Approach to pt with joint pain

Question 1

Valgus vs. varus deformity

Answer 1

Valgus= distal part of limb is directed away from midline

Varus= distal part of limb directed towards midline.

Question 2

Tenosynovitis vs. tendonitis

Answer 2

Tendonitis= inflammation of the tendon

Tenosynovitis= inflammation of the tendon sheath.

Question 3

Sprain vs. strain

Answer 3

sprain= ligament injury. Can hear/feel “a pop””.

Strain= muscular injury. Often occurs late swing phase as the hamstring muscle contracts while lengthening… this is because it is very temporarily decelerating the leg in preparation for the foot strike.

Question 4

Important components of a joint exam

Answer 4

ALWAYS CHECK PULSES DISTAL TO THE INJURY.
Also neuro, ROM, reflexes…
Is it generally tender or is there point tenderness?

Question 5

What is the most sensitive indicator of joint disease?

Answer 5

ROM

Question 6

Sensitivity vs. Specificity

Answer 6

Sensitivity: portion of patients with the diagnosis who have a positive test… want this to be 100%. This is the true positive rate. This is the ability to RULE OUT disease (if it is negative).

Specificity= portion of patients without the diagnosis who do not receive a positive test. This is the true negative rate. This is the ability to RULE IN disease (if it is positive).

Question 7

Likelihood ratio

Answer 7

Values are between zero and infinity.

Numerator: those with disease who got a positive test
Denominator: Those without disease who got a positive test.

LR > 1 = more likely to have disease.

LR < 1 = less likely to have disease.

Question 8

Clonus

Answer 8

Indicative of an upper cord lesion. Seen in stroke patients.

Question 9

Muscle strength

Answer 9

0 –> no muscle contraction
1 –> barely contracting
2 –> can’t move against gravity
3 –> can move against gravity
4 –> can move against gravity and some resistance
5 –> full movement against resistance without fatigue.

Question 10

Vascular

Answer 10

0/4 = PAD. No pulse present. Bad news bears. 
1/4 = Diminishes, barely palpable. 
2/4= normal
3/4 = Strong, full
4/4 = bounding

Question 11

Differential diagnosis mnemonic

Answer 11

Always first ask is it trauma or non-trauma?

Vascular
Inflammatory
Neoplastic (cancer)
Degenerative/deficient
Idiopathic/intoxication
Congenital
Autoimmune/Allergy
Trauma
Endocrine

Question 12

Colle’s Fracture

Answer 12

FOOSH –> distal radius fracture. Due to dorsal angulation/displacement, it is often referred to as a “dinner fork deformity.