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PCMI > 1.4. Joint Exam > Flashcards

1.4. Joint Exam Flashcards

1
Q

What is a strain vs sprain?

A

Strain: muscular injury
Sprain: ligamentous injury

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2
Q

What is a dislocation?

A

Complete lack of contact between 2 articular surfaces

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3
Q

What is a subluxation?

A

partial dislocation: residual contact between 2 articular surfaces

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4
Q

What is a valgus deformity?

A

distal part of limb directed away from midline (knock knee)

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5
Q

What is a varus deformity?

A

distal part of limb directed toward midline (bowleg)

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6
Q

What is the exam approach for a joint?

A
  • Inspect
  • Palpation
  • ROM (active and passive)
  • Speciality testing
  • compare both extremities
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7
Q

What is the exam approach for an extremity?

A

-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

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8
Q

What is an intra-articular structure?

A

Within joint capsule

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9
Q

What is an extra-articular structure?

A

outside joint capsule

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10
Q

Effusion

A

Fluid in joint

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11
Q

What things should you consider specifically for your HPI in regard to joint complaint?

A
  • 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
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12
Q

What types of medications should you specifically ask in regards to joint complaint?

A

-NSAIDS, Tylenol, narcotics, steroids

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13
Q

What medication allergies are complaint specific to joint complaints?

A

Narcotics and NSAIDs

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14
Q

What social history is pertinent to joint complaints?

A

IV drugs: what? how? how often? how recent?

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15
Q

What family history is pertinent to joint complaints?

A
  • Neck and back problem

- Systemic diseases that could manifest as MSK issues (ex: RA)

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16
Q

What part of the joint exam is most sensitive indicator of joint disease?

A

Range of motion, specifically active

-Don’t force ROM if hurts patient

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17
Q

What do you want to pay attention to in palpation of joint CC exam?

A

General tenderness vs point tenderness

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18
Q

What 6 speciality tests can be done for joint complaint of shoulder?

A
  1. Painful ARC: pain w/ abduction 60-120
  2. Cross arm
  3. Neer impingement
  4. Hawkins
  5. Empty can
  6. Drop-arm
19
Q

What 5-8 speciality tests can be done for joint complaint of Elbow?

A
  1. Valgus stress test
  2. Varus stress test
  3. Tinel test
  4. Medial epicondyle test (golfer)
  5. Lateral epicondyle test (Tennis elbow)
  6. Palpate over radial head - annular tear
  7. palpate over medial epicondyle: little league elbow
  8. Palpate over posterior elbow - olecranon bursitis
20
Q

What speciality test can be done for joint complaint of Wrist/hand?

A
  1. Tinel test
  2. Phalen’s test
  3. Flinkelstein test
21
Q

What 9 speciality tests can be done for joint complaint of knee?

A
  1. Valgus: MCL disruption
  2. Varus: LCL disruption
  3. Anterior drawer: ACL insuffiency (pull tibia anteriorly)
  4. Lachman’s Test: ACL
  5. Posterior drawer test: PCL
  6. McMurry’s Test: medial and lateral meniscus
  7. Apley’s Grind/Compression Test: meniscus, collateral l injury or both
  8. Apley’s Grind/Distraction Test:
  9. Patella-Femoral Grinding Test: roughness of articulating surfaces
22
Q

What 8 speciality tests can be done for joint complaint of hip?

A
  1. Labral loading
  2. Labral distraction
  3. Scour: flex and externally rotate
  4. Apprehension/Faber 1: labral pathology
  5. Patrick’s Faber 2: gluteus medius pathology
  6. Patrick’s Faber 3: iliopsoas pathology
  7. Jump sign: pressure to greater trochanter = trochanteric bursitis
  8. Thomas test: hip flexor contraction
23
Q

What 6 speciality tests can be done for joint complaint of ankle/foot?

A
  1. Anterior Drawer
  2. Talar Tilt
  3. Eversion Test
  4. Squeeze test
  5. Thompson test
  6. Homan’s sign
24
Q

What are reflexes scored out of?

A

0-4, normal is 2

25
Q

What is neuro muscular strength recorded out of?

A

0-5, 5/5 is normal

*Always assess and document motor and sensory function distal to soft tissue injury of fracture

26
Q

What scale are pulses recorded out of?

A

0-4

-Always check pulse and cap refill distal to injury

27
Q

What are top causes of life threatening joint pain presentations?

A
  • Septic arthritis

- Referred pain: STEMI, intraperitoneal hemorrhage, lung pathology

28
Q

What should you consider for a traumatic joint injury in regards to extra-articular boney processes?

A

Bone: fracture or dislocation

29
Q

What should you consider for a traumatic joint injury in regards to extra-articular soft tissue processes?

A
  • Myofascial
  • Ligaments
  • Tendon
  • Bursae
30
Q

What should you consider for a traumatic joint injury in regards to intra-articular processes?

A

Cartilage: joint capsule and bone

31
Q

What should you consider for a Atraumatic joint injury in regards to Intrinsic (intra and extra-articular) processes?

A
  • Overuse injuries, joint instability
  • Tendinitis, tendinopathy, impingement
  • Bursitis, synovitis
  • Capsulitis, osteoarthritis
  • Septic arthritis, gout, systemic disease
32
Q

What is a Colle’s fracture?

A
  • Traumatic injury from FOOSH
  • Distal radius fracture
  • Often referred to as “distal fork” deformity
  • Treatment: reduction, sling, rest, ortho followup
33
Q

Arthrocentesis

A

Synovial fluid from joint aspiration

34
Q

What patient population is septic arthritis more frequent in?

A
  • > 80 years old, DM
  • RA
  • Prosthetic joint
  • Recent joint surgery
  • Skin infection
  • IV DRUG ABUSE, alcoholism
  • Prior intraairticular corticosteroid injection
35
Q

What physical findings of the joint would be concerning for septic arthritis?

A
  • Knee involved more than 50%
  • Joint is erythematous, swollen, warm, painful
  • Limited active and passive ROM
36
Q

How would you diagnose septic arthritis?

A
  • Plain x-ray: normal or show effusion

- Lab: elevated CBC, ESR, CRP; synovial fluid show WBC and bacteria after ASPIRATING SYNOVIAL FLUID FROM JOINT

37
Q

How would you treat septic arthritis?

A
  • Antibiotics, broad spect after aspiration

- Surgical washout of joint

38
Q

Describe acute arterial occlusion of LLE in relation to joint complaint?

A
  • Acascular emegency
  • US and arteriogram imaging
  • Heparin, vascular surgery, OR stat
39
Q

What PSH is joint pertinent?

A

prior orthopedic surgery or procedures

40
Q

What PMH is joint pertinent?

A
  • prior symptoms or injury to same location

- systemic illness (like RA)

41
Q

What are the 6 pertinent boney prominences of the wrist and hand?

A
  1. anatomical snuff box
  2. carpal bones
  3. MCP
  4. DIP and PIP
  5. Distal ulna
  6. Distal radius
42
Q

What are the 4 pertinent boney prominences of the hip?

A
  1. iliac crest
  2. ASIS
  3. Greater trochanter
  4. pubic tubercle
43
Q

What are the pertinent boney(3) and ligamentous (2) prominences of the knee?

A
  1. Patella
  2. fibular head
  3. tibial head
  4. quadriceps femoris tendon
  5. patellar ligament
44
Q

What are the 5 pertinent prominences of the ankle?

A
  1. ankle joint
  2. medial and lateral malleolus
  3. achilles tendon
  4. heel
  5. metatarsal joint

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