Applied Muscularskeletal Flashcards
Clues for muscle disease in older infants and children (11)
Floppy baby Delayed milestones Trouble walking/running Trouble climbing stairs/Getting up from sitting Tripping and falling Fatigue Double vision at the end of the day Muscle Pain Difficulty swallowing Garbled speech after eating cold food (myotonia?) Trouble letting go of objects
Perinatal clues for muscle disease (4)
Reduced Intra-uterine movement
Neonatal respiratory distress
Poor Suck
Reduced limb activity
Congenital absence of ____ is associated with _____
- Pectoralis major
Isolated
Congenital absence of ____ is associated with _____
- Depressor labii oris
Congenital heart disease
Congenital absence of ____ is associated with _____
- Pectoralis muscle
leukemia
Congenital absence of ____ is associated with _____
- Temporalis
Myotonia
Wasting 1’ muscle degeneration
Disuse
Wasting 2’ (2)
Anterior horn cell dse
Peripheral nerve dse
T/F Genital hemihypertrophy involves _____% of the body and is considered ________
50%
SERIOUS
Isolated hypertrophy of calf muscles
Duchenne Dystrophy
Type of hypertrophy seen in congenital adrenal hyperplasia
Generalized
Fasciculation of muscle bundles is seen in conditions associated with irritation of
Anterior horn cell
- Polio
- Werdnig-Hoffmann
Palpation of an induration over muscle is seen in (3)
Dermatomyositis
Infectious myositis
Pyomyositis
Tenderness on palpation of muscles is seen in
Dermatomyositis
Trichinosis
Percussion
Contraction on percussion + delayed relaxation
Best tested on _____ muscle
Myotonia congenita
Biceps
Testing Muscle strength
Ant neck flexors
Get up from supine
Testing Muscle strength
Trapezius
Shrug shoulders
Testing Muscle strength
Deltoids
Elevate arms over head
Testing Muscle strength
Biceps
Flex elbow
Palm facing upwards
Testing Muscle strength
Quadriceps
Sit on edge of table w/popliteal space flush
Extend knee
Testing Muscle strength
Gluteus medius
R lateral side
Flex knee
Abduct hip on L side
Testing Muscle strength
Gluteus maximus
Prone
Knees flexed
Lift hip off table
Testing Muscle strength
Gastrocnemius and soleus
Using sole of foot, push down on examiner’s palm
Pattern of weakness
Dermatomyositis
Proximal
Pattern of weakness
Peripheral neuritis
Distal extremity weakness
Pattern of weakness
One sided weakness
Unilateral cerebral insult
Pattern of weakness
Unequal lower limb weakness
Myelomeningocele
Pattern of weakness
Equal lower limb weakness
Paraplegia
Activities of Daily living I - II - III - IV -
I Fully independent
II Most independent, minimal help required
III Wheelchair bound
IV Totally dependent
Clues in diagnosing muscle weakness
Myotonia
Mental retardation
Clues in diagnosing muscle weakness
Exaggerated reflexes
CNS dse
Clues in diagnosing muscle weakness
Fasciculations
Anterior horn cell disease
Clues in diagnosing muscle weakness
Rashes
Collagen vascular disease
Clues in diagnosing muscle weakness
Sensory changes
Peripheral nerve disease
Clues in diagnosing muscle weakness
Dark urine
Myoglobinuria
Gait
Waddling
Proximal muscle weakness around the hip
Gait
Toe walking
Duchenne or
Tight heel cord
Gait
Slapping gait
Peripheral neuropathy
Gait
High stepping gait
Posterior column lesion
History and PE
(+) Joint pain
(-) Swelling
Arthralgia
History and PE
(+) Joint Pain
(+) Swelling
Arthritis
History and PE: Etiology
Pain: Acute onset in 1 joint
Trauma or
Inflammation
History and PE: Etiology
Slow onset of pain
Collagen vascular disease
History and PE: Etiology
Generalized pain
Polyarticular
History and PE: Etiology
Pain in a joint for 1-2 days
Trauma
Infection
History and PE: Etiology
Pain in a joint for days or months
Collagen disease
History and PE:
Intense acute pain
Acute rheumatic fever or
Septic arthritis
(Acute onset could also be trauma or inflammation)
History and PE:
Extreme grades of pain
Vasomotor disease
History and PE:
Moderate pain
Juvenile Rheumatoid Arthritis
History and PE:
Arthritis w/no pain
Neuropathic joint
History and PE:
True migrating pain (Flitting-fleeting)
Acute rheumatic fever
Gonococcemia
History and PE:
Non-migrating pain
Collagen vascular disease
History and PE:
Pain worse on activity
Destructive joint dse
i.e. acute cartilaginous necrosis
History and PE:
Pain and stiffness early in the morning
Suggests JRA
History and PE:
Pain that interferes w/sleep
Vasomotor dse
Joint Bleeding
History and PE:
Growing pain
Septic arthritis
Osteomyelitis
Osteoid osteoma
Inspection
Involves 1 side of the joint
Peri-articular
Inspection
Swelling extends above and below joint
Cellulitis
Peri-articular swelling involves 1 side of joint
Inspection
True swelling w/_____ defined edges suggests __________
ill-defined
effusion in the joint
Inspection
___________ __________ = swelling of joint w/clear defined edges
Synovial thickening
Inspection
Sterno-clavicular swelling
- Acute: ?
- Chronic: ?
Acute - Gonococcemia
Chronic - Juvenile arthritis
Inspection: Etiology?
Obliteration of dimples of olecranon
Swelling of elbow
Inspection: Manifestation
Swelling of carpal joints
Limitation of wrist extension (seen dorsally)
Inspection: Etiology?
Clear, distal, oblique transverse edge
Swelling of extensor tendon sheath
Inspection: Etiology?
Diffuse swelling of dorsum of hand
Sickle cell disease
Tenosynovitis w/lymphedema or serum sickness
Inspection: Etiology?
Flexed, claw-like fingers
Flexor teno-synovitis
Clawhand - paralysis of ulnar nerve
Bifid Claw-like hand - Thalidomide
History and PE:
Swelling of plantar aspect w/tenderness
Ankylosing spondylitis
History and PE:
Swelling of sole and dorsum of feet
(-) Tenderness
Serum sickness
History and PE: Palpation
Heat and tenderness over the joint
Inflammatory arthritis
History and PE: Palpation
Flexor tendon tenderness upon percussion
Flexor tenosynovitis
History and PE: Palpation
Percussion of flexor aspect of wrist –> tingling sensation along outer 3 fingers
Carpal tunnel syndrome
T/F
Tenderness along femoral tibial edges of knee is a feature of arthritis
FALSE
NOT a feature