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47 Cards in this Set
- Front
- Back
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What does the muscle spindle detect?
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Muscle length
rate of change of length in parallel |
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What does the golgi tendon detect?
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Muscle tension
rate of change of muscle tension In series |
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What activates nocicpetors?
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activated by prolonged stretch, injury, pressure, thermal and chemical changes and ischemia
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What do the nociceptors do once they detect something?
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They send an impulse to the all axon branches and to the spinal cord
release substance P and other peptide transmitters chemical attractant --> tissue macrophages and lymphocytes |
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To where do nociceptors transmit their impulses?
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Higher CNS (appreciation of pain)
Spinal interomediolateral system --> stimulate preganglionic autonomic neurons Skeletal muscle motor neurons Pain maximal at this segment but poorly localized |
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What is proprioception?
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the subconscious mechanism involved in the self-regulation of posture and movement through stimuli originating in the receptors inbedded in every joint, tendon, and muscle and combined with info from the vestibular system
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Muscle Imbalance consists of a pattern of what?
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shortening and tightening the muscle group
weakness of certain muscle groups altered proprioception |
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How do you test muscle length?
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Passive stretch
compare both sides |
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How do you test muscle contraction?
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by palpating tone and/or resistance
compare both sides |
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How do you test for muscle firing sequence?
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for a given action, palpate for sequence of muscle contraction
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Which artery is the first major branch off the brachial artery?
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profunda brachial artery (deep brachial artery)
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Which vessel passes between the first rib and the scalene muscles?
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Subclavian vein
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Which vessel passes between the scalene muscles?
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The subclavian artery --> becomes the axillary arteries
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Which vessel passes posterior to the pec minor?
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subclavian artery --> becomes the brachial artery
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Between which structures do the nerve roots of the brachial plexus pass?
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between anterior and middle scalenes
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Between which structures will you find the nerve trunks of the brachial plexus?
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from the scalene triangle to the clavicle
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Between which structures will you find the nerve divisions of the brachial plexus?
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posterior clavicle to axilla
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Where will you find the nerve cords of the brachial plexus?
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axilla
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Which nerve is entrapped in Carpal Tunnel Syndrome?
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median nerve
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What are the symptoms of Carpal Tunnel Syndrome?
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numbness and parsthesia of the palmar surface of the thumb, index and middle fingers
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Which test is the gold standard for diagnosis of Carpal Tunnel Syndrome?
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nerve conduction studies
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Allen's test
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assesses the adequacy of the blood supply to the hand by the radial and ulnar arteriers
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Finkelstein test
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test for tenosynovitis in the abductor pollicis longus and extensor pollicis brevis tendons at the wrist (De Quervain's disease)
pt makes a fist with the thumb tucked inside the fingers. Physician stabilizes the pts forearm and deviates the wrist ulnarly positive test results when the pt feels pain over the tendons of the wrist |
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Phalen test
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aides in the diagnosis of carpal tunnel syndrome
doctor flexes the pt's wrist and holds the position for one minute. If a tingling sensation is felt in the thumb, index finger, middle finger and lateral portion of the ring fingers, then the test is positive |
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Prayer's test
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reverse phalen test
also used for carpal tunnel syndrome diagnosis Have the pt extend the wrist while gripping the doctors hand. if after one minute, the pt feels tingling, then it is a positive test |
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Tinel test
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used for carpal tunnel syndrome
doctor taps over the volar aspect of the pt's transverse carpal ligament positive tinel sign = tingling or parasthesia into the thumb, index, middle and lateral ring finger |
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Compression test
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when you compress the carpal tunnel (press on the transcarpal ligament) for 30 seconds.
positive sign = tingling of the fingers |
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Osteopathic treatment for carpal tunnel
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reduce sympathetic tone (thoracic and rib dysfunction)
removing cervical somatic dysfunction remove myofascial restrictions of the upper extremity increased the space within the carpal tunnel |
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Reflex Sympathetic Dystrophy (RSD)
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Complex Regional Pain Syndrome
Characterized by pain and tenderness accompanied by vasomotor instability, trophic skin changes, and rapid development of bone demineralization usually associated with a precipitating event (trauma, mi, stroke, peripheral nerve injuries) |
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What are the three clinical phases of RSD?
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1. Pain and swelling
2. Skin becomes thin, shiny, and cool 3. Atrophy of skin and tissues with irreversible flexion contractures |
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List the Spencer techniques
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1. Extension with elbow flexed
2. Flexion with elbow flexed 3. Circumduction with traction and elbow extended 4. Circumduction with traction and elbow extended 5. Abduction with internal rotation 6. Adduction and external rotation 7. Abduction and internal rotation with the upper extremity behind the back 8. Pt's hand on physician's shoulder stretching the tissue and pumping fluids |
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What are the neurologic symptoms of TOS?
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parasthesia (C8, T1 dermatome)
muscle weakness and atrophy difficulty with fine motor tasks pain in the arm and hand tingling and numbness in the neck, shoulder region, arm, hand and sometimes face |
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What are the vascular symptoms of TOS?
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less common
bluish discoloration of the hand feeling of heaviness in the arm or hand easily fatigued arms and hands superficial vein distention in the hand |
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What are the three types of TOS?
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1. True neurologic (rare; diagnosed with EMG/NCV)
2. True vascular (rare; diagnosed by doppler, MRA, angiography) 3. Disputed neurologic TOS (most common; diagnosed by history and physical exam, normal studies) |
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What makes up the scalene triangle? What runs through it?
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anterior scalene, middle scalene and first rib
brachial plexus and subclavian artery run through it |
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What makes up the costoclavicular space? What runs through it?
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1st rib, clavicle, middle scalene posteriorly
costoclavicular ligament anteriorly brachial plexus and subclavian artery and vein pass through it |
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What makes up the subcoracoid space?
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Overlying the ribs under the pec minor's attachment of the coracoid process
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What is the pathophysiology of TOS?
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progressive postural distortion = adaptive shortening and hypertonicity
progressive scapular protraction = weakness, painful inhibition scapulothoracic dyskinesis and abnormal scapulohumeral rhythm |
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What is the scapulohumeral rhythm ratio?
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humeral abduction vs. scapular rotation
2:1 |
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What are trigger points?
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Discrete, focal, hyperirritable spots located in a taut band of skeletal muscle
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Adson's test
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neck extended turned toward affected side
narrows the interscalene space |
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Halstead manuever
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exaggerated military posture
scapula retracted and depressed chest protruding narrows costoclavicular space |
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EAST test (Roo's test)
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shoulders externally rotated and abducted to 90 degrees; elbows flexed to 90 degrees
open and close hands repeatedly for up to three minutes |
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Wright maneuver
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shoulder in external rotation
abduction beyond 90 degrees compression below the pectoralis minor insertion |
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Where are the common trigger points in the back and shoulder?
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levator scapulae
upper trap anterior scalene SCM latissmus supraspinatous infraspinatous pec minor/major erector spinae suboccipital muscles |
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Which muscles should you lengthen when treating TOS?
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levator scapulae
Upper trap SCM Scalenes Latissmus pec minor |
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Which muscles should you strengthen when treating TOS?
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Serratus anterior
middle trap/rhomboids lower trap |
