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Clinical Medicine > Exam #5: Musculoskeletal Exam > Flashcards

Exam #5: Musculoskeletal Exam Flashcards

1
Q

What is the purpose of the MSK focused history?

A

Narrowing of the physical exam

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2
Q

What questions should you ask the patient in regards to the MSK?

A
  • Joint & neurological related

- Function/ ADL

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3
Q

What is the order for the MSK examination?

A

1) Inspection
2) ROM
3) Muscle strength eval
4) Reflexes & neuro
5) Special tests
6) Palpation

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4
Q

What is the preliminary step to the MSK exam?

A

Neurological screening exam

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5
Q

What are joint locking or crepitus associated with?

A

Meniscal injury

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6
Q

What is giving-way associated with?

A

Ligamentous or meniscal injury

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7
Q

What is weakness associated with?

A

Neurological
Mylopathy
Tendiopathy
Muscle injury

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8
Q

What is clicking, popping, or tearing associated with?

A

Soft tissue injury

Tear

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9
Q

What are tremors, spasms, and weakness associated with?

A

Neurologic or muscle injury

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10
Q

What is one of the most important things to know in regards to patient’s with MSK complaints?

A

How their ADLs are being affected, and how they’re changing

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11
Q

What are the major red flags that should be asked about in regards to MSK complaints?

A 
Paresthesias 
Weakness 
Painless weakness 
Incontinence 
Retention 
Weight loss 
Night time pain
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12
Q

What is tendonitis?

A

Acute inflammation of a tendon

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13
Q

What is tendinosis?

A

Chronic degeneration of a tendon

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14
Q

What is tenosynovitis?

A

Inflammation of a sheath of a tendon (i.e. DeQuervain’s)

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15
Q

What is tendinopathy?

A

Disease of the tendon–a general term when precise etiology is not know

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16
Q

What is a tremor?

A

Involuntary rhythmic muscle movement

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17
Q

What is spasticity?

A

Velocity dependent resistance to muscle stretch

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18
Q

What is a strain?

A

Trauma to a muscle

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19
Q

What is Arthritis?

A

Joint inflammation

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20
Q

What does Arthrosis mean?

A

Joint degeneration

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21
Q

What does Arthraliga mean?

A

Joint pain

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22
Q

What does Arthropathy mean?

A

Disease of a joint

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23
Q

What is Bursitis?

A

Inflammation of the bursa

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24
Q

What is the difference between smooth weakness & breakaway?

A

Breakaway= painful/ MSK weakness

Smooth= neurologic

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25
Q

What is a positive babinksi sign? What is this is sign indicative of?

A

UMN injury in LE

Upward toes

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26
Q

What is Hoffman’s sign indicative of?

A

UMN injury in UE

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27
Q

Outline the 0-5 grading scale of muscle strength.

A 
0= no movement 
1= trace
2= gravity eliminated 
3= full ROM against gravity but thats it 
4= Full ROM against grav. but weak with DO applied 
5= Full
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28
Q

How are ligaments generally evaluated?

A

Elongated by pushing or pulling bone away

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29
Q

How are joint surfaces evaluated?

A

Rub them together

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30
Q

How is cartilage evaluated?

A

Squeeze them between bones

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31
Q

In a positive trendelenburg sign, which side is the weakness on?

A

Side of the leg that is planted

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32
Q

What does Genu valgum mean?

A

knocked knee

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33
Q

What does Genu varus mean?

A

bow legged

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34
Q

What does Genu recurvatum?

A

back knee

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35
Q

What are Heberden & Bouchard nodes indicative of? Where are they?

A 
H= DIP
B= PIP
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36
Q

What are the common deformities associated with RA?

A

Swan neck deformity
Ulnar deviation
Boutonniere deformity
MCP swelling

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37
Q

What is the classic appearance of ankylosing spondyltis? What is the classic posture?

A
  • Bamboo spine

- Head forward

38
Q

What is Spurling’s test for? How is this test performed?

A

Patient is seated:
1) Extension of c-spine
2) Rotation of head/ neck
+/- sidebending

*Indicates nerve root compression or CERVICAL RADICULOPATHY

39
Q

What is a Bragard’s test/ Lasegue’s Sign?

A

Straight Leg Raise= lumbar radiculopathy (L4, L5, S1)

*Confirmation with dorsiflexion SLR= Bragard test/ Lasegue’s Sign

40
Q

What is the Apley “Scratch Test” for?

A

Shoulder ROM

41
Q

What are the tests for shoulder impingement?

A

Neer’s Sign

Hawkin’ Sign

42
Q

What tests are used for the Rotator Cuff?

A

Arm Drop
Empty Can
Lift off Test

43
Q

What tests are used for the biceps tendon?

A

Speeds Test

Yergason’s Test

44
Q

What test is used for shoulder instability?

A

Apprehension

45
Q

What is Neer’s test? How is this test preformed and what is a positive test?

A

1) Fully internally rotate the shoulder w/ arm extended (thumb down)
2) Bring arm up overhead

*Pain with this test is a sign of IMPINGEMENT

46
Q

What is the Hawkins test? How is this test preformed and what is a positive test?

A

1) ABduct arm to 90 degrees
2) Flex arm
3) Internally rotate

*Pain is a sign of IMPINGEMENT

47
Q

What is the Arm Drop Test? How is this test preformed and what is a positive test?

A

1) Lift arm up for patient overhead
2) Ask to lower slowly

*Sudden drop-off of arm is a sign of a ROTATOR CUFF TEAR

48
Q

What is the Empty Can Test? How is this test preformed and what is a positive test?

A

1) Arm straight & aBducted at 90 degrees
2) thumb down as if “emptying a can”

*Positive test (pain) indicates damage to the SUPRASPINATUS or more generally, the rotator cuff

49
Q

What is the Lift off test? How is this test preformed and what is a positive test?

A

1) Put dorsum of hand behind back
2) Stabilize elbow
3) Ask patient to push into your hand

*Pain is an indication of SUBSCAPULARIS injury or rotator cuff injury more generally

50
Q

What is Speeds Test? How is this test preformed and what is a positive test?

A

1) Arm is raised in front & supinated
2) Push the arm down & see if there is pain

*Positive test is pain in biceps region or tendon subluxation felt on exam, which indicate BICEPS TENDIOPATHY OR SUBLUXATION OF BICEPS TENDON

51
Q

What is the Yergason Test? How is this test preformed and what is a positive test?

A

1) Place thumb in interteburucular groove
2) Flex biceps
3) Ask patient to supinate forearm against resistance

*Positive test is pain in biceps region or tendon subluxation felt on exam, which indicate BICEPS TENDIOPATHY OR SUBLUXATION OF BICEPS TENDON

52
Q

What is the Apprehension test? How is this test preformed and what is a positive test?

A

1) ABduct arm & felx to 90 degrees
2) Stabilize shoulder
3) Pull up & back, looking for signs of apprehension

*Positive test is if there is obvious “apprehension” or guarding

53
Q

What is lateral epicondylitis?

A

Tennis elbow

  • Caused by overuse of wrist extensors and the supinator muscle
54
Q

What is medial epicondylitis?

A

Golfer’s elbow

55
Q

What is the carrying angle? In which sex is this normally larger?

A

Valgus angle between the upper arm and forearm with the elbow extended

  • Females

> 20 degrees is abnormal

56
Q

What is the Varus Test? How is this test preformed and what is a positive test?

A

1) Stabilize arm (flexed to 20 degrees)
2) Push forearm IN to body

*Positive test indicates damage to RADIAL COLLATERAL LIGAMENT

57
Q

What is the Valgus Test? How is this test preformed and what is a positive test?

A

1) Stabilize arm (flexed to 20 degrees)
2) Push forearm AWAY from body

*Positive test indicates damage to ULNAR COLLATERAL LIGAMENT

58
Q

What is Tinel Sign’s (Cubital Tunnel)? How is this test preformed and what is a positive test?

A

1) Find medial epicondyle & olecranon
2) Tap on area

*Positive test indicates CUBITAL TUNNEL SYNDROME or ULNAR NEUROPATHY

59
Q

What is Cozen Test? How is this test preformed and what is a positive test?

A

1) Ask the patient to make a fist (palm down)
2) Grasp lateral epicondyle w/ one hand
3) With other hand ask patient to extend wrist against your resistance

*Positive test is indicative of LATERAL EPICONDYLITIS

60
Q

What is Maudsley’s? How is this test preformed and what is a positive test?

A

This is also known as the “3rd finger Test”

1) Extend arm palm down
2) Ask patient to resist depression of 3rd PIP on extension

*Positive if pain is reproduced over LATERAL EPICONDYLE

61
Q

What is Phalen’s Test? How is this test preformed and what is a positive test?

A

1) Extend the arm
2) Flex the wrist & apply pressure

*Reproduction of symptoms IN LESS THAN 30 SEC= CARPAL TUNNEL SYNDROME

62
Q

What is Tinel’s Sign (Carpal Tunnel)? How is this test preformed and what is a positive test?

A

Tapping over the carpal tunnel

*Reproduction of symptoms= CARPAL TUNNEL SYNDROME

63
Q

What is Finkelstein’s Test? How is this test preformed and what is a positive test?

A

1) Wrap fingers of the thumb
2) Ulnar deviation

*Positive test is reproduction of pain over radial wrist indicative of “DE QUERVAIN’S TENOSYNOVITIS”

64
Q

What is Snuff Box Tenderness? How is this test preformed and what is a positive test?

A

1) Extend thumb
2) Ulnar deviate
3) Push on snuff box

*Need to R/O SCAPHOID FRACTURE if positive (with imaging)

65
Q

What is Dupuytren’s Contracture?

A

Flexion/ contracture of digits 4 & 5

66
Q

What is Trigger Finger?

A

Difficulty flexing until sudden snap on finger with full flexion & inability to extend

67
Q

What is Mallet finger?

A

Trauma causes avulsion of extensor at DIP joint

68
Q

What is APB weakness? How is this test preformed and what is a positive test?

A

This is a test for strength of the abductor pollicus brevis

  • Weak in carpal tunnel syndrome
  • Test abduction of pinkey

**If both are positive, likely more proximal (C8/T1) root level injury

69
Q

What is Patrick’s FABER test? How is this test preformed and what is a positive test?

A

1) Flex hip
2) Flex knee
3) External rotation

**SI vs. Hip

70
Q

What is Thomas’ Sign? How is this test preformed and what is a positive test?

A

1) Bring knee to chest (left)
2) Right knee follows

*Indicates Hip flexor tightness or contracture

71
Q

What is Trendelenburg Sign? How is this test preformed and what is a positive test?

A

Weak or non-functioning gluteus medius (Superior Oblique)

72
Q

What is Ober Test? How is this test preformed and what is a positive test?

A

1) Lay patient on side, hips “stacked”
2) Extend superior hip
3) Drop leg

*If the leg does not go down, test is positive & indicates a tight IT band–note that patients often complain of LATERAL KNEE PAIN in IT BAND SYNDROME

73
Q

What is Ballottement Test? How is this test preformed and what is a positive test?

A

1) Compress from thigh down to knee
2) Alt. hand push down on patella

*Positive test is indicative of JOINT EFFUSION–feel like patella is just floating

74
Q

What is the Anterior Drawer Test? How is this test preformed and what is a positive test?

A

*ACL

75
Q

What is the Posterior Drawer test? How is this test preformed and what is a positive test?

A

*PCL

76
Q

What is the McMurray Test? How is this test preformed and what is a positive test?

A

Meniscal test

77
Q

What is Apley’s Compresison Test? How is this test preformed and what is a positive test?

A

1) Patient is prone
2) Compress toward table
3) Turn foot inward

*Positive test indicates MENISCUS INJURY

78
Q

What is Valgus Stress Test? How is this test preformed and what is a positive test?

A

ABduct the distal leg

*MCL

79
Q

What is Varus Stress Test? How is this test preformed and what is a positive test?

A

ADduct the distal leg

*LCL injury

80
Q

What is Apley’s Distraction Test? How is this test preformed and what is a positive test?

A

1) Patient is prone
2) Pull leg from table while stabilizing hip
3) Turn foot inward

*Positive test indicates MENISCUS INJURY

81
Q

What is Ankle Anterior Drawer Test? How is this test preformed and what is a positive test?

A

1) Cup heel
2) Push posterior on tibia

*ATF Ligment Injury

82
Q

What is the Talar Tilt? How is this test preformed and what is a positive test?

A

1) Cup heel
2) INvert heel

*ATF, CF Ligament Injury

83
Q

What is Squeeze Test? How is this test preformed and what is a positive test?

A

Squeeze tib & fib together

*Indicates high ankle sprain

84
Q

What is the External Rotation Test? How is this test preformed and what is a positive test?

A

1) Dorsiflex the foot
2) Externally rotate foot

*Interosseous membrane injury

85
Q

What are the spinal levels associated with the major movements of the upper extremity?

A 
C5= elbow flexion & shoulder aBduction
C6= wrist extension
C7= elbow extension
C8= long finger flexors 
T1= small finger abduction/ adduction
86
Q

What are the spinal levels associated with the major movements of the lower extremity?

A 
L2= hip flexion
L3= knee extension
L4= ankle dorsiflexion
L5= long toe extension (EHL) 
S1= ankle plantar flexion
87
Q

What spinal levels are associated with the major reflexes typically evaluated?

A

Biceps brachii= C5
Brachioradialis= C6
Triceps= C7

Patellar= L4
Medial Hamstring= L5
Achilles= S1

88
Q

What is the specific name for the standing flexion/ scoliosis screen?

A

Adam’s Forward Bend

89
Q

What is the femoral nerve stretch test? How is this test performed?

A

Patient is prone; passively flex the knee & hip

*Positive test has radicular pain to anterior thigh–indicates high lumbar disc hernation (L2, L3, L4)

90
Q

What is the CMC grind test?

A

Thumb Grind Test
- Push/ twist MCP against trapzeium

*Pain & grinding are indicative of OSTEOARTHRITIS

Clinical Medicine (27 decks)

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