Chapter 17 - MSK Flashcards
How are diseases of the MSK system divided?
- Systemic (RA, SLE, polymyositis)
2. Local (back pain, tennis elbow, arthritis)
Describe patients w/local MSK disease:
Basically healthy individuals who suffer restriction of motion and pain from a single area
Which system’s diseases rank 1st in cost to workers’ comp insurance carriers?
MSK
What disorder ranks 2nd to cardiac disease as a cause of limitation of activity?
Arthritis
What MSK disorders are extremely common (5+%) in 45+ yo?
- Low back pain
- Osteoarthritis
- Tendinitis or bursitis
What MSK disorders are common (0.5-5% prevalence) in 45+ yo?
- Gout
- Fibromyalgia
- RA
Define ganglion and what causes it
- Cyst at a joint or in a tendon sheath (usually back of the hand or wrist)
- Repetitive hand movements
Define tendonitis
Inflammation of area where muscle and tendon join
Define tenosynovitis
Inflammation of tendons or tendon sheaths
What is the MC MSK disorder in the world?
Osteoporosis
Describe Paget’s disease of the bone
- Disrupts normal architecture of bone
- Weakens bone
Define symphysis
Slightly movable joint
MC type of joint?
Synovial (movable)
How are synovial joints classified?
By movement
- Hinge
- Pivot
- Condyloid
- Saddle
- Ball and socket
- Plane
What type of movement does a hinge joint permit?
Only transverse axis - flexion or extension
What type of movement does a pivot joint permit?
Rotation in longitudinal axis
What type of movement does a condyloid joint permit?
Movement in 2 axes (oval articular surfaces, long and short diameters)
Which type of joint is also called “egg in spoon” joints and why?
Condyloid
-Articular surfaces are oval
What type of movement does saddle joint allow?
Movement in 2 axes (articular surfaces are saddle shaped)
What types of joints allow biaxial movement?
Condyloid and saddle joints (synovial)
What are polyaxial joints?
Motion is possible in many axes
- Ball and socket
- Plane
What type of movement does a plane joint allow?
Polyaxial
Stability of a joint depends on what?
- Shape of articular surfaces
- Ligaments
- Associated muscles
Define valgus deformity
Distal portion of the bone is displaced away from midline
knock knees
Define varus deformity
Distal portion of bone is displaced toward midline (bow leg)
What is the largest tarsal bone?
Calcaneus
Define migratory polyarthritis
One joint is affected, disease subsides, then another joint becomes involved
Proximal muscle weakness is usually a ____ while distal weakness is usually a ____
Proximal - myopathy
Distal - neuropathy
Define crepitus
Palpable crunching sensation
What is impingement syndrome also known as?
Rotator cuff tendinitis
What is adhesive capsulitis?
Frozen shoulder
What is de Quervain’s disease?
Tenosynovitis of thumb abductors and extensors
What is the Trendelenburg test used to detect?
Disorder between pelvis and femur
What is a positive Trendelenburg test?
Standing on bad leg, pelvis on opposite side falls
What is hemarthrosis?
Swelling of knee indicating synovial effusion or bleeding into the joint
What is a cavus foot?
Abnormally high arch
What is the Thompson-Doherty squeeze test?
- Test of Achilles tendon
- Squeeze calf
- Normally, plantar flexion occurs
- Ruptured Achilles produces little or no motion of foot
Where is the MC place for Achilles tendon rupture?
1 to 2 inches proximal to its insertion on calcaneus
in poorest blood supply region “watershed area”
What is the “watershed area”?
- Region of poorest blood supply of the Achilles
- 1 to 2 inches proximal to insertion on calcaneus
What is podagra?
Acute attack of gout that manifests in first MTP joint
What are the 2 main deformities of RA?
Swan neck
Boutonniere
Describe swan neck deformity
- Occurs w/RA
- Caused by shortening of interosseous muscles
- Hyperextension of PIPs
- Flexion of DIPs
Describe boutonniere deformity
- Occurs w/RA
- Flexion of PIPs
- Hyperextension of DIPs
What is arthritis mutilans?
Most deforming type of psoriatic arthritis
What is opera glass deformity?
- Telescoping of digits
- Caused by osteolysis of phalangeal and MCP joints
MC causes of plantar fasciitis
- Overpronation
- Foot w/high arch
- Sudden increase in exercise
- Excessive weight on foot
- Improperly fitting shoes
What is Potts test?
- Heel of each hand is used to compress tibia against fibula at a point midway up the leg
- Pain in ankle is positive for sprain
What is a Maisonneuve fracture?
High fibular spiral fracture resulting from ER of ankle
What is Mulder’s sign?
Audible click w/Morton’s neuroma
Describe Hammer toes
Flexion contracture of PIPs of 1 or more lesser toes
Limitus vs. rigidus
- Limitus refers to decreased motion of a joint early on
- Rigidus refers to little joint motion (later stage)
