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Family Medicine > Joints > Flashcards

Joints Flashcards

1
Q

Shoulder examination? (11)

A

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
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2
Q

Which muscles flex shoulder (4)

A
  • Anterior deltoid
  • upper part pectoralis major
  • assist: coracobrachialis, serratus anterior
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3
Q

Which muscles extend shoulder (3)

A
  • posterior deltoid
  • latissimus dorsi
  • assist: teres major
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4
Q

Which muscles abduct shoulder (2)

A
  • Medial deltoid
  • assist: supraspinatus
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5
Q

Which muscles adduct shoulder (4)

A
  • Lower pec major
  • latissimus dorsi
  • assist: teres major and minor
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6
Q

Which muscles internally rotate shoulder (5)

A
  • Pec major
  • subscapularis
  • latissimus dorsi
  • teres major
  • anterior deltoid
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7
Q

Which muscles externally rotate shoulder (4)

A
  • Infraspinatus
  • teres minor
  • posterior deltoid
  • lower trapezius
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8
Q

Elbow examination? (8)

A

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)
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9
Q

Which muscles flex elbow (5)

A
  • Biceps brachii
  • Brachialis
  • brachioradialis
  • assist: extensor carpi, pronator teres
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10
Q

Which muscles extend elbow (2)

A
  • Triceps brachii
  • Anconeus
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11
Q

Which muscles pronate elbow / wrist (3)

A
  • pronator teres / quadratus
  • assist: flexor carpi radialis / longus, brachioradialis
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12
Q

Which muscles supinate elbow / wrist (4)

A
  • Supinator
  • assist: biceps brachii, abductor /extensor policis longus, brachioradialis
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13
Q

Spine examination? (13)

A

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
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14
Q

Hip examination? (10)

A

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
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15
Q

Which muscles flex hip (5)

A
  • Iliopsoas
  • rectus femoris
  • assist: pectineus , sartorius, tensor fasciae latae
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16
Q

Which muscles extend hip (5)

A
  • Gluteus maximus
  • biceps femoris
  • semimembranosus
  • semitendinosus
  • assist: posterior head gluteus medius
17
Q

Which muscles abduct hip (6)

A
  • Gluteus medius
  • gluteus minimus
  • Assist: gluteus maximus, tensor fascia latae, piriformis, obturator internus
18
Q

Which muscles adduct hip (5)

A
  • Adductor magnus
  • adductor longus
  • adductor brevis
  • assist: pectineus, gracilis
19
Q

Which muscles internally rotate hip (4)

A
  • Gluteus medius
  • glutens minimus
  • assist: tensor fascia latae, pectineus
20
Q

Which muscles externally rotate hip (10)

A
  • Pectineus
  • piriformis
  • Quadratus femoris
  • obturator internus
  • obturator externus
  • gemellus
  • assist: gluteus maximus /medius/ minimus, sartorius
21
Q

Knee examination? (11)

A

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.
22
Q

Which muscles flex knee (7)

A
  • Biceps femoris
  • semimembranosus
  • semitendinosus
  • assist: gastrocnemius, plantaris, popliteus, sartorius
23
Q

Which muscles extend knee (5)

A
  • Rectus femoris
  • vastus lateralis, intermedium, medialis
  • assist: tensor fascia latae
24
Q

Ankle examination (7)

A

Look
Feel

Move

  • dorsiflex
  • plantarflex
  • inversion
  • eversion

Special tests

  • Thompson (Achilles rupture): feet hang off bed prone. Squeeze calf. Normal = plantarflex.
25
Q

Which muscles dorsiflex ankle (4)

A
  • Tibialis anterior
  • assist: extensor digitorum longus, peroneus tertius, extensor hallucis longus
26
Q

Which muscles plantarflex ankle (7)

A
  • soleus
  • gastrocnemius
  • assist: tibialis posterior, peroneus longus/brevis, flexor digitorum longus, flexor hallucis longus
27
Q

Which muscles invert ankle (4)

A
  • Tibialis posterior
  • Tibialis anterior
  • assist: gastrocnemius, soleus
28
Q

Which muscles evert ankle (3)

A

Peroneus longus /brevis/ tertius

29
Q

Hand + wrist exam? (10)

A

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

Family Medicine (20 decks)

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