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(PA school) HAPE > Lecture 7.1 (MSK) > Flashcards

Lecture 7.1 (MSK) Flashcards

1
Q

List 4 red flag symptoms of joint pain

A

1) Acute onset
2) Redness
3) Pain
4) Fever

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2
Q

List 2 causes of joint pain

A

1) Septic arthritis (infection)
2) Crystalline arthropathy (ex: gout, pseudogout)

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3
Q

1) What age range is a red flag w low back pain?
2) What histories are red flags w low back pain?
3) What symptoms are red flags?
4) When is pain a red flag?

A

1) Age < 20 (also be very suspicious of ongoing joint/bone pain in any pediatric patient)
2) Cancer or HIV, immunosuppression
3) Unexplained weight loss, fever, general decline
4) > 1 month – refractory to treatment

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4
Q

1) What is a risk of IV drug use with low back pain?
2) What other drugs are red flags with low back pain?

A

1) IV drug use (risk: spinal abscess)
2) Immunosuppression, and long-term steroid therapy

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5
Q

1) What symptoms of cauda equina syndrome should you look out for with low back pain?
2) What neurologic symptoms are red flags w low back pain?

A

1) Saddle anesthesia, bladder or bowel incontinence/loss of function
2) Severe neurologic symptoms or progressive deficit

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6
Q

What symptoms should you always ask abt with low back pain?

A

Saddle anesthesia, bladder or bowel incontinence/loss of function

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7
Q

Weight-bearing physical activity, especially in females, starting early is important why?

A

Build up mass to protect against bone/muscle loss

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8
Q

Discuss ___________ scan in your elderly patients to measure bone density, especially in female population.

A

DEXA

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9
Q

1) Hip fracture is correlated with mortality within ____________ in geriatric population
2) What should you ask fall risk patients to do?

A

1) 5 years
2) Get the rugs out of the house and put a bell on the little dog or cat

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10
Q

1) Define synovial fluid
2) Define cartilage
3) Define disc

A

1) Provides lubrication for the joint
2) Strong connective tissue that reduces friction (prevents bones rubbing together)
3) Shock absorber (ex: spine)

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11
Q

Define:
1) Ligament
2) Tendon
3) Fascia

A

1) Fibrous tissue that attaches bone-to-bone
2) Fibrous tissue that attaches bone-to-muscle
3) Connective tissue that surrounds and holds things in place

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12
Q

1) Define bursa
2) Define epiphysis

A

1) Small fluid-filled sacs in joints to reduce friction
2) Rounded end of a long bone, connects adjacent bones to form joints

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13
Q

List the 3 types of joints

A

1) Fibrous
2) Synovial
3) Cartilaginous

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14
Q

You should inspect and palpate joints for what?

A

Swelling, Crepitus, Alignment, Bony deformity, and Symmetry
(SCABS)

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15
Q

You should assess joints for the 4 signs of inflammation; what are they?

A

Red, hot, painful, and swollen

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16
Q

You should use inspection and palpation to assess surrounding tissues of a joint and note any of what 3 things?
List what each thing is a sign of

A

1) Skin changes: signs of inflammation or infection
2) Atrophy of muscles: seen in chronic illness
3) Systemic illness: be it septic or autoimmune patient
(SAS)

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17
Q

Should you test active ROM first or passive ROM?

A

Active ROM

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18
Q

1) When you’re testing ROM what should you demonstrate?
2) When is decreased ROM present?
3) Should you assess a joint’s strength?

A

1) Any limitations or joint instability / laxity
2) In inflammation, fibrosis, bony fixation (ankylosis)
3) Yes

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19
Q

1) What should you palpate specific joint anatomy for?
2) What should you do after this?
3) What other joints should you palpate?

A

1) Bony deformity, tenderness
2) Perform any special maneuvers
3) Joint ABOVE and Joint BELOW

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20
Q

1) Where is rheumatoid arthritis often located?
2) What about osteoarthritis?
3) What do they have in common?

A

1) Hands; initially small joints (PIP and MCP joints).
2) Knees, hips, hands (distal, sometimes PIP joints).
3) Both chronic and progressive

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21
Q

Recap:
1) What should you inspect for (3 things)?
2) What should you palpate for?
3) What should you do last?

A

1) SCABS, inflammation, SAS
2) Specific anatomy, check ROM / strength
3) Special maneuvers

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22
Q

What specific anatomy of the shoulder should you palpate? (4 things)

A

1) Palpate from sternoclavicular joint, tracing laterally to the AC joint
2) Palpate acromion
3) Palpate greater tubercle
4) Palpate coracoid process

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23
Q

What are the 3 bony landmarks of the shoulder?

A

1) Acromion
2) Coracoid process
3) Greater tubercle

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24
Q

What motions should you check for the shoulder? (3 pairs)

A

1) Flexion / extension
2) Abduction / adduction
3) Internal /external rotation

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25
Q

What are the 5 special tests for the shoulder? What does each test?

A

1) Neer impingement sign: rotator cuff tendons
2) Hawkins impingement sign: rotator cuff tendons
3) Empty can test: strength testing /rotator cuff tear
4) Drop arm test: strength testing / rotator cuff tear
5) Internal and external rotation: also tests rotator cuff tear

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26
Q

1) How do you perform the Neer test for shoulder impingement?
2) What is a positive test?

A

1) Stabilize scapula, internally rotate arm, passively flex the shoulder
2) Positive test = pain (bc it pinches RC tendons between greater tuberosity and acromion)

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27
Q

1) How do you perform the Hawkins(-Kennedy) test for shoulder impingement?
2) What is positive?

A

1) Flex shoulder to 90 degrees, passive internal rotation of the shoulder
2) Positive = pain

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28
Q

1) How do you perform the empty can test (Jobe’s test) for supraspinatus tendinopathy (rotator cuff)? Why?
2) What is positive?

A

1) Shoulder flexion against resistance with wrists pronated
-Isolates supraspinatus tendon
2) Positive = weakness = supraspinatus impingement/tendinopathy

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29
Q

For impingement, you positives are usually ___________

A

pain

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30
Q

1) How do you perform the drop arm test?
2) What is positive?

A

1) Abduct arm 160 (fully); patient slowly adducts arm
After 90 degrees, less deltoid compensation
2) Drop = positive = RC tear

31
Q

What should you palpate on the elbow?

A

1) Palpate the epicondyles
2) Palpate the spaces between epicondyles and olecranon process.

32
Q

What ROMs of the elbow should be tested? (2 pairs)

A

Flex /extend
Supinate / pronate

33
Q

Lateral epicondylitis is also called _________________ and medial epicondylitis is also called __________________

A

tennis elbow; golfer’s elbow

34
Q

What are the 3 main joints of the hand?

A

DIP (distal interphalangeal), PIP, MCP

35
Q

What should you palpate on the hand? (4 things)
Which is the source of scaphoid fractures?

A

1) Bones of the wrist (distal radius and ulna)
2) Carpals
3) Phalanges
4) Anatomic snuff box: source of scaphoid fractures

36
Q

What motions of the wrist should you test? (4)

A

Flexion, extension, ulnar deviation (adduction), radial deviation (abduction)

37
Q

What motions of the fingers should you test? (4)

A

Flexion, extension, abduction (fingers spread apart), adduction (fingers back together)

38
Q

What ROMs of the thumb should you test? (5)

A

Flexion, extension, abduction (thumb moves away from palm), adduction (thumb moves toward palm), opposition (thumb touches each finger)

39
Q

How should you test wrist and hand strength?

A

Test bilateral grip strength and compare them (ex: 5/5)

40
Q

1) What are the clinical features of carpal tunnel? Be specific.
2) When does carpal tunnel often occur?
3) Patients also experience loss of sensation in distribution of the ____________ nerve
4) What does this nerve innervate?

A

1) Pain or numbness on the first three fingers of the hand
2) At night
3) Patients also experience loss of sensation in
4) medial nerve
5) Palmar surface of thumb, index, middle, and medial 4th fingers

41
Q

1) What is Tinel’s sign?
2) What is Phalen’s sign?

A

1) Tingling with tapping over the median nerve as it enters the carpal tunnel
2) Numbness or tingling with pressing backs of hands together in acute flexion for 60 seconds

42
Q

1) How do you perform Tinel’s sign for CTS?
2) What is positive?

A

1) Percussion over the median nerve at the carpal tunnel
2) Positive = Pain and tingling in the nerve’s distribution

43
Q

1) How do you perform Phalen’s test for CTS
2) What is positive?

A

1) Acute wrist flexion against resistance maintained for 30-60 seconds
2) Positive = symptoms reproduced (not pain)

44
Q

1) What should you inspect on the spine from the side?
2) What about from behind?

A

1) Cervical, thoracic, and lumbar curves
2) Upright spinal column and alignment of shoulders, iliac crests, gluteal folds

45
Q

What should you palpate on the spine with the patient standing or sitting? (4 things)
What percussion should you do?

A

1) Spinous process of each vertebrae
2) Step offs
3) Tenderness
4) Paravertebral muscles for tenderness or spasm
-Fist percussion of the spine

46
Q

1) What motions should you test on the neck?
2) What about the spine?

A

1) Neck flexion and extension, rotation, lateral bending
2) Spine flexion and extension, rotation, lateral bending

47
Q

1) What does the Straight leg raise test test for?
2) When would this occur?

A

1) Radicular pain (ex: sciatica)
2) Between 30-70 degrees

48
Q

What is the special test of the spine? Is it active or passive?

A

Straight leg raise; passive

49
Q

What should you palpate on the hip? (2 things)

A

1) Paravertebral muscles for tenderness or spasm
2) Sacroiliac joint

50
Q

What should you observe about the hip?

A

The pt’s gait

51
Q

What should you observe abt a patient’s gait? (2 things)

A

1) ‘Swing’ as the foot moves forward
2) ‘Stance’ as the foot is on the ground
Do they display difficulty in either

52
Q

What are the anterior and posterior bony landmarks of the hip that you should palpate?

A

1) Anterior: Iliac crest, ASIS, greater trochanter
2) Posterior: Posterior ilium, SI joint, sacrum

53
Q

What should you inspect the anterior and posterior surfaces of the hip for?

A

Muscle atrophy or bruising

54
Q

What motions of the hips should you test? Describe them

A

1) Flexion: bend knee to chest
2) Extension: leg extends posteriorly
3) Abduction and adduction: move leg laterally and medially
4) External and internal rotation

55
Q

List 4 ligaments that are important to note on the knee

A

1) Anterior cruciate ligament (ACL)
2) Posterior cruciate ligament (PCL)
3) Lateral collateral ligament (LCL)
4) Medial collateral ligament (MCL)

56
Q

You should identify and palpate structures of anterior, medial, and lateral surfaces of the knee; what are they?

A

1) Medial and lateral condyle of tibia
2) Medial and lateral epicondyle of femur
3) Anterior, medial, and lateral margins of tibial plateau
4) Tibial tuberosity

57
Q

List what you should palpate on the knee

A

1) The contours of the quadriceps muscle
2) Patella - noting its mobility with knee extended
3) Infrapatellar spaces adjacent to patella
4) Patellar tendon
5) Over bursae of the knee

58
Q

1) When should you observe the knee?
2) Should you test passive ROM, active, or both?

A

1) Observe knee during flexion and extension
2) Test active and passive ROM

59
Q

What are the special tests of the knee? (5) What does each test?

A

1) Lachman – ACL
2) Anterior drawer – ACL
3) Posterior drawer – PCL
4) Varus and valgus stress
5) McMurray – medial and lateral menisci

60
Q

1) Describe the sensitivity and specificity of the Lachman test for ACL tear
2) How do you do this?
3) When is it positive?

A

1) 85% sensitivity, 93% specific
2) Grab proximal tibia and lateral distal femur
With knee in slight flexion, stabilize femur and pull tibia
3) Positive = excessive anterior translation when compared to other side

61
Q

1) Describe the sensitivity and specificity of the Anterior drawer test for ACL tear
2) How do you do this?
3) When is it positive?

A

1) 48% sensitive, 87% specific
2) Stabilize patient with knee flexed; firmly grasp proximal tibia and pull
3) Positive: excess anterior translation compared to other knee

62
Q

1) How do you perform the Posterior drawer test for PCL tear?
2) When is it positive?

A

1) Stabilize lower leg, firmly grasp proximal tibia and push
2) Positive if there is significant posterior translation compared to other knee

63
Q

1) How do you perform the Valgus test for MCL tear?
2) What positions should this be performed in?
3) When is it positive?

A

1) Firmly grab medial ankle and apply inward force from lateral knee
2) With knee extended and then slightly flexed
3) When there is significant laxity compared to other knee

64
Q

1) How do you perform the Varus test for LCL tear?
2) What positions should this be performed in?
3) When is it positive?

A

1) Firmly grab lateral ankle and apply outward force from medial knee
2) With knee extended and then slightly flexed
3) Positive when there is significant laxity compared to other knee

65
Q

1) What is the sensitivity of McMurray Test?
2) What is the specificity?
3) Classically only performed with ______________ component
4) _________________ component is disputed

A

1) 26-58% sensitive
2) 59-94% specific
3) rotational
4) Varus/valgus

66
Q

1) How do you perform McMurray Test? List what 2 things are being tested
2) When is it positive?

A

1) Flex kneeand:
-Medial meniscus: Externally rotate ankle and extend knee
-Lateral meniscus: Internally rotate ankle and extend knee
2) Positive with click (heard or felt) or joint line pain

67
Q

1) What flexions are varus and valgus tests done at?
2) List what each tests

A

1) Done at 0- and 30-degree flexion
2)
-Valgus: 30-degree tests medial ligament, 0-degree tests medial ligament and ACL
-Varus: 30-degree tests lateral ligament, 0-degree tests lateral ligament and ACL

68
Q

What does each movement of the McMurray test test?

A

1) External rotation of the foot - and extension – tests the medial meniscus
2) Internal rotation of the foot - and extension– tests lateral meniscus

69
Q

1) What degree is Lachman’s test performed at? What is braced? What is being tested and how?
2) What degree is Anterior drawer test performed at? What is braced? What is being tested and how?
3) What degree is Posterior drawer test performed at? What is braced? What is being tested and how?

A

1) 30-degree flexion, bracing of the femur, anterior stress upon the tibia tests ACL
2) 90-degree flexion, bracing of the foot, and two-handed ant. movement tests ACL
3) 90-degree flexion, bracing of the foot, and posterior movement tests PCL

70
Q

What should you palpate on the ankle and foot? (5 things)

A

1) The anterior aspect of each joint
2) The Achilles tendon for nodules or tenderness
3) Heel (calcaneus) for tenderness
4) Medial and lateral malleolus
5) Heads of the metatarsals by compressing between your thumb and index finger

71
Q

What movements of the ankle should you test? How is each tested?

A

1) Plantar flexion – step on the gas
2) Dorsiflexion – toe to the ceiling
3) Inversion – heel inward
4) Eversion – heel outward

72
Q

What 4 ankle and foot joints are assessed? How?

A

1) Tibiotalar joint (ankle): Dorsiflex and plantar - flex the foot at the ankle
2) Subtalar (talocalcaneal) joint: Stabilize the ankle and grasp the heel; invert and evert the heel
3) Transverse tarsal (talonavicular) joint: Stabilize the heel; invert and evert the forefoot
4) Metatarsophalangeal joints: Flex toes in relation to the feet

73
Q

How do you perform the Thompson test for Achilles tendon rupture?

A

-Patient lying prone
-Weak or absent plantarflexion when calf is squeezed

(PA school) HAPE (28 decks)

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