H&P Midterm MSK UE Flashcards
What are the types of synovial joints?
Spheroidal (ball and socket - convex surface on concave cavity - shoulder/hip)
Hinge (flat planar - motion in one plane - elbow, IP joints )
Condylar (articulating surfaces can be convex or concave - Knee, TMJ)
What are synovial joints (structure)
joints that are freely movable
bones that are covered in cartilage and do not touch
synovial fluid lubricates the cavity
joint is surrounded by a fibrous joint capsule
What are the types of joints?
Synovial ( freely movable)
Cartilaginous (intervertebral joints, slightly movable)
Fibrous (skull sutures, immovable)
What is a bursa?
Sac filled with synovial fluid, providing smooth movement of muscles and tendons over other MSK structures.
What are the key factors in obtaining a musculoskeletal history?
Onset/Duration
Progression
Location
Associated symptoms
What is included in onset/duration
acute or chronic
activity at time of onset
trauma/mechanism of action
repetitive action
What is included in progression
rapid or insidious?
fluctuating or constant symtpoms?
What is included in location
localized or diffuse pain?
articular (joint based) or extraarticular (not joint based)?
what is an additional consideration when obtaining a MSK HX
hand dominance if applicable.
How should you document an HPI for MSK
in progression/chronological order of symptoms.
What defines acute and chronic MSK?
Acute is < 6 weeks, chronic is >12 weeks
Discriminate between the terms rapid and insidious in terms of progression of symptoms
rapid - progressed over a few hours
insidious - progressed over weeks to months
What is myalgia vs arthralgia?
Myalgia is muscle pain
Arthralgia is joint pain
What are some associated symptoms with MSK?
Stiffness
Decreased ROM
Cracking/popping (crepitus)
Locking
“Giving out”
Inflammation
What are the four parts of a MSK exam
inspection (joint symmetry, alignment, bony deformities, swelling)
palpation (tenderness, muscle atrophy, crepitus)
assessing ROM (active and passive)
Assess strength (joint function/stability)
Can you inspect a patient with clothes covering the area of concern
NO!!!!
How is muscle strength graded?
0-5.
0 is no contraction.
1 is palpable or visible contraction
2 is active movement but cant resist gravity
3 is active movement against gravity
4 is active movement against resistance
5 is normal strength.
What do I palpate for TMJ? what is the Cranial nerve associated?
TMJ
Masseters
Pterygoids
Temporal
CN 5
What is pertinent history for TMJ
unilateral chronic pain w/ chewing, clenching or teeth grinding.
associated with stress
may present as a HA
swelling, tenderness, and decreased ROM
pain and tenderness to palpation
what signs are indicative of TMJ when palpating or inspecting a patient
inspection - redness/swelling around TMJ
Palpation - tenderness with popping
Note- popping can also be present in healthy people!
What is included in the scapulohumeral group and what is this groups main job
rotator cuff muscles + deltoid. job - depress and rotate head of humerus
what is in the axioscapular group and what is its major function
pect major
trapezius
rhomboid maj and min
levator scapulae
serratus anterior
pneumonic: PT RLS (pronounced pet reels)
pulls shoulder backward
what is the axiohumeral group
pect maj
latissmus dorsi
assists in internal rotation of shoulder
hint: axiohumeral has less letters than axioscapular so you know its the group with less muscles
What does a shoulder exam check?
Muscle atrophy
Fasciculations
Height of shoulder, scapula, and clavicle bilaterally.
Symmetry
Swelling
Scars
Skin color change
Swelling of joint capsule anterior
Bony deformities
Bulge in subacromial bursa under deltoid
What do you palpate in the shoulder exam
SITS muscles for tenderness
all joints (sternoclavicular, acromioclavicular, glenohumeral)
acromion and coracoid process.
biceps tendon
subacromial and subdeltoid bursa
(SAABS)
What does the apley scratch test check?
Adduction and internal rotation (bottom scratch)
Abduction and external rotation (top scratch)
What are the nerve impingement tests for the shoulder? what are they suggestive of if they are positive?
Hawkins-kennedy (arm like a hawk will land on it)
Neer (near to the ear, arm straight up)
Attempts to impinge subacromial structures with humeral head
if they produce pain they are positive
Indicative of Rotator cuff tear
What is the empty can/jobe test?
Pouring out a can vs resistance.
Supraspinatus/infraspinatus tear/tendonitis.
What is the drop arm test?
Patient lifts arm up and drops it steadily.
+ is pain between 60-120 deg.
suggests subacromial tear or rotator cuff disorder
What is the crossover test?
Adduction of arm across chest.
+ is pain in AC joint, inflammation/arthritis
What is the sulcus sign?
Arm at rest on side, pull arm down.
+ is a depression in front of acromion this suggests inferior glenohumeral instability.
What is the apprehension test?
Externally rotate humerus, then push posteriorly
+ shoulder pops
indicative of anterior instability or laxity or recent shoulder dislocation.
What do I palpate the elbows for?
Medial/lateral epicondyles, olecranon process, grooves between epicondyles and olecrenon
What is the rule of thumb for testing MSK strength actively and passively
active before passive
passive only if active is limited
assess ROM to its fullest extent.
What is tennis elbow and golfer’s elbow?
Tennis elbow is lateral epicondylitis, + when pain is from extending wrist (Think tEnnis and Extend)
Golfer’s elbow is medial epicondylitis, + when pain is from flexing wrist (think golFer and Flex)
what are heberdens nodes vs Bouchards nodes
heberdens = swelling at the DIP joint of fingers
Bouchards = swelling at PIP joint of fingers
What do I palpate the wrist and hand for?
Distal radius/ulna
Carpals
Metacarpals
Anatomic snuffbox
Phalanges
Thenar/hypothenar eminences
Do thumb range of motion rn inlcuding flexion, extension, abduction, adduction and opposition
okayyyyy finnneeee
What is finkelstein’s test?
Thumb inside of fist pointing forward, then ulnar deviate.
+ is pain, indicates de quervain’s tenosynovitis.
What is phalen’s test?
reverse Prayer sign
+ is pain, indicative of carpal tunnel syndrome.
What is tinel’s test?
Percussing carpal tunnel on wrist
+ is pain, indicative of carpal tunnel syndrome
