Joints Flashcards
Shoulder examination? (11)
Look: scars, asymmetry, muscle bulk (deltoids, supra + infraspinatus, trapezius, paraventebral)…
feel: temp, sternoclavicular joint, clavicle, acromioclavicular joint, coracoid process, head humerus, greater tuberosity, scapular spine
Move (first active then passive. During passive feel for crepitus)
- flex: raise arms forward
- extend: keep arms straight + extend behind
- abduction: lift away from sides
- adduction: arms across chest to opposite sides
- external rotation: elbows flexed, forearms out wards
- int rotation: elbows flexed, hands behind back, reach up far as possible
Special tests (rotator cuff)
- empty can test (supraspinatus): abduct arm 90° thumb point down; Dr push down against resist
- external rotation against resistance (infraspiratus)
- Hornblower’s sign test (teres minor): lift arm in 90° abduction and flex elbow 90, lift forearm against resist
Which muscles flex shoulder (4)
- Anterior deltoid
- upper part pectoralis major
- assist: coracobrachialis, serratus anterior
Which muscles extend shoulder (3)
- posterior deltoid
- latissimus dorsi
- assist: teres major
Which muscles abduct shoulder (2)
- Medial deltoid
- assist: supraspinatus
Which muscles adduct shoulder (4)
- Lower pec major
- latissimus dorsi
- assist: teres major and minor
Which muscles internally rotate shoulder (5)
- Pec major
- subscapularis
- latissimus dorsi
- teres major
- anterior deltoid
Which muscles externally rotate shoulder (4)
- Infraspinatus
- teres minor
- posterior deltoid
- lower trapezius
Elbow examination? (8)
Look: cubitus valgus/varus deformity, olecranon bursitis, ra nodules, psoriasis ..,
Feel: radial head, capitellum, radiocapitellar joint, lateral epicondyle, olecranon, medial epicondyle, biceps tendon
Move
- flexion
- extension
- pronation
- supination
Special
- Medial epicondylitis (golfer’s elbow): flex elbow 90, active wrist flex ag resistance + firm palpation medial epicondyle
- lateral epicondylitis (tennis elbow)
Which muscles flex elbow (5)
- Biceps brachii
- Brachialis
- brachioradialis
- assist: extensor carpi, pronator teres
Which muscles extend elbow (2)
- Triceps brachii
- Anconeus
Which muscles pronate elbow / wrist (3)
- pronator teres / quadratus
- assist: flexor carpi radialis / longus, brachioradialis
Which muscles supinate elbow / wrist (4)
- Supinator
- assist: biceps brachii, abductor /extensor policis longus, brachioradialis
Spine examination? (13)
Look: from front (posture head + neck), side (lordosis/kyphosis), back (scoliosis, hair tufts)
Feel: spinal processes, sacroiliac joint, paraspinal muscles
Move C spine
- Flex
- extend
- lateral flexion
- rotation
Move t spine : rotation
Move L spine
- flexion (touch toes)
- extension
- lateral flexion
Special tests
- Schober’s test (l spine Rom): identify PSIS and mark skin in midline 5 cm below, 10 cm above. Touch toes then measure difference - should be > 20 cm. (Reduced ? Ankylosing spondylitis)
- sciatic stretch test (straight leg raise): once hip flexed as far as possible, Dr dorsiflex foot. Pain post thigh/buttock/lower back = positive = sciatica
- femoral nerve stretch test: pt prone. Flex knee, extend hip up, plantarflex foot. Positive = pain thigh/ inguinal region = high lumbar radiculopathy
Hip examination? (10)
Look: gait, front (tilt, quads, foot deform), side (lordosis), back (scoliosis, gluteus)
Feel: greater trochanter, leg length (apparent = umbilicus → tip medial malleolus) (true = ASIS → tip medial malleolus )
Move
- Flex
- extend (10- 20’) - prone
- internal rotation ( hip + knee flexed at 90° then rotate foot laterally) - supine
- external rotation
- abduction (normal 45º)
- adduction (30.)
Special tests
- Thomas’ test: hand under spine, passively flex unaffected leg as far as possible. Normal = lumbar
Lordosis flattens. On other side positive = contralateral thigh raise off bed = loss hip extension = fixed flexion deformity - trendelenburg sign: hands on both iliac crests. Ask pt to stand on 1 leg for 30 sec. Normal = iliac crest on side of foot lifted rise up. Positive = pelvis drops on side with foot lifted = weak abductors on contralat side
Which muscles flex hip (5)
- Iliopsoas
- rectus femoris
- assist: pectineus , sartorius, tensor fasciae latae
Which muscles extend hip (5)
- Gluteus maximus
- biceps femoris
- semimembranosus
- semitendinosus
- assist: posterior head gluteus medius
Which muscles abduct hip (6)
- Gluteus medius
- gluteus minimus
- Assist: gluteus maximus, tensor fascia latae, piriformis, obturator internus
Which muscles adduct hip (5)
- Adductor magnus
- adductor longus
- adductor brevis
- assist: pectineus, gracilis
Which muscles internally rotate hip (4)
- Gluteus medius
- glutens minimus
- assist: tensor fascia latae, pectineus
Which muscles externally rotate hip (10)
- Pectineus
- piriformis
- Quadratus femoris
- obturator internus
- obturator externus
- gemellus
- assist: gluteus maximus /medius/ minimus, sartorius
Knee examination? (11)
Look: front (leg length discrepancy, valgus/varus), back (popliteal swelling - baker’s cyst, aneurysm )
Feel:
- knee straight: quads tendon, patella
- patellar tap for large effusion: sweep l hand down thigh to patella to empty suprapatellar pouch. Keep in position and use R hand to press down on patella with fingertips. + = patella tap ag femur
- sweep test for small effusion: swipe fluid from medial knee into suprapatellar pouch and hold. Swipe down from suprapatellar pouch on lat side with other hand. Bulge / ripple on medial side = +
- knee bent 90: patella tendon, tibial tuberosity, joint line (meniscal injury), head fibula, med + lat collateral ligaments, popliteal fossa
Move
- Flex
- extend (hyper = > 10.)
Special tests
- anterior /posterior drawer (acl/pcl)
- collateral ligament stress test: knee extended. Apply valgus force to test MCL, varus for LCL. Repeat with knee in 20° flex. Palpate ligaments while do.
- crouch compression test: joint pain when squat. Ant pain= patellofemoral path
- mcmurray test: lateral meniscus = int rot foot, varus stress, extend knee. Medial = ext rotate foot, valgus stress, extend knee. (Can also do grinding test)
- Lachman test ACL rupture: flex leg 30 and hold thigh with hand above patella. Other hand thumb on tibial tuberosity and fingers on calf. Pull tibia forward.
Which muscles flex knee (7)
- Biceps femoris
- semimembranosus
- semitendinosus
- assist: gastrocnemius, plantaris, popliteus, sartorius
Which muscles extend knee (5)
- Rectus femoris
- vastus lateralis, intermedium, medialis
- assist: tensor fascia latae
Ankle examination (7)
Look
Feel
Move
- dorsiflex
- plantarflex
- inversion
- eversion
Special tests
- Thompson (Achilles rupture): feet hang off bed prone. Squeeze calf. Normal = plantarflex.
Which muscles dorsiflex ankle (4)
- Tibialis anterior
- assist: extensor digitorum longus, peroneus tertius, extensor hallucis longus
Which muscles plantarflex ankle (7)
- soleus
- gastrocnemius
- assist: tibialis posterior, peroneus longus/brevis, flexor digitorum longus, flexor hallucis longus
Which muscles invert ankle (4)
- Tibialis posterior
- Tibialis anterior
- assist: gastrocnemius, soleus
Which muscles evert ankle (3)
Peroneus longus /brevis/ tertius
Hand + wrist exam? (10)
Look: dorsal (dupuytren contracture, ulnar deviation from ra), palmar (claw hand )
Feel: pulses, median n sensation (index), ulnar (pinkie), radial (1st dorsal webspace), squeeze joints for inflammatory arthropathy
Move
- finger extend
- finger flex (fist)
- finger abduction (ulnar nerve)
- thumb abduction against resistance (medial nerve) (thumb to palm)
- wrist extend (90.) (radial nerve)
- wrist flex (90.)
Special
- Tinel’s test: tap over carpal tunnel. Tingling in thumb + radial 2,5 fingers - median nerve compression= carpal tunnel syndrome
- Phalen’s test: hold wrist in maximum forced flexion (reverse prayer) for 60 seconds. Tingling= carpal tunnel
