Section 1
Preview this deck
Hernia
Front
| 5 | 0 | ||
| 4 | 0 | ||
| 3 | 0 | ||
| 2 | 0 | ||
| 1 | 0 |
Active users
1
All-time users
2
Favorites
0
Last updated
6 years ago
Date created
Mar 1, 2020
Cards (237)
Section 1
(50 cards)
Hernia
protrusion of a loop of an organ or tissue through an abnormal opening
Closed fracture
bone is broken, skin is intact
Compound fracture
bone broken, skin open
Apophysis
bone growth associated with traction force, often from ligament or tendon attachment
Hill-Sachs Lesion
posterior humeral head compression fracture associated with anterior shoulder instability.
Baker's cyst
localized fluid accumulation in the posterior fossa of the knee (popliteal cyst)
Contusion
bruise
Fracture
any break in the continuity of a bone
Dislocation
complete displacement of one or more bones at a joint
Ankylosis
Stiffness or fixation of a joint by disease or surgery
Chronic
marked by long duration, by frequent recurrence over a long time, and often by slowly progressing seriousness: not acute
Growth plates
sites where bones grow longer and wider and are weaker than ligaments in a growing athlete
B.P.T.B.
Bone patellar tendon bone- tissue used as reconstruction by ACL
Antipyretic
Substance to reduce fever
Avulsion Fracture
a ligament or tendinous attachment is pulled off with a piece of bone because the attachment was stronger than the bone
Anti-inflammatories
medication which given by injection or pill reduce the components of inflammation
Idiopathic
arising from unknown cause
Ectomy
to cut out i.e. menisectomy, synovectomy
Bone-callus
immature healing bone
Etiology
the cause of a pathologic process
Bristow procedure
eponym using conjoined tendon transfer (reconstruction) for anterior shoulder instability. Musculocutaneous nerve at risk.
Epiphysis
the end of a growing bone
Heterotopic bone
the formation of new bone in an abnormal location, often as a result of trauma or surgery
Chondromalacia
soft cartilage; a condition without reference to etilogy
Iatrogenic
induced artificially by medical treatment
Chondroplasty
repair cartilage
Bursa
a protective synovial sac serving as a cushion for prominences throughout the body. ex. pre-patellar bursa or subacromial bursae.
Acute
Having a sudden onset, sharp rise, and short course
Arthroplasty
To modify a joint by microfracture or resurfacing
Arthroscopy
joint examination with fiberoptic endoscope placed into the joint
Atrophy
loss of muscle fiber cross-sectional area
Fibrocartilage
normally found int he nose and ear; "scar" repair cartilage in the joint
Comminuted fracture
bone broken into more than 2 fragments
Cellulitis
diffuse and especially subcutaneous, inflammation of connective tissue
Discoid Meniscus
congenital variation of the normal semilunar cushion cartilage in which which the meniscus is a disc-like shape
HAGL
humeral avulsion of glenoid ligament
Diaphysis
shaft or middle part of a cylindrical bone
Anti-biotics
Substance to kill or wound micro-organisms
-itis
suffix added to indicate inflammation
Greenstick fracture
incomplete fracture that passes only partially through the shaft of a bone; in a child, a bone fracture in a young individual in which the bone is partly broken and partly bent
Instability
symptomatic joint ROM; pathological
Analgesic
substance to reduce pain
Autograft
same individual's tissue
Bankart lesion
bony on soft tissue avulsion associated with anterior shoulder instability
Arthrofibrosis
intra-articular scarring leading to impaired motion or function
Allograft
donor tissue from same species
Bankart procedure
eponym for anterior capsular repair of IGHL for anterior shoulder instability. Axillary nerve is at risk.
Edema
fluid "loose" in the tissue, which has escaped from the vascular or lymphatic spaces causing local or generalized swelling
Arthroscopic debridement
to clean out the joint, usually the knee
Carcinoma
cancer of epithelia origin ex. adenocarcinoma
Section 2
(50 cards)
Iliac crests palpation
Located at the level of L3/L4. Palpate with your whole hand, not just your thumbs. Check for symmetry at eye level. Check height from the back in order to assess AROM for the lumbar spine. Origin for the latissimus dorsi, iliacus, glut med, iliocostalis lumborum, TFL, internal oblique, transversus abdominis, and QL. Insertion for the external oblique.
Sacrum palpation
Have the pt lying prone. Palpate just medial and inferior to the PSIS. Follow inferiorly on either side to the coccyx to find the lateral borders. Origin for the glut max, piriformis, iliacus, and multifidus.
Joint replacement
a resurfacing of the articular surface
C2-L5 spinous processes palpation
With the pt prone, start by finding the occipital protuberance and slide down; the first SP you feel is C2. Differentiate between C7 and T1; C7 will move with extension/flexion while T1 won't. T2 SP is in line with rib 2 and the superior angle of the scapula, T3 SP is in line with the spine of the scapula and the acromion, T7 SP is in line with rib 8 and the inferior angle of the scapula, and T11 is in line with rib 12. The pubic crest is in line with either the L3/L4 interspinous space, L3 SP, or L4 SP. In males if you hit a SP, there is a 50/50 chance it is L3, but in females if you hit a SP there is a 75% chance it is L3. In the elderly it could even be L2 due to disc shrinkage. Attachment for the lower traps, rhomboids, lats, multifidus, rotatores, spinalis, semispinalis, splenius, and suboccipitals.
Viscosupplementation
injection of material into joint to supplement viscous properties of synovial fluid; used for the treatment of OA. ex. Synvisc
ASIS palpation
In supine or standing, feel on the anterior aspect of the iliac crest. It is the prominent point below the level of the umbilicus but above the genitals. Check for symmetry. Origin for the TFL and sartorius and also an attachment for the inguinal ligament.
-tumor
swelling
Facet regions L1/2 - L5/S1 palpation
Explore the facet locations with your hypothenar eminence. They should be about 2 inches lateral to the SPs and springy. Be sure to release pressure as you slide up the spine. Use CPR arms (straight), but remember to have one hand stabilizing the opposite facet from the one you are palpating. Palpated in order to do PA mobilizations.
Septic
infectious
Reconstruct
to replace a structure with something else i.e. BPTB for ACL
Neutraceuticals
natural substances to help chondrocytes form and heal joint surfaces
Otomy
to surgically break a bone; osteotomy
Ligament
a collagenous structure that attaches bone to bone. When injured, often associated with a pop, pain and swelling
Sprain
injury to a ligament
resect
to remove ie. meniscus, distal clavicle
Osteomyelitis
bone infection
subluxation
partial dislocation (as of one of the bones in a joint)
Osteoconductive
provides scaffolding for new bone
Osteotomy
the internal shifting of bone by breaking the bone. a surgical operation in which a bone is divided or a piece of bone is excised (as to correct a deformity)
Pubic symphysis palpation
Be especially careful to ask for permission for this one! Move inferior 5-8 inches from the navel but superior to the genitals using the base of your palm (make sure not to let your fingers drag on the skin). You should fee a bony prominence. You can switch your palm out for your fingers once you locate the landmark to check for symmetry (is one side deeper, higher, or more tender). Should be palpated to look for adductor or rectus abdominis strains. Part of the origin for the rectus abdominis.
Laxity
amount of ROM in a joint; non-pathological
-calor
heat
Osteopenia
x-ray characteristics of reduced bone density
Metaphysis
a portion of along bone in the wide portion of an extremity that in children, contains the growth plates
C1 transverse processes palpation
Locate the mastoid process and then contralaterally rotate their head 45 degrees. Slide inferior and anterior from the mastoid process to find the transverse process. A good thing to assess for anyone with headache complaints. Will be tender on everyone, so need to compare bilaterally. Origin for the obliqus capitis superior, rectus capitis anterior, rectus capitis lateralis, and levator scap, and insertion for obliqus capitis inferior, splenius cervicis, and longus colli.
repair
to reattach; implies nutrition source and most times blood supply. exception here w/ cartilage ie. Bankart repair for shoulder ligaments
Osteoinductive
induces bone formation; bone morphogenetic proteins (BMPs) help to control osteoblast proliferation
Ischial tuberosities palpation
At the level of the gluteal fold. Palpate in prone and push superior and medially to find it. Hamstrings, quadratus femoris (lateral aspect of the ischial tuberosity), gemellus inferior, and adductor magnus (hamstring portion) originate here.
plasty
to form
Ribs 1-12 palpation
To find the first rib, have the pt in supine and then do passive shoulder elevation. Feel superior to the medial clavicle and anterior to the upper trap; make sure you are medial enough. Move slowly since this is a sensitive area. Have them inhale and exhale; should feel superior and posterior movement during inhale. Can differentiate the first rib from the superior angle of the scapula by passively elevating the scapula (will feel movement if it's the scapula, won't feel movement if it's the first rib). Can have compression of the brachial plexus at this location. First rib is implicated in decreased cervical rotation; check the contralateral side if the pt has decreased cervical rotation. For ribs 2-10, assess movement with inhalation. Upper ribs have A/P expansion, while lower ribs have medial/lateral expansion. Rib 2 is in line with the superior angle of the scapula and T2; anteriorly it is in line with the sternal angle. Rib 3 is in line with the spine of the scapula and T3, rib 8 is in line with the inferior angle of the scapula and T7, and ribs 11-12 are the floating ribs that are found posteriorly (distal and medial to rib 10). Scalenes, intercostals, subclavius, serratus anterior, pec minor, quadratus lumborum, latissimus dorsi, erector spinae group, obliques, transversus abdominis, diaphragm, levatores costarum, iliocostalis, longissimus etc. all attach to the ribs.
-dolar
pain
Middle scalene O/I/A/N
O: Posterior tubercles of TPs of C2-C7 I: Upper surface of 1st rib posterior to the groove for the subclavian artery A: Unilaterally: With the ribs fixed, ipsilaterally laterally flex and contralaterally rotate the neck Bilaterally: Elevation of 1st rib N: Anterior rami of C3-C7
stress fracture
bone discontinuity from overuse as a result of inadequate healing between insults
Osteoclasis
a gradual stretching of bone after it has been fractured
Tendon
a collagenous structure which attaches muscle to bone
PSIS palpation
In standing seated, and supine, feel on the posterior aspect of the iliac crest. Check for symmetry. Important landmark for lumbopelvic screening for manipulations; seated test is negative if the sides are symmetrial, standing flexion test is negative if the difference between the two sides stays the same from standing straight to bent over. Some people will have dimples over their PSIS. Not as prominent as the ASIS.
C2/3 - C6/7 facet joints palpation
Have the pt supine and have them contralaterally rotate their head 45 deg. After finding the C1 TP, the C2 TP is the first one you feel directly down from the ear, posterior to the SCM. C2-C7 form a "T" from the mastoid process to the clavicle. Move in a zig-zag pattern from TP to facet joint as you go down; C2/C3 facet will be just posterior and inferior to the C2 TP, then C3 will be just anterior and inferior to the C2/C3 facet, and so on. The facets are posterior to the TPs. C7 is very difficult if not impossible to feel. Mobilizations are done at the facets, not the TPs (if you mobilize at the TP where muscular attachments are, it can be too painful).
Coccyx palpation
With your pt in prone, explore the sides and look for any deviations. The tip may be inaccessible due to the curvature of the coccyx. Use thumbs to check symmetry. May due mobilizations for an injured coccyx with specialized training. Part of the origin for glut max.
Anterior scalene O/I/A/N
O: Anterior tubercles of TPs of C3-C6 I: Scalene tubercle and upper surface of 1st rib A: Unilaterally: With the ribs fixed, ipsilaterally laterally flex and contralaterally rotate the neck Bilaterally: Elevation of 1st rib N: Anterior rami of C4-C6
Mumford
an eponym of distal clavicle excision
Osteoporosis
a pathologic diagnosis of reduced bone quality
Mal union
improper bone healing
Monteggia fracture
a fracture in the proximal part of the ulna with dislocation of the head of the radius
Osis
a condition of; implies no inflammation ex. arthrosis
Sarcoma
cancer of connective tissue origin ex. osteosarcoma; lymphoma?
Sacroiliac joint palpation
With the pt in prone, locate the PSIS and move inferior and medial to it. Flex their knee to 90 deg and passively IR/ER the hip while feeling the joint space. ER (moving foot in) closes the space, while IR (moving foot out) opens the space. Won't be able to feel much, if any movement in older adults. Can become loose during pregnancy. Can be a source of LBP.
Non union
bone failing to heal
Strain
injury to a muscle or tendon i.e. hamstring or quad tendon
synovium
aka synovial membrane- the dense connective tissue membrane that secretes synovial fluid and that lines the ligamentous surfaces of articular capsules, tendon sheaths where free movement is necessary, and bursae
-rubor
redness
Section 3
(50 cards)
Rhomboids palpation
Have the pt in prone and feel along the medial border of the scapular from C7-T5. Located deep to the mid trap, so it can be hard to differentiate between them. Has fibers that run down and out. Have them make a chicken wing and row back with their thumb down (gets elevation, retraction, adduction, and downward rotation at once).
Adductor longus palpation
Pt is supine with their leg relaxed on yours so that their hip is in slight flexion and ER. Move medially from the pectineus (which is just medial to the sartorius below the pubic tubercle) and test with adduction of hip. Can differentiate from gracilis because adductor longus does hip flexion, while gracilis does not.
Adductor longus O/I/A/N
O: Body of the pubis inferior to the pubic crest I: Distal aspect of the medial lip of linea aspera A: Adduct the hip, assist with internal rotation and flexion of the hip N: Obturator nerve (anterior division) (L2, L3, L4)
Sternocleidomastoid palpation
Locate the mastoid process, clavicle, and top of the sternum. Have them slightly raise their head while doing contralateral rotation and neck flexion. Can test integrity of CN XI with contraction of the SCM. Torticollis can happen when the SCM becomes the predominant flexor because deep flexors are weak (can happen in utero or as babies from looking only to one side), leading to H/A and dizziness.
Longissimus cervicis O/I/A/N
O: TPs of thoracic vertebrae I: TPs of cervical vertebrae A: Postural muscle that unilaterally does some ipsilateral lateral flexion and rotation of the spine, and bilaterally extends the spine N: Dorsal rami of the segments the muscle spans
Gluteus medius O/I/A/N
O: External surface of ilium between anterior and posterior gluteal lines, just below the iliac crest I: Lateral surface of the greater trochanter A: Open chain, all fibers: Abduction of the femur at the hip joint Closed chain, all fibers: Holds pelvis secure over stance leg and prevents pelvic drop on the opposite swing side during walking Anterior fibers: Internal rotation and flexion of the hip Posterior fibers: External rotation and extension of the hip N: Superior gluteal nerve (L4, L5, S1)
External oblique O/I/A/N
O: Muscular slips from the outer surfaces of the lower eight ribs (5th to 12th ribs) I: Lateral lip of iliac crest and aponeurosis ending in linea alba A: Unilaterally: Ipsilaterally laterally flexes and contralaterally rotates the vertebral column Bilaterally: Flexes the vertebral column and compress abdominal contents N: Anterior rami of lower six thoracic spinal nerves (T7-T12)
Rectus femoris O/I/A/N
O: Anterior inferior iliac spine I: Tibial tuberosity (via the patella and patella ligament) A: Flexion of the thigh at the hip joint and extension of the leg at the knee joint N: Femoral nerve (L2, L3, L4)
Biceps femoris O/I/A/N
O: Long head - Ischial tuberosity Short head - Distal aspect of the lateral lip of linea aspera I: Lateral side of the head of the fibula A: All heads: Knee flexion and some external rotation of the knee joint; Long head: Extension and ER of the hip, posterior pelvic tilt N: Long head: Sciatic (tibial branch): L5, S1, S2 Short head: Sciatic (peroneal branch): L5, S1, S2
Suboccipitals palpation
Palpate between the SP of C2 and the superior nuchal line with the pt in prone. Tightness of these muscles can lead to tension headaches. Find these in order to do a suboccipital release; cup your hands and let them relax this region into your fingertips; continue until the upper cervical pain/headache stops or decreases.
Quadratus lumborum palpation
With the pt in prone, locate the 12th rib, posterior iliac crest, and region of L1-L4 TPs. Place your fingers on the lateral edge of this space and sink medially, then have your pt do a hip hike. In side lying, you can place a pillow between their knees and palpate the same region. Side lying shifts the abdominal contents anterior and may allow for easier access. Overuse/strain of QL can cause LBP; May do ischemic compression with your elbow on this area.
Rectus abdominis O/I/A/N
O: Pubic crest, pubic tubercle, and pubic symphysis I: Costal cartilage of 5th to 7th ribs and the xiphoid process A: Compression of abdominal contents, flexion of vertebral column, tension of abdominal wall, and tilts pelvis posteriorly N: Anterior rami of lower seven thoracic spinal nerves (T6-T12)
Longissimus thoracis O/I/A/N
O: TPs of lumbar vertebrae and thoracolumbar fascia I: TPs of all thoracic vertebrae and lower 9 ribs A: Postural muscle that unilaterally does some ipsilateral lateral flexion and rotation of the spine, and bilaterally extends the spine N: Dorsal rami of the segments the muscle spans
Obliqus capitis inferior
O: SP of the axis (C2) I: TP of the atlas (C1) A: Ipsilateral rotation of the head N: Posterior ramus of C1 (suboccipital nerve)
Vastus medialis palpation
Have the pt supine with a pillow under their knee or sitting. Move medial and proximal to the patella and medial to the rec fem. Have the pt extend their knee. Will feel it more distally than the vastus lateralis. Underrecruitment/weakness of this muscle can lead to patellar subluxation.
Semitendinosus palpation
More medial. While pt is prone, passively IR the hip (move whole foot/shank laterally) and tibia (turn foot in) with knee flexion (50-70 deg) to bias the tendinosus/membranosus. Have the pt flex their knee against resistance, begin palpation at the ischial tuberosity, and then trace down to the tendon that leads into the pes anserine. Weakness will present with anterior pelvic tilt.
Rhomboid minor O/I/A/N
O: Lower end of ligamentum nuchae and SPs of C7 and T1 I: Posterior surface of medial border of scapula at the root of the spine of the scapula A: Elevates, retracts, adducts, and downwardly rotates the scapula N: Dorsal scapular nerve (C4-C5)
Rectus femoris palpation
Tendon: Have the patient in supine with knee relaxed. Find the ASIS and the AIIS and then move anterior and medial 1 inch. Have patient flex hip to feel contraction. Muscle belly: Have them supine with a pillow under their knee. Locate the AIIS and patella and palpate between them. Have the pt extend their knee. Can also be done in sitting. To isolate from other quads, have pt do hip flexion with knee extension.
Gracilis palpation
Have pt supine with their leg relaxed on yours so that their hip is in slight flexion and ER. Move medially from adductor longus. This is a very strappy tendon. Fires with adduction. Can cause problems at the pes.
External obliques palpation
With the pt in supine hook-lying, place your hand on their anterior, lower rib cage and abdomen just above the iliac crest. Have your pt perform an abdominal crunch with contralateral rotation. If this is too difficult in supine hook-lying, you can have them leave one leg down to lock their pelvic in place and make it easier. Feel for fiber direction (will be down and in, like placing your hands in your pockets; want to palpate perpendicular to fiber orientation) and see if you can feel where they attach at the ililac crest and blend with the serratus anterior. Tissue of the external obliques make be used during breast reconstruction surgeries. Damage to it can lessen trunk control.
Greater trochanter palpation
Two ways: Patient standing. Distal to the middle of the iliac crest. Go approximately 4-6 inches down the lateral thigh off of the iliac crest and then have patient internally and externally rotate on their hip (tell them to "squish a bug" under their foot) to feel it move under your fingers. Patient in prone. Feel in same area, have patient bend knee and internally and externally rotate their leg. Part of the origin for the vastus lateralis and the insertion for the gluteus medius, gluteus minimus, piriformis, obturator internus, gemellus superior, and gemellus inferior. A common site for bursitis.
Biceps femoris palpation
More lateral. While pt is prone, passively ER the hip (move whole foot/shank medially) and tibia (turn foot out) with knee flexion (50-70 deg) to bias the biceps. Have the pt flex the knee against resistance, begin palpation at the ischial tuberosity, and then trace the biceps down to the distal tendon and to the femoral head. Helps prevent anterior tibial translation and therefore helps prevent ACL tears. Weakness will present with anterior pelvic tilt.
Intercostals palpation
Just inferior to the pec major, palpate between the ribs. Palpate the fiber direction and have them take deep breaths. After SCI or muscle strain causing loss of use of these muscles, the pt will likely have respiratory problems. Can use targeted breathing to improve any issues.
Erector spinae group palpation
Have the pt in prone and feel just lateral to the SPs. Have the pt raise one leg or one arm at a time to make the muscles contract. Don't do both arms or both legs at once because this causes too much compressive load. This group stabilizes the spinal column before and during extremity movements, so weakness or injury of these muscles can cause motion abnormalities and pain. The more superficial of the two intermediate layers of deep back and neck muscles. The largest group. Fill the groove on either side of vertebral bodies, making it hard to palpate TPs. From lateral to medial, consists of the iliocostalis, longissimus (spans 8-10 segments), and spinalis muscles.
Posterior scalene O/I/A/N
O: Posterior tubercle of TPs of C4-C6 I: Upper surface of 2nd rib A: Unilaterally: With the ribs fixed, ipsilaterally laterally flex and contralaterally rotate the neck Bilaterally: Elevation of 2nd rib N: Anterior rami of C7-C8
Sternocleidomastoid O/I/A/N
O: Sternal head - Upper part of anterior surface of the manubrium of the sternum Clavicular head - Superior surface of medial 1/3 of clavicle I: Lateral 1/2 of superior nuchal line and lateral surface of mastoid process A: Unilaterally: Ipsilaterally laterally flex and contralaterally rotate the head and neck Bilaterally: Flex the neck and assist to elevate the ribcage during inhalation N: Accessory nerve (CN XI) and branches from anterior rami C2, C3, and C4
Longissimus capitis O/I/A/N
O: TPs of upper 5 thoracic vertebrae I: Mastoid process A: Postural muscle that unilaterally does some ipsilateral lateral flexion and rotation of the spine, and bilaterally extends the spine N: Dorsal rami of the segments the muscle spans
Gracilis O/I/A/N
O: Inferior ramus of pubis I: Medial surface of proximal shaft of the tibia at the pes anserine A: Adduction of the thigh at the hip joint and flexion of the leg at the knee joint; internally rotate the flexed knee N: Obturator nerve (L2, L3)
Quadratus lumborum O/I/A/N
O: Ileolumbar ligament and internal (deep) portion of the iliac crest I: Transverse process of L1-L4 and inferior border of 12th rib A: Unilaterally: Laterally tilt (elevate) the pelvis, laterally flex the vertebral column to the same side, and assist to extend the vertebral column Bilaterally: Fix the last rib during forced inhalation and exhalation N: Anterior rami of T12-L4
Piriformis O/I/A/N
O: Anterior surface of sacrum between anterior sacral foramina and sacrotuberous ligament I: Superior border of greater trochanter of femur A: External rotation of the hip, abduction of the hip when the hip is in a flexed position. N: Nerve to piriformis (branches from anterior rami of (S1, S2) of the sacral plexus)
Abdominal aortic pulse palpation
Palpate 2 inches superior to the umbilicus with slow but firm pressure straight down into the abdomen. Should be a strong pulse, but not bounding. Would palpate if you are concerned they have a AAA; would listen with a stethoscope for a whooshing sound and ask if they have nausea, feel full very quickly after eating, and have significant back pain.
Serratus anterior palpation
Have the pt supine and feel along the anterolateral rib region off the lower edge of the pec major. Make sure you're above rib 9. Have them flex their shoulder to 120 deg and then punch against resistance. The PT should stand on the opposite side of the table as the arm that is punching and reach across to feel the fibers. If weak, pt may have scapular winging.
Iliocostalis cervicis O/I/A/N
O: Angles of upper 6 ribs I: TPs of C4-C6 A: Postural muscle that unilaterally does some ipsilateral lateral flexion and rotation of the spine, and bilaterally extends the spine N: Dorsal rami of the segments the muscle spans
Piriformis palpation
With the pt prone, trace out a line between the PSIS and coccyx, then about halfway between these landmarks (feel for the lateral angle of the sacrum) draw a line to the greater troch (makes a "T"). Move transversely across and palpate deep (need to feel through the glut max). Flex the pt's knee to 90 and verify with resisted ER (pt tries to pull foot down to plinth medially/pull leg in). Often can become tight and compress the sciatic nerve, esp in pts with variations of the nerve; will have pain with ER.
Serratus anterior O/I/A/N
O: Lateral (i.e. external) surfaces of upper 8-9 ribs and deep fascia overlying the related intercostal spaces I: Costal (i.e. anterior) surface of medial border of scapula A: With the origin fixed: Abduction/protraction, upward rotation, and depression of the scapula, and holds the medial and inferior borders of the scapula against the rib cage. With the scapula fixed: May act to elevate the thorax during forced inhalation. N: Long thoracic nerve (C5, C6, C7)
Rhomboid major O/I/A/N
O: SPs of T2-T5 I: Posterior surface of medial border of scapula from the root of the spine of the scapula to the inferior angle A: Elevates, retracts, adducts, and downwardly rotates the scapula N: Dorsal scapular nerve (C4-C5)
Obliqus capitis superior
O: TP of the atlas (C1) I: Occipital bone between the superior and inferior nuchal lines A: Extension and ipsilateral lateral flexion of the head N: Posterior ramus of C1 (suboccipital nerve)
Internal intercostal O/I/A/N
O: Lateral edge of the costal groove of the rib above I: Superior margin of the rib below, deep to the attachment of the related external intercostal A: Most active during expiration; supports the intercostal space and moves the ribs inferiorly N: Intercostal nerves (T1-T11)
Gluteus medius palpation
Have the pt in side lying and palpate inferior off the iliac tubercle (between the PSIS and iliac crest) toward the greater troch. The posterior fibers of the glut med are more posterior than the TFL (hard to differentiate between the two). Have them abduct their hip to feel it contract. Isolate it from the TFL by having them extend and ER as well. Weakness of this muscle can lead to a positive Trendelenberg sign (will see pelvic drop on contralateral side).
Semitendinosus O/I/A/N
O: Ischial tuberosity I: Medial surface of proximal tibia at the pes anserine tendon A: Flex the knee, internally rotate the flexed knee, extend the hip, assist to internally rotate the hip, tilt the pelvic posteriorly N: Sciatic nerve (tibial branch) (L5, S1, S2)
External intercostal O/I/A/N
O: Inferior margin of the rib above I: Superior margin of the rib below A: Most active during inspiration; supports the intercostal space and moves the ribs superiorly N: Intercostal nerves (T1-T11)
Scalenes palpation
Located between the SCM and traps. Have them do slight contralateral rotation to expose the posterior triangle where they are located, and then move the head back to neutral. Palpate the stringy, superficial muscles under the lateral SCM by applying pressure toward the anterior clavicle (they attach to the ribs). Try to follow them up toward the TPs. The anterior and middle scalenes are just anterior to the posterior scalene. Differentiate between levator scap and scalenes by having them elevate the scap (shouldn't feel movement for scalenes) and take a deep breath into their upper chest (should feel scalenes contract). The brachial plexus and subclavian artery pass between the anteror and middle scalenes; can do a Tinel's test here.
Iliocostalis lumborum O/I/A/N
O: Iliac crest and the thoracolumbar aponeurosis I: Angles of lower 6 ribs A: Postural muscle that unilaterally does some ipsilateral lateral flexion and rotation of the spine, and bilaterally extends the spine N: Dorsal rami of the segments the muscle spans
Vastus medialis O/I/A/N
O: Medial part of intertrochanteric line and medial lip of the linea aspera I: Tibial tuberosity (via patella and patella ligament) A: Extension of the leg at knee joint N: Femoral nerve (L2, L3, L4)
Adductor tubercle palpation
With the knee flexed and the pt in supine, palpate proximal (about 2 cm) to the medial epicondyle of the femur. Feel for a small point and have patient adduct their hip to feel the adductor magnus tendon pop out (it is the insertion for the hamstring portion of the adductor magnus). The adductor hiatus is just above this landmark, so fracture to this region can disrupt blood supply to the knee.
Iliocostalis thoracis O/I/A/N
O: Angles of lower 6 ribs I: Angles of upper 6 ribs A: Postural muscle that unilaterally does some ipsilateral lateral flexion and rotation of the spine, and bilaterally extends the spine N: Dorsal rami of the segments the muscle spans
Spinalis thoracis O/I/A/N
O: SPs of upper lumbar and lower thoracic vertebrae I: SPs of upper thoracic vertebrae A: Postural muscle that unilaterally does some ipsilateral lateral flexion and rotation of the spine, and bilaterally extends the spine N: Dorsal rami of the segments the muscle spans
Rectus capitis posterior major O/I/A/N
O: SP of axis (C2) I: Lateral portion of the inferior nuchal line A: Extension and ipsilateral rotation of the head N: Posterior ramus of C1 (suboccipital nerve)
Rectus abdominis palpation
With the pt in supine hook-lying, palpate the xiphoid process, just lateral the xiphoid, and then down to the pubic symphysis. Have the pt perform an abdominal crunch and feel the fiber direction.
Rectus capitis posterior minor O/I/A/N
O: Tubercle of the posterior arch of the atlas (C1) I: Medial portion of the inferior nuchal line A: Extension of the head N: Posterior ramus of C1 (suboccipital nerve)
Section 4
(50 cards)
Navicular tubercle/tuberosity palpation
Palpate 1-2 inches distal to the medial malleolus along the medial longitudinal arch (anterior and inferior). Projects more medially than the other structures in the region. Landmark used for the navicular drop test. Insertion for the tib post.
Quadriceps tendon palpation
Palpate just superior to the patella.
Fibular head palpation
With the pt seated and their knee flexed, slide inferiorly and laterally 3-4 inches from the tibial tuberosity. Feels knobby. Check by rotating the foot to feel movement of the fibular head. The common peroneal nerve runs directly behind it; pain here could signify the fibular head impinging it. Insertion for the biceps femoris and part of the origin for the soleus and peroneus longus.
Medial/tibial collateral ligament palpation
With the pt seated and knee flexed, palpate distal to the medial epicondyle. Found in the medial joint space. Strum horizontally in between the joint lines. Test the integrity of this ligament with the valgus stress test. Not as commonly torn as the LCL as it is wider and thicker. Has some attachments to the meniscus. Location of the pes anserine, so pain in this area could indicate a problem with these muscles.
Middle trapezius O/I/A/N
O: Inferior aspect of ligamentum nuchae and the spinous processes of the 7th cervical and upper thoracic vertebrae I: Medial margin of the acromion process of the scapula and the superior lip of the posterior border of the spine of the scapula A: Retraction, adduction, and stabilization of the scapula N: CN XI and C3, C4
Teres major O/I/A/N
O: Lower one third of the lateral border of the scapula. I: Medial lip of the intertubercular sulcus on the anterior surface of the humerus; Crest of the lesser tubercle of the humerus. A: IR, extension, and adduction of the arm at the GH joint. N: Lower subscapular nerve (C5, C6)
Tensor fascia latae O/I/A/N
O: ASIS and the iliac crest posterior to the ASIS I: Iliotibial tract/IT band of the fascia latae A: Closed chain: Stabilize the knee in extension Open chain: Flexion, IR, and abduction of the hip N: Superior gluteal nerve (L4, L5, S1)
Peroneal tubercle/trochlea palpation
With the ankle in DF, passively evert the foot and palpate distal (about an inch) to the lateral malleolus.
Iliotibial band palpation
Find Gerdy's tubercle and palpate superiorly from it along the lateral thigh (about 1 inch lateral to the biceps femoris tendon), checking for pain. More thin and cable-like near Gerdy's, more broad as you move superior. Part of the insertion for the glut max and the TFL.
Levator scapula O/I/A/N
O: Transverse processes of C1-C4 vertebrae at the posterior tubercles I: Posterior surface of medial border of scapula from superior angle to root of spine of the scapula A: Unilaterally: Ipsilateral side bending and ipsilateral rotation of the head, downwardly rotates and elevates the scapula Bilaterally: Extends the head and neck N: Anterior rami of C3 and C4 spinal nerves and by branches (C5) from the dorsal scapular nerve
Latissimus dorsi palpation
Have the pt lie on prone with their arm off the table. Hamburger grab the tissue next to the lateral border of the scapula and have them IR (have them push with their palm down against your leg away from their head).
Coracoid process palpation
Run your thumb along the lateral clavicle and then slide inferiorly about an inch. Should be tender. On the right shoulder: 4 o'clock position from the coracoid is pec minor, 6 o'clock position is the coracobrachialis and short head of the biceps, 10 o'clock (towards the humerus) is the coracohumeral ligament, 11 o'clock is the coracoacromial ligament, and 12 o'clock is the coracoclavicular ligament (made up of the trapezoid and conoid ligaments).
Anterior/posterior joint capsule palpation
Um did we learn this?? The joint capsule attaches distally to the anatomical neck of the humerus and proximally on the scapular region outside of the labrum. The long head of the biceps tendon runs up through it. So I guess just feel around for where you think the ligaments are?? lol 4th card and this is already going so well. Anterior ligaments: Superior glenohumeral lig (resists full adduction/movement of the humeral head inferior and anterior), middle glenohumeral lig (resists ER/anterior glide), inferior glenohumeral lig (resists abduction and ER) Superior: Coracohumeral lig (resists extremes of flexion, extension, and ER) Between the tubercles: Transverse humeral lig (anchors the long head of the biceps)
Acromion process palpation
Have the pt laying prone or sitting, then trace from the spine of the scapula laterally until you reach the acromion. Also trace laterally along the clavicle until you hit a ditch (acromioclavicular joint), and go just slightly laterally to that. The middle traps insert on the medial margin of the acromion and the middle delt originates on the lateral margin of the acromion.
Biceps tendon palpation
Proximal: Find the bicipital groove using bump-ditch-bump. Resist forearm flexion to feel the tendon become taut. Distal: Located in the cubital fossa. At 90 deg of elbow flexion (while supinated), apply resistance and trace down the muscle belly to the tendon that is more medial (the more lateral one is the brachioradialis tendon). Biceps tendon ruptures are the most common tendon ruptures in the UE. Proximal rupture is most common and results in a Popeye sign (little functional deformity due to redundancy of forearm flexion, but will decrease GH stability), while the distal rupture you test for with the Hooks test (more likely to get surgery).
Lateral and medial femoral epicondyles palpation
Have the pt in supine with their knee flexed. Palpate medial and lateral to the patella respectfully. The epicondyles are superior to the tibiofemoral joint line. Attachments for the MCL and LCL.
Tibialis anterior O/I/A/N
O: Lateral condyle of tibia; proximal, lateral surface of tibia and interosseous membrane I: Medial and inferior surfaces of medial cuneiform and adjacent surfaces on base of 1st metatarsal A: Dorsiflexion and inversion of foot; dynamic support of the medial arch of foot N: Deep (peroneal) fibular nerve (L4, L5)
Patellar tendon palpation
Palpate just inferior to the patella. A common site for grafts; can become inflamed or tear at the tibial tuberosity.
Tibial plateaus palpation
Have the pt seated with their knee flexed and your thumbs on either side of their patella. Apply a distraction force at the ankle. Located just distal to the joint line (the joint space is just superior to it). Feel for the edges of the plateau. If there is tenderness here it indicates an articular issue.
Teres major palpation
Have the pt lie in prone, then palpate the inferior angle of the scapula (bring their arm behind their back to find the inferior angle, then put it down so it's hanging over the edge of the plinth). Mark it with one finger to denote the lats, and then place two fingers above it along the lateral border of the scapula. Your top two fingers should be on teres major. Have them IR against your leg to feel for contraction.
Sartorius palpation
Have the pt in supine with their foot resting on the opposite knee to the leg you want to palpate. Palpate the middle of the medial thigh. As the pt raises their knee to the ceiling, strum along the superficial muscle belly (about 2 fingers wide) that is medial to the vastus medialis belly. Follow it proximal to the ASIS and distal to the medial tibia.
Bicipital groove palpation
AKA intertubercular groove. The "ditch" of bump-ditch-bump. Hold the pt's hand like you're shaking it, then palpate off the acromion inferiorly and laterally one inch. The bump you feel is the greater tubercle. While still in the handshake position, slightly ER the pt and the greater tubercle will be replaced with a slender ditch, which is the bicipital groove where the biceps tendon runs. Make sure to support the forearm throughout this palpation and keep their elbow close to their side. Can confirm by resisting forearm flexion; should feel the biceps tendon become taut. The pec major, lats, and teres major all attach to it (from lateral to medial via the lips of the tubercles).
Latissimus dorsi O/I/A/N
O: Spinous processes of T7-T12 and their related interspinous ligaments; Via the thoracolumbar fascia to the spinous processes of the lumbar vertebrae, their related interspinous ligaments, and the posterior iliac crest; The last three or four ribs and the inferior angle of the scapula. I: Floor of the intertubercular sulcus/groove. A: Adduction, IR, and extension of the arm at the GH joint. N: Thoracodorsal nerve (C6, C7, C8)
Levator scapulae palpation
Have the pt lying prone, then trace either superiorly off the superior angle of the scapula or laterally and slightly inferiorly from the cervical transverse processes. To get it to activate, have the pt turn their head ipsilaterally slightly. Can also have them elevate their scapula, but upper trap also does this.
Pectoralis minor palpation
Get pt lying supine. Start from the axillary region and slide your fingers under pec major towards the coracoid process. Will really need to get in deep; a tender palpation. Have them depress their scapula slightly to feel the fibers.
Gastrocnemius palpation
Have your pt stand on their toes using a table for stability. Follow from the posterior heads to the popliteal fossa. Notice that the medial head extends further distally than the lateral head. Follow it distally to the calcaneal tendon. Can also have pt prone with their leg straight, and then have them PF into you. The Thompson's test is where you squeeze this muscle and if you get PF then the calaneal tendon is in tact.
Sartorius O/I/A/N
O: Anterior superior iliac spine I: Medial surface of the tibia just inferomedial to tibial tuberosity at pes anserinus tendon A: Flexion of the thigh at the hip joint and flexion of the leg at the knee joint (will also assist with ER and ABD of the hip and internally rotate a flexed knee) N: Femoral nerve (L2, L3)
Lateral/fibular collateral ligament palpation
With the pt seated and knee flexed across the other leg, palpate between the fibula and lateral epicondyle. Strum horizontally in between the joint lines while the pt is still in figure four. Test the integrity of this ligament with the varus stress test. Has some attachments to the meniscus.
Tibial tuberosity palpation
With the pt seated and their knee flexed, locate the patella and then slide inferior 3-4 inches along the anterior tibia to feel it. Insertion for the quads
Peroneus brevis O/I/A/N
O: Distal two-thirds of the lateral surface of shaft of fibula I: Tuberosity at the 5th metatarsal A: Eversion of the foot and weak plantarflexion of the ankle N: Superficial fibular nerve (L5, S1, S2)
Pes anserinus attachment site palpation
With the pt seated and their knee flexed, locate the tibial tuberosity and then slide medial to it one inch. Explore the flat surface of the pes anserinus tendon. Distal to the joint line. Can be hard to differentiate problems with the pes anserine (tendonities or bursitis) from problems with the MCL. Most anterior is the sartorius, then the gracilis, and then most posterior is the semitendinosus.
Lateral and medial femoral condyles palpation
With the pt in supine and their knee extended, shift the patella medially to feel for the lateral condyle and shift it laterally to feel for the medial condyle. The edges of the condyles are slighly underneath the patella, so if the patella is hypomobile you won't be able to access them. Part of the origin for the gastroc and popliteus.
Trapezius palpation
Get the pt prone. Upper: Find the external occipital protuberance and walk down along the cervical spinous processes. Move laterally slightly and palpate the superficial tissue on the posterior neck and top of the shoulder. Activate with scapular elevation, contralateral rotatation, and/or cervical extension. Middle: Slide medially from the spine of the scapula. Have the pt put their arms out in a "T" and have them lift their arms up towards the ceiling with the focus on bringing their shoulder blades together to activate the muscle. Lower: Draw a line from the spine of the scapula to the T12 spinous process to estimate the region it lies in. Have the pt put their arms up in a "Y" position (slightly above their head), and then ask them to "put their shoulder blades in their back pockets" to get them to depress their scapula and feel the muscle activate.
Coracobrachialis O/I/A/N
O: Apex of the coracoid process. I: Linear roughening on the medial midshaft of the humerus. A: Flexion and adduction of the arm at the GH joint. N: Musculocutaneous (C5, C6, C7)
Pectoralis minor O/I/A/N
O: Anterior surface of the superior borders of third to fifth ribs; and from deep fascia overlying the related intercostal spaces I: Coracoid process of scapula (medial border and upper surface) A: Stabilization of the scapula against thoracic wall by pulling the coracoid process anteriorly, downward rotation of the scapula; depression of the scapula, abduction of the scapula, accessory respiratory muscle N: Medial pectoral nerve (C8, T1) (some with fibers from the communicating branch of the lateral pectoral nerve C6, C7, C8, T1)
Gastrocnemius O/I/A/N
O: Medial head - Posterior surface of distal femur just superior to medial condyle Lateral head - Upper posterolateral surface of lateral femoral condyle I: Posterior surface of calcaneous via calcaneal tendon A: Plantarflexion at the ankle and flexion at the knee N: Tibial nerve (S1, S2)
Pectoralis major O/I/A/N
O: Clavicular head - anterior surface of medial half of clavicle; Sternocostal head - anterior surface of the sternum; first seven costal cartilages; aponeurosis of external oblique I: Lateral lip of the intertubercular sulcus of humerus; crest of greater tubercle of humerus A: All fibers - adduction of glenohumeral (GH) joint, and internal rotation of glenohmeral joint; assist to elevate the thorax during forced inhalation with arm fixed; horizontal adduction Clavicular head - flexion of the extended shoulder horizontal adduction of GH joint; Sternocostal head - extension of the flexed shoulder N: Medial and lateral pectoral nerves (C5-T1) Clavicular head - lateral pectoral (C5, C6) Sternocostal head - lateral and medial pectoral nerves (C7, C8, T1)
Pectoralis major palpation
Get the pt supine. Find the clavicular head by first finding the clavicle and then moving slightly inferiorly. Have the pt flex from an extended position against resistance. For the sternocostal head, find the general region of the tissue and test by having the pt extend from a flexed position. Make sure you are not below rib 7.
Gerdy's tubercle palpation
Move inferiorly off the lateral tibial plateau. It should be located lateral to the tibial tuberosity and distal to the joint line. Attachment site for the ITB, so may have pain here if the ITB is tight.
Patella palpation
With the knee extended shift it from side to side (watch for apprehension when moving it laterally; be careful not to sublux by guarding the side you're moving it towards). Make sure not to press down as you glide and ask if they've ever subluxed before. Have the pt flex/extend the knee and observe patellar movement (should move superiorly with extension, inferiorly with flexion). Restricted glide can be due to quad tightness of another pathology. Insertion for the quads.
Peroneus longus and brevis palpation
Find the fibular head and the lateral malleolus; the muscle bellies lie along this imaginary line. Have your pt evert and follow the course of the muscles all the way down behind the lateral malleolus (lie in the lateral malleolar groove) and palpate the attachment of the peroneus brevis to the lateral 5th metatarsal. Brevis lies more anterior.
Lateral and medial tibiofemoral joint lines palpation
With the pt in supine and their knee flexed feel medial and lateral to the patella for a small dip. Just inferior to the epicondyles. Important in differential diagnosis; tenderness here could be a meniscal tear.
Peroneus longus O/I/A/N
O: Proximal two-thirds of the lateral surface of the fibula, head of fibula I: Base of the first metatarsal and medial cuneiform A: Eversion of foot, weak plantarflexion; support arches of foot N: Superficial fibular nerve (L5, S1, S2)
Upper trapezius O/I/A/N
O: External occipital protuberance, the medial portion of superior nuchal line of occiput, and medial margin of ligamentum nuchae I: Posterior border of lateral 1/3 of the clavicle A: Unilaterally: Elevation and upward rotation of the scapula; ipsilateral side bending (laterally flex) and contralateral rotation of the head; Bilaterally: Extend the head and neck N: Accessory nerve (CN XI) and branches of C3, C4
Coracobrachialis palpation
While in supine, abduct the pt's shoulder to 45 deg with ER and rest their upper arm on the table. Locate the coracoid process and move laterally towards the insertion of the coracobrachialis (midshaft of the humerus). Located just posterior to the pec major in the axilla. Perform gentle resisted horizontal adduction to get the slender belly of the muscle to pop out.
Tensor fascia latae palpation
Have the pt side lying, then palpate inferior off the iliac tubercle, anterior to the glut med. Test with abduction, IR, and flexion to differentiate from glut med. Can also feel in supine by moving off the ASIS posteriorly and distally. Implicated with ITB tightness.
Tibialis posterior palpation
With the pt prone and the LE off the table, locate the medial malleolus. Slide posterior and proximal between the posterior tibia and the calcaneal tendon (located in the medial malleolar groove). Follow the tibialis posterior tendon around the malleolus; it is the most anterior tendon. Invert the ankle to make it taut. Can also palpate it with a standing heel raise (PF and inversion). Part of Tom, Dick, AN Harry in the tarsal tunnel.
Tibialis posterior O/I/A/N
O: Posterior surfaces of interosseous membrane and adjacent regions of tibia and fibula, inferior to the soleal line I: Primarily to tuberosity of navicular and adjacent region of medial cuneiform; some tendinous attachment to the MT bases 2-4 and other tarsal bones A: Inversion and plantarflexion of the foot; support medial arch of foot during walking N: Tibial nerve (L4, L5)
Sustentaculum tali palpation
With the ankle in neutral, locate the medial malleolus and passively invert the foot. Slide distally straight down one inch to the bony tip of the sustentaculum tali. Is the shelf for the tib post and flexor digitorum longus. Flexor hallucis longus passes underneath this in the groove.
Tibialis anterior palpation
Have the pt supine and palpate laterally off the tibial shaft. Have your pt invert and DF, then follow the muscle distally across the ankle to the medial foot as it disappears at the medial cuneiform. Weakness of this muscle is associated with foot drop/slap. Anterior compartment of the tibia is most susceptible to compartment syndrome.
Section 5
(37 cards)