Lecture 7: Approach to Joint Exam Flashcards
What is a:
- Dislocation
- Subluxation
- Valgus Deformity
- Varus Deformity
- complete lack of contact btwn 2 articular surfaces
- Residual contact btwn 2 articular surfaces
- distal part of limb AWAY from midline (knock knees)
- distal part of limb TOWARD midline (bow legs)
Myalgia vs Arthralgia
muscle pain vs joint pain
Tendonitis, Bursitis, Tenosynovitis
T: tendon inflammation
B: bursa inflammation
Teno: tendon sheath inflammation
Sprain vs Strain
Sprain = ligament injury
Strain = muscular injury
Effusion
fluid in the joint
What is proper procedural steps to a joint exam?
- Inspection –> look at it
- Palpation –> touch it
- Range of Motion –> active vs passive (MOST sensitive indicator of joint disease)
- Specialty Testing
- ALWAYS COMPARE TO OPPOSITE EXTREMITY
Scale for Grading Muscle Strength
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)
Colle’s Fracture (cause and treatment)
- usually results from FOOSH (Fall on outstretched hand)
- distal radius fracture (dinner fork deformity)
treat: reduction, sling, rest, ortho follow up
Septic Arthritis
- 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
Acute Arterial Occlusion
- Unstable: vascular emergency
- plan: IV anticoagulation, vascular surgeon or interventionalist –> IMMEDIATELY TO OR
- blood not getting to extremities
Deep Tendon Reflex Scale (0-4)
0 - no response 1 - low normal, somewhat diminished 2 - average, normal 3 - brisker than average (not necessarily diseased) 4 - hyperactive, with clonus
Biceps, Brachioradialis, and Triceps Nerve Roots
Biceps - C5
Brachioradialis - C6
Triceps - C7
7 Major Dermatome Landmarks
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
Capillary Refill (what it tests and normal time)
- tests digit perfusion
- note time to regain color (< 2 sec = normal)
Pulses Scale (0-4)
0 - absent, not palpable 1 - diminished, barely palpable 2 - average, normal 3 - strong, full, increased 4 - bounding
Examination of Edema (where its performed and scale)
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
Apprehension Test (indicates what and positive test)
positive test = patient apprehensive of repeat dislocation
indicates: glenohumeral instability
Empty Can Test (indicates what and positive test)
positive test = pain/weakness
indicates: rotator cuff pathology (supraspinatus)
Drop-Arm Test (indicates what and positive test)
positive test = arm will drop/gentle tap will cause arm to drop
indicates: full thickness tear of supraspinatus
Painful Arc Test (indicates what and positive test)
positive test = pain with 60-120 degrees of shoulder aBduction
indicates: subacromial inpingement/rotator cuff injury
Neer Impingement (indicates what and positive test)
positive test = pain
indicates: subacromial bursa or rotator cuff impingement
Hawkins Test (indicates what and positive test)
positive test = pain
indicates: subacromial bursa or rotator cuff impingement
Cross Arm Test (indicates what and positive test)
positive test = pain in AC joint w/end range adduction
indicates: AC joint pathology
