Seidel Ch 22 MS

Which statement best describes the procedure for testing muscle strength? A. Have the individual press against a stationary object and measure the degree of flexion with a goniometer. B. Have the individual support a specified amount of weight and determine the length of time the individual can support it. C. Have the individual contract a muscle by flexing or extending a joint as you apply opposing force and feel the resistance. D. Have the individual pull on a weighted spring and measure the amount of force needed to maintain the muscles in flexion

C. Have the individual contract a muscle by flexing or extending a joint as you apply opposing force and feel the resistance. Evaluating the strength of each muscle group is considered part of the neurologic examination. Ask the patient first to contract the muscle you indicate by extending or flexing the joint and then to resist as you apply force against that muscle contraction

The FABER test is a part of the assessment of which joint? A. Shoulder B. Wrist C. Hip D. Ankle

C. Hip Examine the range of motion of the hips by asking the patient to perform the following movements: While supine, place the lateral aspect of the foot on the knee of the other leg; move the flexed knee toward the table. This is known as the Patrick or FABER test —Flex, ABduct, and Externally Rotate.

Mr. McKnight, a 72-year-old patient, presents to your office for a routine office visit. Which finding on examination would be considered normal? A. Meningocele B. Myelomeningocele C. Kyphosis D. Scoliosis

C. Kyphosis Kyphosis may be observed in aging adults.

Which factor results in bony prominences becoming more apparent in older adults? A. Increased calcium deposits B. Decreased bursae function C. Loss of subcutaneous tissue D. Increased bone deposition

C. Loss of subcutaneous tissue Bony prominences become more apparent with the loss of subcutaneous fat.

You are examining a patient who had an ankle fracture of the tibia and fibula 12 weeks ago. You find that plantar flexion of the affected foot is 45 degrees. How do you interpret this finding? A. Plantar flexion is somewhat diminished but consistent with a healed fracture. B. Plantar flexion is significantly less than normal. C. Plantar flexion is normal. D. Plantar flexion is slightly greater than normal.

C. Plantar flexion is normal. Assess range of motion of the foot and ankle. Expect plantar flexion of 45 degrees.

Mr. Booker is a 47-year-old patient who presents to your office with a complaint of knee pain. When performing the drawer test, you note there is excessive movement of the knee in the anteroposterior plane. What conclusion do you draw? A. Damage to the femoral condyle is likely. B. There is a possible torn medial meniscus. C. There is possible injury to the anterior cruciate ligament. D. There is excessive fluid within the knee.

C. There is possible injury to the anterior cruciate ligament. The anterior and posterior drawer test is used to identify instability of the anterior and posterior cruciate ligaments.

To assess muscle strength of the temporalis and masseter muscles, the examiner will ask the patient to: A. push the jaw forward while the examiner applies counterforce. B. attempt to open his or her mouth while the examiner applies counterforce. C. clench his or her teeth while the examiner palpates the contracted muscles and applies opposing force. D. move the mandible 2 cm or more to each side against an opposing force.

C. clench his or her teeth while the examiner palpates the contracted muscles and applies opposing force. Strength of the temporalis and masseter muscles may be evaluated by asking the patient to clench the teeth while you palpate the contracted muscles and apply opposing force. This maneuver simultaneously tests cranial nerve V.

During inspection of the muscles of a male construction worker, you notice that his upper extremities are slightly asymmetrical with the right arm slightly larger than his left. Previous observations have led you to conclude that he is right dominant. Based on this information, you may safely conclude that: A. his right extremity is affected by an inflammatory process. B. his left extremity is suffering from a muscle wasting process. C. this is a perfectly normal finding and requires no further follow-up. D. there is the possibility of damage to motor neurons controlling the left extremity.

C. this is a perfectly normal finding and requires no further follow-up. Persons such as athletes who use the dominant arm almost exclusively in their activities (e.g., pitchers and tennis players) may have some discrepancy in circumference.

Synovial Thickening

Can be felt in joints close to skin surface when synovium is edematous or hypertrophied d/t inflammation.

Crepitus

Can be felt when two irregular bony surfaces rub together as a joint moves, when two rough edges of a broken bones rub together, or with the movement of a tendon inside the tendon sheath when inflammed.

tibial torsion

Child prone, flex knee 90 and aline midline of foot parallel to femur

Mrs. Harris is a 69-year-old patient who presents to your office for follow-up of her rheumatoid arthritis. Which deformity would be an expected finding associated with her disease? A. Polydactyly B. Heberden nodes C. Osteomalacia D. Boutonnière deformity

D. Boutonnière deformity Boutonnière deformity is a finding associated with rheumatoid arthritis

Scoliosis is characterized by which type of spinal deformity? A. Lordosis B. Gibbus C. Ellipsis D. Lateral curvature

D. Lateral curvature A lateral curvature or rib hump should make you suspect scoliosis.

Which of the following is considered a normal finding for a woman in her eighth month of pregnancy? A. Stronger ligaments and spinal joints B. Hypercalcemia C. 25% loss of muscle strength D. Lordosis

D. Lordosis The growing fetus shifts the woman's center of gravity forward, leading to increased lordosis and a compensatory forward cervical flexion.

When assessing for carpal tunnel syndrome, which structure is responsible for producing the Tinel sign? A. Dorsal aspect of the wrist B. Volar carpal ligament C. Radial artery D. Median nerve

D. Median nerve Tinel sign is tested by striking the patient's wrist with your index or middle finger where the median nerve passes under the flexor retinaculum and volar carpal ligament. A tingling sensation radiating from the wrist to the hand in the distribution of the median nerve is a positive Tinel sign and is suggestive of carpal tunnel syndrome

Which item from a patient's history indicates an increased risk of osteomyelitis? A. Difficult to control gout B. Rheumatoid arthritis C. Severe osteoporosis D. Open fracture of the radius

D. Open fracture of the radius Osteomyelitis, an infection in the bone, usually results from an open wound or systemic infection.

1. You are planning to assess range of motion (ROM) in a 56-year-old patient with a complaint of joint pain. Which is an important fact related to this assessment that must be considered? A. The reverse tailor position is encouraged in adults with limited ROM to the hip. B. Active ROM is used to assess extremities with complete paralysis. C. Full muscle strength can be maintained with up to 75% of ROM to the related joint. D. Passive ROM is normally 5 degrees greater than active ROM.

D. Passive ROM is normally 5 degrees greater than active ROM. When assessing joint motion, both active and passive range of motion are examined. Passive range of motion often exceeds active range of motion by 5 degrees

Which is not a function of the musculoskeletal system? A. Storage of minerals B. Production of blood cells C. Protection vital organs D. Secretion of minerals

D. Secretion of minerals The musculoskeletal system protects vital organs, provides storage space for minerals, and produces blood cells (hematopoiesis).

What are you testing when you ask a patient to extend the head against the pressure of your hand? A. Cervical spine alignment B. Passive range of motion C. Temporalis muscle strength D. Sternocleidomastoid muscle strength

D. Sternocleidomastoid muscle strength Evaluate range of motion in the cervical spine by asking the patient to perform the following movements (see Fig. 22.28): • Bend the head forward, chin to the chest. Expect flexion of 45 degrees. • Bend the head backward, chin toward the ceiling. Expect extension of 45 degrees. • Bend the head to each side, ear to each shoulder. Expect lateral bending of 40 degrees. • Turn the head to each side, chin to shoulder. Expect rotation of 70 degrees. The strength of the sternocleidomastoid and trapezius muscles is evaluated with the patient maintaining each of these positions while you apply opposing force. With rotation, cranial nerve XI is simultaneously tested.

Trendelenburg sign

weak hip abductor muscles

Ballottement

Effusion of the knee

Bulge Sign

Effusion of the knee

ROM

Examine Passive and Active (Passive exceeds Active by 5 degree). > 5degree can indicated muscle weakness or joint disorder. Do not force joint if pain or muscle spasm. Problem with the joint, related muscle group, or nerve supply is denoted by pain, limited ROM, spastic movement, joint instability, deformity, or contracture.

Thomas test

Flexion contracture of hip

Muscle Strength

Have pt contract the muscle by extending or flexing the joint and then resist force you apply against the contraction. Compare bilaterally. Requires full active ROM. grade 0-5

Femoral stretch test

L1, L2, L3, L4 nerve root irritation Lay on stomach and straight leg raise behind

Straight leg raise

L4, L5, S1 nerve root irritation

Varus-Valgus stress test

Lateral or medial collateral ligament instability in knee Varus - Lateral Valgus - Medial

Tinel's sign

Medial Nerve integrity

Phalen's test

Medial Nerve intergrity (Dr. Phalen - you're on my last nerve)

Katz hand diagram

Median nerve integrity

Thumb abduction test

Median nerve integrity

Metatarsus adductus (metatarsus varus

Most common congenital foot deformity; can be fixed or flexible

Muscle Function Level

No evidence of movement - 0 Trace movement - 1 Full ROM, but not against gravity (passive) - 2 Full ROM against gravity but not against resistance 3 Full ROM against gravity and some resistance, but weak - 4 Full ROM against gravity, full resistance - 5

Acute knee injuries Radiograph

Per Ottawa Knee Rules -Age over 55 -Tenderness at head of fibula - Isolated tenderness of the patella - Inability to flex to 90 degree

Hawkins Test

Shoulder rotator cuff impingement or tear (Stephen Hawking)

Neer's Test

Shoulder rotator cuff impingement or tear (near to the ear)

McMurray Test

Torn Meniscus in knee (MnM)

The spine of a newborn infant is palpated and a split is noted in one of the spinal processes. Which problem does the examiner suspect? A. Bifid defect B. Lordosis C. Down syndrome D. Spina bifida

A. Bifid defect Position the baby with the trunk flexed, and palpate each spinal process. Feel the shape of each, noting whether it is thin and well formed, as expected, or whether it is split, possibly indicating a bifid defect.

Mrs. Blain is a 45-year-old patient who presents to your office. On examination, you note a positive Tinel sign. A positive Tinel sign is associated with which problem? A. Carpal tunnel syndrome B. Rheumatoid arthritis C. Osteoporosis D. Scoliosis

A. Carpal tunnel syndrome A tingling sensation radiating from the wrist to the hand in the distribution of the median nerve is a positive Tinel sign and is suggestive of carpal tunnel syndrome.

Inspect knees for it's natural a. Concavities b. Convexities

A. Concavities If you note a convex appearance to knees, suspect effusions.

The Barlow-Ortolani maneuver is performed on the infant to detect which problem? A. Hip dislocation B. Broken clavicle C. Knee dysplasia D. Shortened femur syndrome

A. Hip dislocation The Barlow-Ortolani maneuver to detect hip dislocation or subluxation should be performed each time you examine the infant during the first year of life.

Which group is susceptible to subluxation of the head of the radius? A. Infants/toddlers B. Adolescents C. Pregnant women D. Older adults

A. Infants/toddlers This injury is common in children 1 to 4 years of age.

Which condition may a woman develop during pregnancy to compensate for the enlarging uterus and shift her center of gravity over the lower extremities? A. Lordosis B. Kyphosis C. Contracture D. Genu valgum

A. Lordosis As the fetus grows, lordosis (inward curvature of the lower spine) occurs in an effort to shift the center of gravity back over the lower extremities.

A straight leg raising test would appropriately be performed as part of the assessment for which problem? A. Lumbar nerve root irritation B. Flexion contracture of the hip C. Tear of the lateral meniscus D. Hip adductor muscle weakness

A. Lumbar nerve root irritation The straight leg raising test is used to test for nerve root irritation or lumbar disk herniation at the L4, L5, and S1 levels.

Mr. Jones is a 37-year-old patient who presents to your office with shoulder pain. Which test would help identify a problem with the rotator cuff? A. Neer test B. Phalen test C. Bragard stretch test D. McMurray test

A. Neer test The Neer test is used to evaluate the rotator cuff for impingement (tendonitis or overuse injury from repetitive overhead activities) or a tear. To perform the Neer test, forward flex the patient's arm up to 150 degrees while depressing the scapula. This presses the greater tuberosity and supraspinatus muscle against the anteroinferior acromion. Increased shoulder pain is associated with rotator cuff inflammation or a tear.

For which problem does a family history have significance? A. Rheumatoid arthritis B. Dislocation of the radius C. Lumbosacral radiculopathy D. Bursitis

A. Rheumatoid arthritis Persons with a family history of rheumatoid arthritis are considered at increased risk for the disease.

A variation in leg alignment identified as genu varum is commonly known as: A. bow legged. B. knock kneed. C. pigeon toed. D. flat footed.

A. bow legged. Assess for bowleg (genu varum) with the child standing, facing you, knees at your eye level.

The rubbing of two irregular bony edges together produces: A. crepitus. B. effusion. C. spasticity. D. bursitis.

A. crepitus. Crepitus can be felt when two irregular bony surfaces rub together as a joint moves, when two rough edges of a broken bone rub together, or with the movement of a tendon inside the tendon sheath when tenosynovitis is present.

The elbow joint consists of articulation of the: A. humerus, radius, and ulna. B. radius, ulna, and tibia. C. acromion and coracoid processes. D. humerus, fibula, and tibia

A. humerus, radius, and ulna. The elbow consists of the articulation of the humerus, radius, and ulna.

Mr. Berlin is a 42-year-old patient who presents to the clinic with complaints of right elbow pain. This started about 4 weeks ago when he started playing tennis. You suspect he has bursitis. What is the etiology of this disease? Inflamed synovial tissue Excessive pressure on the bursa Inflammatory cytokines and enzymes Cartilage abrasion from tennis

ANS: B Rationale: Bursitis is due to repetitive movement and excessive pressure placed on the bursa. Cartilage abrasions are common in osteoarthritis; antiinflammatory cytokines and enzymes are common in rheumatoid arthritis.

Mr. Berlin is a 42-year-old patient who presents to the clinic with complaints of right elbow pain. This started about 4 weeks ago when he started playing tennis. You suspect he has bursitis. Which of the following would you expect to find on examination: Enlarged joint, osteophyte Limitation of motion caused by swelling Crepitus in the joint Synovitis

ANS: B Rationale: Enlarged joints and crepitus are found in osteoarthritis synovitis, which is found in rheumatoid arthritis. Limitation of motion caused by swelling is found in bursitis

Inquiry about nocturnal muscle spasms would be most significant when taking the musculoskeletal history of: Adolescents Older adults Middle-aged adults Children

ANS: B Rationale: History taking of older adults should include symptoms of nocturnal muscle spasms.

Medial and lateral stability of the knee is provided by which of the following: Cruciate ligament Collateral ligament Meniscus Fibrocartilaginous disks

ANS: B Rationale: The medial and lateral stability of the knee is provided by the collateral ligament.

A goniometer is used to assess: Bone maturity Joint proportions Range of motion Muscle strength

ANS: C Rationale: The angle of a joint can be accurately measured using a goniometer. This is used when the joint range of motion is beyond the normal limits.

The patient with rheumatoid arthritis will complain of pain: Especially in the morning After resting for 2 to 3 hours With stiffness during activity At rest, especially during sleep

ANS: D Rationale: The pain of rheumatoid arthritis occurs at rest, especially during sleep.

Inspection

Ability to stand erect, symmetry of body parts and alignment of extremities. Observe spinal irregularities. Look for muscle atrophy or hypertrophy, twitching or spasms.

Goniometer

An instrument used to measure ROM. Use this when a joint appears to have an increase or limitation in it's ROM.

Anterior and Posterior drawer test

Anterior and posterior cruciate ligament integrity

Lachman Test

Anterior cruciate ligament integrity

Muscle Tone

Assess by feeling for resistance to passive stretch.

limb measurement

Asymmetry in limb size - Should be no more than 1 cm difference in length and circumference between matching extremities

Which of the following questions asked by the examiner would be most helpful in understanding a patient complaining of acute back pain? A. "What medications do you currently take?" B. "Was there any activity or injury that occurred before the onset of the pain?" C. "Were you born with any congenital deformities of the spine?" D. "Have you recently lost weight?"

B. "Was there any activity or injury that occurred before the onset of the pain?" When a patient presents with a complaint of back pain, it is important to ask about any associated event, such as trauma, lifting of heavy weights, long-distance driving, sports activities, change in posture, or deformity.

Changes in bone density occur in older adults as a result of which normal age change? A. Bone resorption is less than bone deposition. B. Bone deposition is less than bone resorption. C. Cartilage calcification is increased. D. Fibrosis of connective tissue increases.

B. Bone deposition is less than bone resorption For menopausal women, decreased estrogen increases bone resorption and decreases calcium deposition, resulting in bone loss and decreased bone density.

Which is an effect of increased levels of hormones in the pregnant woman? A. Muscle weakness B. Increased elasticity of ligaments C. Joint tenderness D. Osteoporosis

B. Increased elasticity of ligaments Increased hormone levels contribute to the elasticity of ligaments and softening of the cartilage in the pelvis at about 12 to 20 weeks of gestation.

When measuring the circumference of the extremities of a 43-year-old patient, the examiner compares the right and left sides. What finding should the examiner expect? A. Identical measurements on the right and left B. Nearly equal right and left side measurement C. Right and left measurement differences within 2 inches D. Significantly larger muscle groups on the dominant side

B. Nearly equal right and left side measurement Expect to find bilateral symmetry in length, circumference, alignment, and the position and number of skinfolds.

Which statement is true in regard to passive range of motion (ROM)? A. Passive ROM is often less than 20 degrees less than active ROM. B. Passive ROM often exceeds active ROM by 5 degrees. C. Contralateral joints may often differ by 10 degrees. D. Crepitation may often be palpated during passive ROM.

B. Passive ROM often exceeds active ROM by 5 degrees. Passive range of motion often exceeds active range of motion by 5 degrees

With an infant lying supine on the examining table, both knees flexed, feet flat on table, and femurs aligned, you note that one knee is higher than the other. Which would be a correct documentation of this finding? A. Negative Neer test B. Positive Allis sign C. Negative Gower sign D. Positive McMurray test

B. Positive Allis sign The test for the Allis sign is used to detect hip dislocation or a shortened femur. When one knee appears lower than the other, the Allis sign is positive.

A Hawkins test would appropriately be performed as part of the assessment for which problem? A. Herniated disc B. Rotator cuff injury C. Flexion contracture of the hip D. Tear of the lateral meniscus

B. Rotator cuff injury The Hawkins test is performed to detect shoulder rotator cuff impingement or tear.

Mrs. Bower is a 38-year-old patient who presents to your office with complaints of pain and a clicking noise with jaw movement. The pain extends into the face. These symptoms are suggestive of which condition? A. Gout in the jaw B. Temporomandibular joint dysfunction C. Rheumatoid arthritis of the jaw D. Bursitis of the temporomandibular joint

B. Temporomandibular joint dysfunction Temporomandibular joint syndrome includes unilateral facial pain that usually worsens with joint movement. In addition clicking, popping, or crepitus commonly occurs.

Mrs. Bower brings in her 8-year-old daughter for an office visit. You note proximal muscle weakness indicated by the Gower sign. Which is the best description of the Gower sign? A. The child is unable to support herself without additional support structures. B. The child rises from a sitting position by placing her hands on her legs and pushing the trunk up. C. The child is unable to perform five pushups. D. The child uses support structures to assist in walking and maneuvering around.

B. The child rises from a sitting position by placing her hands on her legs and pushing the trunk up. Proximal muscle weakness is indicated by the Gower sign, in which the child rises from a sitting position by placing hands on the legs and pushing the trunk up.

Which factor can cause excessive hyperextension of the knee with weight bearing? A. Parrot beak tear of the medial meniscus B. Weakness of the quadriceps C. Displacement of the patells D. Presence of a Baker cyst

B. Weakness of the quadriceps Excessive hyperextension of the knee with weight bearing (genu recurvatum) may indicate weakness of the quadriceps muscles.

During fetal development, bone develops from: A. ligaments and tendons. B. calcified cartilage. C. specialized muscle fibers that calcify. D. bursae cavities that enlarge and harden.

B. calcified cartilage. During fetal development, the skeletal system emerges from embryologic connective tissues to form cartilage that calcifies and eventually becomes bone.

The curves of the cervical and lumbar spines are: A. convex. B. concave. C. elliptical. D. parabolic.

B. concave. Expect the cervical spine curve to be concave with the head erect and in appropriate alignment. The curve of the lumbar spine should be concave.

Mr. Gerrard is a 56-year-old construction worker who presents to your office with a complaint of knee pain. On examination, you perform ballottement of the knee. Ballottement of the knee is performed to determine the: A. presence of infection in the knee bursae. B. presence of fluid in the knee. C. integrity of the tendons and ligaments supporting the knee. D. strength of the knee muscles.

B. presence of fluid in the knee. Ballottement is used to determine the presence of excess fluid or an effusion in the knee.

Muscles are attached to the bones by: A. cartilage. B. tendons. C. ligaments. D. bursae.

B. tendons. The joints of the musculoskeletal system are held together by ligaments, attached to muscles by tendons, and cushioned by cartilage, which facilitates movement.

Palpate

Bones, joints, tendons, and surrounding muscles if symptomatic. Note heat, tenderness, pain, crepitus, swelling, and resistance to movement. Muscles should be firm and not doughy or hard.

Which statement made by a patient helps the examiner differentiate osteoarthritis from rheumatoid arthritis? A. "I have swelling and pain in my joints." B. "I notice a crackle sound when I move my joints." C. "I get extremely tired by mid-morning, even when I sleep well." D. "I used to be double jointed when I was younger."

C. "I get extremely tired by mid-morning, even when I sleep well." Symptoms of rheumatoid arthritis include fatigue, often severe, with onset 4 to 5 hours after rising.

Mr. Bartlet is a 24-year-old patient who presents to your office with a complaint of knee pain. On examination, what degree of knee flexion is considered a normal finding? A. 15 degrees B. 90 degrees C. 130 degrees D. 160 degrees

C. 130 degrees Bend each knee. Expect 130 degrees of flexion.

"Normal" muscle strength is documented as grade ______. A. 0 B. 1 C. 5 D. 10

C. 5 Grade 5 represents normal strength, which means full range of motion against gravity and full resistance.

For what are you testing when you hold an infant in vertical suspension with your hands under the axillae? A. Fracture of the clavicle B. Degree of muscle tone C. General muscle strength D. Hip dislocation

C. General muscle strength General muscle strength is evaluated by holding the infant in vertical suspension with your hands under the axillae. Adequate shoulder muscle strength is present if the infant maintains the upright position. If the infant begins to slip through your fingers, proximal muscle weakness is present.