Lecture 7: Approach to Joint Exam

Question 1

What is a:

1. Dislocation
2. Subluxation
3. Valgus Deformity
4. Varus Deformity

Answer 1

1. complete lack of contact btwn 2 articular surfaces
2. Residual contact btwn 2 articular surfaces
3. distal part of limb AWAY from midline (knock knees)
4. distal part of limb TOWARD midline (bow legs)

Question 2

Myalgia vs Arthralgia

Answer 2

muscle pain vs joint pain

Question 3

Tendonitis, Bursitis, Tenosynovitis

Answer 3

T: tendon inflammation

B: bursa inflammation

Teno: tendon sheath inflammation

Question 4

Sprain vs Strain

Answer 4

Sprain = ligament injury

Strain = muscular injury

Question 5

Effusion

Answer 5

fluid in the joint

Question 6

What is proper procedural steps to a joint exam?

Answer 6

1. Inspection –> look at it
2. Palpation –> touch it
3. Range of Motion –> active vs passive (MOST sensitive indicator of joint disease)
4. Specialty Testing

• ALWAYS COMPARE TO OPPOSITE EXTREMITY

Question 7

Scale for Grading Muscle Strength

Answer 7

0 - no contraction detected
1 - barely detectable flicker/trace of contraction
2 - active movement w/gravity eliminated
3 - active movement against gravity
4 - active movement against gravity and some resist
5 - active movement against full resistance w/o fatigue (NORMAL)

Question 8

Colle’s Fracture (cause and treatment)

Answer 8

• usually results from FOOSH (Fall on outstretched hand)
• distal radius fracture (dinner fork deformity)
  treat: reduction, sling, rest, ortho follow up

Question 9

Septic Arthritis

Answer 9

• joint erythematous, swollen, warm, painful to touch
• signs of systemic disease: tachycardia, fever, hypotension
• elevated CBC, ESR, CRP (synovial fluid will show WBC’s and bacteria); ASPIRATION OF SYNOVIAL FLUID
• treat: antibiotics, surgical washout of joint

Question 10

Acute Arterial Occlusion

Answer 10

• Unstable: vascular emergency
• plan: IV anticoagulation, vascular surgeon or interventionalist –> IMMEDIATELY TO OR
• blood not getting to extremities

Question 11

Deep Tendon Reflex Scale (0-4)

Answer 11

0 - no response
1 - low normal, somewhat diminished
2 - average, normal
3 - brisker than average (not necessarily diseased)
4 - hyperactive, with clonus

Question 12

Biceps, Brachioradialis, and Triceps Nerve Roots

Answer 12

Biceps - C5
Brachioradialis - C6
Triceps - C7

Question 13

7 Major Dermatome Landmarks

Answer 13

C4 - top of shoulder
C6 - radial aspect of arm
C8 - 5th digit
T4 - nipple line
T10 - umbilicus
L5 - greater toe
S1 - posterolateral calf/small toe

Question 14

Capillary Refill (what it tests and normal time)

Answer 14

• tests digit perfusion

- note time to regain color (< 2 sec = normal)

Question 15

Pulses Scale (0-4)

Answer 15

0 - absent, not palpable
1 - diminished, barely palpable
2 - average, normal
3 - strong, full, increased
4 - bounding

Question 16

Examination of Edema (where its performed and scale)

Answer 16

examination at: dorsum of foot, anterior tibia, behind medial malleolus (press firmly for 5 sec)

0 - absent
1 - slight pitting, rapidly disappear (2mm)
2 - slight indention (4mm) –> 10-15 sec
3 - deeper indention (6mm) –> > 1 min
4 - very marked indention (8mm) –> 2-5 min

Question 17

Apprehension Test (indicates what and positive test)

Answer 17

positive test = patient apprehensive of repeat dislocation

indicates: glenohumeral instability

Question 18

Empty Can Test (indicates what and positive test)

Answer 18

positive test = pain/weakness

indicates: rotator cuff pathology (supraspinatus)

Question 19

Drop-Arm Test (indicates what and positive test)

Answer 19

positive test = arm will drop/gentle tap will cause arm to drop

indicates: full thickness tear of supraspinatus

Question 20

Painful Arc Test (indicates what and positive test)

Answer 20

positive test = pain with 60-120 degrees of shoulder aBduction

indicates: subacromial inpingement/rotator cuff injury

Question 21

Neer Impingement (indicates what and positive test)

Answer 21

positive test = pain

indicates: subacromial bursa or rotator cuff impingement

Question 22

Hawkins Test (indicates what and positive test)

Answer 22

positive test = pain

indicates: subacromial bursa or rotator cuff impingement

Question 23

Cross Arm Test (indicates what and positive test)

Answer 23

positive test = pain in AC joint w/end range adduction

indicates: AC joint pathology