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Bates-MSK Flashcards

1
Q

rank of low back pain among reasons for clinical visits and rank for most common symptom of patients seeking care

A

5th highest reason

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2
Q

articular disease

A

involves swelling and tenderness of entire joint and limits both active and passive ROM

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3
Q

extra-articular disease

A

involves selected regions of the joint and types of movement

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4
Q

ligaments connect

A

bone to bone

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5
Q

list articular structures

A

joint capsule and articular cartilage, synovium and synovial fluid, intra-articular ligaments, juxta-articular bone

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6
Q

list extra-articular structures

A

periarticular ligaments, tendons, bursae, muscles, fascia, bone, nerve, overlying skin

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7
Q

tendons connect

A

muscle to bone

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8
Q

bursae

A

pouches of synovial fluid that cushion movement of tendons and muscles over bone or other joints

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9
Q

synovial joints

A

bones do not touch each other- joint articulations are freely moveable

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10
Q

cartilaginous joints

A

vertebral bodies

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11
Q

fibrous joints

A
  • skull sutures
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12
Q

spheroidal (bone and socket)

A
  • convex surface in concave cavity
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13
Q

hinge

A
  • flat, planar
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14
Q

condylar

A
  • convex or concave
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15
Q

fraction of adults with low back pain

A

2/3

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16
Q

what percentage of patients have idiopathic back pain

A

85%

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17
Q

think what for midline back pain

A

musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, epidural abscess

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18
Q

think what for off the midline pain

A

sacroiliitis, trochanteric bursitis, sciatica, hip arthritis

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19
Q

presentation of sciatica

A

radicular gluteal and posterior leg pain in S1 distribution that increases with cough or fever

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20
Q

presentation of spinal stenosis

A

leg pain that resolves with rest and/or lumbar forward flexion

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21
Q

presentation of cauda equina syndrome

A

bowel or bladder dysfunction (esp urinary retention and overflow incontinence)

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22
Q

red flags for serious underlying systemic disease

A
  • age >50
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23
Q

probability of serious systemic disease in cases of LBP (low back pain) plus a red flat

A

10%

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24
Q

most common radicular pain in the neck region

A

spinal cord compression C7 followed by C6

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25
Q

usual cause of radicular pain in the neck

A

foraminal impingement from degenerative joint changes (not herniation)

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26
Q

pain in one joint suggests

A

trauma, monoarticular arthritis, tendinitis, bursitis

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27
Q

lateral hip pain near greater trochanter suggests

A

trochanteric bursitis

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28
Q

migratory pattern of spread seen when

A

rheumatic fever or gonococcal arthritis

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29
Q

progressive additive pattern with symmetric involvement

A

RA

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30
Q

presentation of acute septic arthritis or gout

A

severe pain of rapid onset in a red, swollen joint; maybe osteomyelitis in kids

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31
Q

fever, chills, warmth, redness seen in?

A

septic arthritis, gout, rhematic fever

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32
Q

gelling

A

stiffness and limited motion after inactivity in degenerative joint disease but usually lasts only a few minutes

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33
Q

stiffness lasting 30 minutes or more

A

RA

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34
Q

systemic findings common in these arthritides

A

RA, SLE, PMR

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35
Q

papules, pustules, vesicles on reddened bases, on distal extremities

A

conococcal arthritis

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36
Q

expanding erythematous patch early in illness

A

Lyme

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37
Q

hives

A

serum sickness, drug rxn

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38
Q

erosions or scale on the penis and crusted, scaling papules on soles and palms

A

Reiter’s syndrome- arthritis, uveiitis, urethritis

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39
Q

red, burning, itchy eyes

A

Reiter’s; Behcet’s syndrome

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40
Q

diarrhea, abdominal pain, cramping

A

arthritis with UC, regional enteritis, scleroderma

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41
Q

urethritis

A

reiter’s; gonococcal

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42
Q

percentage of americans who are lazy as shit and live sedentary lifestyles

A

20- 30%

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43
Q

vulnerable area of the lower back involved with lifting

A

L5-S1

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44
Q

what percentage of the population experiences low back pain in life

A

60-80%

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45
Q

leading cause of non-fatal injuries and account for rise in death rates after age 65

A

falls

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46
Q

general population vs. 65-74 y.o. population vs. 85+ population for death rates related to falls

A

5/100,000

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47
Q

fraction of patients who regain prior level of function and of those who require nursing home placement

A

1/3 each

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48
Q

how many americans have osteoporosis and how many are at increased risk

A

10 million

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49
Q

what percentage of patients with osteoporotic hip fractures die within 1 year

A

20%

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50
Q

osteopenia on the bone density scale

A

1.0-2.5 standard deviations below the mean for young adult white women

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51
Q

osteoporosis on bone density scale

A

2.5 or more standard deviations below the mean for young adult white women

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52
Q

who uses Z scores as a better measure

A

young people, because it allows comparison with those of similar, age, ht, wt

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53
Q

where is bone density measured

A

hip, femoral neck, Ward’s triangle, greater trochanter, total hip

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54
Q

what drop in bone density is assd with what increase in risk for fracture

A

10% drop in bone density is assd with a 20% increase in risk for fracture

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55
Q

statistics for those with osteoporosis vs osteopenic groups and fracture risk

A

relative risk is higher in those with osteoporosis but almost half of all fragility fractures occur in osteopenic group

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56
Q

risk factors for osteoporosis

A
  • postmenopausal white women
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57
Q

treatment for osteoporosis

A
  • calcium
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58
Q

subcutaneous nodules seen in

A

RA or rheumatic fever

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59
Q

effusions seen in

A

trauama

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60
Q

crepitus over inflamed joints

A

osteoarthritis

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61
Q

conditions where there is decreased ROM

A

arthritis, inflammation, fibrosis around joint, bony fixation (ankylosis)

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62
Q

palpable bogginess or doughiness of synovial membrane

A

synovitis; accompanied by effusion

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63
Q

osteomyelitis

A

arthritis, tendinitis, bursitis

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64
Q

DDx for nonarticular condition

A
  • trauma/fracture
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65
Q

possibilities if chronic noninflammatory arthritis that does not involve DIP, CMC1, hip, or knee joints

A
  • osteonecrosis
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66
Q

possibilities if chronic inflammatory arthritis involving 1-3 joints

A
  • indolent infection
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67
Q

most active joint in the body

A

TMJ

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68
Q

what makes up the TMJ

A

fossa and articular tubercle of temporal bone and condyle of mandible

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69
Q

principle muscles that open the mouth

A

external pterygoids

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70
Q

muscles that close the mouth and their innervation

A

cranial nerve V

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71
Q

DDx for pain with chewing

A

TMJ

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72
Q

dynamic stablers of the shoulder

A

SITS

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73
Q

function of SItS muscles

A

move the humerus and depress and stabilize humeral head in glenoid fossa

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74
Q

statis stabilizers of shoulder

A

bone, labrum, articular capsule, glenohumeral ligaments

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75
Q

labrum

A

fibrocartilaginous ring that surrounds the glenoid and deepends its socker

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76
Q

articular capsule

A

formed by tendons of rotator cuff- adds to stability

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77
Q

Supraspinatus

A
  • runs above glenohumeral joint; inserts on greater tubercle
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78
Q

infraspinatus and teres minor

A

-cross glenohumeral joint posteriorly; insert on greater tubercle

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79
Q

subscapularis

A
  • originates on anterior surface of scapula and crosses joint anteriorly; inserts on lesser tubercle
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80
Q

axioscapular group

A
  • attaches the trunk to the scapula
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81
Q

axiohumeral group

A
  • attaches trunk to humerus
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82
Q

principal bursa of the shoulder

A

subacromial bursa- between acromion and head of humerus and overlying supraspinatus

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83
Q

when will subacromial bursa be painful if inflamed

A

abduction and rotation

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84
Q

shoulder muscles of flexion

A

anterior deltoid, pectoralis major, coracobrachialis, biceps brachii

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85
Q

shoulder muscles- extension

A

lat, teres major, posterior deltoid, triceps brachii

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86
Q

shoulder muscles- abduction

A

supraspinatus, middle deltoid, serratus anterior

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87
Q

how do you test pure glenohumeral motion

A

raise arms to 90 degrees with palms facing down

88
Q

shoulder muscles adduction

A

pec major, coracobrachialis, lat dorsi, teres major, subscapularis

89
Q

shoulder muscles- internal rotation

A

subscapularis, anterior deltoid, pec major, teres major, lat

90
Q

shoulder muscles- external rotation

A

infraspinatus, teres minor, posterior deltoid

91
Q

apley scratch test

A

patient touches opposite scapula behind them; difficulty- rotator cuff

92
Q

neer’s impingement sign

A

press on scapula with one hand and raise pts arm with the other; compresses greater tuberosity of humerus against acromion

93
Q

hawkin’s impingement sign

A

flex patient’s shoulder and elbow to 90 degrees with palm down; rotate arm internally; compress greater tuberosity against coracoacromial ligament

94
Q

empty can test- tests supraspinatus

A

elevate arms to 90 degrees and internally rotate

95
Q

test infraspinatus how

A

patient place arms at side and flex elbows to 90 degrees with thumbs up; resist as patient presses forearms out

96
Q

articulations of the radius, ulna, humerus

A

humeroulnar joint, radiohumeral joint, radioulnar joint

97
Q

elbow flexion

A

biceps brachii, brachialis, brachioradialis

98
Q

elbow extension

A

triceps brachii, anconeus

99
Q

elbow supination

A

biceps brachii, supinator

100
Q

elbow pronation

A

pronator teres, pronator quadratus

101
Q

where does the ulnar nerve run by the elbow

A

posteriorly in the ulnar groove between the medial epicondyle and the olecranon process

102
Q

location of the medial nerve at the elbow

A

medial to the brachial artery

103
Q

tenderness distal to the epicondyle

A

lateral epicondylitis

104
Q

when is the olecranon displaced posteriorly

A

posterior disolcation of elbow and supracondylar fracture

105
Q

the carpal tunnel contains

A

the sheath and flexor tendons of the forearm muscles and the median nerve

106
Q

median nerve sensory distribution (distal)

A

palm and palmar surface of most of the thumb, second and third digits, and half of the fourth digit; innervates muscles of flexion, abduction, and opposition in thumb

107
Q

poor finger alignment seen in what kind of damage

A

flexor tendon damage

108
Q

nodes in osteoarthritis

A

Heberden’s at DIPs

109
Q

ulnar deviation seen when

110
Q

thenar atrophy

A

carpal tunnel syndrome

111
Q

flexion contractures in the ring, 5th, and 3rd fingers are what and arise from what

A

Dupuytren’s contractures; from thickening of palmar fascia

112
Q

colles’ fracture produces pain where on exam

A

distal radius

113
Q

de Wuervain’s tenosynovitis and gonococcal tenosynovitis present how

A

tenderness over the extensor and abductor tendons of the thumb at the radial styloid

114
Q

tenderness over the “snuffbox”

A

scaphoid fracture- most common injury of carpal bones

115
Q

wrist flexion

A

flexor carpi radialis, flexor carpi ulnaris

116
Q

wrist extension

A

extensor carpi ulnaris, extensor carpi radialis longus, extensor carpi radialis brevis

117
Q

adduction (tested palm down)

A

flexor carpi ulnaris

118
Q

abduction (tested palm down)

A

flexor carpi radialis

119
Q

hand grip stregth tests

A

wrist joints, finger flexors, intrinsic muscles of hand

120
Q

wrist pain and grip weakness

A

deQuervain’s tenosynovitis

121
Q

decreased grip strength

A

arthritis, CTS, epicondylitis, cervical radiculopathy

122
Q

Finkelstein’s test

A

pain IDs de Quervain’s tenosynovitis from inflammation of abductor pollicis longus and extensor pollicis brevis tendons and tendon sheaths

123
Q

why is there increased risk for disc herniation and subluxation, or slippage, of L5 on S1

A

vertebral column angles sharply posterior at lumbosacral junction and becomes immovable

124
Q

neck stiffness think of

A

arthritis, muscle strain, underlying pathology

125
Q

lateral deviation and rotation of the head suggest

A

torticollis from contraction of SCM

126
Q

level of iliac crests

127
Q

tenderness in arthritis especially at the facet joints between which vertebrae

128
Q

step-offs felt on palpation of lower lumbar area in?

A

spondylolisthesis

129
Q

spondylolisthesis

A

forward slippage of one vertebra- may compress spinal cord

130
Q

tenderness over sacroiliac joint

A

ankylosing spondylitis

131
Q

pain on percussion

A

osteoporosis, infection, malignancy

132
Q

unequal shoulder heights seen in

A

scoliosis, Sprengel’s deformity of scapula; winged scapula; contralateral weakness of trap

133
Q

unequal heights of iliac crests of pelvic tilt

A

leg length difference; scoliosis and hip abduction/adduction; listing in herniated lumbar disk

134
Q

what may overlie spina bifida

A

birthmarks, port wine stains, hairy patches, lipomas

135
Q

cafe au lait spots in

A

with skin tags and fibrous tumors in NF

136
Q

sciatic nerve roots and where it lies

A

L4-S3; midway between the greater trochanter and ischial tuberosity as it leaves pelvis through sciatic notch

137
Q

most common herniated IV discs and tenderness they produce

A

L5-S1; L4-L5; tenderness of spinous processes, IV joints, paravertebral muscles, sacrosciatic notch, sciatic nerve

138
Q

neck muscles of flexion

A

SCM, scalene, prevertebral muscles

139
Q

neck muscles of extension

A

splenius capitus and cervicis, small intrinsic neck muscles

140
Q

neck muscles of rotation

A

SCM, small intrinsic neck muscles

141
Q

neck muscles of lateral bending

A

scalenes and small intrinsic neck muscles

142
Q

muscles involved in flexion

A

psoas major, psoas minor, quadratus lumborum; int/ext obliques and rectus abdominis

143
Q

muscles involved in extension

A

erector spinae, transversospinalis

144
Q

bones of the pelvis, inferior and posterior connections

A
  • acetabulum, ilium, ischium
145
Q

level of PSIS

146
Q

percentage of walking cycle when foot is on ground and bearing weight

147
Q

wide based gait suggests

A

cerebellar problems

148
Q

hip dislocation, arthritis, abductor weakness can produce what type of gait

A

cause pelvis to drop on opposite side- waddling gait

149
Q

width of the base from heel to heel

A

2-4 inches

150
Q

leg shortening and external rotation suggests

A

hip fracture

151
Q

inguinal ligament

A

from ASIS to pubic tubercle

152
Q

relation of femoral contents to inguinal ligament

A

structures bisect; NAVEL; lymph nodes are medial

153
Q

focal tenderness over the trochanter

A

trochanteric bursitis

154
Q

weaver’s bottom

A

ischiogluteal bursitis; may mimic sciatica

155
Q

hip flexion

156
Q

hip extension

A

gluteus maximus

157
Q

hip abduction

A

gluteus medius and minimus

158
Q

hip adduction

A

adductor brevis, adductor longus, adductor magnus, pectineus, gracilis

159
Q

hip external rotation

A

internal and external obturators, quadratus femoris, superior and inferior gemelli

160
Q

internal rotation

A

gluteus medius and minimus

161
Q

flexion deformity of the hip- when opposite hip is flexed

A

affected hip does not allow full leg extension and affected thigh looks flexed

162
Q

quadriceps femoris muscles

A

rectus femoris, vastus lateralis, vastus medialis

163
Q

hamstring muscles

A

semimembranosus, gracilis, sartorius, semitendinosus

164
Q

describe medial and lateral menisci

A

cushion action of femur on tibia; crescent-shaped; fibrocartilaginous

165
Q

describe MCL

A

broad, flat ligament; connects medial femoral epicondyle to medial condyle of tibia

166
Q

describe LCL

A

connects lateral femoral epicondyle to head of fibula

167
Q

describe ACL

A

crosses obliquely from anterior medial tibia to lateral femoral condyle; prevents tibia from moving forward

168
Q

describe PCL

A

crosses from posterior tibia and lateral meniscus to medial femoral condyle; prevents tibia from moving backwards

169
Q

prepatellar bursa lies where

A

between patella and overlying skin

170
Q

anserine bursa lies where

A

1-2 inches below the knee joint on the medial surface, proximal and medial to the attachments of the medial hamstring muscles on the proximal tibia

171
Q

signs of quadriceps weakness

A

stumbling of pushing the knee into extension with the hand during heel strike

172
Q

genu varum vs genu valgum- lay terms

173
Q

swelling over the patella

A

prepatellar bursitis

174
Q

swelling over tibial tubercle

A

infra-patellar or anserine bursitis

175
Q

think of what if presentation of bony ridges along joint margins, genu varum deformity, stiffness 30 minutes or less

A

osteoarthritis

176
Q

which meniscus is more likely to tear

A

medial (with trauma)

177
Q

pain and crepitus in patellofemoral grind test

A

roughening of patellar undersurface where it articulates with femur; also when climbing or getting up from a chair

178
Q

pain with compression during grind

A

chondromalacia or degenerative patella (patellofemoral syndrome)

179
Q

housemaid’s knee

A

prepatellar bursitis from excessive kneeling

180
Q

anserine bursitis commonly from

A

running, valgus knee deformity, fibromyalgias, osteoarthritis

181
Q

popliteal or “baker’s” cyst

A

from distention of gastrocnemius semimembranous bursa

182
Q

bulge sign

A
  • for minor effusions
183
Q

positive bulge sign

A

fluid wave on medial side between patella and femur- consistent w effusion (minor)

184
Q

balloon sign

A

place thumb and index finger on either side of patella; with L hand compress suprapatellar puch against femur; feel for fluid entering in spaces next to patella under R thumb and index finger

185
Q

positive balloon sign

A

with a large effusion suprapatellar compression ejects fluid into spaces adjacent to patella

186
Q

ballotting the patella

A

push patella sharply against femur and watch for fluid to return to pouch

187
Q

Achilles tendon is common to which two muscles

A

gastrocnemius and soleus

188
Q

ruptured Achilles tendon

A

defect in muscles with tenderness and swelling

189
Q

Achilles tendonitis

A

thickening of tendon above calcaneus, with protuberant posterolateral bony process of calcaneus

190
Q

absence of plantar flexion

A

positive to indicate rupture of Achilles tendon

191
Q

muscles of IR at knee

A

sartorius, gracilis, semitendinosus, semimembranosus

192
Q

muscles of ER at knee

A

biceps femoris

193
Q

McMurray test

A

pt supine; grasp heel and flex knee; cup hand over knee joint with fingers and thumb along medial and lateral joint line; from heel- rotate lower leg internally and externally; push on lateral side to apply a valgus stress on medial side of the joint

194
Q

to test MCL

A

apply valgus stress (abduction)

195
Q

to test LCL

A

apply varus stress (adduction)

196
Q

positive anterior drawer sign makes ACL tear how many times more likley

197
Q

lachman test

A

knee in 15 degrees of flexion and external rotation

198
Q

positive Lachman test makes ACL tear how many times more likely

199
Q

principle joints of the ankle

A

tibiotalar, subtalar (talocalcaneal)

200
Q

plantar flexion of ankle powered by what muscles

A

gastrocnemius, posterior tibial muscle, toe flexors

201
Q

dorsiflexion powered by what muscles

A

anterior tibial muscle, toe extensors

202
Q

deltoid ligament

A

medially; fans out from inferior surface of medial malleolus to the talus and proximal tarsal bones- protects from eversion

203
Q

lateral ligaments

A
  • anterior talofibular ligament
204
Q

which ligaments of ankle are most likely to be injured

A

lateral ligaments; most at risk from inversion= anterior talofibular ligament

205
Q

inserts on medial tubercle of calcaneus

A

plantar fascia

206
Q

plantar fasciitis presentation

A

focal heel pain on palpation of plantar fascia

207
Q

plantar fasciitis associated with

A

prolonged standing or heel-strike exercise; RA, gout

208
Q

post-trauma; can’t bear weight after 4 steps and tenderness over posterior aspect of either malleolus- especially medial- think what

A

ankle fracture- Ottowa ankle rule

209
Q

metatarsalgia seen with what

A

trauma, arthritis, vascular compromise

210
Q

Morton’s neuroma

A

tenderness over 3rd and 4th metatarsal heads on plantar surface

211
Q

muscles of ankle flexion (plantar flexion)

A

gastrocnemius, soleus, plantaris, tibialis posterior

212
Q

muscles of ankle extension (dorsiflexion)

A

tibialis anterior, extensor digitorum longus, extensor hallucis longus

213
Q

muscles of ankle inversion

A

tibialis posterior and anterior

214
Q

muscles of ankle eversion

A

peroneus longus and brevis

215
Q

difference between pain elicited in arthritic joint vs ligamentous sprain

A

arthritic joint- pain when moved in any direction

Physical Diagnosis (9 decks)

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