BoneMSK Pt 1 Flashcards
What is a synovial joint and what are examples?
freely moveable joint, lubricated with synovial fluid and surrounded by joint capsule and ligaments. Allows for cushioning.
e.g. shoulder, knee
What is a cartilaginous joint?
-Highlighted by discs which separate bony surfaces
-Allow for small movement
-Bony surfaces covered by hyaline cartilage
-Absorb shock across the joint
-Nucleus Pulposus
What is a fibrous joint?
-Layers of fibrous tissue/cartilage that hold bones together
-e.g. Skull sutures
-Bones near direct contact- No appreciable movement
__________ surrounds joints and gives it strength
capsule
What is a Ball and socket
shoulder and. hip, wide rom
Examples of hinge movement in one plane are ________ and _______
elbow and knee
Condylar jojnt
two articulating surfaces
e.g. TMJ
What is a bursae?
It is a fluid filled sac that surrounds our joints, filled with synovial sac which facilitates joint motion
What are articular structures of the joint?
joint capsule and bone
Ligaments connect
bone to bone
Tendons connect to
muscle to bone
What are the surrounding structures that support the joint capsule?
Bursae, muscle, facia, nonarticular bone, nerve, skin
What are things that you would think of with a pt under 60
acute injuries, trauma, sprains or RA. Early stages of osteoarthritis, infections arthritis
What are things that you would think of with a pt over 60
affects of osteoarthritis , osteoporotic fractures, gout , ground level fall= hip fracture, pelvis, pathologic fractures
With a MSK Hx taking, you want to focus on ______ and ________
age, acuity
Pain suggests _____ or _______
injury, inflammation
You want to ALWAYS examine the joint from _____ and _________
above, below
What is an example of asymmetric joint pain?
psoriasis or Irritable bowel disease, osteoarthiritis
What is an example of symmetric joint pain?
RA
What is the gel phenomenon?
Have periods of daytime stiffness that lasts seconds to a minute or 2 and then it gets worse with movement.
Active ROM
the patient does it on their own
Passive ROM
the patient is being moved by someone else,
P= provider
What are associated symptoms for joints?
Fever/Chills
Rash
Fatigue
Anorexia
Changes in weight
Generalized weakness
What is the order of the MSK exam?
- Inspection
-Look- inspect for deformity, swelling, scars, inflammation or atrophy
One or Multiple; Symmetry - Palpate
-Locate tenderness and areas of fluid collection
Always palpate bilaterally for comparison - ROM> Muscle Strength Testing
Active»_space; Passive - Special Tests
Always remember to document and check __________ exam distal to injury/complaint and also when applying a splint/cast
neurovascular
When you are palpating, you want to feel ______ AND _________ vs ___________
affected structures, surrounding areas, uninvolved side
What are the 4 signs of inflammation
swelling, warmth, redness, pain/tenderness
Synovial jont involvement _________
swelling,
If the swelling is outside the joint
soft tissues surrounding joint, bursititis, tendon infmallatin/ tendonitits
Warmth
with arthtiris, tendonitis, osteomylititis
Redness
infection, cellulitis, over overlying skin of joint is the least common sign seen when talking about joint involvement. more common in superficial joints like fingers, toes
More likely to see a lot of ______ and ________ when it pertains to joints
swelling, warmth
Passive ROM may exceed active ROM by ________ degrees
5
Active ROM and passive ROM should be __________ in ________ joints
equal, contralateral
Discrepencies in ROM may indiciate muscle ______ or _____
weakness, disorder
Use goniometer where there is ________ or _________ ROM
INCREASED or LIMITED
Assessing Muscle Strength Scale
- No evidence of movement = 0
- Trace of movement = 1
- Full ROM but not against gravity (passive movement) = 2
- Full ROM, but not against resistance= 3
- Full ROM against gravity and some resistance but weak = 4
- Full ROM against gravity, full resistance = 5
What may weakness result from?
Underlying muscle disorder, pain, fatigue, overstretching
TMJ is a __________ joint
condylar synovial
Which is the most active joint in the body?
TMJ
How do you assess TMJ ROM?
Open and close; lateral movement; protrusion and retraction
How do you assess TMJ muscle stregnth?
Done by asking patient to clench teeth
To assess the ROM for the shoulder, you would assess the 6 cardinal directions, what are they?
- forward flexion- 180 degrees
- extension- 50 degrees
- abduction- 180 degrees( away from midline)
- adduction- 50 degrees (coming back to midline, adding to midline)
- internal rotation- 90 degrees
- external rotation- 90 degrees
What are dynamic stabilizers of the shoulder?
4 rotator cuff muscles “SITS” supraspinatus, infra spinatus, teres minor, subscapularis
What are the static stabilizers of the shoulder?
= incapable for movement bone structure, ligaments of shoulder girdle itself, the labrum, glenohumeral ligaments
What can cause scapular winging?
weakness in trap, or serratus anterior or never injury
Shoulder adduction involves nerve roots________ to ________. What is the main muscle of adduction?
C5-T1
Pectoralis Major, though the Latissiumus and others contribute as well
What is the positive findings for the cross over test?
Pain with adduction
AC joint tenderness and compression
What is the positive apley scratch test mean?
Pain with both motions suggests rotator cuff disorder or adhesive capsulitis
Neer impingement positive test
Pain- subacromial impingement, RTC tendonitis
Hawkins-Kennedy positive finding
Pain – impingement of supraspinatus
Gerber/Lift-Off positive test
Inability to move against resistance / keep hand in place (Subscapularis pathology)
Shoulder- Supraspinatus (Empty Can) Test positive test
Supraspinatus weakness
Shoulder- Glenohumeral Instability Tests
- Apprehension test- externally rotating shoulder, positive finding would be instability where they pt arm will feel like it will pop and watch for facial grimace
- Relocation Test- push their GH joint straight down, thats a positive relocation test, Confirms GH instability
Shoulder- Speed’s Maneuver for Bicipital Tendonitis positive test
Biceps tendonitis, this will produce pain.
Assessing ROM for elbow
Flexion(160 degrees);
extension (180 degrees);
pronation (90 degrees);
supination (90 degrees)
Olecranon Bursitis
collection of fluid, some cases it needs to be drained
Elbow nodules
-Subcutaneous nodules on the extensor surface of the forearm near the elbow
-Can be associated with Rheumatoid arthritis or gouty tophi
Tinel sign– Elbow
trying to get ulnar nerve,starts at elbow going down pinky and ulnar aspect of ring finger.
positive is pain, numbness/tingling shooting down that aspect of fingers
Positive Cozen Test
Lateral Epicondylitis
“tennis elbow”
Pain along extensior tendor/lateral epicondyle
- testing for tennis elbow remember tennis you use back hand, leading with lateral aspect of elbow.
Positive Mill Test
Lateral Epicondylitis
“tennis elbow”
flexor muscle group,
Pain/Tenderness over medial epicondyle, tenderness over wrist flexors
Assess ROM of hands/wrists
Flexion of fingers (90 degrees);
hyperextension of fingers (30 degrees);
flexion of wrist (90 degrees);
hyperextension of wrist (70 degrees);
rotation of hand (20 degrees);
ulnar motion (55 degrees)
Heberden & Bouchard nodes
Bony overgrowth in distal interphalangeal joints, they are hard they are nontender usually 2-3 mm in diameter but can be larger, associated with osteoarthritis.
Distal- they are called Heberden nodules.
Proximal- Bouchard nodes
Swan neck and Ulnar deviation and subluxation of
metacarpophalangeal joints are associated with
RA
Boutonniere deformity
Fusiform swelling or spindle shaped enlargement of the PIP
Extension/flexion then extension again.
associated with RA
Why is it important to palpate the anatomic snuffbox?
scaphoid bone it is important because of fallen outstretched hand which can fracture scaphoid bone. This bone if fractures wont show up on initial imaging. missed fracture can cause avascular necrosis
CTS
Channel beneath palmar surface of wrist and proximal hand
-Thumb/Finger flexors
-Median Nerve
Flexor Retinaculum
-Holds tendons in place
-Median N lives between flexor retinaculum and tendon sheath
What does the ulnar nerve innervate?
ulnar aspect of the 4th digit and the pinky finger
Weakness of with Thumb Abduction is associated with
CTS
During thumb abduction, one is isolating the strength of
of the abductor pollicis brevis muscle (innervated by median nerve)
Hand & Wrist- Tinel’s Sign positive test
A tingling sensation radiating from the wrist to the hand in the distribution of the median nerve is a Positive Tinel sign suggestive of CTS
Hand & Wrist – Phalens positive test
Numbness and paresthesia in the distribution of the median nerve suggestive of CTS
Hand & Wrist- Allen Test
Release the occlusive pressure on the ulnar artery. You should notice a flushing of the hand within 5 to 15 seconds. This denotes that the ulnar artery if patent and has good blood flow. This normal flushing of the hand is considered to be a positive modified Allen’s test. If the hand does not flush within 5-15 seconds, it indicates that ulnar circulation is inadequate or nonexistent; in this situation, the radial artery supplying arterial blood to that hand should not be punctured. This is called Negative modified Allen test.
What does the median nerve innervate?
volar (palmar) surface:
-most of the palm and the other part of the 4th digit and the 2nd, 3rd digits and part of the thumb
dorsal surface
-the PIP on 2nd and 3rd digits
What does the radial nerve innervate?
volar (palmar) surface
-part of the thumb
Dorsal surface
-most of the dorsum of hand and some of the 3nd, 2nd digits and the thumb
Trauma
nerves, soft tissue, bones, joints; residual problems, bone infections
Chronic illness
cancer, arthritis, sickle cell disease, hemophilia, osteoporosis, renal or neurologic disorder
FH of arthritis
rheumatoid, osteoarthritis, ankylosing spondylitis (back), gout
Genetic disorders
osteogenesis imperfecta, skeletal dysplasia, rickets, hypophosphatemia, hypercalciuria
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Shoulder abduction involves nerve roots _______ to __________. What is the main muscle of abduction?
C5, C6. the deltoid
