MSK Flashcards
Varus
Inward ambulation toward midline of distal segment of bone/joint
E.g., bowleggec
Valgus
Limb displaced away from midline
E.g., knock knees
Synovial joint
Freely movable
Bones sep by synovial cavity, which secretes synovial fluid that lubricates joint movement
Bones covered by articular cartilage
Ex. Shoulder, knee
Cartilaginous joint
Slightly movable
Bones sep by fibrocartilaginous discs, which contain nucleus pulposus that cushions bony movement
Ex. Vertebral bodies of the spine
Fibrous joint
No appreciable movement
Bones sep by fibrous tissue or cartilage
Skull sutures allow head to fit thru birth canal, growth in childhood, swelling with injury
Ex. Sutures of of skull
Spheroidal joint
Aka ball and socket
Convex surface in concave cavity
Mvmt: wide ranging flexion, extension, adduction, abduction, rotation, circumduction
Ex. Shoulder, hip
Hinge joint
Flat, planar shape
Motion in one place: flexion, extension
Ex. Interphalangeal joints, elbow
Condylar joint
Convex or concave
Mvmt of 2 articulating surfaces not dissociable
Ex. Knee, TMJ
MSK red flags
Bowel/bladder changes + LBP May mean cauda equina, compression of spine
Joint pain in systemic disorders
Annular rash- Lyme disease
Psoriatic plaque- psoriatic arthritis
H/o cancer of organ near bones, then bone pain can be bc cancer spread to bones
Congenital abnormalities
Spina bifida
Hip dysplasia- assess with Ortolani and Barlow btwn birth-6 mo
MSK stages of PE
- Inspect
- Palpate
- ROM- active and passive and muscle strength
- Maneuvers (joint specific) to test joint function and stability and integrity of ligaments, tendons, bursae
Crossover test
Shoulders- inflammation or arthritis of acromioclavicular joint
Adduct one arm
Positive: pain
Apley scratch test
Rotator cuff
Take each arm and scratch back, should be able to get as far as scapula
Drop arm test
Lift arm over head and slowly let it go down sideways
Positive: significant pain, arm suddenly falls, can’t hold arm fully abducted at shoulder level
Can test
Put hand out in front of them, practitioner pushes down
Positive: can’t hold arm up
Impingement sign
Rotator cuff tear
Flex shoulder up and keep scapula down
Positive: pain
Wrist/hand PE
- Inspect
- Palpate (e/t + anatomical snuffbox bc this is a classic place for fracture)
- ROM (wrist, finger, thumb)
- Hand grip strength, sensation on palmar/dorsal surfaces inner areas by median, ulnar, and radial nerves
Carpal tunnel syndrome
D/t inflammation of medial nerve
Pain or numbness of first 3 fingers of hand, but not in the palm, especially at night
Loss of sensation in palmar surface of thumb, index, middle, medial 4th fingers
Causes: pregnancy, postpartum, repetitive motion
Maneuvers for CTS
Weak abduction of thumb- most sensitive test
Tinel’s sign- tingling with tapping over median nerve as it enters carpal tunnel
Phalen’s sign- n/t with pressing backs of hands together in acute flexion x60 sec
Tinel’s sign
Tingling with tapping over median nerve as it enters carpal tunnel
Phalen’s sign
N/T with pressing backs of hands together in acute flexion x60 sec
Joints of the knee
2 condylar tibiofemoral joints
Patellofemoral joint
Trochlear groove
Bulge sign
Minor knee effusion
Milk downward from thigh to knee, apply medial pressure, tap and watch for fluid wave on lateral side
Balloon sign
Major effusion in knee
Compress suprapatellar pouch against femur, feel for fluid entering spaces next to patella
Patellar ballottment
Major effusion in knee
Press suprapatellar pouch and push patella against femur, watch for fluid returning to pouch- patella will look like it springs down and then pops back up
Valgus stress test
Stability if MCL, LCL
Lachman test
Test ACL
Drawer test
Stability of ACL, PCL
McMurray’s test
Meniscus
Person lies down, internally rotate ankle and bend knee, in u-shape externally rotate and pull out
Positive: pain, locking
Kyphosis
Bent over
Commonly from compression fractures from OP
Most common herniated discs
L4-L5
Pain radiates to outside of hip and then to outer leg and commonly stops at the knee
Straight leg test
Disc herniation
Supine position
Back pain at 45 degrees of hip flexion (30-60 degrees positive)
More accurate if they flex their foot
Crossed SLR
More sensitive for significant nerve root involvement
Positive right sided pain with right SLT and then lift left leg and still have right back pain
