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Physical Assessment 2 > MSK > Flashcards

MSK Flashcards

1
Q

What are articular structures?

A

Joint capsule & articular cartilage, synovium & synovial fluid, intra-articular ligaments, and juxta-articular bone.

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2
Q

What are extra-articular structures?

A

Periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, & overlying skin.

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3
Q

What are ligaments?

A

Rope-like bundles of collagen fibrils that connect bone to bone.

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4
Q

What are tendons?

A

Collagen fibers connecting muscle to bone.

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5
Q

What is cartilage?

A

Collagen matrix overlying bony surfaces.

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6
Q

What is bursae?

A

Pouches of synovial fluid that cushion the movement of tendons & muscles over bone or other joint surfaces.

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7
Q

Synovial joint?

A

Joint is freely movable.
Bones are covered by articular cartilage & separated by synovial cavity.
Synovial membrane secretes synovial fluid that lubricates joint movement.

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8
Q

Examples of synovial joint?

A

Shoulder & knee.

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9
Q

Cartilaginous joint?

A

Joint is slightly movable.

Bones separated by fibrocartilaginous discs that contain nucleus pulpous that cushions bony movement.

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10
Q

Examples of cartilaginous joint?

A

Vertebral bodies of the spine.

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11
Q

Fibrous joint?

A

Have no appreciable movement.

Bones separated by fibrous tissue or cartilage.

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12
Q

Examples of fibrous joint?

A

Sutures of the skull.

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13
Q

Spheroidal (ball & socket)?

A

Shape: Convex surface in concave activity.
Movement: Wide ranging flexion, extension, abduction, adduction, rotation, and circumduction.
Examples: Shoulder, hip

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14
Q

Hinge?

A

Shape: Flat, Planar.
Movement: Motion in one plane; flexion & extension.
Example: Interphalangeal joints of hand & foot; elbow.

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15
Q

Condylar?

A

Shape: Convex or concave.
Movement: Movement of two articulating surfaces not dissociable.
Examples: Knee; temporo-mandibular joint.

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16
Q

Steps to evaluating joint pain?

A

Articular vs. extra articular
Acute (<6 wks) vs. chronic (>12 wks)
Inflammatory vs. noninflammatory
Localized (monoarticular) vs. diffuse (polyarticular)

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17
Q

What do you ask a patient w’/ joint pain?

A

Fever/chills.

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18
Q

What is monoarticular?

A

Single joint –> injury, monoarticular arthritis, extra articular cause (tendinitis, bursitis)

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19
Q

What is polyarticular?

A

Several joints (>/= 4), Ask about pattern of involvement.

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20
Q

Pt presents w/ migratory pattern from joint to joint?

A

Rheumatic fever, gonococcal arthritis.

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21
Q

Pt presents with pain spreading from one joint to multiple joints or additive/progressive pattern & symmetric?

A

RA

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22
Q

What causes inflammatory joint disorders?

A

Infectious (Neisseria gonorrhea, Mycobacterium tuberculosis).

Crystal induced (gout)
Immune related (lupus, rheumatoid arthritis).

Reactive (reactive arthritis).

Idiopathic

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23
Q

Signs of articular joint pain?

A

Decreased active & passive ROM and morning stiffness.

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24
Q

Signs of extra articular joint pain?

A

Decreased active ROM & nml passive ROM and periarticular tenderness (occurring around the joint).

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25
Q

Myalgias?

A

“Aches & pains”, pain is in the muscle.

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26
Q

Arthralgias?

A

Joint pain w/ no evidence of arthritis.

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27
Q

Tenosynovitis?

A

Inflammation of tendon sheaths.

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28
Q

Sprains?

A

Stretching/tearing of ligaments.

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29
Q

Extra articular conditions?

A

Myalgias, arthralgia, tendonitis, bursitis, tenosynovitis, & sprains.

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30
Q

Pt has joint pain and butterfly rash on cheeks?

A

Lupus

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31
Q

Pt has joint pain and scaly plaques on extensor surfaces?

A

Psoriasis

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32
Q

Pt has joint pain and stiffness especially in the morning, better throughout the day w/ movement?

A

RA

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33
Q

Pt has joint pain and bulls eye rash?

A

Lyme

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34
Q

Red Flags for Low Back Pain?

A

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

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35
Q

Pain when pt touches the opposite scapula also called Apley Scratch Test signifies?

A

Rotator cuff disorder or adhesive capsulitis.

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36
Q

Pain with adduction (crossover test) is positive for what disorder?

A

AC joint disorder.

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37
Q

What is the MCC of shoulder pain?

A

rotator cuff disorder.

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38
Q

Pain provocation tests for Rotator Cuff Disorder?

A

Pain arc test, neer impingement, & Hawkins impingement sign.

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39
Q

Strength Tests for Rotator Cuff Disorder?

A

External rotation lag test: Supraspinatus & infraspinatus disorders.
Internal rotation lag test: Subscapularis disorder
Drop-arm test: Supraspinatus rotator cuff tear/bicipital tendinitis

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40
Q

Composite Tests for Rotator Cuff Disorder?

A

External rotation resistance test and Empty can test.

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41
Q

What is a positive painful arc test and what does it mean?

A

Fully abduct the patient’s arm from 0° to 180° and shoulder pain from 60° to 120 and it signifies subacromial impingement/rotator cuff tendinitis disorder.

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42
Q

What test signifies infraspinatous disorder?

A

External Rotation Resistance Test

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43
Q

What test signifies a supraspinatous rotator cuff disorder?

A

Empty Can Test

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44
Q

What are the carpal tunnel syndrome special tests?

A

Tinel Sign: Tap lightly on median nerve & phalen sign: backwards praying for 60 s.

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45
Q

What does Finkelstein Test signify?

A

de Quervain’s Disease

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46
Q

Tests to check for MCL injury?

A

Abduction or valgus stress test.

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47
Q

Tests to check for LCL injury?

A

adduction or varus stress test.

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48
Q

Tests to check for ACL injury?

A

Anterior drawer sign, Lachman Test

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49
Q

Tests to check for PCL injury?

A

Posterior Drawer sign.

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50
Q

Tests to check for medial and lateral menisci injury?

A

McMurray Test

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51
Q

How to check for minor knee effusion?

A

Bulge Sign

52
Q

How to check for major knee effusion?

A

Balloon Sign

53
Q

What does articular disease typically involve?

A

Swelling & tenderness of joint, crepitus, instability, “locking” or deformity, and limits active and passive ROM due to stiffness or pain.

54
Q

What does extra articular disease typically involve?

A

“Point or focal tenderness in regions adjacent to articular structures” and limits active ROM . Rarely cause swelling, instability, or joint deformity.

55
Q

Pt has lateral hip pain w/ focal tenderness over great trochanter?

A

Trochanteric bursitis.

56
Q

Pt w/ severe pain of rapid onset in a red swollen joint or pt w/ inflammation with fever & chills?

A

Acute septic arthritis and crystalline arthritis.

57
Q

In noninflammatory disorders consider what?

A

trauma (rotator cuff tear), repetitive use (bursitis, tendinitis), degenerative changes (OA), or fibromyalgia.

58
Q

Pt w/ morning stiffness that gradually improves w/ activity?

A

Inflammatory disorders like RA and PMR?

59
Q

Pt w/ intermittent stiffness and gelling and crepitus over inflamed joints?

60
Q

Categories of monoarticular arthritis?

A

Traumatic, crystalline, septic.

61
Q

Categories of oligoarticular arthritis?

A

Gonorrhea infx, rheumatic fevers, connective tissue disease, and OA.

62
Q

Categories of polyarticular arthritis?

A

Viral or inflammatory from RA, SLE, or psoriasis.

63
Q

Pt w/ symmetric pain?

A

RA, SLE, and ankylosing spondylitis.

64
Q

Pt w/ asymmetric pain?

A

Psoriatic, active, & IBD-associated arthritis.

65
Q

Pt w/ constitutional sxs?

A

RA, SLE, PMR, and other inflammatory arthritides.

66
Q

What can chemo cause?

A

Joint pain

67
Q

What condition can infiltrate the synovium?

68
Q

Pt w/ heliotrope rash on upper eyelid + joint pain?

A

Dermatomyositis

69
Q

Pt w/ papules, pustules, or vesicles with reddened bases on the distal extremities+ joint pain?

A

Gonococcal arthritis

70
Q

Pt w/ Painful subcutaneous nodules especially in pretibial area + joint pain?

A

Sarcoidosis, Behcet disease (erythema nodosum)

71
Q

Pt w/ palpable purpura + joint pain?

A

Vasculitis

72
Q

Pt w/ hives + joint pain?

A

Serum sickness or drug reaction.

73
Q

Pt w/ erosions or scaling on the penis and crusted scaling papules on the soles and palms + joint pain?

A

Reactive (Reiter) arthritis (with urethritis, uveitis).

74
Q

Pt w/ maculopapular rash of rubella + joint pain?

A

Arthritis of rubella

75
Q

Pt w/ nail fold capillary changes + joint pain?

A

Dermatomyositis, systemic sclerosis

76
Q

Pt w/ clubbing of fingernails + joint pain?

A

Hypertrophic osteoarthropathy

77
Q

Pt w/ red, burning, and itchy eyes (conjunctivitis), eye pain and blurred vision (uveitis) + joint pain?

A

Reactive (Reiter) arthritis, Behçet syndrome,13,14 ankylosing spondylitis

78
Q

Pt w/ scleritis + joint pain?

A

RA, IBD, vasculitis

79
Q

Pt w/ preceding sore throat + joint pain?

A

Acute rheumatic fever or gonococcal arthritis

80
Q

Pt w/ oral ulcerations + joint pain?

A

RA (usually painless); Behçet disease

81
Q

Pt w/ pneumonitis; interstitial lung dz + joint pain?

A

RA; systemic sclerosis

82
Q

Pt w/ diarrhea, abdominal pain, cramping + joint pain?

A

IBD, reactive arthritis from Salmonella, Shigella, Yersinia, Campylobacter; scleroderma

83
Q

Pt w/ urethritis + joint pain?

A

Reactive (Reiter) arthritis, gonococcal arthritis

84
Q

Pt w/ mental status change, facial or other weakness, stiff neck?

A

Lyme w/ CNS involvement.

85
Q

Pt w/ radicular pain?

A

Spinal nerve compression and/or irritation, most commonly at C7 or C6 from foraminal impingement from degenerative joint changes (70% to 75%), rather than disc herniation.

86
Q

Pt w/ nonspecific low back pain?

A

Musculoligamentous injuries and age-related degenerative pro- cesses of the intervertebral discs and facet joints.

87
Q

Pt w/ midline back pain?

A

Musculoligamentous injury; disc herniation; vertebral collapse; spinal cord metastases; and, rarely, epidural abscess

88
Q

Pt w/ pain off the midline?

A

Muscle strain, sacroili- itis, trochanteric bursitis, sciatica, and hip arthritis as well as for renal condi- tions like pyelonephritis or stones.

89
Q

Pt w/ radicular gluteal and posterior leg pain in the S1 distribution that
increases with cough or Valsalva?

90
Q

Sciatica is usually due to what?

A

Disc disorder, usually at L4–L5 or L5-S1.

91
Q

Pt w/ leg pain that resolves w/ rest and/or lumbar forward flexion?

A

Spinal stenosis.

92
Q

Pt w/ an S2–S4 a midline disc or tumor w/ bowel or bladder dysfunction (usually urinary retention with over- flow incontinence), and saddle anesthesia or perineal numbness?

A

Cauda equina syndrome.

93
Q

Pt w/ malalignment?

A

Dupuytren contracture, bow legs or knock knees.

94
Q

Pt w/ crepitus over inflamed tendon sheaths?

A

tenosynovitis

95
Q

Pt w/ decreased ROM?

A

arthritis, joints with tissue inflam- mation or surrounding fibrosis, or bony fixation (ankylosis).

96
Q

Pt w/ ACL laxity?

A

Knee trauma; muscle atrophy

97
Q

Pt w/ subcutaneous nodules and weakness?

98
Q

Pt w/ palpable bogginess or doughiness of synovial membrane usually w/ effusion?

99
Q

Pt w/ tenderness over tendon sheaths?

A

Tendinitis

100
Q

Pt w/ palpable joint fluid?

101
Q

Pt /w increased warmth?

A

Arthritis, tendinitis, bursitis, and osteomyelitis.

102
Q

Pt w/ redness over a tender joint?

A

Septic or crystalline arthritis, or possibly RA.

103
Q

Pt w/ diffuse tenderness and warmth over a thickened synovium?

A

Arthritis or infection.

104
Q

Pt w/ focal tenderness?

A

Injury or trauma.

105
Q

Pt w/ facial asymmetry and unilateral chronic pain w/ chewing, jaw clenching, or teeth grinding often associated w/ stress & accompanied by headache?

A

TMJ disorders

106
Q

Pt w/ swelling, tenderness, decreased ROM?

A

TMJ inflammation or arthritis.

107
Q

Pt w/ palpable crepitus or clicking of jaw?

A

Poor occlusion, meniscus injury, or synovial swelling from trauma.

108
Q

Pt w/ pain and tenderness of jaw?

A

TMJ syndrome

109
Q

Pt w/ elevation of one shoulder?

110
Q

Pt w/ flattened rounded lateral aspect of the shoulder?

A

Anterior dislocation of the shoulder.

111
Q

Pt w/ atrophy of the supraspinatus and infraspinatus with increased prominence of scapular spine can appear within 2 to 3 week?

A

Rotator cuff tear

112
Q

Pt w/ localized tenderness points to subacromial or subdeltoid bursitis?

A

Degenerative changes, or calcific deposits in the rotator cuff.

113
Q

Pt w/ swelling of shoulder?

A

bursal tear

114
Q

Pt w/ tenderness over SITS muscle insertions and inability to abduct arm above shoulder level?

A

Sprains, tears, and tendon rupture of the rotator cuff, most commonly the supraspinatus

115
Q

Pt w/ shoulder tenderness and effusion?

A

Glenohumeral joint synovitis.

116
Q

Pt w/ restricted shoulder ROM?

A

Bursitis, capsulitis, rotator cuff tears or sprains, and tendinitis.

117
Q

An age of ≥60 years and a positive drop-arm test are the findings most likely to identify what?

A

Degenerative rotator cuff tear.

118
Q

Pt w/ swelling over olecranon process?

A

olecranon bursitis

119
Q

Pt w/ tenderness distal to epicondyle?

A

Lateral or medial epicondylitis.

120
Q

Pt w/ olecranon posteriorly placed?

A

Posterior dislocation of the elbow and supracondylar fracture.

121
Q

Pt w/ tenderness over distal radius after fall?

A

Colles fracture

122
Q

Pt w/ local swelling of wrist?

123
Q

Pt w/ Heberden nodes (DIP joints) and Bouchard nodes (PIP joints)?

124
Q

Pt w/ Thenar atrophy?

A

Median nerve compression from carpal tunnel.

125
Q

Pt w/ trigger digits?

A

stenosing tenosynoviti

Physical Assessment 2 (4 decks)

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