Advanced MSK Exam Flashcards
What is included if the injury is Articular?
INERT tissue damage
(doesn’t move)
* Ligament
* Cartilage
* Bone
* Connective tissue
* Monoarticular
* Polyarticular
What is included if the injury is Non-Articular?
Dynamic tissue damage (moves)
* Tendons
* Muscles
* Localized
* Limited, focal
* Widespread
* Regional, systemic
Traumatic vs. Atraumatic
- Traumatic = acute, defined moment
- Atraumatic = chronic, insidious onset
Referred vs. radiating pain
Referred
* Pain felt in a part of the body remote from source of the pain
* Left shoulder pain with myocardial infarction
Radiating pain
* Usually neuropathic
* Felt along a particular nerve innervation
* Ulnar nerve trauma (funny bone)
Nociceptive pain
Stimulation of pain receptors
(Nociceptors)
stabbing, stinging, sharp
* Traumatic injury
* Burns
* Infection
* Tissue degeneration
Somatic pain
Constant, achy pain:
* Cutaneous - Well localized in the superficial tissues
* Deep - Poorly localized the deeper tissues
Bone fracture
* Incision in the skin
* Arthritis
* Peripheral Vascular Disease (PAD)
Visceral Pain
Poorly localized, deep & diffuse pain sensation emanating
from internal organs or cavity linings
* Described as cramping
* Distention of a hollow viscous (ie bladder, bowel)
Neuropathic Pain
Poorly localized sensation of pain resulting from injury nerves
in the CNS or PNS.
* Described as shooting, electric shock, or burning
* Diabetic Neuropathy
* Post-herpetic neuralgia
* Nerve compression
Phantom Pain
Sensation of pain in a region of the extremity now amputated.
* Experienced by 30-81% of amputees, often described as:
* Aching, cramping, burning, tearing, squeezing
Calor
↑ heat = vascular permeability/blood flow
Rubor
redness = vascular permeability/blood flow
Tumor
swelling = accumulation of exudate
(↑ vascular permeability, 2° ischemic injury, cellular lysis)
Dolor
pain = chemical mediators of inflammation
Inflammatory Arthritides
Rheumatoid arthritis (RA)
Seronegative
spondyloarthropathies
Crystalline deposition
diseases (ex/ gout)
Septic arthritis
Bursitis
Tenosynovitis
Trauma
Laboratory markers for inflammatory conditions
Erythrocyte Sedimentation Rate (ESR)
C-Reactive Protein (CRP)*
Rheumatoid Factor (RF) (autoantibody)
Cyclic Citrullinated Peptide Antibody, IgG (CCP)
Erythrocyte Sedimentation Rate (ESR)
Blood in a tall, thin tube
Inflammation causes cells to
clump
more dense than individual
cells
settle to the bottom
more quickly
Non-specific test used to
detect inflammation
C-Reactive Protein (CRP)
Acute phase
inflammation
What is Rheumatoid Factor (RF)?
- Aids in the workup of suspected RA or
undifferentiated inflammatory arthritides - Order with Cyclic Citrullinated Peptide
Antibody, IgG - ↑specificity
- ↑sensitivity
What is Cyclic Citrullinated Peptide
Antibody, IgG (CCP)?
(+) ~69-83% of patients with RA
* Together with (+) RF
* Specificity = 93-95% for RA
Non-inflammatory Musculoskeletal Conditions
Painful conditions that, typically, are NOT accompanied by
the OVERT cardinal signs of inflammation:
* Osteoarthritis (OA)
* Neoplasm
* Pain amplification
* Fibromyalgia
Musculoskeletal Physical Exam (H.I.P.S.)
History
Inspection
Palpation
Special Tests
Warmth + joint effusion (& soft tissue swelling) =
synovitis
Special Tests - MSK exam
Range of motion tests (AROM, PROM, RROM)
Pronation
palmar surface
toward posterior or plantar
surface toward midline
Supination
palmar surface
toward anterior or plantar
surface away from midline*
Dorsiflexion
↓ angle between dorsum of the
foot & tibia (sagittal plane)
Plantar flexion
↑ angle between dorsum of the
foot & tibia (sagittal plane)
Protraction
ant. movement
(transverse/sagittal plane)
Retraction
post. movement
(transverse/sagittal plane)
Circumduction
conical shaped moved of the segment
centered on the joint involved
Convex vs concave gliding
- Glide = One joint surface translates/slides over another
- Convex: gliding is in the OPPOSITE direction of the angular movement of the bone.
- Concave: gliding is in the SAME direction as the angular movement of the bone.
↓ AROM + Normal PROM =
Dynamic tissue disorders
* Eg. tendinitis, or muscle injury (possible bursitis)
* ↓ RROM = tendinitis or muscle injury
AROM + ↓ PROM =
INERT tissue disorder
* Eg. soft tissue contracture, synovitis,
and/or joint structural abnormality
Goniometry
Tool used for Measurement of ROM
How does goniometry work?
- “0°” starting position
- Varies for each joint
- Typically, the extended anatomical position
- Center axis of the goniometer with the center
axis of the joint (depends on the plane) - Align arms with proximal (fixed) & distal
(movable) segments - Degree of joint motion is read off the distal arm
of the goniometer
Flexion
Ant. sagittal plane*
↓ angle between segments
Extension
= Post. sagittal plane*
↑ angle between segments
Manual Muscle Testing - basic principles
- Place the muscle in a lengthened position
- Examiner resists movement through ROM
- Semi-quantitative measurement of muscle strength
* Brake Test vs. Full Range of Motion?
Sensory/Motor Pathways: SAME and DAVE
S-Sensory D-Dorsal
A-Afferent A-Afferent
M-Motor V-Ventral
E-Efferent E-Efferent
If you want to text the Axillary n.
(Deltoid)
shoulder abduction
sensory area: lateral aspect of the arm)
If you want to text the Musculocutaneous n.
(Biceps)
elbow flexion
Sensory area: Lateral proximal forearm
If you want to test the median n.
Flexor pollicis longus
some flexion
sensory area: Tip of thumb, Volar aspect
If you want to test the ulnar n
First Dorsal interosseous
abduction
Sensory area: Tip of little finger, volar aspect
If you want to test the radial n.
Extensor pollicis longus
thumb extension
Sensory area: Dorsum thumb web space
If you want to test the Obturator n.
Adductors hip
adduction
Sensory area: Medial aspect, mid-thigh
If you want to test the Femoral n.
Quadriceps
knee extension
Sensory area: Proximal to medial malleolus
If you want to test the Peroneal Deep
branch n.
Extensor hallucis longus
great toe extension
Sensory area: Dorsum first web space
If you want to test the Peroneal Superficial
branch n.
Peroneus brevis
foot eversion
Sensory area: Dorsum lateral foot
If you want to test the Tibial n.
Flexor hallucis
great toe flexion
Sensory area: Plantar aspect foot
____ Tests exacerbate pain or contractures of
injured/deformed structures
Tension Stress
What is Diagnostic joint aspiration
(arthrocentesis) used for?
- Evaluation for a septic
joint - Initial confirmation of
gouty arthritis
