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
2
Q
articular disease
A
involves swelling and tenderness of entire joint and limits both active and passive ROM
3
Q
extra-articular disease
A
involves selected regions of the joint and types of movement
4
Q
ligaments connect
A
bone to bone
5
Q
list articular structures
A
joint capsule and articular cartilage, synovium and synovial fluid, intra-articular ligaments, juxta-articular bone
6
Q
list extra-articular structures
A
periarticular ligaments, tendons, bursae, muscles, fascia, bone, nerve, overlying skin
7
Q
tendons connect
A
muscle to bone
8
Q
bursae
A
pouches of synovial fluid that cushion movement of tendons and muscles over bone or other joints
9
Q
synovial joints
A
bones do not touch each other- joint articulations are freely moveable
10
Q
cartilaginous joints
A
vertebral bodies
11
Q
fibrous joints
A
- skull sutures
12
Q
spheroidal (bone and socket)
A
- convex surface in concave cavity
13
Q
hinge
A
- flat, planar
14
Q
condylar
A
- convex or concave
15
Q
fraction of adults with low back pain
A
2/3
16
Q
what percentage of patients have idiopathic back pain
A
85%
17
Q
think what for midline back pain
A
musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, epidural abscess
18
Q
think what for off the midline pain
A
sacroiliitis, trochanteric bursitis, sciatica, hip arthritis
19
Q
presentation of sciatica
A
radicular gluteal and posterior leg pain in S1 distribution that increases with cough or fever
20
Q
presentation of spinal stenosis
A
leg pain that resolves with rest and/or lumbar forward flexion
21
Q
presentation of cauda equina syndrome
A
bowel or bladder dysfunction (esp urinary retention and overflow incontinence)
22
Q
red flags for serious underlying systemic disease
A
- age >50
23
Q
probability of serious systemic disease in cases of LBP (low back pain) plus a red flat
A
10%
24
Q
most common radicular pain in the neck region
A
spinal cord compression C7 followed by C6
25
usual cause of radicular pain in the neck
foraminal impingement from degenerative joint changes (not herniation)
26
pain in one joint suggests
trauma, monoarticular arthritis, tendinitis, bursitis
27
lateral hip pain near greater trochanter suggests
trochanteric bursitis
28
migratory pattern of spread seen when
rheumatic fever or gonococcal arthritis
29
progressive additive pattern with symmetric involvement
RA
30
presentation of acute septic arthritis or gout
severe pain of rapid onset in a red, swollen joint; maybe osteomyelitis in kids
31
fever, chills, warmth, redness seen in?
septic arthritis, gout, rhematic fever
32
gelling
stiffness and limited motion after inactivity in degenerative joint disease but usually lasts only a few minutes
33
stiffness lasting 30 minutes or more
RA
34
systemic findings common in these arthritides
RA, SLE, PMR
35
papules, pustules, vesicles on reddened bases, on distal extremities
conococcal arthritis
36
expanding erythematous patch early in illness
Lyme
37
hives
serum sickness, drug rxn
38
erosions or scale on the penis and crusted, scaling papules on soles and palms
Reiter's syndrome- arthritis, uveiitis, urethritis
39
red, burning, itchy eyes
Reiter's; Behcet's syndrome
40
diarrhea, abdominal pain, cramping
arthritis with UC, regional enteritis, scleroderma
41
urethritis
reiter's; gonococcal
42
percentage of americans who are lazy as shit and live sedentary lifestyles
20- 30%
43
vulnerable area of the lower back involved with lifting
L5-S1
44
what percentage of the population experiences low back pain in life
60-80%
45
leading cause of non-fatal injuries and account for rise in death rates after age 65
falls
46
general population vs. 65-74 y.o. population vs. 85+ population for death rates related to falls
5/100,000
47
fraction of patients who regain prior level of function and of those who require nursing home placement
1/3 each
48
how many americans have osteoporosis and how many are at increased risk
10 million
49
what percentage of patients with osteoporotic hip fractures die within 1 year
20%
50
osteopenia on the bone density scale
1.0-2.5 standard deviations below the mean for young adult white women
51
osteoporosis on bone density scale
2.5 or more standard deviations below the mean for young adult white women
52
who uses Z scores as a better measure
young people, because it allows comparison with those of similar, age, ht, wt
53
where is bone density measured
hip, femoral neck, Ward's triangle, greater trochanter, total hip
54
what drop in bone density is assd with what increase in risk for fracture
10% drop in bone density is assd with a 20% increase in risk for fracture
55
statistics for those with osteoporosis vs osteopenic groups and fracture risk
relative risk is higher in those with osteoporosis but almost half of all fragility fractures occur in osteopenic group
56
risk factors for osteoporosis
- postmenopausal white women
57
treatment for osteoporosis
- calcium
58
subcutaneous nodules seen in
RA or rheumatic fever
59
effusions seen in
trauama
60
crepitus over inflamed joints
osteoarthritis
61
conditions where there is decreased ROM
arthritis, inflammation, fibrosis around joint, bony fixation (ankylosis)
62
palpable bogginess or doughiness of synovial membrane
synovitis; accompanied by effusion
63
osteomyelitis
arthritis, tendinitis, bursitis
64
DDx for nonarticular condition
- trauma/fracture
65
possibilities if chronic noninflammatory arthritis that does not involve DIP, CMC1, hip, or knee joints
- osteonecrosis
66
possibilities if chronic inflammatory arthritis involving 1-3 joints
- indolent infection
67
most active joint in the body
TMJ
68
what makes up the TMJ
fossa and articular tubercle of temporal bone and condyle of mandible
69
principle muscles that open the mouth
external pterygoids
70
muscles that close the mouth and their innervation
cranial nerve V
71
DDx for pain with chewing
TMJ
72
dynamic stablers of the shoulder
SITS
73
function of SItS muscles
move the humerus and depress and stabilize humeral head in glenoid fossa
74
statis stabilizers of shoulder
bone, labrum, articular capsule, glenohumeral ligaments
75
labrum
fibrocartilaginous ring that surrounds the glenoid and deepends its socker
76
articular capsule
formed by tendons of rotator cuff- adds to stability
77
Supraspinatus
- runs above glenohumeral joint; inserts on greater tubercle
78
infraspinatus and teres minor
-cross glenohumeral joint posteriorly; insert on greater tubercle
79
subscapularis
- originates on anterior surface of scapula and crosses joint anteriorly; inserts on lesser tubercle
80
axioscapular group
- attaches the trunk to the scapula
81
axiohumeral group
- attaches trunk to humerus
82
principal bursa of the shoulder
subacromial bursa- between acromion and head of humerus and overlying supraspinatus
83
when will subacromial bursa be painful if inflamed
abduction and rotation
84
shoulder muscles of flexion
anterior deltoid, pectoralis major, coracobrachialis, biceps brachii
85
shoulder muscles- extension
lat, teres major, posterior deltoid, triceps brachii
86
shoulder muscles- abduction
supraspinatus, middle deltoid, serratus anterior
87
how do you test pure glenohumeral motion
raise arms to 90 degrees with palms facing down
88
shoulder muscles adduction
pec major, coracobrachialis, lat dorsi, teres major, subscapularis
89
shoulder muscles- internal rotation
subscapularis, anterior deltoid, pec major, teres major, lat
90
shoulder muscles- external rotation
infraspinatus, teres minor, posterior deltoid
91
apley scratch test
patient touches opposite scapula behind them; difficulty- rotator cuff
92
neer's impingement sign
press on scapula with one hand and raise pts arm with the other; compresses greater tuberosity of humerus against acromion
93
hawkin's impingement sign
flex patient's shoulder and elbow to 90 degrees with palm down; rotate arm internally; compress greater tuberosity against coracoacromial ligament
94
empty can test- tests supraspinatus
elevate arms to 90 degrees and internally rotate
95
test infraspinatus how
patient place arms at side and flex elbows to 90 degrees with thumbs up; resist as patient presses forearms out
96
articulations of the radius, ulna, humerus
humeroulnar joint, radiohumeral joint, radioulnar joint
97
elbow flexion
biceps brachii, brachialis, brachioradialis
98
elbow extension
triceps brachii, anconeus
99
elbow supination
biceps brachii, supinator
100
elbow pronation
pronator teres, pronator quadratus
101
where does the ulnar nerve run by the elbow
posteriorly in the ulnar groove between the medial epicondyle and the olecranon process
102
location of the medial nerve at the elbow
medial to the brachial artery
103
tenderness distal to the epicondyle
lateral epicondylitis
104
when is the olecranon displaced posteriorly
posterior disolcation of elbow and supracondylar fracture
105
the carpal tunnel contains
the sheath and flexor tendons of the forearm muscles and the median nerve
106
median nerve sensory distribution (distal)
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
poor finger alignment seen in what kind of damage
flexor tendon damage
108
nodes in osteoarthritis
Heberden's at DIPs
109
ulnar deviation seen when
RA
110
thenar atrophy
carpal tunnel syndrome
111
flexion contractures in the ring, 5th, and 3rd fingers are what and arise from what
Dupuytren's contractures; from thickening of palmar fascia
112
colles' fracture produces pain where on exam
distal radius
113
de Wuervain's tenosynovitis and gonococcal tenosynovitis present how
tenderness over the extensor and abductor tendons of the thumb at the radial styloid
114
tenderness over the "snuffbox"
scaphoid fracture- most common injury of carpal bones
115
wrist flexion
flexor carpi radialis, flexor carpi ulnaris
116
wrist extension
extensor carpi ulnaris, extensor carpi radialis longus, extensor carpi radialis brevis
117
adduction (tested palm down)
flexor carpi ulnaris
118
abduction (tested palm down)
flexor carpi radialis
119
hand grip stregth tests
wrist joints, finger flexors, intrinsic muscles of hand
120
wrist pain and grip weakness
deQuervain's tenosynovitis
121
decreased grip strength
arthritis, CTS, epicondylitis, cervical radiculopathy
122
Finkelstein's test
pain IDs de Quervain's tenosynovitis from inflammation of abductor pollicis longus and extensor pollicis brevis tendons and tendon sheaths
123
why is there increased risk for disc herniation and subluxation, or slippage, of L5 on S1
vertebral column angles sharply posterior at lumbosacral junction and becomes immovable
124
neck stiffness think of
arthritis, muscle strain, underlying pathology
125
lateral deviation and rotation of the head suggest
torticollis from contraction of SCM
126
level of iliac crests
L4
127
tenderness in arthritis especially at the facet joints between which vertebrae
C5 and C6
128
step-offs felt on palpation of lower lumbar area in?
spondylolisthesis
129
spondylolisthesis
forward slippage of one vertebra- may compress spinal cord
130
tenderness over sacroiliac joint
ankylosing spondylitis
131
pain on percussion
osteoporosis, infection, malignancy
132
unequal shoulder heights seen in
scoliosis, Sprengel's deformity of scapula; winged scapula; contralateral weakness of trap
133
unequal heights of iliac crests of pelvic tilt
leg length difference; scoliosis and hip abduction/adduction; listing in herniated lumbar disk
134
what may overlie spina bifida
birthmarks, port wine stains, hairy patches, lipomas
135
cafe au lait spots in
with skin tags and fibrous tumors in NF
136
sciatic nerve roots and where it lies
L4-S3; midway between the greater trochanter and ischial tuberosity as it leaves pelvis through sciatic notch
137
most common herniated IV discs and tenderness they produce
L5-S1; L4-L5; tenderness of spinous processes, IV joints, paravertebral muscles, sacrosciatic notch, sciatic nerve
138
neck muscles of flexion
SCM, scalene, prevertebral muscles
139
neck muscles of extension
splenius capitus and cervicis, small intrinsic neck muscles
140
neck muscles of rotation
SCM, small intrinsic neck muscles
141
neck muscles of lateral bending
scalenes and small intrinsic neck muscles
142
muscles involved in flexion
psoas major, psoas minor, quadratus lumborum; int/ext obliques and rectus abdominis
143
muscles involved in extension
erector spinae, transversospinalis
144
bones of the pelvis, inferior and posterior connections
- acetabulum, ilium, ischium
145
level of PSIS
S2
146
percentage of walking cycle when foot is on ground and bearing weight
60%
147
wide based gait suggests
cerebellar problems
148
hip dislocation, arthritis, abductor weakness can produce what type of gait
cause pelvis to drop on opposite side- waddling gait
149
width of the base from heel to heel
2-4 inches
150
leg shortening and external rotation suggests
hip fracture
151
inguinal ligament
from ASIS to pubic tubercle
152
relation of femoral contents to inguinal ligament
structures bisect; NAVEL; lymph nodes are medial
153
focal tenderness over the trochanter
trochanteric bursitis
154
weaver's bottom
ischiogluteal bursitis; may mimic sciatica
155
hip flexion
iliopsoas
156
hip extension
gluteus maximus
157
hip abduction
gluteus medius and minimus
158
hip adduction
adductor brevis, adductor longus, adductor magnus, pectineus, gracilis
159
hip external rotation
internal and external obturators, quadratus femoris, superior and inferior gemelli
160
internal rotation
gluteus medius and minimus
161
flexion deformity of the hip- when opposite hip is flexed
affected hip does not allow full leg extension and affected thigh looks flexed
162
quadriceps femoris muscles
rectus femoris, vastus lateralis, vastus medialis
163
hamstring muscles
semimembranosus, gracilis, sartorius, semitendinosus
164
describe medial and lateral menisci
cushion action of femur on tibia; crescent-shaped; fibrocartilaginous
165
describe MCL
broad, flat ligament; connects medial femoral epicondyle to medial condyle of tibia
166
describe LCL
connects lateral femoral epicondyle to head of fibula
167
describe ACL
crosses obliquely from anterior medial tibia to lateral femoral condyle; prevents tibia from moving forward
168
describe PCL
crosses from posterior tibia and lateral meniscus to medial femoral condyle; prevents tibia from moving backwards
169
prepatellar bursa lies where
between patella and overlying skin
170
anserine bursa lies where
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
signs of quadriceps weakness
stumbling of pushing the knee into extension with the hand during heel strike
172
genu varum vs genu valgum- lay terms
- bowlegs
173
swelling over the patella
prepatellar bursitis
174
swelling over tibial tubercle
infra-patellar or anserine bursitis
175
think of what if presentation of bony ridges along joint margins, genu varum deformity, stiffness 30 minutes or less
osteoarthritis
176
which meniscus is more likely to tear
medial (with trauma)
177
pain and crepitus in patellofemoral grind test
roughening of patellar undersurface where it articulates with femur; also when climbing or getting up from a chair
178
pain with compression during grind
chondromalacia or degenerative patella (patellofemoral syndrome)
179
housemaid's knee
prepatellar bursitis from excessive kneeling
180
anserine bursitis commonly from
running, valgus knee deformity, fibromyalgias, osteoarthritis
181
popliteal or "baker's" cyst
from distention of gastrocnemius semimembranous bursa
182
bulge sign
- for minor effusions
183
positive bulge sign
fluid wave on medial side between patella and femur- consistent w effusion (minor)
184
balloon sign
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
positive balloon sign
with a large effusion suprapatellar compression ejects fluid into spaces adjacent to patella
186
ballotting the patella
push patella sharply against femur and watch for fluid to return to pouch
187
Achilles tendon is common to which two muscles
gastrocnemius and soleus
188
ruptured Achilles tendon
defect in muscles with tenderness and swelling
189
Achilles tendonitis
thickening of tendon above calcaneus, with protuberant posterolateral bony process of calcaneus
190
absence of plantar flexion
positive to indicate rupture of Achilles tendon
191
muscles of IR at knee
sartorius, gracilis, semitendinosus, semimembranosus
192
muscles of ER at knee
biceps femoris
193
McMurray test
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
to test MCL
apply valgus stress (abduction)
195
to test LCL
apply varus stress (adduction)
196
positive anterior drawer sign makes ACL tear how many times more likley
11.5
197
lachman test
knee in 15 degrees of flexion and external rotation
198
positive Lachman test makes ACL tear how many times more likely
17
199
principle joints of the ankle
tibiotalar, subtalar (talocalcaneal)
200
plantar flexion of ankle powered by what muscles
gastrocnemius, posterior tibial muscle, toe flexors
201
dorsiflexion powered by what muscles
anterior tibial muscle, toe extensors
202
deltoid ligament
medially; fans out from inferior surface of medial malleolus to the talus and proximal tarsal bones- protects from eversion
203
lateral ligaments
- anterior talofibular ligament
204
which ligaments of ankle are most likely to be injured
lateral ligaments; most at risk from inversion= anterior talofibular ligament
205
inserts on medial tubercle of calcaneus
plantar fascia
206
plantar fasciitis presentation
focal heel pain on palpation of plantar fascia
207
plantar fasciitis associated with
prolonged standing or heel-strike exercise; RA, gout
208
post-trauma; can't bear weight after 4 steps and tenderness over posterior aspect of either malleolus- especially medial- think what
ankle fracture- Ottowa ankle rule
209
metatarsalgia seen with what
trauma, arthritis, vascular compromise
210
Morton's neuroma
tenderness over 3rd and 4th metatarsal heads on plantar surface
211
muscles of ankle flexion (plantar flexion)
gastrocnemius, soleus, plantaris, tibialis posterior
212
muscles of ankle extension (dorsiflexion)
tibialis anterior, extensor digitorum longus, extensor hallucis longus
213
muscles of ankle inversion
tibialis posterior and anterior
214
muscles of ankle eversion
peroneus longus and brevis
215
difference between pain elicited in arthritic joint vs ligamentous sprain
arthritic joint- pain when moved in any direction
