module 21 MS part 1

Question 1

4 parts to the MS exam

Answer 1

inspection
palpation
ROM
muscle-strength

Question 2

Inspection

Answer 2

posture and spine
joints
gait
positioning
symmetry
gross deformity or misalignment 
hypertrophy or atrophy
unusual movement
discoloration
swelling

Question 3

Palpation

Answer 3

tenderness
inflammation
edema
crepitus
tone
joint mobility: passive or active

Question 4

passive palpation

Answer 4

provider is manipulating the joint

- how the joint feels

Question 5

active palpation

Answer 5

provider palpating the joint while the pt moves it through its ROM
- looking for crepitus, popping, tracking issues

Question 6

ROM

Answer 6

flexion
extension and hyperextension
rotation
adduction
abduction
pronation
supination
eversion
inversion

Question 7

Active ROM

Answer 7

activating contractile elements of limb or joint
- muscles, tendons, nerves
stressing non-contractile components
- bones, ligaments, menisci
Determining which component is affected or limiting ROM not immediately possible.

Question 8

passive ROM

Answer 8

testing only non-contractile components of joint

- bones, ligaments, menisci

Question 9

P-ROM > A-ROM

Answer 9

problem is either with the muscle of the nerve supplying the muscle

• by removing stress on these components during P-ROM, greater ROM was achieved.
• • torn or avulsed muscle

Question 10

P-ROM = A-ROM

Answer 10

suggests the problem is within the joint

- frozen shoulder syndrome, dislocations, fractures

Question 11

Muscle strength testing

Answer 11

combine with ROM
test in all ranges
think in opposites
test large muscle groups

Question 12

Strength testing: 0

Answer 12

no muscle contraction is detected visually or with palpation

Question 13

Strength testing: 1

Answer 13

a trace of muscle contraction is detected visually or with palpation, but no movement of the joint.

Question 14

Strength testing: 2

Answer 14

pt is actively able to move the muscle when gravity is removed. (side to side, or laying on side)

Question 15

Strength testing: 3

Answer 15

pt is able to actively move the muscle against gravity but not against any resistance

Question 16

Strength testing: 4

Answer 16

pt is able to actively move against some resistance

- compare side to side

Question 17

Strength testing: 5

Answer 17

pt is able to actively move against and overcome resistance applied

Question 18

orthopedic tests purpose

Answer 18

pinpoint specific nature of an MS injury

• isolate specific structures
• eliciting pain
• identifying laxity

Question 19

orthopedic tests process

Answer 19

take joint through specific motions to determine

• if the joint moves correctly
• if specific movements cause pain

Question 20

straight leg test

Answer 20

tests for nerve root irritation

• Lasegue sign
• Bragard sign

Question 21

Lasegue sign

Answer 21

straight leg raise of more than 30 degrees

• tests for pain in the affected or unaffected leg
• • L4, L5, or S1 nerve root irritation or herniation

Question 22

Bragard sign

Answer 22

passive straight leg raise

• when pt feels pain slightly lower leg, dorsiflex foot, and internally rotate leg.
• • pain below knee at less than 70 degrees indicates herniated nucleus pulposus at L5 or S1

Question 23

Femoral stress/stretch test

Answer 23

pt in prone position

• pt raises affected leg by extending hip; leg straight
• pain indicates nerve root irritation, usually L1, L2, or L3
• • pain is in anterior thigh

Question 24

Low back pain red flags

Answer 24

Bowel or bladder dysfunction or significant change
Saddle paresthesia
Lower extremity weakness
Back or lower extremity muscle atrophy

Question 25

Knee pain location of pain

Answer 25

can reveal the origin or affected anatomy - tendon - meniscus - ligament - bones

Question 26

Tests for knee effusion

Answer 26

ballottement test | bulge test

Question 27

ballottement test

Answer 27

palpate patella downward against femur listen for clicking sound - can do with or without milking fluid

Question 28

McMurray test

Answer 28

used to detect medial or lateral meniscus damage - click/pop with pain = meniscus tear Knee flexed, 90 degree, then lower leg rotated medially or laterally.

Question 29

Apleys test

Answer 29

``` for complaints of locking - evaluated problems with meniscus Pt position - prone with knee flexed 90 degrees, or supine with proper stabilization. -- click/ pop and pain = meniscus tear ```

Question 30

valgus or varus stress test

Answer 30

tests for damage to medial or lateral collateral ligaments Pt Position: - supine with knee extended. Stabilize femur with one hand and hold the ankle with other hand. Varus: force against the ankle toward midline and internal rotation. - laxity: injury to the lateral collateral ligament Valgus: force against the ankle away from midline and external rotation - laxity: injury to medial collateral ligament

Question 31

Anterior and posterior drawer test

Answer 31

identify anterior and posterior cruciate ligament instability (ACL/PCL) Pt position - lie supine and flex the knee 45 to 90 degrees placing foot flat on table - place both hands on lower leg with thumbs on the ridge of the anterior tibia - Move the tibia forward and then backward -- >5mm in either direction is abnormal

Question 32

ACL

Answer 32

normally resists posterior displacement of femur on tibia

Question 33

PCL

Answer 33

normally resists anterior displacement of femur on tibia

Question 34

Red flags of joints

Answer 34

``` excessive joint laxity or movement obvious deformity muscle weakness - nerve injury - avulsion muscle atrophy - carpal tunnel syndrome interruption of pulses ```