Approach To Joint Exam Flashcards
What are intra-articular structures?
Within the joint capsules
What are extra articular structures?
Outside the joint capsule
What is a dislocation?
Complete lack of contact between 2 articular surfaces
What is subluxation?
Residual contact between 2 articular surfaces
Not completely separated - shifted
What is valgus deformity?
Distal part of limb directed away from midline
Genu valgus = knock knees (knees touching)
What is a varus deformity?
Distal part of limb directed toward midline
Genu varus = bow legs
What is mono articular?
One joint
What is poly articular?
Multiple joints
What is migratory?
Moves from one joint to another
What are extra articular structures?
Bones, muscles, tendons, bursa and skin
What is myalgia?
Muscle pain
What is arthralgia?
Joint pain
What is tensoynovitis?
Inflammation of the tendon sheath
What is a sprain?
Ligament injury
What is a strain?
Muscular injury
What is effusion?
Fluid in the joint
What are important components of a history and physical regarding joints?
Location (mono or poly; entire joint or just one spot) Duration (acute or chronic) General ROS (discriminators and life threats like fever, chills, CP, SOB) Complaint specific ROS
What is an important aspect to obtain during an HPI for joint complaints?
Traumatic or atraumatic
What is important information to know regarding medications the pt with joint complaint may be taking?
Blood thinners
Effects surgery and body’s response
What are important aspects during a joint exam?
Inspection, palpation, range of motion and specialty testing
What must you always do during a joint exam?
Always compare to the opposite extremity
Describe inspection of the joint
Look at the joint what do you see?
Describe what to look for upon palpation of the joint
Temperature difference? Tenderness (general tenderness or point tenderness?)
Describe evaluation ROM during a joint exam
Active ROM first then try passive
Restricted ROM is the most sensitive indicator of joint disease
Never force ROM if it hurts the pt
What should always be evaluated during an extremity exam?
Always check neurovascular status distal to the injury
Which components are involved during an extremity exam?
Inspection, palpation, ROM, specialty testing Neurovascular status (neuro/reflexes and vascular/pulses)
Specialty tests
There are a ton of them
Some are helpful others are not
Reflexes
Always check the reflexes in affected extremity and compare to the opposite extremity
Recorded as 0-4 out of 4
What should you always assess for muscle strength?
Always assess and document motor and sensory function to soft tissue injury of fracture
Compare with opposite extremity
Scale for grading pulses
0 = absent, unable to palpate 1+ = diminished, weaker than expected 2+ = brisk, expected, normal* 3+ = bounding
What do you always check for when evaluation vasculature?
Always check pulses and/or capillary refill distal to the site of injury
What are some pearls for the joint exam?
Do not ever force a range of motion exam or specialty test that greatly increases the pts pain
Always compare the joint/extremity with the pathology to the opposite “normal” extremity
What is the process for developing and working through a DDx?
Develop broad DDx* Narrow DDx* Develop working DDx* Pursued DDx Assessment and plan
What is the VINDICATE pneumonic for a systemic approach when developing a broad DDx?
Vascular Inflammatory Neoplastic Degenerative/deficiency Idiopathic/intoxication Congenital Autoimmune/allergic Traumatic Endocrine
What are examples of traumatic joint pain?
Extra-articular (bone vs soft tissue) or intra-articular
What are examples of ataumatic joint pain?
Extrinsic/referred pain
Intrinsic (the joint in general) - intra or extra articular
What is the top causes of life threatening joint pain?
Referred pain (ex. MI)* Septic arthritis
What is FOOSH?
Fall on out stretched hand
What is a Colle’s fracture?
Distal radius fracture
Usually results from a FOOSH
