MSK Flashcards
Osteoartrhtisit is MC in:
M or W?
and what anatomical location
women
knee
tenderness of the entire joint, crepitus, instability, locking and deformity limiting both active and passive ROM due to pain or stiffness explains?
articular disease
point or focal tenderness in regions adjacent to articular strucutres and limits ROM explains?
extra-articular dz
which rarely causes swelling, instability or joints deformity:
-extra articular dz
or
-articular dz
extra articular dz
__ cervical
__ thoracic
___ lumbar
vertebrae are stacked on?
7 cervical
12 thoracic
5 lumbar
*stacked on sacrum and coccyx
bringing chin to chest is?
flexion of neck
looking up to the ceiling is
extension of neck
looking over the right and left shoulder is
rotation of neck
bringing right ear to shoulder and then same with the left is
lateral bending of neck
spine ROM
flexion–bend forward and touch toes
extension–bend as far back as poss
rotation–rotate side to side
lateral bending–bend side to side
list the articular strucutures (6)
- joint capsule
- articular cartilage
- synovium
- synovial fluid
- intra-articular ligaments
- juxta-articular bone
list extra articular strucs (8)
- periarticular ligaments
- tendons
- bursae
- muscle
- fascia
- bone
- nerve
- overlying skin
ropelike bundles of collagen fibrils that connect bone-bone
ligaments
collagen fibers that connect muscle-bone
tendons
collagen matrix overlying bony surfaces
cartilage
pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures
bursae
synovial joints:
- move freely?
- what is bone covered by?
- what are bones separatd by?
- what lurbicates joint movement
- ex 5
moves freely
bones are covered by articular cartilage
bones are separated by synovial cavity
synovial membrane secreted synovial fluid that lubricates joint movement
EX: shoulder, knee, hip, tmj, interphalangeal joints of hand/foot
cartilaginous joints
- move freely?
- what is bone covered by?
- what lurbicates joint movement
- ex 2
slightly movable
bones sep by fibrocartilaginous discs
discs contain nucleus pulposus that cushions bony movement
EX: vertebral bodies of spine
fibrous joint
- movement?
- bones are separated by?
- ex
joints have no movement
-bones sep by fibrous tissue or catilage
ex: sutures of skull
spheroidal joint
- also called
- articular shape
- movement
- ex
ball and socket
articular shape=convex surface in concave cavity
-movement: wide range flexion, extension, abduction, adduction, rotation, circumduction
ex: shoulder, hip
Hinge joint
- articular shape
- movement
- ex
shape=flat, plantar
movement: motion is one plane…flexion and extension
ex: interphalangeal joints of hand and foot, elbow
condylar joint
- articular shape
- movement
- ex
shape= convex or concave
movenet: movement of two articulating surfaces.. not dissociable
ex: knee, TMJ
how does the knee joint move
its a condylar joint (type of synovial joint)
movement of two articulating surfaces— not dissociable
list the common or concerning symps
- low back pain
- neck pain
- joint pain
how do we categorize patient complaints? (4)
- articular vs extra-articular
- acute (<6 wks) or chronic (>12wks)
- inflammatory vs noninflammatory
- localized (monoarticular) vs diffuse (polyarticular)
list the features of inflammation (4)
swelling
warmth
redness
pain
ex of single joint injuries
tendinitis
bursitis
what can migratory pattern of pain indicate?
rheumatic fever
gonococcal arthritis
additive/progressive pattern + symmetric involvement=?
RA
cause inflamamtory joint disorders (5)
- infectious: N. gonorrhea, TB
- crystal induced–gout
- immune related–lupus, RA
- reactive— reactive arthritis
- idiopathic
pain in single joint suggests
monoarthritis
injury
extra articular dz– tendinitis or bursitis
lateral hip pain with focal tenderness over the greater trochanter is suggestive of
trochanteric bursitis
inflammatory arthritis is more comon in?
women
caues of extra articular pain
bursitis
tendinitis
tenosynovitis–tendon sheaths
sprains from stretching or tearing of ligaments
decrease active and passive ROM
+morning stiffness or gelling
articular joint pain
decrease active ROM and normal passive ROM
extra-articular joint pain
myalgias
“aches and pains”
muscle is the pain
-extra articular
arthralgias
joint pain but no evidence of artritis
-extra articular
tendonitis
inflamation of tendon
-extra articular
bursitis
infalmmatino of bursae
-extra articular
inflamm of tendon sheaths
tenosynovitis
-extra articular
sprains
stretching/tearing of ligaments
-extra articular
joint pain + butterfly rash on cheeks
lupus
joint pain + scaly plaques on extensor surfaces
Psoriasis
Joint pain + stiffness especially in morning, better throughoug the day with movemnt
RA
joint pain + bulls eye rash
lyme
12 red flag s/s for low back pain
- Age <20 yrs or >50 yrs
- History of cancer
- Unexplained weight loss, fever, or decline in general health
- Pain lasting more than 1 mo or not responding to treatment
- Pain at night or present at rest
- History of intravenous drug use, addiction, or immunosuppression
- Presence of active infection or human immunodeficiency virus (HIV) infection
- Long-term steroid therapy
- Saddle anesthesia
- Bladder or bowel incontinence
- Neurologic symptoms or progressive neurologic deficit
- Lower extremity weakness
where is location of biceps tendon
what movement does it do
bicipital groove
runs medial to greater tubercle
flexion of elbow
pain with adduction of arm or pain with crossover tests suggests
AC joint disorder
pain during apley scratch test suggests
rotator cuff disorder or adhesive capsulitis
MCC of shoulder pain ?
rotator cuff disorder
list the pain provocation tests for the shoulder —3
painful arc test
neer impingement sign
hawkins impingement sign
strength tests for the shoulder —3
external rotation lag test
internal rotation lag test
drop-arm test
composite tests for the shoulder–2
external rotation resistance test
empty can test
symmetric involvement –list the disorders (3)
- RA
- SLE— lups
- ankylosing spondylitis
asymmetric involvement-list the disorders (3)
-psoriatic, reactive and IBD assoc arthritis
radicular pain signals?
spinal nerve compression
MC at C7 or C6
MC site for spinal nerve compression
C6 C7
how to perform painful arc test
+ sign means?
Full abduct the patients arm from 0 to 180 degrees
*shoulder pain from 60-120 is a positive test for subacrominal impigement/rotator cuff tendinitis disorder
positive painful impinegment test means?
subacrominal impingement/rotator cuff teninditis disorder
how to do the near impingement test
-positive test means?
press on scapula while raising patients arm
+ test=pain during test
means: subacrominal impingement/rotator cuff tendonitis
how to do hawkins test
-pos test means?
flex shoulder and elbow to 90 degrees with palm down
-next rotate arm interally
postive test=pain during test
means: supraspinatus impingement/rotator cuff tendonitis
drop arm test-how to do
+ means?
abduct arm to shoulder level and lower it slowly
-Weakness is a + test
+ finding for external rotation resistance test means
infraspinatus disorder—weakness/pain=pos
positive finding for empty can test means?
supraspinatus rotator cuff tear
+ test= inability for pt to hold up arm
ROM for elbow
flexion–bend elbow
extension–straighten elbow
pronation–turn palm down
supination–turn palm up
location of ulnar nerve
b/w olecranon process and medial epicondyle
finkelstein test–what does it show
tests for thumb dequervains tenosynovitis
what muscles are part of the hamstring
semimembranous
gracilis
sartorius
semitendinosus
scoliosis
deformity of the thorax on forward bending
-esp when the height of the scapulae is unequal
height of scapulae are unequal suggests?
scoliosis
elevation of one shoulder, lateral and rotatory curvature of spine brings head back t midline
scoliosis
___ can cause unequal leg lengths
scoliosis
deformity of throax on forward bending
scoliosis
persistence of lumbar lordosis suggests?
muscle spasm or ankylosing spondylitis
inward curvature of spine
lordosis
hunchback… can occur with age
kyphosis
what is the largest joint in the body?
knee joint
type of joint for knee?
hinge
how m any ligaments support the knee
four
deeply embeded in pelvis and noted for strenght, stability and wide ROM
hip joint
what is the hip joint noted for?
strength
stability
wide ROM
what provides stability in hip joint
deep fit of femur head into acetabulum
what provides hip joint strength
strong fibrous articular capsule and power muscles
what type of joint is the hip
ball in socket–wide ROM
can you readily palpate hip joint?
no
nocturnal hand or arm numbness
carpal tunnel
droping objects (decr grip strenght) or inability to twist lids off jars?
carptal tunnel
aching at wrist or forearm
carpal tunnel
numbness of the first 3 digits
carptal tunnel
carpal tunnel involves what nerve
-what causes it
compression of median nerve
causes: foreceful repeptitive handwork with wrist flexion like— keyboarding, mail, sorting, virbation, or cold envir
RF for carpal tunnel (5)
pregnancy RA wrist anatomy DM hyPOthyroidism
what tests do we use to diagnose carpal tunnel
phalen test
tinnel test
explain median nerve teritory
VOLAR (palm) surface of
- thumb,
- secnod finger
- half of ring finger
DORSAL surface:
-inner aspect of thumb
-PIP and up of second third fingers
half of the fourth
osgood schlatter dz –what is it
-who gets it
tibial tubercle tenderness
-knee pain in adolescents from inflammation of the tendon from kneecap to tibial tuberosity
*repeptitve use injury so MC in kids who play sports–running, jumping,
colles fracture affects what nerve
median
tenderness over the distal radius after a fall is suscious for?
colles fracture
palpable click or pop along the medial or lateral joint line of the knee?
what + sign would this be?
+ test for medical meniscal tear
+mcmurry sign
pain or a gap in the medial joint line of the knee is a positive?
+ test for MCL injury
pain or a gap in the lateral joint line of the knee?
+ test for LCL injury
degenerative joint dz
+degeneration
+progressive loss of joint cartilage
osteoarthritis
causes of osteoarthritis
mechanical stress w damage to underlying bone, formation of new bone at the cartilage margin
crepitus over inflammed joints?
osteoarthritis
heberden nodes over DIP joints
osteoarthritis
Bouchard nodes over PIP joints?
osteoarthritis
what nodes are over DIP joints with osteoarthritis
heberden
what nodes are over the PIP joints with osteoarthritis
Bouchard
degree with ROM for the wrist
- extension?
- flexion?
- radial deviation
- ulnar deviation
extension= 70 degrees
flexion=80 degrees
20 degrees radial deviation
30 degrees ulnar deviation
adhesive capsulitis
aka frozen shoulder
-pain with overall shoulder rotation
+diffuse, dull aching progressive restriction of active and passive ROM
+apley scratch test
+ apley scratch test?
adhesive capsulitis aka frozen shoulder
diffuse dull aching progressive restriction of active and passive ROM and pain with overall shoulder rotation
adhesive capsulitis aka frozen shoulder
what nerves innervate the wrist and hands
median
radial
ulnar
mcmurry tests?
medial and lateral menisci
Valgus tests?
MCL
*also called abduction test
Varus tests?
LCL
*also called Adduction test
anterior drawer sign or Lachman tests what anatomical structure?
ACL
posterior drawer sign tests?
PCL
+ bulge sign?
minor effusion
+ balloon sign?
major effusion
