MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
Precautions/Contras to clear before doing DTFM - ANSWER Contraindications:
-skin breakdown or infection
-CT or inflam joint disease
-ossification/calcification
-bursitis
-neural irritation
-recent local injection
-long term user of steroids or anti-coagulants
Precautions:
-elderly/children (skin integrity, cognition)
-diabetes (sensation and tissue health)
-substrate phase of healing (too acute for the technique)
SO; clear: infection/skin breakdown (inspect skin), inflammatory joint disease (i.e. RA), recent injection
to the area, use of steroids or anti-coagulants, sensation intact
Maitland's Oscillation Grades - ANSWER Small amplitudes: grades 1 and 4
Large amplitudes: grades 2 and 3
R1: first resistance felt by PT
R2: end of ROM due to tissue resistance
Anatomical Limit: joint ripped off
[Grade 5: (not covered here): small amplitude, high velocity thrust at end range (aka manipulation)]
Open Packed Position - ANSWER -resting position
,MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
-most amount of movement available between articular surfaces
-position for acute/irritable joints
-position for applying mobes/tx and ax
-position for casting/splinting
What position should a tendon be put in for DTFM? - ANSWER on a pain-free stretch
usually follow with exercise
can be done on acute, subacute or chronic tendons
Osteokinematic vs Arthrokinematic movements - ANSWER Osteokinematic: gross/physiologic
movements, can be performed voluntarily, i.e. flexion, abduction...
Arthrokinematic: relative motion between joint surfaces i.e. roll, glide, spin, distraction, AKA accessory
movements.Cannot be voluntary; Needed for full movement to occur-problems with arthrkinematic
movements leads to pathology/impingement and restricted osteokinematic range
Abnormal End-feels and what they could indicate - ANSWER -Boggy: swelling
-Springy: loose body i.e. meniscal tear
-Muscle spasm: pain/protective response
-early or late capsular: hypo/hyper mobility
-normal end-feels where they should not occur (i.e. bony -> HO)
-empty: pain, sinister pathology...
How to interpret isometric testing? - ANSWER o No pain and strong: inert tissue
o No pain and weak: complete tear, nerve injury
o Pain and strong: grade 1 tear
o Pain and weak: grade 2 tear
,MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
Sensitive vs Specific Tests - ANSWER Specific: helps rule IN; if +ive likely true, if -ive might be false
Sensitive: helps rule OUT; if -ive likely true, if +ive might be false
What is a hard neurological sign? - ANSWER Loss of conduction; i.e. loss of a DTR, dermatome, myotome
Spinal nerve is being compressed somehow: disc protrusion, palsy
Will likely take longer to heal, may want to rx to Dr for co-treatment
Mechanical vs Non-mechanical pain - ANSWER Mechanical: eased with rest, certain positions, AM
stiffness <30 min, articular findings at joint i.e. inappropriate EF
Non-Mechanical: constant pain, not eased with rest or positional changes, not eased with activity; may
require rx to Dr (not an MSK problem)
Facilitated Segment: what is it and how do we test for it? - ANSWER Disturbance in afferent input at a
spinal nerve causes a state of increased excitability and decreased threshold -> hyper-responsive
efferent output at a given spinal level i.e. hyperalgesia, trophic changes, hypertonicity
To test: skin drag (sweating), scratch test (hyperaemia), peak d'orange (edema), skin rolling
(hypertonicity)
Mandatory Questions to ask during a lumbar scan - ANSWER Cauda Equina: bowel/bladder, saddle
paraesthesia/numbness
Spinal Cord: bilateral LE numbness/tingling
Disc: pain with cough/sneeze
Cancer: night pain, night sweats, unexplained weight-loss, malaise, constant pain
Past medical Hx
Medications: NSAIDs, corticosteroids, anti-coagulants
Imaging done?
Effect of sitting vs standing vs walking (helps to determine compression vs flexion vs extension)
, MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
Lumbar Scan - ANSWER 1. Subjective: mandatory questions
2. AROM and observation (standing)
3. Squat clearance test (standing)
4. S1 myotome (standing)
5. Neuro screen: dermatomes L2-S2, myotomes L1/2-L5, long tract reflexes (plantar response and
clonus) (supine)
6. Neuro screen: S1/2 and L3 reflexes (sitting)
7. Dural mobility: slump, SLR, FNST (sit, stand, prone)
8. S2 myotome (prone)
9. Special tests: FABER (static), laslett's cluster, kinetic test
10. Lumbar compression and traction (supine)
11. Farfan's general torsion (prone)
12. palpation of relevant structures
Laslett's Cluster - ANSWER Cluster of tests to rule in SIJ pathology
-distraction (supine)
-thigh thrust (supine)
-compression (SL)
-sacral thrust (prone)
If at least 3 are +ive: SIJ likely the source
How to perform and interpret the kinetic test - ANSWER Standing; palpate PSIS and S2 (sacrum; same
level as PSIS), have client lift each leg separately
Normal:
-ipsilateral: posterior movement of PSIS relative to S2
-contralateral: no movement of PSIS relative to S2
scans...) 161 complete solutions.
MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
Precautions/Contras to clear before doing DTFM - ANSWER Contraindications:
-skin breakdown or infection
-CT or inflam joint disease
-ossification/calcification
-bursitis
-neural irritation
-recent local injection
-long term user of steroids or anti-coagulants
Precautions:
-elderly/children (skin integrity, cognition)
-diabetes (sensation and tissue health)
-substrate phase of healing (too acute for the technique)
SO; clear: infection/skin breakdown (inspect skin), inflammatory joint disease (i.e. RA), recent injection
to the area, use of steroids or anti-coagulants, sensation intact
Maitland's Oscillation Grades - ANSWER Small amplitudes: grades 1 and 4
Large amplitudes: grades 2 and 3
R1: first resistance felt by PT
R2: end of ROM due to tissue resistance
Anatomical Limit: joint ripped off
[Grade 5: (not covered here): small amplitude, high velocity thrust at end range (aka manipulation)]
Open Packed Position - ANSWER -resting position
,MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
-most amount of movement available between articular surfaces
-position for acute/irritable joints
-position for applying mobes/tx and ax
-position for casting/splinting
What position should a tendon be put in for DTFM? - ANSWER on a pain-free stretch
usually follow with exercise
can be done on acute, subacute or chronic tendons
Osteokinematic vs Arthrokinematic movements - ANSWER Osteokinematic: gross/physiologic
movements, can be performed voluntarily, i.e. flexion, abduction...
Arthrokinematic: relative motion between joint surfaces i.e. roll, glide, spin, distraction, AKA accessory
movements.Cannot be voluntary; Needed for full movement to occur-problems with arthrkinematic
movements leads to pathology/impingement and restricted osteokinematic range
Abnormal End-feels and what they could indicate - ANSWER -Boggy: swelling
-Springy: loose body i.e. meniscal tear
-Muscle spasm: pain/protective response
-early or late capsular: hypo/hyper mobility
-normal end-feels where they should not occur (i.e. bony -> HO)
-empty: pain, sinister pathology...
How to interpret isometric testing? - ANSWER o No pain and strong: inert tissue
o No pain and weak: complete tear, nerve injury
o Pain and strong: grade 1 tear
o Pain and weak: grade 2 tear
,MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
Sensitive vs Specific Tests - ANSWER Specific: helps rule IN; if +ive likely true, if -ive might be false
Sensitive: helps rule OUT; if -ive likely true, if +ive might be false
What is a hard neurological sign? - ANSWER Loss of conduction; i.e. loss of a DTR, dermatome, myotome
Spinal nerve is being compressed somehow: disc protrusion, palsy
Will likely take longer to heal, may want to rx to Dr for co-treatment
Mechanical vs Non-mechanical pain - ANSWER Mechanical: eased with rest, certain positions, AM
stiffness <30 min, articular findings at joint i.e. inappropriate EF
Non-Mechanical: constant pain, not eased with rest or positional changes, not eased with activity; may
require rx to Dr (not an MSK problem)
Facilitated Segment: what is it and how do we test for it? - ANSWER Disturbance in afferent input at a
spinal nerve causes a state of increased excitability and decreased threshold -> hyper-responsive
efferent output at a given spinal level i.e. hyperalgesia, trophic changes, hypertonicity
To test: skin drag (sweating), scratch test (hyperaemia), peak d'orange (edema), skin rolling
(hypertonicity)
Mandatory Questions to ask during a lumbar scan - ANSWER Cauda Equina: bowel/bladder, saddle
paraesthesia/numbness
Spinal Cord: bilateral LE numbness/tingling
Disc: pain with cough/sneeze
Cancer: night pain, night sweats, unexplained weight-loss, malaise, constant pain
Past medical Hx
Medications: NSAIDs, corticosteroids, anti-coagulants
Imaging done?
Effect of sitting vs standing vs walking (helps to determine compression vs flexion vs extension)
, MSK (manual therapy, joint inspections,
scans...) 161 complete solutions.
Lumbar Scan - ANSWER 1. Subjective: mandatory questions
2. AROM and observation (standing)
3. Squat clearance test (standing)
4. S1 myotome (standing)
5. Neuro screen: dermatomes L2-S2, myotomes L1/2-L5, long tract reflexes (plantar response and
clonus) (supine)
6. Neuro screen: S1/2 and L3 reflexes (sitting)
7. Dural mobility: slump, SLR, FNST (sit, stand, prone)
8. S2 myotome (prone)
9. Special tests: FABER (static), laslett's cluster, kinetic test
10. Lumbar compression and traction (supine)
11. Farfan's general torsion (prone)
12. palpation of relevant structures
Laslett's Cluster - ANSWER Cluster of tests to rule in SIJ pathology
-distraction (supine)
-thigh thrust (supine)
-compression (SL)
-sacral thrust (prone)
If at least 3 are +ive: SIJ likely the source
How to perform and interpret the kinetic test - ANSWER Standing; palpate PSIS and S2 (sacrum; same
level as PSIS), have client lift each leg separately
Normal:
-ipsilateral: posterior movement of PSIS relative to S2
-contralateral: no movement of PSIS relative to S2
