Physical Assessment Techniques in Musculoskeletal Care
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Questions and Answers

Which area of the spine is most commonly affected by fragility fractures due to osteoporosis?

  • Cervical spine
  • Sacral spine
  • Thoracic spine (correct)
  • Lumbar spine

What is a characteristic symptom associated with an acute fracture in the neck?

  • Muscle weakness in the legs
  • Increased strength in the arms
  • Bilateral paresthesia (correct)
  • Unilateral numbness

Which of the following stages of Ankylosing Spondylitis represents the phase characterized by progressive inflammatory disease?

  • Dysfunction (correct)
  • Recovery
  • Fusion
  • Instability

In the assessment of potential cervical spine injury, what observation might indicate a protective response?

<p>Rust's sign (B)</p> Signup and view all the answers

Which of the following conditions is classified as a non-inflammatory spondylopathy?

<p>Spondylolysis (A)</p> Signup and view all the answers

Which of the following mechanisms of injury is associated with spinal issues?

<p>Repetitive microtrauma and degenerative trauma (D)</p> Signup and view all the answers

What demographic factors increase the risk of Schmorl's nodes?

<p>Males aged 25-55 with obesity (B)</p> Signup and view all the answers

Which statement accurately defines Schmorl's nodes?

<p>Herniation of the nucleus pulposus into the vertebral end plate (B)</p> Signup and view all the answers

What is centralization in the context of pain assessment?

<p>Pain moving towards the spine from peripheral regions (B)</p> Signup and view all the answers

Which risk factor is linked to increased vascular health issues in the context of spinal problems?

<p>Smoking habits (B)</p> Signup and view all the answers

Which mechanism of injury involves excessive stress produced in areas of adhesion in the dura?

<p>Traction/vibration injuries (A)</p> Signup and view all the answers

What is the primary focus of neurodynamics in the context of nerve function?

<p>The mechanics and physiology of nerves (D)</p> Signup and view all the answers

Which special test is NOT typically associated with assessing cervical conditions?

<p>First thoracic nerve root stretch (D)</p> Signup and view all the answers

During nerve movement, the nerve does which of the following?

<p>Slides towards the point where tension is applied (A)</p> Signup and view all the answers

In the context of adverse neurodynamics, which of the following is NOT a physiological component?

<p>Invasiveness (C)</p> Signup and view all the answers

What does structural differentiation help assess in nerve function?

<p>The ability to differentiate nerve from surrounding structures (A)</p> Signup and view all the answers

Which structure adjacent to a nerve is considered an interface?

<p>Fascia (B)</p> Signup and view all the answers

What symptom is likely to aggravate pain during the assessment?

<p>Prolonged sitting (C)</p> Signup and view all the answers

Which of the following is a common observation of nerve dysfunction?

<p>Poor posture (B)</p> Signup and view all the answers

Which condition is indicated by the presence of bilateral or quadrilateral paresthesia?

<p>Myelopathies (C)</p> Signup and view all the answers

What position is least likely to alleviate pain?

<p>Standing (A)</p> Signup and view all the answers

What quality of pain is characterized as dull, aching, and stiff?

<p>Mechanical pain (D)</p> Signup and view all the answers

What factor can lead to an increase in pain during the morning?

<p>Fluid repletion overnight (D)</p> Signup and view all the answers

Which of the following is a sign of muscle wasting?

<p>Prolonged immobility (B)</p> Signup and view all the answers

Which symptom is not typical of radiating pain due to disc impingement?

<p>Local stiffness in the spine (A)</p> Signup and view all the answers

What method is often used to assess the change in symptoms during movement?

<p>Mackenzie technique (A)</p> Signup and view all the answers

What is a common characteristic of spondylolisthesis?

<p>Forward slippage of a superior vertebra (C)</p> Signup and view all the answers

Which sign is NOT typically associated with stenosis?

<p>Pain alleviated by extension (B)</p> Signup and view all the answers

In an adolescent athlete, which condition is often associated with repetitive spinal extension?

<p>Spondylolysis (C)</p> Signup and view all the answers

What type of movement typically aggravates pain in facet joint dysfunction?

<p>Closing patterns of the joint (D)</p> Signup and view all the answers

Which group of individuals is at a greater risk for developing osteoporosis?

<p>Older Caucasian males and females (B)</p> Signup and view all the answers

What is a possible consequence of central stenosis?

<p>Bowel or bladder dysfunction (D)</p> Signup and view all the answers

In assessing a patient for spondylolysis, which motion is likely to be restricted?

<p>Extension (D)</p> Signup and view all the answers

Which symptom is most commonly associated with spondylolisthesis?

<p>Localized pain at the superior vertebra (D)</p> Signup and view all the answers

Which factor is NOT a common cause of sprains and strains?

<p>Low-impact activities (B)</p> Signup and view all the answers

What finding is consistent with rib joint dysfunction?

<p>Localized sharp pain (A)</p> Signup and view all the answers

What is the most common position that alleviates symptoms in individuals with foraminal stenosis?

<p>Sitting or flexed posture (D)</p> Signup and view all the answers

Which of the following is a classic observation in patients with osteoporosis?

<p>Dowager's hump (A)</p> Signup and view all the answers

What type of tests are contraindicated in patients with osteoporosis?

<p>Tests requiring spinal flexion (B)</p> Signup and view all the answers

Which of the following muscle groups is typically affected by muscle spasms in spondylolysis/spondylolisthesis?

<p>Erector spinae (A)</p> Signup and view all the answers

Which age group is typically more affected by vascular issues related to sustained overhead positions?

<p>Younger individuals (C)</p> Signup and view all the answers

What is a common quality of pain associated with vascular symptoms?

<p>Aching and burning (D)</p> Signup and view all the answers

Which of the following is NOT a factor that could aggravate pain in individuals with neck and shoulder issues?

<p>Rest (D)</p> Signup and view all the answers

Which special test might be considered for assessing first rib mobility?

<p>PAIVMs (A)</p> Signup and view all the answers

What characteristic is associated with a neurological issue involving the arm?

<p>Radiating pain (B)</p> Signup and view all the answers

Which symptom is indicative of vascular complications in the arm?

<p>Pallor or cyanosis (A)</p> Signup and view all the answers

What mechanism of injury is commonly related to poor posture?

<p>Muscle strain (A)</p> Signup and view all the answers

Which sleeping position could potentially exacerbate symptoms related to neck and shoulder pain?

<p>On one side with the head elevated (B)</p> Signup and view all the answers

What is a common observation in patients experiencing vascular symptoms?

<p>Decreased skin temperature (C)</p> Signup and view all the answers

Which of these demographic factors is more prevalent in patients with neck and shoulder issues?

<p>Women &gt; men (C)</p> Signup and view all the answers

Flashcards

Vertebral Body Fracture

A break in the main part of a vertebra, most often in the thoracic spine, frequently due to osteoporosis.

Ankylosing Spondylitis

Progressive inflammatory disease causing gradual fusion of vertebral joints and bony structures.

Fragility Fracture

A fracture caused by minimal force, often related to osteoporosis.

Axial Compression

A force applied directly down through the spine.

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Canadian C-spine Rules

Clinical guidelines used to determine if a neck injury requires imaging.

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Schmorl's Nodes

A small herniation of the nucleus pulposus (NP) into the vertebral endplate.

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Protrusion

The nucleus pulposus pushes outwards against the annulus fibrosus, but the outer layers remain intact.

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Prolapse

The nucleus pulposus bulges through the annulus fibrosus, partially breaking through the outer layers.

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Extrusion

The nucleus pulposus completely ruptures through the annulus fibrosus and escapes into the spinal canal.

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Sequestration

A portion of the nucleus pulposus breaks off and becomes free within the spinal canal.

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Peripheralization

Pain spreading further away from its initial location during assessment.

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Centralization

Pain becoming more localized or concentrated during assessment.

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Aggravating Factors

Activities or postures that worsen pain, often suggesting a mechanical issue.

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Alleviating Factors

Activities or postures that reduce or eliminate pain.

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Mackenzie Technique

A series of specific spinal movements used to assess pain patterns and identify nerve root irritation.

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Cord Signs

Symptoms indicating potential spinal cord compression, requiring urgent medical attention.

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Muscle Spasm

Involuntary muscle contractions, often a protective response to pain.

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Observation

Visual inspection of a patient's posture, gait, muscle condition and movement patterns.

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Spondylolysis

A defect in the pars interarticularis of the vertebrae, typically in the lumbar spine. It's usually unilateral or bilateral, and involves no displacement of the vertebral body.

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Spondylolisthesis

A condition where a vertebra slips forward over the vertebra below, often due to a bilateral pars defect. Most common at L5.

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Stenosis

Narrowing of a canal, typically the spinal canal, often due to arthritic changes or spondylolisthesis.

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Central Stenosis

Narrowing of the spinal canal, leading to bilateral symptoms.

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Foraminal Stenosis

Narrowing of intervertebral foramina, leading primarily to unilateral symptoms.

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Osteoporosis

A condition characterized by decreased bone density and increased risk of fragility fractures.

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Sprain

Ligament injury.

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Strain

Muscle or tendon injury.

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Facet Joint Dysfunction

Problems with the facet joints (joints between vertebrae), often caused by repetitive stress.

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Disc Pathology

Issues with the intervertebral discs, often involving herniation or bulging.

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Anterolisthesis

Forward slippage of a vertebra.

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Retrolisthesis

Posterior slippage of a vertebra.

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Whiplash

A sprain or strain in the neck caused by sudden, forceful movement.

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PPIVMs & PAIVMs

PPIVMs are Postural Painful Impairment Variants that are hypomobile and painful. PAIVMs are Postural Activity Impairment Variants that are also hypomobile and painful. They both indicate limitations with movement and pain.

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Special Tests for Cervical Radiculopathy

These tests assess the function and integrity of the nerves in the neck. They help determine if a nerve root is compressed or irritated, which is common in cervical radiculopathy.

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What are Adverse Neurodynamics?

Adverse neurodynamics occur when nerves are stretched, compressed, or otherwise irritated, affecting their normal function. This can lead to pain or other neurological symptoms.

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What are the 'Naturally Occurring Convergence Points'?

These are areas in the body where nerves frequently converge and are more prone to tension or irritation. These include C6, T6, L4, Elbow, Shoulder and Knee

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What are 'Sensitizing Movements'?

These are movements that increase or worsen pain in cases of nerve issues. They are used to identify nerve tension or irritation.

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What are Common Causes of Nerve Injury?

Various factors like trauma, disc problems, poor posture , inflammation, injections, and even surgery can lead to nerve damage.

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What are some Clinical Observations?

People with nerve problems might show signs like poor posture and muscle wasting in the affected area. However, sometimes there are no visible abnormalities.

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What are Some Less Common Special Tests for Nerve Issues?

In addition to common nerve tests, some less frequently used tests include Tinel's sign, brachial plexus traction test, and the prone knee bend.

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Thoracic Outlet Syndrome (TOS)

A condition where nerves, blood vessels, or both are compressed in the space between your collarbone and your first rib. This can cause pain, numbness, tingling, and weakness in your arm and hand.

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What are the 3 types of Thoracic Outlet Syndrome?

  1. Neurogenic TOS: Compression affects the nerves, causing pain, numbness, and tingling.
  2. Vascular TOS: Compression affects the blood vessels, causing pain, swelling, and discoloration.
  3. Non-specific TOS: A combination of nerve and blood vessel compression, showing symptoms of both types.
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Common TOS Symptoms

Pain, numbness, tingling, weakness in the arm, hand, or fingers. Swelling, discoloration, heaviness in the arm. Fatigue, loss of strength in the arm and hand. Cramping, pallor, cyanosis, decreased skin temperature, edema, distended veins.

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Who is more likely to have TOS?

Women are more likely than men to develop TOS. People with jobs involving repetitive overhead movements or sustained positions, like desk workers, are also more susceptible.

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How does smoking contribute to TOS?

Smoking reduces vascular health, which can worsen TOS symptoms by limiting blood flow to the arm.

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How does a car accident (MVA) contribute to TOS?

Whiplash injuries from car accidents can cause damage to nerves or blood vessels in the neck, leading to compression and TOS.

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What are some common causes of Chronic TOS?

Poor posture, repetitive overhead activities, using heavy backpacks or bags, and adaptive muscle shortening can all contribute to chronic TOS.

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Congenital TOS

A condition present at birth, often caused by a cervical rib or decreased space between the first rib and clavicle. This can compress nerves and vessels.

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What is the role of Special Tests in diagnosing TOS?

Special tests help assess nerve and blood vessel function and identify potential compression points. These tests include: neurodynamic testing, vascular tests, and evaluation of first rib mobility.

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Why are PAIVMs (Passive Accessory Intervertebral Movements) important in TOS?

PAIVMs help assess joint mobility and restriction in the thoracic spine, which can be affected by TOS and may contribute to the condition.

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Study Notes

Critical Rule Outs

  • Upper cervical instability
  • Fractures
  • Vertebral artery injury

Scanning

  • Upper Quadrant:
    • Tspine PAVCP's (Upper: T1-6)
    • Peripheral Joint Scan:
      • TMJ (open, close, side to side)
      • Shoulder (AROM/OP)
      • Elbow (AROM/OP)
      • Wrist (AROM/OP)
    • Myotomes: C3-T1
    • Dermatomes: C1-T2
    • Reflexes:
      • Biceps tendon
      • Brachioradialis
      • Triceps tendon
  • Lower Quadrant:
    • Tspine PACVPs (Lower: T7-12)
    • Quick Test - Squat
    • Peripheral Joint Scan:
      • SI Joint (Gillet's)
      • Hip (AROM/OP)
      • Knee (AROM/OP)
      • Ankle (AROM/OP)
    • Myotomes: L1-S2
    • Dermatomes: L1-S2
    • Reflexes

Clearing

  • Upper Quadrant:
    • Clear joint above & below
  • Cervical:
    • TMJ (open, close, side to side)
    • T spine (PACVPs (T1-6))
    • Shoulder (AROM/OP)
  • Thoracic:
    • C spine PAVCPs
    • L spine PACVPS
    • Shoulder AROM/OP
  • Lower Quadrant:
    • Tspine PACVPS (T7-12)
    • SI Joint (Gillet's)
    • Hip (AROM/OP)

Bony Conditions of the Spine

  • Bone Pain Characteristics: Deep, nagging, aching, sharp, localized
  • Fractures:
    • Acute: More common in cervical spine, compression (osteoporosis), and avulsion. Can involve Spinous process, Transverse process, Vertebral arch, Vertebral body
    • Insidious: Fewer but more common than traumatic, often stress fractures. Most common in lumbar spine (spondylolysis and spondylolisthesis) or thoracic spine (osteoporosis). May involve Pars interarticularis or Vertebral end plate

Acute Fracture Rule-Out

  • Mechanism of Injury: Axial compression, MVA & other traumatic forces
  • Associated symptomatology: Central, local pain, Bilateral paresthesia, Headaches, Tinnitus, Nausea, Cranial nerve symptoms
  • Patient profile - Osteoporosis

Spondylopathies

  • Inflammatory: Ankylosing Spondylitis
  • Non-Inflammatory: Spondylosis, Spinal stenosis, Spondylolysis, Spondylolisthesis

Spondylolysis

  • Defect of pars interarticularis, often unilateral or bilateral
  • Predominantly in lumbar spine, especially at L5
  • Sometimes associated with trauma and occurs in adolescents related to spondylolysis / growth spurts
  • May also be seen in older populations, athletes who frequently engage in repetitive spinal extension

Spondylolisthesis

  • Bilateral defect of pars interarticularis
  • Predominately seen in lumbar spine, most common at L5
  • Forward slippage (traumatic or chronic) of superior vetebrae over the inferior vertebrae
  • Similar symptoms to spondylolysis, but different on physical examination

Spondylosis

  • Development of osteophytes around vertebral margins, decreasing disc space
  • Possible ligamentum flavum hypertrophy/ossification
  • Seen predominantly in individuals >40 but degeneration may start in 20s

Stenosis

  • Narrowing of spinal canal, often caused by facet joints, arthritis, disc degeneration, etc.
  • Usually appears in people over 50 years old
  • Can be congenital (present at birth)

Whiplash

  • Caused by high velocity/traumatic forces, often associated with MVA or WCB (Workplace Compensation Board)

Facet Joint Dysfunction

  • Mechanism of Injury
    • Sustained or repeated spinal extension/rotation
    • Sudden or unusual movements
    • Habitual posture
    • Poor sleeping positions
    • Degenerative/cumulative trauma
  • Often insidious onset and can have positional faults and misalignments

Rib Joint Dysfunction

  • Mechanism of Injury
    • Sustained/repeated thoracic movements
    • Traumatic twisting/torsional movement
    • Direct blow/trauma
    • Exertional
    • Habitual postures/muscular imbalances
    • Insidious onset

Disc Pathologies

  • Disc Pathology: Localized, graded herniation of the nucleus pulposus against or through the wall of the intervertebral disc

Vertebrobasilar Artery Insufficiency (VBI)

  • Localized or diffuse disruption of circulation to the brain and brainstem.
  • Most frequently injured site C1-C2

Thoracic Outlet Syndrome

  • Obstruction of structures emerging from the superior thoracic aperture
  • Types: Neural, Vascular, Non-specific/mixed

Sprains/Strains

  • Location: Dependent on involved tissue structure (usually posterior or lateral muscle groups)
  • Quality: Dull, aching, stiff, tight
  • Severity: Variable
  • Aggravates: AROM contraction, PROM stretch, sustained posture
  • Alleviates: Supine or neutral/unloaded position, ice or heat, medications for pain, stiffness in AM
  • Radiating: Variable

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Description

This quiz covers critical rule outs, scanning techniques, and clearance protocols in physical assessment of the musculoskeletal system. Focused on upper and lower quadrant evaluations, it addresses myotomes, dermatomes, and joint mobilizations to ensure a comprehensive understanding of the assessment process.

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