M&A 5: Examination Philosophies – Flashcards
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To tell the difference in tissue turgor you would use
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Palpation Test
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Dryness or excessive moisture of the skin could indicate
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an ANS dysfunction
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Radiculopathy means
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Nerve root injury
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AROM is a Category __ test
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II
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5 cardinal signs of inflammation
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Redness, Swelling, Heat, Pain, Inhibited function
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3 palpable signs of inflamation
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Swelling, Heat, pain
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Functio lasa means
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Inhibited function
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Turgor, in physical therapy, means
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Firmness
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MMT means
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Manual Muscle Testing
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Founders of Manual Muscle Testing were these three:
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Lovett, the Kendalls
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Examination procedure designed to assess the force production capability of a muscle or muscle group
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Manual Muscle Test
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Polio affects the ___ neurons
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alpha motor neurons
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Three factors in MMT measurement scales
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1. Extent of the arc of movement, 2. Gravity, 3. Magnitude of force applied by examiner
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Two most common MMT scales
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Daniels and Worthingham scale...Kendall scale
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Daniels and Worthingham scale score of 5 indicates
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Normal: Motion through full range against gravity and max applied forces
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Motion through full range and max applied forces is...
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The "Normal" #5, top rating in the Daniels and Worthingham scale. It is not an operational definition
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Tolerance of slightly less than the maximum applied force implies this score on the D+ W scale
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5- ("Normal -")
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Good+ would be scored as __ on the D+W scale
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4+, i.e. slightly more than moderate amount of force
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3 bases of operational definitions
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1. Universally understood, 2. Sound theoretical basis
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In the Daniels and WOrthingham scale, there will always be ___ in grades above ___
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Error in grades above Fair (3)
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Toleration of slightly less than moderate amount of force indicates
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4- in D+W scale. "Good -"
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Tolerance of slight resistance at end of the range of motion against gravity means
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The patient has a score of "Fair +" or 3+ on the D+W scale
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3 or Fair score on D+W scale indicates the patient
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has Motion through the full range against gravity and can hold
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Kendall scale is from 0 to
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10, (also a zero to normal scale like D+W)
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D+W is a ___ type of scale
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ORDINAL
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THe scores on the D+W scale that are operationally well defined include
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0-Fair(3)
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A poor score on the D+W indicates
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Motion through full range of with gravity diminished (because it can never be "eliminated")
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"Poor -" or 2- indicates this on the D+W
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More than half of the range with gravity diminished
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"Poor +" on the D+W is a scale of
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2+, meaning less than half of the range against gravity
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Fair - on the D+W scale indivates
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More than half of the range against gravity, and is noted as 3-
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Zero indicates on both the Kendall and D+W Scales:
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No contraction felt in the muscle/No palpable contraction
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The Kendall scale has both numerical values of ___ to ___ and this value
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0-10 and "t" for trace
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"trace" or "t" on the Kendall scale indicates
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Tendon becomes prominent or contraction felt in muscle but no visible movement
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On the Kendall scale, 1 corresponds with __
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Poor-
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On the D+W scale, 1 corresponds with
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Trace
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On the Kendall scale, P+ indicates
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Moves through complete range of motion with gravity minimized and holds against resistance
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Cyriax is known for his method of
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determining the lesion (pathology) that is present
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Menell is known for identifying
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joint movements that are abnormal
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Maitland identifies...
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activities and exam procedures that alter the patient's signs and symptoms
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Maitland's approach is driven by
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Symptom behavior change (i.e. alleviation) during treatment
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Comparable signs and use of the body diagram are aspect's of __'s approach
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Maitland's
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Determination of severity, irritability, nature and stage of condition are aspects's of ___'s approach
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Maitland
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PPIVM and PAIVM are aspect's of ___'s apprach to examination
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Maitland
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comparable signs are
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the patient's report of symptoms that are comparable to the symptoms associated with the chief complaint, and are elicited during any exam procedure
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Severity means
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the Intensity of symptoms related to a functional activity -- a self-report
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Irritability is
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related to the amount of activity needed to provoke symptoms and the amount of time needed for symptoms to subside
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Nature of impairment is
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Most closely aligned with the type of pathology present
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Stage of impairment is
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Prognosis of the condition, i.e. recurring, chronic, comorbidities
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Irritability guides your __ during exam
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agressiveness
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Menell believed that abnormal joint play...
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leads to dysfunction
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in Menell's approach joint manipulation...
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restores normal joint play
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Patient and examiner must be relaxed -- this is part of ___'s exam approach
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Menell
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One joint/movement examined at a time -- part of ___'s approach
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Menell
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Menell thought that the joint surface examined should be ___ on the joint surface __
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moved on the stabilized joint surface
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No forceful or ___ movements should be used in the Menell approach
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abnormal
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Williams believed that most Low Back Pain is caused by
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excessive lordosis and degeneration of intervertebral disc
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William's philosophy resulted in a non-specific...
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treatment approach
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McKenzie's approach looks at these body parts
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Cervical and Lumbar spine only
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McKenzie believed that most LBP is due to
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flexion related activities
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Most patients can be taught to self-manage. This is a belief of
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McKenzie
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McKenzie was influenced by
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Cyriax
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McKenzie believed, somewhat like Williams, that most LBP originates from
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the intervertebral disc
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Patients can be grouped into categories to guide treatment, this is a part of __'s approach
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McKenzie
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McKenzie is opposite of ___ in his approach of LBP
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Williams
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Three important contributions from McKenzie:
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- emphasis on sagital spinal motions during exam/treatment, - concept of classification, - concepts of centralization and peripheralization
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Convex-Concave rule is from ___
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Kaltenborn
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Assessment of end-feel is a contribution of this practitioner:
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Cyriax
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Concepts of centralization and peripheralization of pain are from
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Cyriax
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Arthrosis is a
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fibrous joint
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Inguinal line separates these two dermatomes
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T12 and L1
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Medial knee is this dermatome
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L3
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Medial side of great toe is this dermatome
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L4
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Referred pain does not
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cross the midline
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Three categories of non-capsular pattern are
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-ligamentous shortening or adhesions, internal derangements, - extra-articular lesions (bursitis)
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Pain-Resistance Sequence is a ___ concept
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Cyriax
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Pain-Resistance Sequence defines these three stages of inflammatory process
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Pain prior to resistance, Pain with resistance, Pain after resistance
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Pain prior to resistance indicates
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Acutely inflammed joint
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Pain with resistance indicates
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Mildly inflammed joint
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Pain after resistance is...
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a non-inflammed joint
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The Pain-Resistance Sequence is useful for guiding the
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vigor of examination and treatment
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Selective Tissue Tension Testing does not work with
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Spine or Glenohumeral joint
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Capsular patterns are usually tested with...
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PROM
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Selective Tissue tension Testing (STTT) is a ..
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series of exam procedures designed to aide in determining diagnosis
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Exam procedures of STTT
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active, passive and resistive movements at mid-range. Interpretation is based on pattern of pain, weakness or limitation
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In the Cyriax method, the PT's conclusion is based on
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the combo of test results: PRS, STT, Capsular v. non-Capsular pattern
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Selective Tissue Tension testing helps determine...
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acuity (severity) of injury, and to ID the structure at fault (contractile v. non-contractile)
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The best test to determine whether lesion is in contractile or non-contractile tissue
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Resisted isometric testing
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Pattern 1 of STT is:
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Inert tissue pattern. Active and Passive range of motion in same direction produce pain at end range, but resisted isometric is not painful
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Pattern 2 of STT is:
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Contractive Tissue Pattern - resisted isometric contraction is painful and/or weeak and Passive ROM is painful in the direction that LENGTHENS affected tissue. Active painful or weak when involved mm group is contracted
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Resisted isometric testing is painful and strong indicates
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Minor COntractile injury
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Resisted isometric motion is painless and weak indicates
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complete rupture of contractile tissue
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Pattern 3 of STT is
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Excessive range of motion found -- indicating capsular or ligamentous laxity
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Meniscus tear of knee has this end-feel
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Springy block
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Cyriax claimed that palpation is almost always
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misleading
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___ and ___ are the most common nerve roots involved in radiculopathy
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S1, L5
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