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206 Cards in this Set
- Front
- Back
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What are the 3 planes of motion for the hip?
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flexion/extension
abduction/adduction Internal/External rotation |
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What are the 4 ligaments of the hip?
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Iliofemoral
Pubofemoral Ischiofemoral Ligament of the head of the femur |
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What is the action of the iliopsoas?
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Flexor of the hip
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What is the mnemonic "Say grace before tea" referring to?
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Sartorius, Gracillis, and SemiTendinosus come together to insert
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How can you tell if a newborn has congenital dislocation of the hip?
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asymmetry of the gluteal skin folds
leg seems shorter limitation of abduction positive Ortolani's sign |
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What is Ortolani's sign?
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hip "clicks" with reduction as it is flexed, abducted and externally rotated
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What is Legg-Calve-Perthes' Disease?
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Idiopathic avascular necrosis of the epiphysis
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In whom is Legg-Calve-Perthes' more common?
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Males predominate
4-12 years |
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How does Legg-Calve-Perthes' present?
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Unilateral antalgic gait
Groin pain radiates to knee elevated sed rate |
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What tests are used on Legg-Calve-Perthes' disease work up?
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Thomas Test (+)
- contracture of psoas/adductors Limited hip: adduction, extension, internal rotation Disuse atrophy develops in upper thigh X-ray evidence |
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In whom does a slipped capital femoral epiphysis occur?
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boys 10-15 years old
obesity is a significant risk factor int he development of SCFE. |
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How does SCFE present?
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Coxa vara develops
Bilateral involvement in 40% antalgic gait generalized limitation of hip motion male may present with female fat distribution and sexual underdevelopment |
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What is a Klein sign?
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the line drawn on x-ray to show slipped femoral epiphysis.
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Who gets ischiogluteal bursitis?
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adults in sedentary occupations
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How does ichiogluteal bursitis present?
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Point tenderness over ischial tuberosity
pain relieved with standing "medical student syndrome" |
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How does trochanteric bursitis present?
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point tenderness over greater trochanter
pain radiates down lateral aspect of leg Increased pain with weight bearing or walking |
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What are some causes of trochanteric bursitis?
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ITB syndrome
Chapman's reflex sites - ileocecal area on the right - sigmoid area on the left Piriformis syndrome Gluteus medius insertional tendonitis |
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Who gets ITB syndrome?
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Marathon runner
Ischemic colitis pts |
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What is Meralgia Paresthetica?
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Entrapment of the lateral femoral cutaneous nerve under the inguinal ligament, tensor fascia lata, &/or iliopsoas
Persistent paresthesias (almost always) and (occasional) pain lateral & anterior thigh No point tenderness Tinel sign may be (+) Distended abdomen or pregnancy may compress the nerve |
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Describe the pain of osteoarthritis of the hip?
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pain worse in the morning
pain with weight bearing pain felt in groin decreased joint space internal rotation pain |
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What is the Thomas test for?
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psoas muscle
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What is the Trendelenburg test for?
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weak gluteus medius
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What is Ober's test for?
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IT band dysfunction
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What is the hip compression test for?
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inflammation of the hip joint
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What is the Patrick Test/FABERE test for?
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pathology of the hip
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Per Savarese, when there is somatic dysfunction where the hip is externally rotated what muscles are involved?
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piriformis or ileopsoas
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Per Savarese, when there is somatic dysfunction where the hip is internally rotated what muscles are involved?
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gluteus minimus, semimembranosus, semitendinosus, TFL, adductor longus, adductor magnus
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What causes a positive trendelenburg sign?
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L5 radiculopathies or lesions of the superior gluteal nerve
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What causes a positive Ober test?
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variety of neurological disorders including polio and meningomyelocele. More commonly and to a lesser severity, it is seen in a tight IT band as a result of SD.
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What can cause positive Thomas test?
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Posterior abdominal medical problems such as kidney stones and pancreatitis can irritate the iliopsoas muscle causeing possible contracture
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What does the hip drop test test for?
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ability of the lumbar spine to sidebend (misnomer)
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Describe the hip drop test.
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With the pt standing, the physician contacts the iliac crests posteriorly. The pt bends one knee without lifting the heel from the floor. The lumbar spine should sidebed toward the opposite side as the bent knee, producing a smooth convexity of the lumbar spine on the same side as the bent knee. Also, the iliac crest should drop on the side of the bent knee. The test is positive if the hip does not drop at least 20deg indicating lumbar somatic dysfunction
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What causes an internally rotated hip dysfunction (aka restricted in external rotation)?
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Gluteus medius and minimus restriction
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What causes an externally rotated hip dysfunction (aka restricted in internal rotation)?
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piriformis restriction
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What causes hip flexion dysfunction (aka restricted in hip extension)
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iliopsoas restriction
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What causes knee extension dysfunction (restriction of knee flexion)?
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quadriceps restriction
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What is the blood supply of the interior aspects of the medial and lateral menisci of the knee?
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diffusion only!
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What is the function of the ACL?
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Prevents anterior displacement of the tibia on the femur
Prevents hyperextension of the knee |
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What are the tests to detect ACL tears?
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Drawer or Lachman's test
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What is the terrible triad?
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ACL
Medial Meniscus MCL |
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Where is the injury that causes the terrible triad?
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lateral
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What is the function of the PCL?
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prevents posterior displacement of the tibia relative to the femur.
Prevents hyperflexion of the knee |
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When do PCL tears occur?
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when tibia is driven posterior
femur is driven anterior or knee is hyperflexed |
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When does the LCL tear?
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with a blow to the medial side of the knee
injury may also sever the common peroneal nerve |
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What are the muscles of the quads?
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rectus femoris
vastus lateralis vastus medialis vastus intermedius |
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What are the muscles of the hamstrings?
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semetendinosus
semimembranosus biceps femoris |
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What is Osgood-Schlatter Disease?
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pain and swelling of the infrapatellar tendon insertion onto the tibial tubercle
(Growth plate issue) |
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In whom is Osgood-Schlatter's most common?
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boys
active growth, sports |
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What is the tx for Osgood-Schlatter's?
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NSAIDs, relative rest, ice, Cho-Pat strap (allows secondary growth plate to heal, changes the fulcrum)
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What is another name for prepatellar bursitis?
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housemaid's knee
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What does prepatellar bursitis result from?
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chronic kneeling
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What is the tx for prepatellar bursitis?
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NSAIDS, relative rest, ice, avoid temptation to to needle it (risk infection)
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What is Pes Anserine Bursitis?
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located between the tendons of the
- sartorius - gracilis - semitendinosus Posterior medial knee pain Typically with overuse vs. acute trauma NSAIDs, relative rest, ice |
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What is Patellofemoral Pain Syndrome? (PFPS)
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Imbalance between the medial and lateral quadriceps gourp
Abnormal patella glide with motion aka "lateral tracking" Tenderness at the facets Palpate for plica bands |
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What are some special tests for PFPS
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Patella grind
apprehension test Q angle Garrett's test (hamstring inflexibility test) |
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Describe Gastrocnemius-semimembranosus bursitis.
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baker's cyst
usually painless mobile firmness typically located on the medial side of the popliteal fossa |
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What is McMurray's test for?
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menisci
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What is Apley's compression/distraction test for?
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medial and lateral menisci
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What is the best test for ACL integrity? Why?
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Lachman test because joint capsuleis relaxed
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What are you testing for when applying valgus stress to the knee?
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MCL
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What are you testing for when applying varus stress to the knee?
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LCL
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What does it mean if there is pain during the Apley's distraction test? No pain?
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ligamentous damage = pain
menisci shouldn't elicit pain |
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What is the most sensitive test for meniscal injury associated with a torn ACL?
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Childress's sign (squat test) - walk like a duck!!
70% sensitivity |
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What's the difference between Apley's distraction test and Apley's compression test?
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Distraction = applying traction
Compression = apply compression |
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What does it mean if there is pain during the Apley's compression test?
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Meniscal damage
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What is the corrective movement in Anterior Fibular head HVLA?
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downward and internal rotation of the tibia
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What is the corrective movement of Posterior Fibular head HVLA?
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forward pressure against the head of the fibula with the index finger of your right hand in conjunction with further flexion and external rotation of the tibia with your left hand.
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What is the function of the deltoid ligament of the foot?
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prevents excessive eversion as well as forward or backward displacement of the tibia
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How many muscles are involved in producing the movement so the foot?
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12
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What arteries are palpated in the foot during the LE PE?
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dorsalis pedis and posterior tibial
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What is Homan's sign?
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DVT test
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What is the sens/spec for Homan's sign?
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Sensitivity: 60-88%
Specificity: 30-72% |
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What is the keystone of the medial arch?
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navicular
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What does the transverse arch consist of?
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Cuneiforms, Cuboid, and 5 metatarsal bases
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What does the medial longitudinal arch consist of ?
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calcaneous, talus, navicular, cuneiforms and first 3 metatarsals
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What is the common dysfunction of the lateral longitudinal arch?
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dropped cuboid
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What does the lateral longitudinal arch consist of?
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calcaneous, cuboid, 4th and 5th metatarsals
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What is the most common dysfunction of the medial longitudinal arch?
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dropped navicular
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What is the gait cycle of the foot?
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stance phase (65%)
- contact (27%) - midstance (40%) - propulsion (33%) Swing phase (35%) |
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Describe supination of the foot
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inversion and adduction
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Describe pronation of the foot
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eversion and abduction
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When evaluating the foot and ankle osteopathically also look at what ?
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knee, sacrum, pelvis, and lumbar spine
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What is pes cavus?
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too high of an arch
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What is pes planus?
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flat feet
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What can you get as a result of pes planus?
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valgus
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What is hallux valgus?
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bunion
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What is the most common ankle sprain?
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Inversion sprain
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What ligament is associated with an eversion ankle sprain?
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deltoid ligament
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What does a Type 1 Ankle sprain involve?
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Involves the ATF ligaments
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What does a Type 2 Ankle sprain involve?
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Involves the ATF, and CF ligaments
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What does a Type 3 Ankle sprain involve?
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ATF, CF, and PFT ligaments
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What does the anterior drawer test test for in the ankle?
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tests the anterior talofibular ligament
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What is the sens/spec of the anterior drawer test (ankle)?
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96% sensitive
86% specific for an ATF tear |
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What are the Ottawa Ankle rules?
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Rules of whether to get an x-ray or not with ankle injuries
1. inability to bear wt and take more than 4 steps at the time of injury in the ED 2. tender at the lateral malleolus 3. tender at the medial malleolus |
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When evaluating an ankle sprain also look for what?
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somatic dysfunction of the fibula and ipsilateral 3rd rib
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Which tendonopathy of the ankle is more common in women?
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posterior tibialis tendonitis
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What does the Thompson test test for?
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Achiles tendon rupture
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What are the symptoms of tarsal tunnel syndrome?
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numbness, burning pain, or parasthesias in portions of the plantar surface of the foot
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What is the most common injured ligament of the foot/ankle?
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Anterior Talofibular ligament
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What is the hiss whip used for?
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dropped cuboid or navicular
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Where is Medial ankle tenderpoint? How do you treat it? What muscle is it associated with?
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2 cm below medial malleolus
Marked inversion Tibialis Anterior |
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Where is the Medial Calcaneus tenderpoint? How do you treat it? What muscle is it associated with?
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3 cm caudad and posterior to medial malleolus on the medial aspect of the calcaneous.
Marked inversion of the calcaneous; evert distal aspect of foot. Abductor hallucis |
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Where is the Lateral ankle tenderpoint? How do you treat it? What muscle is it associated with?
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In depression 3cm anterior and slightly caudad from lateral malleolus.
Marked EVERSION is induced from medial aspect of foot. Peroneus Longus and Brevis |
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Where is the Lateral calcaneus tenderpoint? How do you treat it?
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3cm caudad and posterior to lateral malleolus.
Eversion at heel and inversion at distal foot |
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How do you treat the Navicular tenderpoint?
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Pt. prone
Wrap index finger around navicular bone and reinforces this with 3rd finger. Induce inversion of navicular |
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Where do you find the Cuboid tenderpoint? How do you treat it?
What muscle is it associated with? |
3 cm proximal and medial to prominence of 5th metatarsal
Pt. prone - Grasp lateral half of metatarsals and presses towards table with MCP joint at patient proximal 5th metatarsal. This induces eversion and some extension of the cuboid in relation to the rest of the foot. Extensor digitorum brevis |
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Where do you find the Flexion MEdial Calcaneus tenderpoint? How do you treat it?
What muscle is it associated with? |
Posterior to medial aspect of tibia on the fibers of the muscle.
Pt. prone - flex knee - dorsal arch on thigh, marked extension of ankle by pushing on plantar surface of the heel toward the calf, angle medially to fine tune. Soleus |
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What does the sternoclavicular joint do?
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transfers motion from arm to axial skeleton - only joint that does this
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What is the action of the supraspinatous muscle?
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abduction
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What is the action of the subscapularis muscle?
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internal rotation of humerus
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What is the action of the infraspinatous and teres minor muscles?
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externally rotate humerus
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What is Erb-Duchenne Palsy?
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Injury to C5-6
Upper arm paralysis Usually during childhood (birthing injury) Paralysis of deltoid, external rotators, biceps, brachioradialis and supinator muscles (assume the waiter position) |
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What is Klumpke's Palsy?
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(Claw hand)
Injury to C8-T1 Affects intrinsic muscles of the hand Common injury hx includes falls from a tree/ladder in which the pt attempts to prevent the fall Arm commonly suppinated with wrist in extension |
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What is the most common shoulder diagnosis?
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bursa or tendon inflammation caused by overuse
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How do you diagnose Bursitis/Tendonitis of the shoulder?
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Positive Jobe's tests or Impingement
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How do you diagnose Adhesive capsulitis?
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Positive Hawkin's or Neer's test
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What can cause a shoulder separation? How do you diagnose it?
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Fall on outstretched hand
Positive Crossover test |
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What does Jobe's Sign test?
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supraspinatus tendinitis
(thumbs down and push up against physician's resistance) |
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What does the Drop Arm Test test
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Possible tears in the rotator cuff
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What does Speed's sign test for?
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biceps tendinitis
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What are the 3 ways to test for impingement?
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1 unnamed test
Hawkin's Test Neer's test |
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In which direction is the elbow least stable?
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anterior posterior
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What ligament is the primary stabilizer of the elbow?
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ulnar collateral ligament
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What is the annular ligament?
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the strong band of fivers encircling the head of the radius - retains it in contact with the radial notch of the ulna
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How do the fibers of the interosseous membrane run?
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from the distal medial ulna to the proximal lateral radius
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At the end of pronation...what is the position of radius?
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radial head glides posterior
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At the end of supination....what position is the radial head?
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anterior
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Of the upper extremity, which muscles tend to get inhibited?
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muscles of extension and supination
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Of the upper extremity, which muscles tend to get hypertonic and tight?
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muscles of flexion and pronation
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What is the carrying angle for men?
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5 degrees
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What is the carrying angle for females?
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10-12 degrees
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In an increased carrying angle, what happens to the olecranon?
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moves medially - adduction
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In an increased carrying angle what happens to the distal ulna?
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abduction
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What happens to the wrist in an increased carrying angle?
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adduction
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In a decreased carrying angle, what happens to the olecranon?
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moves laterally - decreasing adduction
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In a decreased carrying angle, what happens to the distal ulna?
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adduction
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What happens to the wrist in a decreased carrying angle
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abduction
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Where does ulnar nerve entrapment usually occur?
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posterior to the medial epicondyle
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What are the 4 P's of fascial funcion?
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packaging
protection posture passageways |
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What would a PE of a compartment syndrome reveal?
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elevated compartment pressure
pain that is out of proportion to the original injury pain with passive movement paralysis parasethesia or numbness pulselessness pallor |
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What are the 4 P's of fascial funcion?
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packaging
protection posture passageways |
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What would a PE of a compartment syndrome reveal?
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elevated compartment pressure
pain that is out of proportion to the original injury pain with passive movement paralysis parasethesia or numbness pulselessness pallor |
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Which fracture of the wrist is more common in the elderly?
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Smith's fracture = Flexion fracture of the radius
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Which fracture of the wrist is more common in the elderly?
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Smith's fracture = Flexion fracture of the radius
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Which fracture of the wrist is more common in children?
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Colle's Fracture = extension fracture of the radius (dinner fork)
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Which fracture of the wrist is more common in children?
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Colle's Fracture = extension fracture of the radius (dinner fork)
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What is golfer's elbow?
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medial epicondylitis
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What is tennis elbow?
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lateral epicondylitis
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How would you diagnose lateral epicondylitis?
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have the pt grab the back of a chair and try to lift it, pain will refer to the elbow
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What OMT considerations would you make with carpal tunnel syndrome?
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Reduce sympathetic tone in UE by correcting upper thoracic and upper rib dysfunctions.
Remove cervical somatic dysfunctions to improve brachial plexus function. Remove myofascial restriction in the UE. Increase space within the carpal tunnel using direct release techniques |
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What is the most common restriction? Pronation or supination?
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supination restriction (i.e. likes to pronate)
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What does the "extensor wad" consist of?
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extensor carpi radialis brevis
extensor digitorum extensor carpi ulnaris |
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What is the most sensitive of all tests for Carpal tunnel?
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Carpal tunnel compression test
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What is the Allen's test?
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used to assess vascular competence. Should be done prior to doing an arterial blood gas.
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What is the technique of carpal tunnel syndrome muscle energy?
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the joint is moved into ulnar deviation to the barrier. The pt is then asked to push toward the radial aspect as the physician provides resistance.
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What is the HVLA technique for wrist dysfunctions?
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It's like the hissy whip but for the wrist
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What is the flexor retinaculum stretch?
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the physician interlaces his/her fingers of both hands and encircles the pts wrist - the physicians thenar eminence should contact the patient's wrist over the flexor retinaculum - as firm compression is provided by the physician, the pt actively opens and closes hand 5-10 times
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What is Opponen's Roll?
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stretches the muscles and the ligaments of the wrist, which releases pressure on the median nerve.
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What is thoracic outlet syndrome?
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pain, numbness, or muscular weakness of the arm secondary to compression of the brachial plexus at the cervicobrachial junction
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What is the peak age of onset for thoracic outlet syndrome?
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4th decade
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Do women or men get TOS more?
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woman 9:1
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What does the Thoracic INLET consist of?
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T1 vertebrae
1st rib manubrium (bony structures) |
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What does the thoracic OUTLET consist of?
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everything that goes through the inlet
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What are the sites of entrapment for TOS?
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anterior scalene
costoclavicular region pec minor |
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What are some factors that predispose to TOS?
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Cervical ribs
Abnormal fibrous band Long transverse process of C7 etc |
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What is Adson's test?
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diagnosis of the scalenes
Arm is extended posterior with head turned away from the affected side. A positive test = diminished radial pulse or reproduction of neurologic symptoms indicates hypertonic anterior, middle scalenes Nerve root impingement proximal to brachial plexus |
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What is the military posture test?
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costoclavicular maneuver - head is extended with shoulders retracted
A positive test = diminished radial pulse or reproduction of neurologic symptoms Indicates inhaled 1st rib or inferior clavicle Nerve root impingement distal to the brachial plexus |
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What is the hyperextension test?
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for TOS - arm is extended behind and raised up to 90 degrees
Positive test = diminished radial pulse or reproduction of neurlogic symptoms Indicates hypertonic pec mino and attachment to the humerus |
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What is the axial compression test?
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TOS
Used to assess spinal nerve impingement at the level of the spine With pt seated the physician pushes strait down on the head Positive test = induces pain or numbness in the nerve distribution at the spinal level of the pathology |
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What nerve does DTR of Biceps go with?
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C5
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What nerve does DTR of Brachioradialis go with?
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C6
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What nerve DTR of Triceps go with?
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C7
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What is the hyperabduction test?
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for TOS
Tests for vascular compromise of the subclavian artery as palpated at the radial artery The arms are externally rotate and hyperabducted - monitor pulse - test is positive if the pulse disappears or diminishes or if the pt's sx are elicited/increased |
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What is Jackson's test?
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Tests for nerve root impingement - TOS
Like axial compression test but slightly side bend the cervical spine to the affected side and then apply axial compression. Repeat with sidebending to the other side. |
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What is Spurling's Maneuver?
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Provacative test designed to exacerbate encroachment of ea cervical nerve root at the neural foramen by extension and rotation of the neck toward the invovled side followed by applying an axial load.
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In an older patient, what is the cause of encroachment of a cervical nerve root?
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foraminal stenosis
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In younger patients, what is the cause of encroachment of a cervical nerve root?
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intervertebral disk prolapse
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Posterior rib tenderpoint....what is happening with the arm?
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arm on the side of the dysfunction is draped over the physician's knee
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What is the key rib in exhaled dysfunctions?
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upper-most rib
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Anterior rib tenderpoint....what is happening with the arm?
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Anterior = opposite
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What is the key rib in inhaled dysfunctions?
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lower-most rib
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What is the tx for superior clavicular head?
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the one where my clavicle moved like crazy
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What is the tx for anterior clavicular head?
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pt's hand on physician's shoulder - physicians hand behind scapula and one on clavicle - physician stands up to pull arm and patient pulls on physicians shoulder
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What kind of dysfunctions can be treated with chin pivot HVLA?
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flexed only
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Which way is the head turned/sidebent in chin pivot HVLA?
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rotate the head to the SAME side and sidbend neck OPPOSITE side
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What happens to postural muscles?
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become hypertonic when injured
Inhibit the dynamic muscles |
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What happens to dynamic muscles?
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become inhibited when injured
core muscles |
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Which muscles of the upper quarter sidebend and rotate the head to the opposite side?
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upper trap
SCM scalenes |
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Which muscle(s) of the upper quarter rotate and sidebend to the same side?
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levator scap
due to twist in it from rotation during development |
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What innervates Latissimus dorsi?
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C4-5
(The great integrator) |
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What muscle is associated with C2 dysfunction?
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Levator scap
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which rotator cuff muscle gets tight?
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subscapularis
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How do you treat neuromuscular dysfunction in Upper quadrant syndrome?
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1. proprioceptive retraining
2. stretch hypertonic muscles 3. retrain (Strengthen) inhibited muscles |
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What can weak forearm extensors lead to?
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lateral epicondylitis
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Greenman's principles: UQS
What gets tight? |
shoulder capsule
levator scapula latissimus dorsi |
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Greenman's Principles: UQS
What gets weak? |
Mid and low trap
Serratus anterior |
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Greenman's Principles UQS
What substitutes? |
Pec major and minor
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What does the cervical flexion test test for?
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identifies weak deep flexors of the neck (longus colli - l. cervicis, L capitis)
Hypertonic SCM and scalenes Leads to forward head posture and neck pain |
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What pattern of somatic dysfunction will be seen in a positive cervical flexion test?
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extended upper cervicals
flexed lower cervicals flexed upper thoracics |
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What does the bilateral shoulder abduction maneuver test for?
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Asymmetry of gliding motion of scapula on trunk
Winging of scapula |
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In abnormal firing pattern of the U/L shoulder abduction, what fires?
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contralateral QL doesn't fire and the I/L QL does
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What is the ideal sequence of firing for U/L shoulder abduction?
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Supraspinatous
Deltoid Infraspinatous Middle and Lower Trap C/L QL |
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What is the dysfuncitonal sequence of firing for the U/L shoulder abduction test?
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Tight levator scapula fires and inhibits ideal firing pattern
Late firing of middle and lower trapezius I/L QL fires (instead of C/L) |
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What does the scapular depression test look for?
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inhibited lower trapezius
hypertonic levator scap and upper trap |
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What does the B/L shoulder flexion test look for?
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observe for asymmetric arm elevation: indicates hypertonic latissimus dorsi on side of restricted flexion
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What does the anterior shoulder position test look for?
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hypertonic:
- posterior shoulder capsule - levator scapulae - upper trap Inhibited: - Middle/Lower trap - serratus anterior - rhomboids Substitues: pec minor Result = shoulder impingement syndrome |
