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DPT 509 > Quiz 3 > Flashcards

Quiz 3 Flashcards

1
Q

what are the 3 key elements of muscle performance?

A

1) strength
2) power
3) endurance

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2
Q

what is muscle strength?

A

ability of contractile tissue to produce tension and a resultant force based on the demands placed on the muscle

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3
Q

what is muscle power?

A

related to strength and speed of movement

F x D/T

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4
Q

what is muscle endurance?

A

ability to perform low-intensity, repetitive, or sustained activities over a prolonged period of time

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5
Q

what can MMT give us insights into?

A

muscle strength

pain/level of irritability

differentiating inert vs contractile lesions

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6
Q

what is inert tissue?

A

ligaments and bursa

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7
Q

what is contractile tissue?

A

muscles and tendons

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8
Q

what is the accuracy of MMT based upon?

A

comparison w/a cohort of norms

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9
Q

if there is a greater difference bw active and passive tests is there likely a weakness or stiffness problem?

A

weakness

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10
Q

if there is a smaller difference bw active and passive tests is there likely a weakness or stiffness problem?

A

stiffness

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11
Q

what are contraindications for MMT?

A

unhealed fx/potential fx

post-surgery protective phase (6 wks for tendons)

inflammation/pain

dislocation

bone carcinoma

osteoporosis

myositis ossificans

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12
Q

what is grade 5 (normal)?

A

completes full ROM against gravity w/max resistance

inability of therapist to break contraction

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13
Q

what is a make test?

A

testing though ROM

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14
Q

what is a break test?

A

testing isometrically

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15
Q

what is grade 4 (good)

A

completes full ROM against gravity w/mod resistance

fails the break test with mod resistance

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16
Q

what is 4+?

A

completes full ROM against gravity w/mod to max resistance

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17
Q

what is 4-?

A

completes full ROM against gravity w/min to mod resistance

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18
Q

what is grade 3 (fair)?

A

complete full ROM against gravity w/o resistance

represents the “functional threshold”

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19
Q

what is 3+?

A

complete full ROM against gravity w/min resistance

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20
Q

what is 3-?

A

completes >50% <100% ROM against gravity w/o resistance

can passively go through full ROM

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21
Q

what is grade 2 (poor)?

A

completes full ROM in a “gravity-lessened” position

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22
Q

what is a gravity lessened position?

A

usually in a transverse plane or parallel to the ground

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23
Q

what is 2+?

A

initiates motion against gravity and completes <50% ROM

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24
Q

what is 2-?

A

unable to complete full ROM in “gravity-lessened” position

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25
Q

what is grade 1 (trace)?

A

visual and/or palpable contraction w/o jt movement

tests by moving jt into test position and asking pt to hold

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26
Q

what is grade 0 (absent)?

A

no active muscle contraction seen or felt

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27
Q

what is the general procedure for MMT?

A

position limb against gravity

test major action against gravity w/o resistance

add resistance if they can complete ROM

unable to finished 50%-put pt in gravity minimized position and test ROM

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28
Q

how should a pt be seated when performing a grip dynamometry test?

A

back, pelvis, and knees as close to 90 deg as possible

shoulder adducted (at their sides) and neutrally rotated

elbow flexed to 90 deg

forearm neutral (no pro/sup)

wrist bw 0-15 deg ulnar deviation

arm isn’t supported by examiner or armrest

dynamometer is vertical and in line w/the forearm

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29
Q

how many trials is standard for grip dynanometry?

A

3 trials

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30
Q

what position of the grip dynamometer is usually used?

A

2 or 3

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31
Q

how long should the contraction be held with grip dynamometry?

A

3 secs

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32
Q

how long of a rest periods should be taken bw trials of grip dynamometry?

A

60 secs

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33
Q

how often should the grip dynamometers be calibrated?

A

annually (sooner if used more often)

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34
Q

what is the acceptable CV (coefficient of variation) for women?

A

12%

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35
Q

what is the acceptable CV (coefficient of variation) for men?

A

10%

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36
Q

a change of >__kg is necessary to detect genuine change in grip strength 95% of the time with grip dynamometry

A

6

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37
Q

t/f: grip is typically a bit stronger in the dominant hand

A

true

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38
Q

what is a key grip?

A

thumb and side of index finger grip

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39
Q

what is a chuck grip?

A

pads of thumb and index finger grip

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40
Q

what is a tip to tip grip?

A

tips of thumb and index finger grip

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41
Q

what are the outer core/global muscles?

A

erector spinae

rectus abdominis

external obliques

gluteal muscles

thoracolumbar fascia (quad lumborum , lats)

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42
Q

t/f: the outer core is the same thing as the core stabilizers

A

false, the core stabilizers are deeper

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43
Q

what are the 2 phases of upper abdominal trunk raises?

A

1) trunk curl
2) hip flexion

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44
Q

what is the trunk curl phase of upper abdominal trunk raises?

A

trunk flexion

posterior pelvic rotation

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45
Q

what is the hip flexion phase of upper abdominal trunk raises?

A

hip flexors lift the trunk anteriorly

anterior pelvic rotation

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46
Q

what is a 5/5 grading for upper abdominal trunk raises?

A

hand behind head

trunk stays flexed

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47
Q

what is a 4/5 grading for upper abdominal trunk raises?

A

arms folded (reduced level arm length)

trunk stays flexed

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48
Q

what is a 3+/5 grading for upper abdominal trunk raises?

A

arms flexed

trunk stays flexed

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49
Q

what is a 3/5 grading for upper abdominal trunk raises?

A

arms extended

only trunk curl

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50
Q

what is the procedure for lower abdominal leg lowering?

A

assist in raising both legs

perform posterior pelvic rot and flatten the back

hold as the legs are lowered

monitor for lordosis and ant pelvic rot

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51
Q

who should probably not performance a lower abdominal leg lowering test?

A

pts with LBP

52
Q

what is a 5/5 grading for lower abdominal leg lowering?

A

lower to table

back flat

53
Q

what is a 4/5 grading for lower abdominal leg lowering?

A

lower 30 deg from table

back flat

54
Q

what is a 3+/5 grading for lower abdominal leg lowering?

A

lower 60 deg from table

back flat

55
Q

how is an inflatable stabilizer used?

A

pt lies on it and contracts muscle to see it on the reader and can use this as biofeedback to teach pts how to use their muscles

56
Q

what is the purpose of selective tissue tension?

A

determine what tissue is causing the problem

inert vs contractile lesion

57
Q

what are the components of selective tissue tension?

A

AROM

PROM

mid-range isometric testing

58
Q

what is the purpose of PROM in STT?

A

identify increase/decrease in symptoms

identify the nature of end feels

identify the quantity of motion (capsular vs non-capsular)

59
Q

what does positive PROM in STT mean?

A

noncontractile, inert soft tissue lesion

60
Q

what is the purpose of AROM in STT?

A

identify increase/decrease in symptoms

identify weakness

identify quantity of motion (capsular vs non-capsular)

61
Q

what does positive AROM in STT mean?

A

contractile soft tissue lesion

62
Q

what does strong and painless mid-range isometrics mean?

A

normal

63
Q

what does strong and painful mid-range isometrics mean?

A

minor contractile (tendinopathy, micro-tear)

nerve entrapment

underlying tissue impairment

64
Q

what does weak and painful mid-range isometrics mean?

A

major contractile (partial thickness tear)

bony insertion fx

65
Q

what does weak and painless mid-range isometrics mean?

A

neurological impairment

major contractile (full thickness tear)

poor muscle length

66
Q

what does pain with repeat movements in mid-range isometrics mean?

A

minor contractile (tendinopathy, micro-tear)

67
Q

what does pain with >1 test in mid-range isometrics mean?

A

double lesion

emotional overlay

discogenic in spine

68
Q

reproduction of symptoms could include…

A

pain

abnormal movement pattern

weakness

functional deficit

69
Q

t/f: minor contractile lesions may not be irritated unless after repeated contractions or stress

A

true

70
Q

what is the MMT for the biceps?

A

90 deg of elbow flexion

supinated forearm

pt pushes up while PT resists down

normal grading scale

71
Q

what is the MMT of the brachialis?

A

90 deg elbow flexion

forearm pronation

pt pushes up while PT resists down

normal grading scale

72
Q

what is the MMT of the brachioradialis?

A

90 deg elbow flexion

neutral forearm

pt pushes up while PT resists down

normal grading scale

73
Q

what is the MMT for the triceps?

A

pt in prone with arm off the side of the table and your hand under their arm for cushioning

pt pushes straight out and PT resists down at the wrist

normal grading scale

74
Q

what is the MMT for supination?

A

pt sitting with arm resting on table

grip under the forearm and have pt move into supination while pushing against your thenar eminence as you resist

normal grading scale

75
Q

what is the MMT for pronation?

A

pt in sitting with arm resting on table

start in a bit of supination and resist going “uphill” into pronation

stand in front of patient

grip under the arm with them pushing into your thumb/thenar eminence

normal grading scale

76
Q

what is the MMT for wrist flexion?

A

forearm supination

have pt flex and you try to pull them into extension

ulnaris: start in radially deviated position
- resistance over 5th metacarpal trying to pull into extension and radial deviation

radialis: start in ulnarlly deviated position
- resistance over the 1st metacarpal trying to pull into extension and ulnar deviation

normal grading scale

77
Q

what is the MMT for wrist extension?

A

pt with forearm on the table

extensor carpi radialis brevis and longus
- resist extension and radial deviation

extensor carpi ulnaris
- resist extension and ulnar deviation

normal grading scale

78
Q

what is the MMT for thumb adduction?

A

forearm pronation

pull thumb up to the second metacarpal

try to hold on the metacarpal and pull down (DON’T PULL ON THE PHALYNX)

gravity lessened-neutral

palpate in the web space to palpate for contraction

Fromen sign: squeeze paper and try to pull the paper away
- flexed IP-using flexor pullicus instead of adductor-(+) sign

normal grading scale

79
Q

what is the MMT for thumb opposition?

A

bring thumb and pinky together

resist on the ulnar side of the thumb and ulnar side of the palm

normal grading scale

80
Q

what is the MMT for thumb abduction?

A

pt in sitting resting arm on table

longus-push distal at the metatarsal

brevis-push proximal on the first phalynx

normal grading scale

81
Q

what is the MMT for thumb flexion?

A

pt in sitting resting arm on table

longus: bends IP
- stabilize at the proximal phalynx and bend the IP jt

brevis: flexes MCP jt
- resist at proximal phalynx without bending the IP jt

hold the metacarpal stable to stop opposition

normal grading scale

82
Q

what is the MMT for thumb extension?

A

pt sitting with arm resting on table

resistance at proximal phalynx or distal phalynx

hold the metacarpal stable

normal grading scale

83
Q

what is the MMT for finger flexion?

A

pt sitting with arm resting on table

IP jts:
- supination
- stabilize MCPs with your thumb and grab under their flexed fingers to resist
- resist each finger at the same time
- superficialis: resist at middle phalanges
- profudus: extend finger and flex the tip
- lumbricals: extend phalanges and resist at proximal phalanges

normal grading scale

84
Q

what is the MT for finger extension?

A

fingers off the table

extend at the MCP joints (at IP would be lumbricals)

in tabletop hand position resist extension to test lumbricals

normal grading scale

85
Q

what is the MMT for the interossei of the hand?

A

palmar: adduction

dorsal: abduction

flick finger in and it comes back out=5

86
Q

what is the MMT for the illiospoas?

A

sitting and ask pt to lift knee against your resistance (may do in supine)

gravity minimized: sidelying supporting the knee

be sure it’s illiosoas and not rectus bc it’s strictly hip flexion and no knee extension

normal grading scale

87
Q

what is the MMT for the sartorius?

A

ask pt to try to draw their heel up to opposite knee in sitting

2 hands doing 2 dif things
- one hand pushing pt into extension and adduction
- one hand pushing pt into internal rotation and pulling knee into extension
- “try to resist me”

not a commonly tested muscle

below 3=in supine ask pt to bring heel up to opposite knee

normal grading scale

88
Q

what is the MMT for hip extension?

A

testing hamstrings and glut max

ask pt to lift whole leg off the table

5=max resistance at the ankle

4=max resistance at the knee, mod resistance at the ankle

89
Q

what is the MMT for hip abduction?

A

pt tend to substitute a lot here
- ER
- pelvis drifts up and/or back

bring leg back and straight up
- leg needs to be in line with the body

grav min: supine and bring leg out to the side with toes pointing up at the ceiling

normal grading scale

90
Q

what is the MMT for the TFL?

A

hip at about 45 deg flexion in sidelying

lift leg against resistance

long sitting for gravity minimized and bring leg out

normal grading scale

91
Q

what is the MMT for the hip adductors?

A

pt in sidelying

lift leg 25 deg and ask pt to lift the other leg to it and resist the leg coming up tot the ceiling

grav min in supine – ask pt to slide heel to other leg
- can put support at the ankle and lift ever so slightly to lessen friction in grav min

normal grading scale

92
Q

what is the MMT for hip ER?

A

testing the PGOGOQ muscles

lift foot up and in

try to push tibia out and femur in

max and mod-5 and 4

add light resistance to grade it a 3 here

full active motion here is a 2 (same with IR)

grav min in supine – add light resistance at the femur

93
Q

what is the MMT for hip IR?

A

tests glut med and min

lift foot out

push tibia in and femur out

max and mod-5 and 4

add light resistance to grade it a 3 here

full active motion here is a 2 (same with ER)

94
Q

what is the MMT for the hamstrings?

A

prone

bend the knee to 45 deg

add resistance to knee extension

scoop the knee to support it

grav min: sidelying: bend knee and bring heel to body

med hamstrings: semtendinosis/semimembranosis
- pull down and out
- pt going into IR

lat hamstrings: biceps fem
- pull down and in
- pt going into ER

95
Q

what is the MMT for the quads?

A

15 deg ext and kick leg up towards ceiling

grav min: sidelying

good quad set-shouldn’t be able to move their knee cap

normal grading scale

96
Q

what is the MMT for the gastrocs?

A

pt standing next to table and balance with 2 fingers if necessary

ask pt to go up on toes 25 times

25=5

2-24=4

1=3

up and down as long as calcaneous raises 2 inches

lie on table in long sitting and push against your hand with strong resistance=2

97
Q

what is the MMT for tibialis anterior?

A

dorsiflex foot and invert foot

push down and out on the pt

palpate ant tib for a 1

normal grading scale

98
Q

what can result from a weak ant tib?

A

foot slap, steppage gait (high lift to try to clear the toe), toe drop

99
Q

what is the MMT for the tibialis posterior?

A

ask pt to point foot down and in

resistance is out and up like trying to uncurl the foot

pt long sitting or short sitting on a table

sidelying-grav resistance

normal grading scale

100
Q

what is the MMT for the peroneus longus and brevis?

A

eversion and plantarflexion

pt in long or short sitting on the table

pt pushes down and out

PT pushes up and in

normal grading scale

101
Q

what is the MMT for the toes/big toe?

A

lumbricals: flex toes and resist it

flexor digitorum: flex toes and resist at the middle phalynx or distal phalynx

flexor hallicus: flex big toe and resist

curl toes and give pressure at each

extensor digitorum: resist at toes

extensor hallicus-resist at proximal phalynx

normal grading scale

102
Q

what is the MMT for capital extension?

A

pt in prone

nodding up (OA jt)

head off table, with your hand under their head for support

ask pt to look up at the wall ahead of them

resistance at occiput

gravity minimized=pt in supine-have them look up behind at you

don’t lift head all the way up bc that will include cervical spine

normal grading scale

103
Q

what is the MMT for cervical extension?

A

pt in prone

head off table with your hand supporting

lift head toward ceiling while looking at the floor – like a retraction

resist at the occiput

gravity minimized-supine
- ask patient to push towards table into your hands

normal grading scale

104
Q

what is the MMT for combined extension at the neck?

A

pt prone with arms at their side

guard head

ask pt to try and look up at the ceiling

pressure at occipital region with force down and forward

normal grading scale

105
Q

what is the MMT for capital flexion?

A

pt in supine and have pt bring chin down

palpate SCM and rotate – should be relaxed muscle during this test

give resistance under the chin pulling up

106
Q

what is the MMT for cervical flexion?

A

lift face to ceiling in protrusion like motion

pt in supine

2 finger resistance at the chin

4-mild resistance

5-moderate resistance

palpate SCM rotating R and L

107
Q

what is the MMT for combined neck flexion?

A

lift head all the way

give resistance at the forehead

full motion-3

mod-4

max-5

1s and 2s=rotation

108
Q

what is the MMT for the SCM?

A

turn head and lift towards the ceiling and give resistance to test combined rotation flexion?

max 5

mod 4

min 3+

rotation alone to test below 3

can resist rotation to test direct rotation

rotate L tests R SCM

109
Q

what is the MMT for lumbar extension?

A

pt in prone

lift head shoulders and chest off the table with hands behind the head

may give pressure at the LE to keep them down

no resistance, just observation

5-full motion

4-gets to motion then gives a bit

3-partial motion

3 or below, look at lumbar and thoracolumbar together

110
Q

what is the MMT for thoracic extension?

A

pt in prone

nipple line and above off the table

hand up to head

lift head neck and shoulders up

full strong motion-5

horizontal-4

111
Q

what is the MMT for thoracolumbar extension?

A

pt prone on table

arms at the side, fully on the table

lift head neck and chest off the table

clear xiphoid process-3

partially up-2

palpate contraction-1

112
Q

what is the MMT for lower abdominals?

A

lift legs up to the ceiling and feel for pelvis movement

split lunge position (PT)

lower legs while keep back flat against the table

60 deg from table=3+

30 deg from table=4+

113
Q

what is the MMT for the quadratus lumborum?

A

pt laying in supine and PT pulls on one leg while the pt tries to hip hike

114
Q

what is the MMT for trunk flexion?

A

rectus abdominis

hands on side of head

legs bent

head neck and shoulders off the table with chin up to ceiling

arms at the head and scapulae clear the table-5

hands across chest and scapulae clear the table-4

hands at the side and scapulae clear the table-3

can’t clear the scap with arms at the side-evaluate for a 2

raise head off the table= 2 if they elevate the head

tell pt to lean forward, if rib cage depresses=2

ask pt to cough and if the rib cage depresses=2

rib cage doesn’t depress, but there’s a palpable contraction=1

115
Q

what is the MMT for the obliques?

A

lift head neck and shoulders off table and bring R elbow to L knee: R ext, L int

lift head neck and shoulders off table and bring L elbow to R knee: L ext, R int

5=arms at the sides of the head

4=arms across chest

3=arms at the sides

2=partial clearing of the scapulae

1=palpate contraction and look for ribs to depress

116
Q

what is the MMT for the serratus anterior?

A

arm up in 130 deg flex

resist patient pushing up

normal grading scale

117
Q

what is the MMT for the rhomboids?

A

in prone with arm behind the back and lift hand off the back

add resistance to the distal forearm

resistance is down and out

palpate in the medial scapular border

5-finger pops out of the medial border

4-tolerates mod resistance and finger may get pushed out a little but not as much as a 5

3-lift off actively and scap retracts

2-support arm, try to lift hand off back and scap moves actively all the way through

1- palpating the contraction with no visible movement

118
Q

what is the MMT for the lower and mid traps?

A

140 deg scaption

GM: prone with support under the arm

max resistance distal to the elbow-5

mod distal to the elbow-4

max resistance proximal to the elbow-4

119
Q

what is the MMT for the lats?

A

resistance at the forearm in prone

arm straight at the side

resistance anterior and lateral as pt tries to lift arm up and in

normal grading scale

use yoga blocks and have pt lift their body up using upper body
- full range-5
- partial range-4
- less range-3

120
Q

what is the MMT for shoulder flexion?

A

give resistance proximal to the elbow

arm straight out in front

GM=sidelying, move arm through flexion range

normal grading scale

121
Q

what is the MMT for shoulder extension?

A

prone

arm at the side

IR

lift arm up to the ceiling and give resistance

testing lats, teres major, post delt, triceps

resistance in straight sagittal plane just pushing straight down

resistance above the elbow

normal grading scale

122
Q

what is the MMT for shoulder abduction?

A

lift arm over head in neutral rotation in sitting

have to have some deg of external rotation to avoid impingement

gravity minimized: supine and lift to at least 90 deg

tests the delts and supraspinatus

normal grading scale

123
Q

what is the MMT for horizontal abduction?

A

prone

push down with arm to side and elbow flexed to 90 deg

GM: in sitting hold arm out to side and have them pull their elbow back towards you

normal grading scale

124
Q

what is the MMT for the pec major/shoulder horizontal adduction?

A

resist above the elbow pulling out when pt pulls in

sternal-120 deg abduction and pull down and across to opposite hip – out and up resistance

clavicular-60 deg abduction and pull across and up - down and out to resist

GM: sitting and support the arm and ask pt to pull their arm across

normal grading scale

125
Q

what is the MMT for the rotator cuff?

A

arm to side, elbow flexed to 90 deg

IR and ER

GM: neutral pro/sup in sitting with supported arm on table; just have them move arm in and out

DPT 509 (7 decks)

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