion/extension
107
What are the joint play techniques for the wrist?
Distal radioulnar shear PA/AP glide/shear of the carpals (proximal & distal row) PA/AP glide/shear of intercarpal joints (individual carpal)
108
What are the joint play techniques for the hand?
Shear of metacarpals
109
What are the joint play techniques for the carpometacarpals?
PA/AP glide/shear Traction
110
What are the joint play techniques for the interphalangeals?
PA/AP glide/shear Traction Rotation

Osteopathy (1 decks)

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