703 Review Study Guide
Vital Signs: Blood Pressure, Pulse, Respiration, Temperature- asses the physiological status of a person
Blood Pressure: Systole (ventricular contraction)
Diastole (ventricular relaxation)
Categories / Systolic BP / Diastolic BPNormal / <120 AND / <80
Prehypertension / 120-139 OR / 80-89
Hypertension / ------/ ------
Stage 1 / 140-159 OR / 90-99
Stage 2 / 160-179 OR / 100-109
Stage 3 / 180-209 OR / 110-119
Stage 4 / >210 OR / >120
Contraindication: A-V fistula, Suspected blood clot, After a mastectomy, PICC line
~typically use left arm unless otherwise indicated
Positioning: arm should be at chest level, and the width of the bladder should be about 40% the circumference of the arm at the midpoint of the limb segment.
Pulse:
Should be taken if you suspect a cardiac related problem, circulatory problem, skin color change, or initiating an exercise program for a sedentary patient.
Normal rate: 60-100 bpm
Abnormal pulse rate: Tachycardia= > 100 bmp
Bradycardia= <60 bpm
Grade / Pulse / Description0 / Absent / No perceptible pulse even with maximum pressure
1+ / Thready / Barley perceptible; easily obliterated with slight pressure; fades in and out
2+ / Weak / Difficult to palpate; slightly stronger than thread; can be obliterated with light pressure
3+ / Normal / Easy to palpate; requires moderate pressure to obliterate
4+ / Bounding / Very Strong; hyperactive; is not obliterated with moderate pressure
Taken at multiple places: carotid, brachial, radial pulse, femoral, popliteal, posterior tibial, pedal pulse
Respiration: pulmonary ventilation
Measured: one cycle= one inhalation and one exhalation
Normal resting rates: 12-18/ min for adults
Abnormal rates : >20 or <10 /min
Infants : 30-50/min
Documentation: breaths per min, depth, and any irregularities
Temperature: intensity or degree of heat within the body
Increase in core temperature indicates a possible infection or systemic disorder
Increased local tissue temperature indicates a possible local inflammation
Sensation:
Asses sensation with patients who have a musculoskeletal and or/ neurological conditions
Documentation: intact, abnormal (describe), numbness or tingling, picture of mapped area
Types of sensation: light touch, vibration, cold/hot, painful stimulus
Reflexes: simplest reflex involves an afferent (sensory) and efferent (motor) pathway and a monosynaptic reflex
Normal response: present bilaterally and symmetrically
Abnormal response: too much (hyper)– upper motor neuron lesion (stroke)
Too little (hypo) – lower motor lesion (spinal cord injury)
Grade / Description0 / No response
1+ / Present, but depressed, Low normal
2+ / Average; normal
3+ / Increased, brisker than average; possibly but not necessarily abnormal
4+ / Very brisk; Abnormal
Goniometry:
AAOS normative values
Types of ROM: Active ROM- motion produced by an active contraction
Passive ROM- motion produced by an external force
Active-assistive ROM
Active ROM – status of inert tissue
Passive ROM- joint integrity, joint flexibility, extensibility of ligaments and muscles
Joint play= End feel = felt by applying over pressure
Description: Soft (limited by tissue), Firm (limited by tendons, capsules, ligaments), Hard (bones), Empty
Reliability in goniometry:
Intra tester: the amount of agreement between measurements of the dame joint by the same
Tester.
Inter tester: the amount of agreement between measurements of the same joint by different testers (5 degrees is acceptable)
Validity: suitability of the measurement to the population
Capsular Patterns of Resistance
Joint / CPR / Loose Pack / Close PackAtlanto-occipital / Flex à Ext
Atlantoaxial / Rotation
Cervical / Sidebending and Rotation à Ext
Thoracic / Side Bending and Rotation à Ext à Flex
Lumbar / Side Bending and Ext à Flex
Shoulder / ER à ABD à Flex à IR / 60 deg Abd, 30 deg Horz. Add / Max abd and ER or IR and ext
Elbow / Flex à Ext / 70 deg flex, 10 deg supination / Max ext and supination
Radio-Ulnar / Pronation = Supination
Wrist / Flexion = Extension / 10 deg flex, slight ulnar deviation / ER and radial deviation
IP / Flex à Ext
Hip / Flex à IR à ABD / 30 deg flex, 30 deg abd, slight ER / Max ext, IR, slight Abd
Knee / Flex à Ext / Midflexion / Max ext
Ankle / PF à DF / 10 deg PF / Max DF
Subtalar / Inv à Ever / Pronation / Supination
Midtarsal / Supination à Pronation
Hallux / Ext à Flex
Toes (II- IV) / Flex
Interphalangeal joints
MMT:
When do we use MMT :
Neurological: increased muscle tone, decreased muscle tone, decreased coordination
Neuromuscular: patterns of muscle involvement, spotty weakness, symmetry, site or levelof peripheral lesion
Musculoskeletal: muscle imbalance, posture, weakness, disuse, fracture, intrinsic muscle damage
Agonist: prime mover
Antagonist: a muscle that acts in opposition to the action of another muscle
Fixation/stabilization: the firmness or stability of the body pr body part
Single joint muscle should be tested in the shortened position, Two joint muscle should be tested in the mid-range position.
Pressure= mid-mod-max
Active Insufficiency: A muscle which crosses two or more joints produces simultaneous movement at all joints it crosses, reaches a length at which it can no longer actively contract a usual amount of force
Passive Insufficiency: A muscle which crosses two or more joints, when lengthened at both or all joints simultaneously reaches a length at which is limits further motion.
Grading:
Numerical Score / Qualitative Score5 / Normal
4 / Good
3 / Fair
2 / Poor
1 / Trace
0 / No activity
MMT procedure:
Ask the patient to perform an active muscle contraction through its full ROM against gravity.
If AROM is full (patient has at least a 3/5) complete muscle test as needed
If AROM is limited check PROM. If PROM =AROM break test/ ART . If PROM is > AROM a less than fair grade is given. Grade muscle strength as outlined
MMT is not appropriate or children or infants and people with a upper motor neuron lesions where significant tone is present.
Look at MMT grading charts such as Kendall and Daniels & Worthingham
Segmental Neuro Exam for sensory:
Myotome- Max force for 6 seconds
Dermatome: Eyes closed, test with light touch
Reflexes: attempt 3 times, look for unsymmetrical response
Nerve Root / Sensory / Motor / ReflexC1 / Cervical Flexion (Rectus Capitis Anterior and lateral)
C2 / Side of head / Cervical Ext (Rectus Capitis Posterior
C3 / Anterior Lateral neck / Cervical Lateral Flex (Scalenes)
C4 / Supraclavicular area over trap / Scap Elevation (Upper traps, levator scapule) / Levator Scapule
C5 / Lateral arm / Shoulder Abd (middle deltoid) / Deltoid
C6 / Pad of thumb / Wrist Ext (Extensor Carpi Radialis) / Biceps
C7 / Pad of index and middle finger / Elbow Ext (Triceps) / Triceps
C8 / Hyperthenar eminence and fifth finger / Thumb Ext (Extensor pollicis longus)
T1 / Medial forearm / Finger Add (interossei)
L1 / Groin
L2 / Anterior proximal thigh / Hip Flex (Psoas)
L3 / Medial aspect of distal thigh and knee / Knee Ext (Quads) / Patellar Tendon
L4 / Lat. Aspect of knee and medial distal leg / DF / Inversion (Anterior Tibialis)
L5 / Dorsum of foot / Toe Ext (EHL and EDL) / Medial hamstring
S! / Lateral foot / Eversion (Peroneals) / Achilles Tendon
S2 / Medial aspect of heel / Toe Flexion (FDL)
PALPATION
Hip:
Anterior Superior Iliac Spine
Iliac crest
Greater trochanter – supine, knee bent, to feel better rotate leg back and forth
Posterior Superior Iliac Spine – look for dimples on back
Ischial Tuberosity – side-lying use heel of hand
Knee:
Medial joint line
Medial femoral condyle – easier w/knee bent
Tibial tubercles
Adductor tubercle
Lateral joint line
Lateral femoral condyle – easier w/knee bent
Head of fibula
Patella
Ankle & Foot:
Lateral malleolus – important for goni
Medial malleolus – more superior than the lateral mal.
Talus -
Calcaneus – heel bone
Navicular – past the 1st cuneiform, most prominent medial bump
1st cuneiform
1st metatarsal
1st M-P joint
Cuboid – follow 5th metatarsal, just past styloid process
5th metatarsal – will feel styloid process
Thoracic Spine:
1st rib
T1 – find C7 (most prominent) go down one, pt flexes neck C7 will move and T1 will stay stable
Lumbar Spine:
Anterior Superior Iliac Spine
Iliac crest
Pubic tubercle – palpate over pt’s hand
Posterior Superior Iliac Spine
Ischial tuberosity
L5 – pt prone, find iliac crest first and move to midline, will feel gap between L4 and L5
Wrist and Hand:
Radial Styloid
Ulnar Styloid
Lister’s tubercle- on radius in line with 2nd metacarpal
Scaphoid- anatomical snuff box
Lunate- between capitate and lister’s tubercle
Triquetrum- on ulnar side, sticks out more with RD
Pisiform
Trapezium
Trapezoid
Capitate
Hamate- hook of hamate just distal and lateral to pisiform
Metacarpals
Phalanges
Scapula:
Superior angle
Medial border
Inferior angle
Spine of scapula
Lateral border
Cervical Spine:
Occiput
Inion- between superior nuchal lines
Mastoid Process
Atlas- transverse process of C1 is inferior and anterior to mastoid process
Axis
C6- disappears with neck extension
C7
C2-T1 Spinous process
Shoulder:
Suprasternal notch- directly above sternum at base of neck
Manubrium
Xiphoid
Clavicle
Coracoid process
A-C joint
Great tubercle
Bicipital groove
Lesser tubercle
Elbow:
Medial epicondyle
Ulnar groove
Olecranon
Olecranon fossa
Lateral epicondyle
Radial head
GONIOMETRY
Action / Normal range / Fulcrum / Stationary arm / Moving armThoracolumbar Flexion
*Tape Measure
No pelvic rotation / Standing,~10cm
-Measure before and after movement / Midline of Back / Measure from S2
*Find PSIS go to midline / Measure to C7
Thoracolumbar Finger to Floor
*Tape Measure
Includes pelvic motion / Standing,~2.2cm / Not Applicable / Measure from ground / Measure to tip of middle finger
Thoracolumbar Extension
*Tape Measure / Standing,~2.2cm
-Measure before and after movement / Midline of Back / Measure from S2 / Measure to C7
Lumbar Flexion
*Tape Measure / Standing,~6cm / Midline of Back / Measure up 15cm from S2 & make mark / Measure between marks
Lumbar Extension
*Tape Measure / Standing, ~1.6cm / Midline of Back / Measure up 15cm from S2 & make mark / Measure between marks
Lumbar Lateral Flexion
*Goni or tape measure / Standing, 35º
-slide hand down leg / S2 / Perpendicular to floor / C7
Lumbar Lateral Rotation
*Goni / Sitting,45º / Superior Cranium / Line between ASISs / Acromian Process
Hip Flexion / Supine, 120º
(Pelvis stays flat) / Lat. Greater Trochanter / Lat Midline of Pelvis / Lat Midline of Femur
Hip Extension / Prone, 20º
(Leg straight, pelvis stays flat) / Lat Greater Trochanter / Lat Midline of Pelvis / Lat Midline of Femur
Hip Abduction / Supine, 45º
(no rotation) / ASIS / Line between ASISs / Ant Midline of femur
Hip Adduction / Supine, 30º
(don’t cross legs) / ASIS / Line between ASISs / Ant Midline of femur
Hip Medial Rotation
(Internal) / Sitting, 45º
(foot goes away from midline) / Ant. Patella / Perpendicular to floor / Ant. Midline of Tibia
Hip Lateral Rotation
(External) / Sitting, 45º
(foot goes toward midline) / Ant. Patella / Perpendicular to floor / Ant. Midline of Tibia
Knee Flexion / Supine, 135º / Lat. Epicondyle / Lat. Midline of Femur / Lat. Midline of Fibula
Knee Extension / Supine, -10º / Lat. Epicondyle / Lat. Midline of Femur / Lat. Midline of Fibula
Talocrural Dorsiflexion / Sitting, 20º / Inf. Side of Lat. Malleolus / Midline of Fibula / 5th metacarpal
Talocrural Plantarflexion / Sitting, 50º / Inf. Side of Lat. Malleolus / Midline of Fibula / 5th metacarpal
Tarsal Inversion / Sitting, 35º / Ant. Ankle in Midline / Midline of Tibia / 2nd Metatarsal
Tarsal Eversion / Sitting, 15º / Ant. Ankle in Midline / Midline of Tibia / 2nd Metatarsal
Subtalar Inversion / Prone (ft off), 5º / Behind Malleoli in midline / Midline of Calf / Midline of Calcaneous
Subtalar Eversion / Prone (ft off),5º / Behind Malleoli in midline / Midline of Calf / Midline of Calcaneous
Goniometry
Action / Normal ROM / Patient Positioning / Fulcrum Positioning / Proximal/Stationary Arm / Distal/Moving ArmCervical Flexion / 45°
AMA : 50° / Sitting, 90-90-90 / External auditory meatus / Perpendicular to floor / Base of nose
Cervical Extension / 45°
AMA: 60° / Sitting, 90-90-90 / External auditory meatus / Perpendicular to the floor / Base of nose
Cervical Side Bending / 45° / Sitting, 90-90-90 / C7 / Thoracic spinous processes / Midline of head/occipital protuberance
Cervical Rotation / 60°
AMA : 80° / Sitting, 90-90-90 / Center of cranium / In line with acromion process / Nose
Thoracolumbar Flexion / Combined: 10 cm
Lumbar only: 6-7 cm
Thoracic on ly: 3-4 cm / Measure from S1 to C7, pt standing and reaches forward to touch toes without pelvic anterior tilt / Can use inclinometer and place at L1.
Thoracolumbar Extension / 1.3-1.4 cm / Measure from S1 to C7, pt stands and leans back without pelvic posterior tilt / Can use inclinometer and place at L1.
Thoracolumbar Side Bend / 35°,
22 cm or greater difference from standing to bent / Standing, pt slides hand down the side of leg. Can also measure from finger tips to floor on each side to compare bilateral tightness. / L1 (can use inclinometer) / Perpendicular to floor / C7
Thoracolumbar Rotation / 45° / Sitting, 90-90-90 / Center of head / In line with iliac crests / In line with acromion process
Shoulder Flexion / 180° / Supine, bring arm over head
Substitution: thoracic extension / Greater tubercle / Midline of thorax / Midline of humerus
Shoulder Extension / 60° / Prone / Greater tubercle / Midline of thorax / Midline of humerus
Shoulder Abduction / 180° / Supine, keep thumb towards the head
Substitution: thoracic side bend / Acromion process / Midline of thorax / Midline of humerus
Shoulder Internal Rotation / 70°; or reaches arm behind back to T11 / Supine, arm at 90°, palm down to ground, watch shoulder elevation / Olecranon process / Perpendicular to floor / Ulnar styloid process, midline of ulna
Shoulder External Rotation / 90°; or reaches arm behind back over shoulder to T3 / Supine, arm at 90°, palm faces up / Olecranon process / Perpendicular to floor / Ulnar styloid process, midline of ulna