MSK 1 Flashcards
greenstick fracture
only one side of the bone is broken, more common in long bones of children
referral pattern for liver and lung
neck/shoulder
boxer’s fracture
5th MC
Maitland grades of mobilization
1, 2, 3, 4, 5 is thrust
basketball court
anterior interosseous syndrome
median n.
motor only
pinch grip test
nerve injury levels
- neuropraxia
- axonotmesis
- neurotomesis: full neuron and sheath
biceps femoris reflex level
S1
boyes test
for central tendon rupture
+ inability to flex DIP
boutonnière deformity
cervical spinal manip screen
- signs of UMN lesion
- vertebral artery/ligament instability testing
- bilateral radicular symptoms
MMT grading
0= no contraction 1= trace 2- = initiates movement gravity eliminated 2= full ROM in gravity eliminated 3= full ROM against gravity 3+ = minimal resistance 4= moderate resistance 5= max resistance
myositis ossificans
atypical bone formation in elbow or thigh
spaces where TOS can happen
- interscalene triangle
- costoclavicular space
- subpectoralis minor space
what phase are patients in with dynamic splints for tendon repair?
repair phase
biceps brachii reflex level
C5
gangrene
death of tissue due to loss of vascularity
beighten scale parts and score
- pinky (2)
- thumb (2)
- elbow (2)
- knee (2)
- hamstring (1)
4/9 is hyper mobility syndrome
spiral groove syndrome
radial n.
wrist drop
radial n. sensory deficits
symptoms of carpal tunnel
weakness and atrophy of thenar mm., sensory changes/pain, positive phalen’s and reverse phalen’s, tinel’s and direct compression
ulnar collateral testing
moving valgus stress test
valgus stress test
milking maneuver
stand up test (posterior band)
game keepers thumb
sprain of UCL at MCP
valgus stress test
secondary bone healing
4 stages of healing
- hematoma formation (inflammation stage)
- soft callus formation (proliferative stage, 3-4 week formation)
- hard callus formation (maturing or modeling phase, 2-3 months) CLINICAL UNION
- bone remodeling (woven into stronger bone)
secondary OA
specific cause (injury, obesity, genetics)
claw finger
intrinsic mm. wasting, either ulnar or median n., occurs when asked to extend fingers
chronic fatigue syndrome
general fatigue more than 6 months, reduction in activity ability, unrefreshing sleep AND cognitive impairment OR orthostatic hypotensin
pain location for dequervain’s syndrome
radial styloid process
C-spine manip rules
- symptoms less than 38 days
- think it will help
- rotation difference 10 degrees or greater
- pain with spring testing
arthrodesis
fusion
DVT probability: wells criteria
+1 for…
- active cancer
- paralysis/paresis/immobilization
- bedridden recently
- localized tenderness along deep vein
- calf swelling 3cm
- pitting edema in painful leg
- collateral superficial veins
- previous DVT
-2 for alternative diagnosis
2 or more DVT likely
which is worse proximal, middle, or distal scaphoid fracture?
proximal takes longest to heal 12-23 weeks
special tests for lateral epicondylalgia
pain-free grip
Cozen’s test
Mill’s test
resistance of 3rd digit (maudsley’s)
brachioradialis reflex level
C6
distal bicipital tendon rupture signs
swelling and bruising
tenderness over radial tubercle
pain with elbow flexion or supination
Popeye deformity
what muscles does the median n. innervate past the wrist
abductor pollicis brevis
flexor pollicis brevis
opponens pollicis
lumbricals 1 and 2
TFCC tests
piano key test on ulna
supination lift test
body weight at water levels…
C7 = 10% zyphoid = 30% ASIS = 50%
grading scale for joint play
0 = no movement 1 = decrease in motion 2 = slight decrease 3 = normal 4 = slight increase 5 = increase in motion 6 = complete instability
lumbar spinal manip screen
- unexplained weight loss
- severe unremitting pain
- b/b dysfunction
- bilateral radicular symptoms
wartenberg syndrome
superficial radial n. entrapment…
pain/paresthesia over radial dorsal wrist, grip aggravates
differential: dequervain’s
compound fracture
breaks through skin
triceps reflex level
C7
adhesive capsulitis stages
1: painful/pre-adhesive
2: freezing/adhesive
3: frozen/fibrotic
4: thawing stage
ape hand
thenar eminence wasting, median n. palsy
signs of TSA prosthetic loosening
- increased pain
- instability
- decreased ROM
insufficiency stress fracture
normal activity on poor bone quality
sweater finger
extended DIP, flexor profundus rupture
bunnel-littler test
test for capsule vs. intrinsic m. tightness
if PIP restricted w/ both then capsular tightness
if PIP only restricted with MCP ext., team intrinsic mm.
integumentary screening questions
- unusual or new moles
- fever or night sweats
- swelling or redness in any joint
- pregnancy
dx of knee OA
knee pain + radiograph charges + one of …
- older than 50
- morning stiffness
- crepitus
dx of hip OA
older than 50
morning stiffness
15 degree difference in IR and flexion
colles fracture
distal radius
AC separation types
1: sprain of AC
2: ruptured AC, sprain of coracoclavicular
3: both sets ruptured
4: clavicle posterior
5: clavicle superior
6: clavicle inferior
indications for wrist arthroplasty
severe pain, instability, deformity
cyriax pain and inflammation with passive range
pain before resistance –> acute inflammation
pain with resistance –> subacute inflammation
resistance prior to pain (overpressure) –> mild or chronic inflammation
wartenburg’s syndrome
superficial radial n.
sensory only/pain
mimics de quervian syndrome (pain with thumb flex and ulnar deviation)
BMD score osteoporosis
T score -2.5 or lower
FRAX score
cancellous bone
ribs, pelvis, vertabrae
-heal faster
psychological screening questions
- changes in mentation
- LOC
- attention
- orientation
- judgement
semitendinosus reflex level
S2
primary bone healing
approximation of bone fragments from surgery
radiographic healing
- callus size
- cortical continuity
- progressive loss of fracture line on x-ray
osteomyelitis
bone infection
kaltenborn’s grades of mobilization
1: loosening, unweighting
2: tightening, taking up slack
3: stretching capsule
cardiovascular screening questions
- SOB
- dizziness
- heaviness in chest
- pulsating pain
- constant pain in lower leg
- discolored or painful feet
- swelling with MOI
carpel tunnel stages
- preclinical: symptoms only with prolonged activity
- mild: night N&T
- moderate: constant N&T, pain at night
- severe: constant, atrophy
zigzag deformity
flexion of CMC, hyperextension of MCP
tests for medial epicondylalgia
resisted elbow flexion
passive wrist extension
valgus stress test
allen test
circulatory testing
open and close hand
occlude radial and ulnar a.
let one go compare bth
cyriax lesion type
- painful and strong= minor lesion
- painful and weak= major lesion
- painless and weak= total rupture or neurologic lesion
- painless and strong= normal
pronator syndrome
median n.
sensory only
tests: resist pronation, extend elbow
mill’s test
passive wrist flexion stretch
+ for lateral epicondylalgia
extrinsic primary RTC tendinopathy
mechanical compression of tissue and can result from loss of stability of shoulder
clinical healing
- absence of pain at site
- no pain on weight bearing
- return to normal limb function
tests for ulnar n. dysfunction in the hand
formet’s sign (IP flexion while holding paper)
Jeanne’s sign ( MCP extension in pinch grip)
wartenburg’s sign (unable to adduct 5th digit)
synovitis
wrist, hand, fingers, tendon f the digits
extrinsic internal RTC tendinopathy
compression of supraspinatus between glenoid and humerus, usually in throwers
-20 degrees GIRD is risk factor
GI/GU screening questions
- frequent or severe abdominal pain
- frequent heartburn or indigestion
- nausea or vomiting
- change in B/B
- unusual menstrual irregularities
smith’s fracture
distal segment displaced anteriorly
osteotomy
realigns joint surfaces
simple fracture
not breaking through skin
primary OA
wear and tear with time
what is important to remember about total elbow arthroplasty
protect tricep since it gets cut (10-12 weeks before isolated tricep work)
referral pattern for gallbladder and stomach
thoracic/rib
saltar harris fracture
fracture involving growth plate
radial tunnel syndrome
posterior interosseous n. –> radial n.
mimics lateral epicondylitis
olecranon bursitis signs
pain with end range flexion
student’s elbow
contraindications of massage
- acute inflammatory disease
- infection of skin
- open wounds
- acute thrombophlebitis
- localized malignancy
- congestive heart failure
supracondylar process syndrome
ligament of strutters compression
very rare
referral pattern for heart
men: L shoulder, throat, jaw, neck
women: R shoulder and R arm
Guyon tunnel compression
ulnar n.
sensory to hand
wartenberg’s SIGN
often from longterm crutch use
what zone is bad for flexor tendon lacerations
zone 2
there are 5 for fingers and 3 for thumb
cubital tunnel syndrome
ulnar n. positive tinel's wartenberg's sign elbow flexion test (provocation and weakness) throwers
what is intrinsic RTC tendinopathy?
age-related degeneration
- very rare to have purely intrinsic, likely partly something else
- articular side
bishops hand
occurs when asked to make a fist
median nerve palsy
can’t close the fingers 1-3
lateral collateral testing
varus stress test
cozen’s test
resisted wrist extension
+ for lateral epicondylalgia
referral pattern for kidney and appendix
low back/flank
common avascular necrosis sites
proximal femur and humerus, and scaphoid neck
algometry
reliable pain measurement
colles fracture
distal segment displaced dorsally, more common
supinator syndrome
posterior interosseous n. –> radial n.
thumb and finger ext. weakness
motor only
types of wrist instability
volar/dorsal intercalated segmental instability (VISI/DISI)
TFCC
patellar reflex level
L4
achilles reflex level
S1
Outerbridge classification for OA
0=normal cartilage 1=cartilage with softening and swelling 2=fragmentation of 1/2 in or smaller 3=fragmentation more than 1/2 in 4=erosion of cartilage down to bone
remodeling stage of healing
4-8 weeks, no inflammation
proliferation/repair stage of healing
5-28 days
active scar formation from fibroblasts laying down collagen
extension test for elbow fracture
if they can get full extension its really unlikely that they have an elbow fracture
deep tendon reflex testing grading
0= absent 1= diminished 2= normal 3= exaggerated 4= clonus
fibromyalgia syndrome
chronic widespread muscle pain, fatigue, and multiple tender points
oncologic screening questions
- persistant night pain
- constant pain anywhere
- unexplained weight loss
- loss of appetite
- unusual lumps or bumps
joint mob contraindications/precautions
C:unstable/hypermobile joints (spondylolithesis)
P: joint effusion, inflammation, pregnancy, generalized hyper mobility, osteoporosis
neurologic screening question
- changes in hearing
- severe headaches
- swallowing or speech difficulties
- changes in vision
- balance or coordination probs
- fainting spells
- sudden weakness
- onset of saddle paresthesia
bennett’s fracture
base of 1st MC
