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75 Cards in this Set

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What are the 6 parts to a routine orthopedic evaluation?
1) Observation and inspection
2) Soft tissue and Bony palpation
3) ROM
4) Neuro eval
5) Ortho Tests
6) Examination of related areas
What is the basic idea for: 1) Observation and Inspection
Look at general appearance, fx, and body type (Somatotyping)
What are the Somatotypes?
1) Ectomorphs
2) Endomorphs
3) Mesomorphs
Detail Ectomorphs
Long distance runners. Best at Aerobic activity. Hyperextensible joints. Ligament laxity.
20-30% > Motion than Mesomorphs.
Predominant Tissue from ectoderm.
Detail Mesomorphs
One showing predominance of tissue from mesoderm, i.e. muscle, bone, ct.A well proportioned individual.
Detail Endomorphs
Line backer type. Best at anaerobic activity. Have limited flexibility. Tight ligaments/ 10-20% < motion than mesoderms. Predominance of tissue from endoderm (GI, glands, resp, bladder, vagoina, urethra).
Observation and Inspection: On the SKIN what indicates how the body is healing?
Bruising, wounds, scars.
Observation and Inspection: On the SKIN what indicates anomalies, or deviation from nml?
Pallor, pigmentation, hair growth pattern.
Observation and Inspection of Sub Q - Soft tissue; watch for:
Inflammation
Swelling
Hypertrophy
Compare bilaterally, i.e. carrying angle.
Circumfrential measurement = indicates hypertrophy.
Carrying Angle
Anatomical position: Forearm and upper arm don not lie in a straight line.
The forearm is deviated 5-10% laterally,
ie pitchers.
Observation and Inspection:

Bony structures
Traumatic malformations
Congenital malfomations
Postural Deviations, i.e scoliosis.
Soft tissue and Bony Palpation
Skin: Temp and Mobility (elasticity).
Sub Q soft tissue: tender or painful, swelling, adhesions (marbles in the mud).
Pulse: weak? is the vasculature compromised?
Bony Structure: Alignment, ligament, enlargement, tendons. (i.e. osteoarthritic)
ROM
A) Active
B) Passive; usu 1/3 > active rom
C) Resistive
D) Coordinated multiple motions (i.e. circumduction)
E) Associated movements.
F) Joint and feel evaluation.
Resistive ROM, rated on Muscle strength.
Kendall, Kendall Scale:
0-4 are abnormal
5 is nml
Kendall Scale
0 = no contractility (LMN lesion, or peripheral damage)
1 = sliht contraction, no motion
2 = complete ROM, Gravity Eliminated
3 = Complete ROM, against Gravity
4 = Complete ROM, against gravity and some resistance
5 = Complete ROM, against graity and full repeated resistance
Associated movements of ROM?
Function of joint or area distal and proximal to injury
IE-a dropped arch can affect foot, ankle, knee and hip
You sprain what?
You strain what?
Sprain ligaments ie-ankle
Strain muscles
Joint End Feel Evaluation
End of ROM
5 differents end feels
Hard
Firm
Soft
Springy
Empty
Hard=bone on bone
NL
Elbow extension
ABNL
Degenerative joint
Firm=some give
NL
Wrist Flexion
ABNL
Frozen shoulder
Soft=muscle to muscle block
NL
Elbow flexion
ABNL
Ligamentous Sprain
Springy=ligament or muscle
NL
?
ABNL
Torn meniscus
Empty
NL
?
ABNL
Joint inflammatoin
Fracture
Passive ROM and Pain
What tissues are involved?
1. NL mobility, No pain=NL
2. NL mobility, Some pain=minor sprain
3. Hypomobility, No pain=adhesion
4. Hypomobility, With Pain=acute sprain, capsular lesion, muscle spasm
5. Hypermobility, No pain=complete tear, NL variant
6. Hypermobility, With pain=partial tear
Active ROM
*Person must have at least a 3 on Kendall Kendall Scale to perform active ROM
We will be looking at:
Cervicals
Thoracics
Lumbars
Shoulders
Active ROM measurements
Cervical Spine
Degrees
Flexion 50
Extension 60
Right Lateral Flexion 45
Left Lateral Flexion 45
Right Rotation 80
Left Rotation 80
Where does 50% cervical flexion occur?
Occiput/C1
Where does 50% cervical rotation occur?
C1/C2
Where is the >est motion on cervical spine?
C5
Active ROM measurements
Thoracic Spine
Degrees
Flexion 50-60
R.or L. Rotation 30
Active ROM measurements
Lumbar Spine
Degrees
Flexion 60
(anything >er than this is d/t hip flexion
Extension 25
R or L LF 25
R or L R 30
Where is the >est area of motion in the lumbar spine?
L4-S1
Where is the most often herniated discs?
1st - 3rd
L4
L5
L3
Active ROM measurements
Shoulders
Forward Flexion 180
Extension 60
Abduction 180
Adduction 50
External Rotation 90
Internal Rotation 90
Neuro Evaluation
a. palpations and assessment of skull
b. CNs
c. Reflex status
d. Pathologic Reflexes
e. Motor Function
f. Sensory Function
c. Reflex Status
Wexler Scale
Tests reflexes
0=absent (LMN lesion)
1=diminished or only elicited w/reinforcement (for reinforcement-add Jandessik Maneuver)
2=NL sluggish
3=NL Brisk
4=Increased/Hyperreactive
5=Clonus
Clonus
Involuntary muscle contraction d/t sudden stretching of muscles (UMN lesions-stroke, MS, S.cord damage)
Causes large motions that are usually initiated by a reflex
Jandessik Maneuver
One thumb up, one down
Lock fingers and pull while reflex is illicited
Fasciculations
Small spontaneous twitching usually caused by LMN lesions
d. Pathologic Reflexes
+ usually indicates UMN lesions
Lower Extremity
Upper Extremity
Lower Extremity
Babinski's
Gordon's
Oppenhein's
Schaeffer's
Chadock's Foot
Upper Extremity
Chadock's Wrist
Hoffman's Reflex
Tromner's Sign
Babinski's Reflex
+ = dorsiflexion of great toe when the sole of foot is stimulated with the other toes spreading out = ABNL
- = plantarflexion of toes = NL
*BUT, 0-18 mos + can be NL
Gordon's Reflex
Extension of big toe on sudden pressure of the deep flexor mm of calf
(Pyramidal Track Dz)
Ooppenhein's Reflex
Rub something up medial tibia
+ = extension of big toe (dorsiflexion)
Schaeffer's Reflex
Squeeze Achilles Tendon
+ = extension of big toe (dorsiflexion)
Chadock's Foot
Lateral malleolus
+ = extension big toe
Chadock's Wrist
Pressure on Palmaris Longus
+ = flexion wrist, extension fingers
Hoffman's Reflex
Flick nail of middle finger
+ = flexion of fingers, adduction of thumb
Tromner's Sign
Hand pronated-flip up distal phalanx of middle finger
+ = flexion of fingers and thumb
Neuro Eval
Motor Function
Strength Testing (1-5 scale)
Dynometer
Neuro Eval
Sensory Function
Dermatomes
ORTHOPEDIC Tests
a. Names Tests
b. Spinous Percussion
c. Paraspinal Percussion
d. Circumferential Measurements
Named Tests
i. Least invasive to most
ii. Always use confirmative tests
Spinous Percussion
w/soft hammer
Spinous Process
Rib Head (to process)
Iliac Crest
SI Joint
What are you looking for in spinous percussion?
Pain sensations
If yes, are there any differences? What's going on?
Subluxation
When one or more of the bones of your spine move out of position and creat pressure on or irriate spinal nerves
Paraspinal Percussion
Looking for atrophy
Circumferential Measurements
(compare bilaterally)
4" below patella's inferior poll
3" and 7" above superior aspect of patella
7" measure quads
3" measure vastus medialis
Which quad is the first to go is there's neuro damage?
Vastus medialis
Examination of Related Areas
(areas above and below injury)
a. Malingering Tests
b. Vascular Screen
c. Thoracic Outlet Screen
Malingering Tests
Mannkopt's
Magnuson's
Vascular Screen
BP on all 4 extremities
2 biceps
2 quads
(he was suppose to give us the measurements for this!)
Thoracic Outlet Screen
Vertebrae
Quick Test
Squat and bounce 3xs and stand quickly
Helps to r/o ankle, knee or hip involvement
Lateral flexion, rotation and extension of spine
Pain on same side = facet/capsular involvement closing facets, narrowing foramina and locking SI Joint
What do you do if there's bulging disc problems suspicion?
Bend Laterally
pain on same side = bulging disc, bulging on that side
no pain = bulging disc, bulging on opposite side
KNOW THIS
PAIN on concave side of lateral flexion indicates what?
(concave-side you are bending into)
Intra-articular or lateral disc herniation
KNOW
Pain on convex side of lateral flexion indicates what?
(convex-side you are bending away from)
Muscle strain, articular sprain, medial disc herniation
Pain at End Point Flexion indicates what?
Possible ligamentous involvement
Pain in straightening?
Muscle strain or disc herniation
Passive ROM
Removes muscle from evaluation allowing evaluatoin of ligamentous structures
What is important to look at w/Passive ROM?
Joint feel not degrees of motion
Dual Inclinometer Method
what does it measure?
Flexion
Extension
Lateral Flexion
Dual Inclinometer Method
how?
one inclinometer on the occiput and one on T1
Subtract T1 from occiput
Rotate single inclinometer at vortex or use protractor