1.4. Joint Exam Flashcards
What is a strain vs sprain?
Strain: muscular injury
Sprain: ligamentous injury
What is a dislocation?
Complete lack of contact between 2 articular surfaces
What is a subluxation?
partial dislocation: residual contact between 2 articular surfaces
What is a valgus deformity?
distal part of limb directed away from midline (knock knee)
What is a varus deformity?
distal part of limb directed toward midline (bowleg)
What is the exam approach for a joint?
- Inspect
- Palpation
- ROM (active and passive)
- Speciality testing
- compare both extremities
What is the exam approach for an extremity?
-Inspect
-Palpation
-ROM (active and passive)
-Speciality testing
PLUS (compared to joint)
-Reflexes
-Neurovascular status: Neuro (motor/sensory) and Vascular (pulses/cap refill, always check distal to injury)
*compare both extremities
What is an intra-articular structure?
Within joint capsule
What is an extra-articular structure?
outside joint capsule
Effusion
Fluid in joint
What things should you consider specifically for your HPI in regard to joint complaint?
- Traumatic or atraumatic
- Mechanism
- Can they bear weight or use extremity?
- Last food intake (possible surgery)
- Location: mono or polyarticular
- Duration: acute or chronic problem
- Onset: sudden or gradual
What types of medications should you specifically ask in regards to joint complaint?
-NSAIDS, Tylenol, narcotics, steroids
What medication allergies are complaint specific to joint complaints?
Narcotics and NSAIDs
What social history is pertinent to joint complaints?
IV drugs: what? how? how often? how recent?
What family history is pertinent to joint complaints?
- Neck and back problem
- Systemic diseases that could manifest as MSK issues (ex: RA)
What part of the joint exam is most sensitive indicator of joint disease?
Range of motion, specifically active
-Don’t force ROM if hurts patient
What do you want to pay attention to in palpation of joint CC exam?
General tenderness vs point tenderness
What 6 speciality tests can be done for joint complaint of shoulder?
- Painful ARC: pain w/ abduction 60-120
- Cross arm
- Neer impingement
- Hawkins
- Empty can
- Drop-arm
What 5-8 speciality tests can be done for joint complaint of Elbow?
- Valgus stress test
- Varus stress test
- Tinel test
- Medial epicondyle test (golfer)
- Lateral epicondyle test (Tennis elbow)
- Palpate over radial head - annular tear
- palpate over medial epicondyle: little league elbow
- Palpate over posterior elbow - olecranon bursitis
What speciality test can be done for joint complaint of Wrist/hand?
- Tinel test
- Phalen’s test
- Flinkelstein test
What 9 speciality tests can be done for joint complaint of knee?
- Valgus: MCL disruption
- Varus: LCL disruption
- Anterior drawer: ACL insuffiency (pull tibia anteriorly)
- Lachman’s Test: ACL
- Posterior drawer test: PCL
- McMurry’s Test: medial and lateral meniscus
- Apley’s Grind/Compression Test: meniscus, collateral l injury or both
- Apley’s Grind/Distraction Test:
- Patella-Femoral Grinding Test: roughness of articulating surfaces
What 8 speciality tests can be done for joint complaint of hip?
- Labral loading
- Labral distraction
- Scour: flex and externally rotate
- Apprehension/Faber 1: labral pathology
- Patrick’s Faber 2: gluteus medius pathology
- Patrick’s Faber 3: iliopsoas pathology
- Jump sign: pressure to greater trochanter = trochanteric bursitis
- Thomas test: hip flexor contraction
What 6 speciality tests can be done for joint complaint of ankle/foot?
- Anterior Drawer
- Talar Tilt
- Eversion Test
- Squeeze test
- Thompson test
- Homan’s sign
What are reflexes scored out of?
0-4, normal is 2
What is neuro muscular strength recorded out of?
0-5, 5/5 is normal
*Always assess and document motor and sensory function distal to soft tissue injury of fracture
What scale are pulses recorded out of?
0-4
-Always check pulse and cap refill distal to injury
What are top causes of life threatening joint pain presentations?
- Septic arthritis
- Referred pain: STEMI, intraperitoneal hemorrhage, lung pathology
What should you consider for a traumatic joint injury in regards to extra-articular boney processes?
Bone: fracture or dislocation
What should you consider for a traumatic joint injury in regards to extra-articular soft tissue processes?
- Myofascial
- Ligaments
- Tendon
- Bursae
What should you consider for a traumatic joint injury in regards to intra-articular processes?
Cartilage: joint capsule and bone
What should you consider for a Atraumatic joint injury in regards to Intrinsic (intra and extra-articular) processes?
- Overuse injuries, joint instability
- Tendinitis, tendinopathy, impingement
- Bursitis, synovitis
- Capsulitis, osteoarthritis
- Septic arthritis, gout, systemic disease
What is a Colle’s fracture?
- Traumatic injury from FOOSH
- Distal radius fracture
- Often referred to as “distal fork” deformity
- Treatment: reduction, sling, rest, ortho followup
Arthrocentesis
Synovial fluid from joint aspiration
What patient population is septic arthritis more frequent in?
- > 80 years old, DM
- RA
- Prosthetic joint
- Recent joint surgery
- Skin infection
- IV DRUG ABUSE, alcoholism
- Prior intraairticular corticosteroid injection
What physical findings of the joint would be concerning for septic arthritis?
- Knee involved more than 50%
- Joint is erythematous, swollen, warm, painful
- Limited active and passive ROM
How would you diagnose septic arthritis?
- Plain x-ray: normal or show effusion
- Lab: elevated CBC, ESR, CRP; synovial fluid show WBC and bacteria after ASPIRATING SYNOVIAL FLUID FROM JOINT
How would you treat septic arthritis?
- Antibiotics, broad spect after aspiration
- Surgical washout of joint
Describe acute arterial occlusion of LLE in relation to joint complaint?
- Acascular emegency
- US and arteriogram imaging
- Heparin, vascular surgery, OR stat
What PSH is joint pertinent?
prior orthopedic surgery or procedures
What PMH is joint pertinent?
- prior symptoms or injury to same location
- systemic illness (like RA)
What are the 6 pertinent boney prominences of the wrist and hand?
- anatomical snuff box
- carpal bones
- MCP
- DIP and PIP
- Distal ulna
- Distal radius
What are the 4 pertinent boney prominences of the hip?
- iliac crest
- ASIS
- Greater trochanter
- pubic tubercle
What are the pertinent boney(3) and ligamentous (2) prominences of the knee?
- Patella
- fibular head
- tibial head
- quadriceps femoris tendon
- patellar ligament
What are the 5 pertinent prominences of the ankle?
- ankle joint
- medial and lateral malleolus
- achilles tendon
- heel
- metatarsal joint
