Bates Chapter 23 Flashcards
Freely movable
Synovial (knee, shoulder )
Slightly moveable joint
Cartilaginous (vertebral bodies of the spine, symphysis pubis, sternomanubrial joint)
Immovable joint
Fibrous (skull sutures)
Bursae
disc-shaped synovial sacs that facilitate joint action and allow adjacent muscles or muscles and tendons to glide over each other during movement with reduced friction. They can lie between the skin and the convex surface of a bone or joint, as in the prepatellar bursa of the knee or in areas where tendons or muscles rub against bone, ligaments, or other muscles and tendons, as in the subacromial bursa of the shoulder
Arthralgia
joint pain without evidence of arthritis
monoarticular
If pain is localized to only one joint
oligoarticular or pauciarticular
Joint pain may also involve two to four joints
(polyarticular)
pain in more than 4 joints
gel phenomenon
brief periods of daytime stiffness following inactivity that usually last from 30 to 60 minutes then get worse again with movement?
ligamentous laxity.
excess mobility of joint ligaments, called ligamentous laxity.
The temporomandibular joint (TMJ)
the most active joint in the body, opening and closing up to 2,000 times a day
fasciculations
fine tremors of the muscles
six cardinal movements of the shoulder girdle
flexion, extension, abduction, adduction, and internal and external rotation
Risk factors for PVD
Amplitude scale
➢4: Bounding, aneurysmal
➢3: Full, increased
➢2: Expected
➢1: Diminished, barely palpable
➢0: Absent, not palpable
Mono articular
Localized
Polyarticular
Diffuse-more than 4 joints
Sciatica
radicular gluteal and posterior leg pain usually caused by impingement nerve roots at the L4–S1 root levels for related neurologic findings). Up to 85% of cases are associated with a disc disorder, usually at L4–L5 or L5–S1 levels.15 Pain associated with forward flexion of the spine, straight-leg raise or seated slump maneuvers, or Valsalva or sneezing is suggestive of underlying disc disease. Leg pain that improves with lumbar forward flexion occurs in spinal stenosis.
cauda equina
S2–S4 midline disc herniation or tumor if there is bowel or bladder dysfunction (usually urinary retention with overflow incontinence), especially with saddle anesthesia or perineal numbness. Pursue immediate imaging and surgical evaluation
ankylosis
Decreased ROM is present in arthritis, joints with effusion, joints with tissue inflammation or surrounding fibrosis, or bony fixation
Articular structures
Articular structures include the joint capsule and articular cartilage, the synovium and synovial fluid, intraarticular ligaments, and juxtaarticular bone
Extraarticular structures
Extraarticular structures include periarticular ligaments (rope-like bundles of collagen fibers that connect bone to bone), tendons (bundles of collagen fibers that connect muscle to bone), bursae, muscle, fascia, nonarticular bone, nerves, and overlying skin.
consider repetitive strain or overuse syndromes, crystal-induced arthritis, rheumatoid arthritis (RA), psoriatic arthritis, reactive arthritis, and infectious arthritis.
If age <60 years
look for osteoarthritis (OA), gout and pseudogout, polymyalgia rheumatica (PMR), osteoporotic fracture, and septic bacterial arthritis.
If age >60 years,
a leading complaint of patients seeking health care
Joint pain
Superior mesenteric artery
Distal duodenum, jejunum, ileum, ascending and transverse colon (small intestine)
Inferior mesenteric
Ascending colon and cecum (large intestine)
Celiac artery
Distal esophagus, stomach, proximal duodenum, liver,spleen, and pancreas
Site of arterial ischemia
-Buttock, hip: aortoiliac
-genitalia presenting as erectile dysfunction (ED): aortoiliac-pudendal
-thigh: common femoral or aortoiliac
-upper calf: superficial femoral
Lower calf: popliteal
-Foot: tibial or peroneal
Neurogenic claudication
Pain with walking, or prolonged standing, radiating from the spinal area into the buttocks, thighs, lower legs, or feet. Happens with spinal stenosis. Relieved by leaning forward or sitting down
Risk factors of PAD=CAD risk factors
-Greater than 50
-smoking
-DM
-HTN
-elevated cholesterol
-African American
-CAD
Spinal stenosis pain
Pain relieved by sitting and bending forward, or if there is bilateral buttock or leg pain
Widely dilated artery
Aneurysmal
Bounding carotid, radial, and femoral pulses are present in
Aortic regurgitation
Pulses parvus
Weal pulses usually seen in artherosclerotic pvd
Pulses tardus
Sluggish pulses, usually occurring in the setting of aortic stenosis or low cardiac output
Enlarged epitrochlear node (are not palpable in healthy individual)
Suggests local or distal infection or maybe associated with lymphadenopathy from lymphoma or HIV
This pulse can be congenitally absent at birth
Dorsalis pedis
Ankle-brachial index ( ABI)
Used to assess PAD
-pressure in foot divided by pressure in both arms
Allen test
To test radial artery patency
Psoriatic arthritis
Scaly plaques, especially on extensor surfaces, and pitted nails
Gonococcal arthritis
Papules, pustules, or vesicles with reddened based on the distal extremities-monoarticular
psoriatric arthritis
fibromyalgia
joint pain with multiple point of tenderness (polyartucular)
occurs in inflammation of bursae (bursitis), tendons (tendinitis), or tendon sheaths (tenosynovitis) as well as in sprains from stretching or tearing of ligaments
Extraarticular pain
Red Flags for Low Back Pain
Age <20 yrs or >50 yrs
History of cancer
Unexplained weight loss, fever, or decline in general health
Pain lasting more than 1 mo or not responding to treatment
Pain at night or present at rest
History of intravenous drug use, addiction, or immunosuppression
Presence of active infection or human immunodeficiency virus (HIV) infection
Long-term steroid therapy
Saddle anesthesia
Bladder or bowel incontinence
Neurologic symptoms or progressive neurologic deficit
Lower extremity weakness
are the most common cause of shoulder pain in primary care.
Rotator cuff disorders
Overall Shoulder Rotation
Apley scratch test. Ask the patient to touch the opposite scapula using the two motions shown below. Pain during these maneuvers suggests a rotator cuff disorder or adhesive capsulitis
Drop-arm test. Ask the patient to fully abduct the arm to shoulder level, up to 90°, and lower it slowly. Note that abduction above shoulder level, from 90° to 120°, reflects action of the deltoid muscle
Weakness during this maneuver is a positive test for a supraspinatus rotator cuff tear or bicipital tendinitis
rotator cuff tear tests
-drop test: Ask the patient to fully abduct the arm to shoulder level, up to 90°, and lower it slowly
-empty can test: levate the arms to 90° and internally rotate the arms with the thumbs pointing down, as if emptying a can. Ask the patient to resist as you place downward pressure on the arms.
risk factors for carpal tunnel syndrome.
Forceful repetitive handwork with prolonged wrist extension (such as keyboarding) and mail sorting, vibration, cold exposure, wrist anatomy, pregnancy, RA, diabetes, and hypothyroidism are risk factors for carpal tunnel syndrome.
Decreased sensation in the median nerve territory is a common sign of
carpal tunnel syndrome
tinel test
Testing for carpal tunnel syndrome
Shooting pain, aching, or worsening numbness in the median nerve distribution is a positive test
Phalen sign
Testing for carpal tunnel syndrome
Numbness and tingling in the median nerve distribution within 60 seconds is a positive test
torticollis
Lateral deviation and rotation of the head are seen in torticollis, often from contraction of the sternocleidomastoid muscle.
Assess all low back pain for possible cauda equina compression, the most serious cause of pain, due to risk of limb paralysis or bladder/bowel dysfunction.
Assess all low back pain for possible cauda equina compression, the most serious cause of pain, due to risk of limb paralysis or bladder/bowel dysfunction.
is positive when the patient feels pain going down the arm on the same side the head is turned and indicates cervical nerve root involvement
The Spurling test
two phases of gait
-Stance—when the foot is on the ground and bears weight (60% of the normal gait cycle)
-Swing—when the foot moves forward and does not bear weight (40% of the normal gait cycle)
Most hip problems appear during the weight-bearing stance phase.
vaulting
standing up on the toes of the stance phase foot during swing phase on the affected side to provide greater clearance).
McMurray test
rotation of the tibia on the femur to determine injury to meniscal structures-torn ligament
For the reflex to occur, all components of the reflex arc must be intact
For the reflex to occur, all components of the reflex arc must be intact: sensory nerve fibers, spinal cord synapse, motor nerve fibers, neuromuscular junction, and muscle fibe
Headache Warning Signs
Progressively frequent or severe over a 3-month period
Sudden onset like a “thunderclap” or “the worst headache of my life”
New onset after age 50 years
Aggravated or relieved by change in position
Precipitated by Valsalva maneuver or exertion
Associated symptoms of fever, night sweats, or weight loss
Presence of cancer, HIV infection, or pregnancy
Recent head traumaChange in pattern from past headaches
Lack of a similar headache in the past
Associated papilledema, neck stiffness, or focal neurologic deficits
Oral–facial dyskinesias
Oral–facial dyskinesias are arrhythmic, repetitive, bizarre movements that chiefly involve the face, mouth, jaw, and tongue: grimacing, pursing of the lips, protrusions of the tongue, opening and closing of the mouth, and deviations of the jaw. The limbs and trunk are involved less often. These movements may be a late complication of antipsychotic or antiemetic drugs such as phenothiazines, termed tardive (late) dyskinesias. They also occur in long-standing psychoses, in some older adults, and in some edentulous persons.
tics
Tics are brief, repetitive, stereotyped, coordinated movements occurring at irregular intervals. Examples include repetitive winking, grimacing, and shoulder shrugging. Causes include Tourette syndrome and late effects of drugs such as phenothiazines.
Dystonia
Dystonia causes irregular movements resembling athetosis or tremor. These are often accompanied by abnormal postures that limit voluntary movement and can at times be painful. Examples include writer’s cramp, blephorospasm, and as illustrated, spasmodic torticollis.
athetosis
Athetoid movements are slower and more twisting and writhing than choreiform movements and have a larger amplitude. They most commonly involve the face and the distal extremities. Athetosis is often associated with spasticity. Causes include cerebral palsy.
chorea
Choreiform movements are brief, rapid, jerky, irregular, and unpredictable. They occur at rest or interrupt normal coordinated movements. Unlike tics, they seldom repeat themselves. The face, head, lower arms, and hands are often involved. Causes include Sydenham chorea (with rheumatic fever) and Huntington disease.
Nystagmus
Nystagmus is a rhythmic oscillation of the eyes, analogous to a tremor in other parts of the body. It has multiple causes, including impairment of vision in early life, disorders of the labyrinth and the cerebellar system, and drug toxicity. Nystagmus occurs normally when a person watches a rapidly moving object (e.g., a passing train). Study the three characteristics of nystagmus described in this table so that you can correctly identify the type of nystagmus. Then refer to textbooks of neurology for differential diagnoses.
six cardinal views
