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Fundamentals of MSK > Fundamentals of MSK > Flashcards

Fundamentals of MSK Flashcards

1
Q

What is a differential diagnosis?

A

Systematic process used to identify the most probably dx from a set of possible competing diagnosses

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2
Q

When does a differential diagnosis begin?

A

In the hx with a working dx

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3
Q

What does the differential diagnosis direct?

A

The POC

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4
Q

What should we do when we begin our examination?

A

Obtain informed consent

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5
Q

What should we know about informed consent?

A

Specific
benefits and risks
offer options
full understanding

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6
Q

What does a history provide us with?

A

A mutual patient focused relationship

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7
Q

What should our history questioning begin with?

A

Open ended questions

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8
Q

When should we use closed ended questions in our history?

A

To clarify and verify

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9
Q

What kind of questions do we not want in our history?

A

Leading questions

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10
Q

What does SINSS stand for?

A

Severity
Irritability
Nature
Stage
Stability

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11
Q

Why do we use SINSS?

A

Helps determine the vigor and extent of physical exam and intervention as well as prognosis

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12
Q

What is minimal severity?

A

0-3/10
intermittent pain/limitation/medication

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13
Q

What is moderate severity?

A

4-7/10
Intermittent and constant pain/limitaiton/medication

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14
Q

What is maximal severity?

A

8-10/10
constant pain/limitation/severity

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15
Q

What about sleep are we concerned with?

A

If it is interrupted, influence of positional changes

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16
Q

What do we need to know about medications and supplements?

A

Dosage - OTC or precription
Frequency
Results

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17
Q

What is minimal irritability?

A

Easing > aggravating activities
Easier relief and slower aggravation

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18
Q

What is moderate irritability?

A

Easing = aggravating activities
Similar relief and aggravation timing

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19
Q

What is maximal irritability?

A

Aggravating > easing activities
Easier aggravation and slower relief

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20
Q

What is a mechanical issue?

A

Symptoms respond to movement

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21
Q

What is a non-mechanical issue?

A

Symptoms do NOT respond to movement - RED FLAG

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22
Q

What is nociceptive pain?

A

MSK or viscerogenic
vague, dull, achy

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23
Q

What is neuropathic pain?

A

Nervous tissue compromised
paresthesias and/or numbness

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24
Q

What is nociplastic pain?

A

Mismatched and heightened pain perception

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25
Q

pain that is inflammatory is ….?

A

sharp

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26
Q

What do patient characteristics such as psychological factors influence?

A

pain perception

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27
Q

What is a suspicious MSK red flag S&S?

A

unwillingness to move or splinting after trauma

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28
Q

What qualifies a condition as being acute?

A

less than 3 weeks

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29
Q

What qualifies a condition as being sub-acute?

A

3-6 weeks

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30
Q

What qualifies a condition as persistent?

A

More than 6 weeks

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31
Q

What is high sensitivity better at?

A

RULING OUT

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32
Q

What parts of the social history should we be concerned with?

A

Smoking
alcohol
drugs
work

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33
Q

When does observation happen?

A

From introduction through intervention

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34
Q

What may we observe during conversation?

A

Slurred speech, hoarseness

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35
Q

What are some structural characteristics we may observe during observation?

A

Body type, postures, swelling, skin markings, hair quality, asymmetries, othotics, etc.

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36
Q

What is a red flag that we may see during observation?

A

deformity after trauma

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37
Q

What is our general assessment?

A

Scan or screen

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38
Q

What is a biomechanical exam?

A

Greater detailed assessment based on scan findings

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39
Q

What are symptoms?

A

Reported by/for the patient

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40
Q

What are signs?

A

Objective; measured by the clinician

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41
Q

Can symptoms be present without signs or impairments?

A

Yes

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42
Q

What are the 5 purposed of a scan?

A
  1. assess for red flag S&S
  2. assess neuro status
  3. determine if symptoms are referred or radicular
  4. assess severity of condition
  5. identify need for more in-depth biomechanical exam
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43
Q

What does active ROM assess?

A

Willingness to move, ROM, integrity of contractile and inert tissues, pattern of restriction, quality of motion, and symptom reproduction

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44
Q

What does passive ROM assess?

A

Integrity of inert and contractile tissues, ROM, end feel, and sensitivity

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45
Q

What does resisted testing assess?

A

Integrity of contractile tissues

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46
Q

What does stress testing assess?

A

Integrity of inert tissues

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47
Q

What does neurologic testing assess?

A

Nerve conduction

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48
Q

What should we scan first without recent trauma?

A

spine first

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49
Q

What do we scan first with recent trauma?

A

involved areas first

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50
Q

What is the purpose of selective tissue tension testing?

A

discerning contractile from non-contractile tissue integrity

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51
Q

What are contractile tissues?

A

muscles
tendons
fascia

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52
Q

What are non-contractile tissues?

A

everything else such as cartilage, bones and ligaments

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53
Q

What are the 3 components of a STTT?

A

A/Prom with overpressure
combined motions
Resisted testing

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54
Q

What do we observe with ROM?

A

Quantity and quality

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55
Q

What is WNL ROM?

A

full, pain free, coordinated motion and smooth curves

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56
Q

What does aberrant motion indicate?

A

joint hypermobility/instability

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57
Q

What do sharp curves or fulcrums in the spine indicate?

A

Impaired motions

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58
Q

Full quantity of ROM is not always synonymous with …

A

Normal or efficient motion

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59
Q

What are essential or basic ADLs?

A

Walking, reaching, squatting, bending, turning, etc.

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60
Q

What are some higher level ADLs?

A

Lifting, throwing, jumping, running, etc.

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61
Q

What does improved pain/function with repetitive tests indicate?

A

Possible inhibited muscle, disc injury, etc.

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62
Q

What does worse pain/function with repetitive tests indicate?

A

Acute injury/irritation

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63
Q

What can a inhibited muscle be due to?

A

Pain
swelling
disuse/immobilization
joint laxity

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64
Q

What is an end feel?

A

What the clinician feels at the end of a movement

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65
Q

What type of tissue is indicated if the same pain occurs in the same direction of AROM and PROM?

A

Non-contractile tissue

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66
Q

What type of tissue is indicated if PROM is similarly restricted as AROM in the same direction?

A

Hypomobility, protective guarding or a shortened muscle

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67
Q

What is indicated by PROM being significantly greater than AROM in the same direction?

A

Hypermobility/instability

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68
Q

When should we perform combined motion?

A

If uniplanar motions don’t provide much if any guiding information

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69
Q

What kind of motions are combined motions usually??

A

Circumductions

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70
Q

What does a consistent block indicate?

A

Hypomobility so follow up with accessory motion tests

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71
Q

What does an inconsistent block or crepitus indicate?

A

Hypermobility/Instability so follow up with stability tests

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72
Q

What does opposing spinal quadrants being consistently blocked indicate?

A

A fibrotic joint so follow up with accessory motion tests

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73
Q

How long do we hold manual muscle tests?

A

At least 3 seconds

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74
Q

What would strong and painful resisted testing indicate?

A

Mild injury

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75
Q

What does weak and painful resisted testing indicate?

A

Acute, moderate to severe injury

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76
Q

What does a painless and strong resisted testing indicate?

A

Normal

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77
Q

What does weak and painless resisted testing indicate?

A

Neurological damage or chronic contractile rupture

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78
Q

What do symptoms upon release of resisted testing indicate?

A

Non contractile tissue

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79
Q

What do multiple planes of weakness at one joint with resisted testing indicate?

A

Severe injury

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80
Q

What do multiple joint of weakness indicate with resisted testing?

A

Possible CNS issue

81
Q

What does weakness throughout a range and NOT just in mid range indicate with resisted testing?

A

Possible Pathology

82
Q

If resisted testing is weak and painful you can retest up to ___ times?

A

3

83
Q

When would we NOT perform stress tests?

A

If known damage, deformity, or fusion

84
Q

What does pain with the brief force with stress tests indicate?

A

Acute condition

85
Q

What would we find with stress tests that would indicate hypermobility?

A

Late, empty and or soft end feels
click clunk and/or spasm

86
Q

What does increased pain with distraction indicate?

A

Capsule ligament or annulus

87
Q

What does decreased pain with distraction indicate?

A

Joint surface tissues such as cartilage nucleus pulposus bone or spinal nerve involved

88
Q

What does decreased pain with compression indicate?

A

Capsule, ligament, or annulus involved

89
Q

What does increased pain with compression indicate?

A

Joint surface tissues such as cartilage nucleus pulposus bone or spinal nerve involved

90
Q

What does it mean if both distraction and compression produce pain?

A

Acute condition

91
Q

What are dematomes? What do they create?

A

An area of skin sensation supplied by single segmental spinal nerves with considerable overlap, typically creates paresthesias

92
Q

What are cutaneous nerve distributions?

A

An area of skin supplied by a peripheral nerve, more distinct boundary; typically creates numbness

93
Q

What is the first sensation lost?

A

Light touch

94
Q

If sensation with light touch is diminished, what do we do next?

A

Repeat for incrimination of either spinal nerve or cutaneous nerve pattern

95
Q

If both ligh and sharp touch are WNL but the patient has paresthesias, use the pinwheel to check for…

A

Hyperesthesias

96
Q

If loss of light touch check..

A

Vibration, 2 pt discrimination, and proprioception for possible dorsal column issue

97
Q

If loss of sharp touch check…

A

Temperature and crude touch for possible spinothalmic tract issue

98
Q

What are the grades for neuro tests?

A

0= absent
1= diminished
2= WNL
3= hyperesthesia

99
Q

What is deep tendon reflex?

A

Look from muscle spindle afferents to ventral horn efferents

100
Q

What are the grades of DTR neurological tests?

A

0= absent LMN condition
1+ = hyporeflexive; LMN consition
2+ = WNL
3+ = hyperreflexive; UMN condition
4+ clonus > than 3 beats; UMN condition

101
Q

What are myotomes?

A

key muscle or group of muscles innervated by single spinal nerve

102
Q

What do myotomes test for?

A

Fatiguing weakness

103
Q

How much conduction loss is needed before percievable fatiguing weakness?

A

80%

104
Q

What does dural mobility assess?

A

Sequential/progressive assessment of neural mechanosensitivity

105
Q

What are we looking for with dural mobility testing?

A

Reproduction of achy or sharp symptoms or paresthesias

106
Q

Slow growing tumors may cause dural mobility to be …

A

WNL - not much inflammation

107
Q

What is muscle tone for a LMN condition?

A

Decreased or flacid

108
Q

What is muscle tone for a UMN condition?

A

Increased or spastic

109
Q

What will a LMN do to the bowel and bladder?

A

Cause incontinence or leakage

110
Q

What will a UMN do to the bowel and bladder?

A

Spastic/retentive

111
Q

What are dematomes/myotomes findings for a LMN condition?

A

Often a single segment

112
Q

What are dermatomes/myotomes findings for a UMN condition?

A

Multi-segments diminished

113
Q

What are DTRs with LMN conditions?

A

Hypoactive

114
Q

What are DTRs with UMN condition?

A

Hyperactive

115
Q

What is accessory motion testing?

A

Involuntary joint surface motion: roll glide and spin

116
Q

When do we perform accessory motion?

A

If limited ROM and/or consistent block during combined motions

117
Q

Is it easier to pick up joint hypomobility than joint hypermobility?

A

Hypomobility

118
Q

What is PPM?

A

Passive Physiological Mobility - assessing glides with extremity osteokinematic

119
Q

What is PAM?

A

Passive accessory mobility - assessing glides without ostokinematics, more often performed in extremities

120
Q

What is PPIVM?

A

Passive Physiologic Intervertebral Mobility
- assessing glides with spinal osteokinematics

121
Q

What is PPAIVM?

A

Passive physiologic Accessory Intervertebral Mobility - assessing glides without osteokinematics

122
Q

What is joint hypomobility indicated by in accessory motion?

A
  • limited gliding
  • early, firmed end feell
123
Q

What is joint hypermobility/instability indicated by with accessory motion?

A
  • excessive gliding
  • later, softer, and/or empty end feel
  • click, clunk, spasm
124
Q

If accessory motion and ROM limited, then restriction is __________ or related to a joint restriction

A

Articular

125
Q

If accessory motion is WNL or excessive but ROM limited then restriction is _____________

A

Extraarticular

126
Q

What does accessory motion abnormality indicate?

A

Improper axis of joint motion and subsequent excessive stress on adjacent tissue

127
Q

What is a centrode?

A

Axis

128
Q

What does the centrode do?

A

Changes due to gliding and rolling

129
Q

What are special tests?

A

More precise than stress tests, may help to identify a more specific tissue, its integrity and assess progress

130
Q

Why are most special tests not “special”?

A

Fail to incriminate a tissue, make a dx, or determine an effective intervention as they clain

131
Q

What are provocative tests?

A

Identify tissues by the reproduction of tissues

132
Q

What do provocation assess the integrity of?

A

Non-contractile tissues

133
Q

What does segmental play assess for?

A

Excessive linear shearing or vertebra

134
Q

When do we perform provocative tests?

A

If excessive ROM and/or inconsistent block noted with combined motions

135
Q

How long do we hold provocative tests?

A

10 secs

136
Q

What position should we test stability in?

A

CPP

137
Q

What do muscle length tests help us determine?

A

Passive flexibility of muscles

138
Q

What is sensitivity or SNOUT?

A

so good at finding positives when the test is negative you can rule the tissue/condition OUT

139
Q

What is SNOUT good for?

A

Avoiding false negatives

140
Q

What is specificity or SPIN?

A

So good at finding negatives that when the test is positive you can rule the tissue/condition in

141
Q

What is the acceptable level for sensitivity and specificity?

A

~90%

142
Q

What does a likelihood ratio combine?

A

Sensitivity and specificity

143
Q

What is the likelihood ratio not affected by?

A

condition prevlanace

144
Q

What is a postive likelihood ration?

A

Likelihood of a positive test when a patietint has the condition - the higher the better

145
Q

What is a large likelihood shift?

A

> 10

146
Q

What is a moderate likelihood shift?

A

5-10

147
Q

What is a negative likelihood ratio?

A

Likelihood of a negative test when the patient does not have the condition; the lower the better

148
Q

What is a large likelihood shift?

A

<.1

149
Q

What is a moderate likelihood shift?

A

.1-.2

150
Q

What is MMT?

A

Typically mid-range with break test and dont let me move you commend

151
Q

What is the lengthened position in terms of MMT?

A

Passively insufficient position used to locate milder or grade I muscle strains that were not painful in mid-range

152
Q

Why do we test MMT in mid-range?

A

Muscle in strongest position

153
Q

When is the muscle in its weakest position?

A

when fully shortened

154
Q

When is a muscle in a position of passive insufficency?

A

Fully lengthened

155
Q

How long do we hold MMT?

A

At least 3 seconds

156
Q

Why do we hold MMT for 3 seconds?

A

To better assess neuromuscular adaptation capacity and NOT max strength

157
Q

What is MMT not good at finding?

A

Smaller deficits

158
Q

What does MMT tend to overestimate?

A

Strength

159
Q

Can MMT be used to predict function?

A

NO

160
Q

What does it mean when you have symptoms upon release with MMT?

A

Possible articular issue as glide is released when muscle relaxes

161
Q

What does it mean when you have multiple planes of weakness at one joint with MMT?

A

Possible acute and/or significant injury

162
Q

What does it mean when someone has multiple joint of weakness with MMT?

A

Possible CNS issue

163
Q

What does it mean when someone has weakness throughout a range in MMT?

A

Possible pathology

164
Q

What does it mean if with repetitive MMT the patient has improved pain / function?

A

Inhibited muscle and/or regional interdependance

165
Q

What does it mean if with repetitive test findings a patient has fatiguing weakness?

A

Decreased nerve conduction

166
Q

What does it mean if with repetitive tests of MMT a patient has a consistent weak force?

A

Deconditioned/torn muscle

167
Q

What does it mean if with repetitive MMT testing a patient has worse pain/function?

A

Acute injury/irritation

168
Q

How long should endurance holds be?

A

Solid for ~20 seconds

169
Q

What is muscle activation and endurance assessing?

A

stabilizing, postural and local muscles

170
Q

What does a warm temp with palpation indicate?

A

Acuity

171
Q

What does a cold temp with palpation indicate?

A

Poor circulation

172
Q

What does turgor and possible pain with skin rolling?

A

Dehydration or nociplastic pain

173
Q

What does watery swelling indicate?

A

Acuity

174
Q

What does thickness and pitting swelling indicate?

A

Chronicity

175
Q

What is hypertonicity of a muscle? What causes it?

A

Inhibited muscles that are overworked and protecting

176
Q

When is hypertonicity palpation not reliable?

A

in deeper spinal muscles

177
Q

What is TTP doing?

A

Localizing involved tissue or deformity such as a fracture or tear

178
Q

What are the grades of TTP?

A

0- none
I - mild
II- mod
III - severe
IC - hypersensitive

179
Q

What kind of diagnosis is rarely made clincally?

A

Absolute dx

180
Q

What is hypothetico-deductive reasoning?

A

methodical investigation of all data from multiple hypotheses

181
Q

What population uses hypothetico-deductive reasoninc?

A

More by PT students or when experienced clinicians don’t see a pattern

182
Q

Is hypothetico-deductive reasoning more analytic or intuitive?

A

Analytic and slower; deductive reasoning

183
Q

What is pattern recognition?

A

A recognizable set of signs and symptoms

184
Q

Who uses pattern recognition more?

A

Experienced physical therapists

185
Q

What is pattern recognition promoted by?

A

Clinical prediction rules

186
Q

Is pattern recognition more analytic or intuitive?

A

Intuitive and efficient; inductive reasoning

187
Q

When should we use both types of reasoining?

A

Always to some degree to reduce the error of the other

188
Q

What are short term goals?

A

Anticipated interim steps

189
Q

What are long term goals?

A

overall outcomes

190
Q

What is a prognosis?

A

Predicted level of function in a specified time

191
Q

What is prognosis based on?

A

Numerous + and - factors such as severity, PMH, age, time for tissue healing, etc.

192
Q

What guides the POC?

A

Prognosis

193
Q

What is minimal detectable change (MDC)?

A

Minimal change that exceeds measurement error

194
Q

What does MDC indicate?

A

Clinical relevance

195
Q

What is minimally clinically important difference (MCID)?

A

measures clinical relevance; more definitive measure of improvement

196
Q

What is EQ-5D?

A

commonly used generic instruments; captures quality of life from mobility, self-care, usual activity, pain, and anxiety/depression

197
Q

What is the Orebro MSK pain screening tool?

A

A tool designed specifically to facilitate clinical decision making

198
Q

What is the MSK patient reported outcome measures?

A

A tool that enables clinicians to quickly evaluate and monitor MSK health status using question s for each health domain

Fundamentals of MSK (4 decks)

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