Lecture 7: Approach to Joint Exam

Question 1

What is dislocation?

Answer 1

Complete lack of contact between 2 articular surfaces

Question 2

What is subluxation?

Answer 2

Residual contact between 2 articular surfaces

Question 3

What is valgus deformity?

Answer 3

Distal part of limb directed away from midline

“Knock Knees”

Question 4

What is varus deformity?

Answer 4

Distal part of limb directed toward midline

Bowlegs

Question 5

What is the most sensitive indicator of joint disease?

Answer 5

Check active vs passive ROM

Question 6

Where should you always check pulses in joint exams?

Answer 6

Check pulses distal to injury

Question 7

What does 0/5 in muscle strength mean?

Answer 7

No muscular contraction detected

Question 8

What does 1/5 muscular strength mean?

Answer 8

Barely detectable flicker or trace of contraction

Question 9

What does 2/5 muscular strength mean?

Answer 9

Active movement of body with gravity eliminated

Question 10

What does 3/5 muscular strength mean?

Answer 10

Active momvement against gravity

Question 11

What does 4/5 muscular strength mean?

Answer 11

Active movement against gravity and some resistance

Question 12

What does 5/5 muscular strength mean?

Answer 12

Active movement against full resistance without evident fatigue

-Normal muscle strength

Question 13

What are top causes of life threatening joint pain?

Answer 13

1. Septic Arthritis
2. Referred Pain from acute MI, hemorrhage, lung pathology

Question 14

What is Colle’s Fracture?

Answer 14

Distal radius fracture

Usually results from FOOSH (Fall On OutStretched Hand)

-looks like a dinenr fork

Question 15

What is septic arthritis?

• what causes it
• what joint is it at
• give me sx
• is rom active or limited
• what lab stuff can u dx with
• how else can you dx it?

Answer 15

• Painful infection of joint
• due to IV drug abuse
• knee is involved 50% if the time
• joint is read, warm, swollen
• rom limited
• elevated CBC, ESR, CRP
• athrocentesis: synovial fluid from joint aspriation: will show wbc and bacteria

Question 16

Intratricular structures vs extra atricular structures?

Answer 16

Within the joint capsule vs outside the joint capsule

Question 17

mono articular

Answer 17

one joint

Question 18

poly artticular

Answer 18

multiple joints

Question 19

migratory

Answer 19

moves from one joint to anohter

Question 20

extra atricular

Answer 20

bones, muscle tendons, bursa, skin

Question 21

myalgia

Answer 21

muscle pain

Question 22

arthralgia

Answer 22

joint pain

Question 23

tendonitis

Answer 23

inflamation of the tendon

Question 24

bursisits

Answer 24

inflamation of the bursa

Question 25

tenosynovitis

Answer 25

inlamation of the tendon sheath

Question 26

sprain vs strain

Answer 26

-ligament injury vs muscular injury

Question 27

effusion

Answer 27

fluid in the joint

Question 28

If pt is on IV drugs what should you think about?

Answer 28

-is joint hot and swollen and no Hx of trauma? Then it might be a risk factor for septic arthritis.

Question 29

In a joint exam what should you always do?

Answer 29

Compare to the oppisite extemitiy.

Question 30

For any exam what should you do?

Answer 30

Inspection palpation ROM Speciality testing

Question 31

Inspection

Answer 31

what do you see? are they splinting their hand, is it symetric, erythematoous, scars, abrasion, injiries, swelling, echymosis, effusion

Question 32

palpation

Answer 32

temp diffrenes, effusion, tenderness, edema, crepitius

Question 33

ROM

Answer 33

ACTIVE VS PASSIVE -most senitive indictior of joint dz

Question 34

Always assess and doctument what?

Answer 34

motor and sensory function DISTAL TO SOFT TISSUE INJURY AND FX

Question 35

After you pop a shoulder back in feel what?

Answer 35

the distal part of the arm, as the axillary nerve runs through there and doctument that they can feel that area.

Question 36

vascular tests

Answer 36

- check peripheral exremity pulses - record 0/4 to 4/4 - compare to opp extremity: strengh of pulse, cap refill, color

Question 37

If you note a fever what should you think

Answer 37

INFECTION, NOT DUE TO TRAUMA

Question 38

edema ranges

Answer 38

0- absent 1- barley detectale, slight pitting 2mm (disapears rapidly) 2+ - slight indentaiton (4mm) 10-15 sec 3+ deeper indentation (6mm) \>1 min 4+ very marked indentation (8mm) 2-5 mins

Question 39

What class of meds are imporant during the joint exam?

Answer 39

blood thinners

Question 40

How do you dx septic arthitis? What are signs for septic artiitis?

Answer 40

- xray, elevated cbc, esr, crp, and asperation of synovial fluid (yellow) - sings are erythema, sollwen, tehnder, fever, chills

Question 41

How is an acute arterial occlusion diagnosed? what would be the treatment plan?

Answer 41

- Ultra sound or arteriogram - IV anticoagulation, vascular srugeron, Interventionalist, or OR