MS 2 Flashcards
With the patient supine, grasp the heel and flex the knee. Cup your other hand over the knee joint with fingers and thumb along the medial joint line. From the heel, externally rotate the lower leg, then push on the lateral side to apply a valgus stress on the medial side of the joint.
At the same time, slowly extend the lower leg in external rotation.The same maneuver with internal rotation of the foot stresses the lateral meniscus.If a click is felt or heard at the joint line during flexion and extension of the knee, or if tenderness is noted along the joint line, further assess the meniscus for a posterior tear.
McMurray Test
Structure: Medial Meniscus and Lateral Meniscus
A palpable click or pop along the medial or lateral joint line is a positive test for a tear of the posterior portion of the medial meniscus (positive LR of 4.5). The tear may displace meniscal tissue, causing “locking” on full knee extension.
McMurray Test
With the patient supine and the knee slightly flexed, move the thigh about 30° laterally to the side of the table. Place one hand against the lateral knee to stabilize the femur and the other hand around the medial ankle. Push medially against the knee and pull laterally at the ankle to open the knee joint on the medial side (valgus stress).
Pain or a gap in the medial joint line is a positive test for an
Medial Collateral Ligament (MCL)
With the thigh and knee in the same position, change your position so that you can place one hand against the medial surface of the knee and the other around the lateral ankle. Push laterally against the knee and pull medially at the ankle to open the knee joint on the lateral side (varus stress).
Pain or a gap in the lateral joint line points is a positive test for
Lateral Collateral Ligament (LCL)
With the patient supine, hips flexed and knees flexed to 90° and feet flat on the table, cup your hands around the knee with the thumbs on the medial and lateral joint line and the fingers on the medial and lateral insertions of the hamstrings. Draw the tibia forward and observe if it slides forward (like a drawer) from under the femur. Com-pare the degree of forward movement with that of the opposite knee.
A forward jerk showing the contours of the upper tibia is a positive test, or
anterior drawer sign, with a positive LR of 11.5 for an ACL
Anterior Drawer Sign
Place the knee in 15° of flexion and external rotation. Grasp the distal femur on the lateral side with one hand and the proximal tibia on the medial side with the other. With the thumb of the tibial hand on the joint line, simultaneously pull the tibia forward and the femur back. Estimate the degree of forward excursion.
Lachman Test
Position the patient and place your hands in the positions described for the anterior drawer test. Push the tibia posteriorly and observe the degree of backward movement in the femur.
Posterior Drawer Sign
the proximal tibia falls back, this is a positive test for
Posterior Cruciate Ligament (PCL)
Type of joint that is freely movable and do not touch each other. It is found in knee and shoulder.
Synovial
Cartilaginous joint that is slightly movable is found in such as the intervertebral joints and the symphysis pubis and also in
Vertebral bodies of the spine
Immovable fibrous joint is found in
Skull sutures
is often in the buttock, and trochanteric pain from bursitis occurs on the lateral thigh.
Sacral/sacroiliac pain
Lateral hip pain with focal tenderness over the greater trochanter is typical of
trochanteric bursitis
the pattern of pain is additive and progressive with symmetric involvement.
RA
There is a migratory pattern of spread of pain found in
rheumatic fever or gonococcal arthritis
pain occurs in inflammation of bursae (bursitis), tendons (tendinitis), or tendon sheaths (tenosynovitis) as well as in sprains from stretching or tearing of ligaments.
Extra-articular
Inflammation of joint with fever and chills is seen in___; also consider crystalline arthritis.
septic arthritis
occurs in infection from gonorrhea or rheumatic fever, connective tissue disease, and OA
Oligoarticular arthritis
Weakness on thumb abduction is a positive test. Combined use of a hand symptom
diagram, median nerve territory hypalgesia, and thumb abduction weakness are most consistent with nerve conduction diagnoses of
Carpal Tunnel Syndrome
Aching and numbness in the median nerve distribution is a positive test for
Carpal Tunnel Syndrome
Numbness and tingling in the median nerve distribution within___ seconds is a positive test for Carpal Tunnel Syndrome
60
there is swelling and thickening of the MCP and PIP joints. Range of motion becomes limited, and fingers may deviate toward the ulnar side. The interosseous muscles atrophy. The fingers may show “swan neck” deformities (hyperextension of the PIP joints with fixed flexion of the distal interphalangeal [DIP] joints). Less common is a boutonnière deformity (persistent flexion of the PIP joint with hyperextension of the DIP joint). Rheumatoid nodules are seen in the acute or the chronic stage.
Chronic Rheumatoid Arthritis
The elbow has a flexion deformity of 45° and can be flexed farther to
90°
Supination at elbow
30°
Pronation at elbow
45°
