MSK

Question 1

List the average age at which bone growth is completed with closure of the epiphyses, and the age at which peak bone mass is achieved.

Answer 1

● Bone growth is completed at about age 20 years, when the last epiphysis closes and becomes firmly fused to the shaft.
○ Once bone growth stops, bone density and strength continue to increase.
● Peak bone mass is not achieved in either sex until about 35 years of age.

Question 2

1. Kyphosis

Describe what types of skeletal changes occur in the elderly and why these happen.

Answer 2

abnormally excessive convex curvature of the spine
- Osteoporosis, a potential cause of kyphosis, can be confirmed with a bone density scan
- New bone creation doesn’t keep up with old bone removal = increased resorption
Equilibrium between bone deposition and bone resorption changes, so that resorption
(osteoclasts break down the tissue in bones. any issues with osteoblasts?)
dominates.

Question 3

• For menopausal women, decreased estrogen increases bone resorption and decreases calcium deposition, resulting in bone loss and decreased bone density.

Answer 3

• By 80 years of age, a woman can lose up to 30% of her bone mass.

Question 4

Injury

List three potential causes of muscle wasting (atrophy) and explain their clinical significance.

Answer 4

results in pain & immobility → muscle wasting

Question 5

Disease of the muscle

List three potential causes of muscle wasting (atrophy) and explain their clinical significance.

Answer 5

• makes it difficult or impossible for you to move an arm or leg, the lack of mobility can result in muscle wasting
  a. Muscular dystrophy - group of genetic disorders involving gradual degeneration of the muscle fibers
  i. S/sxs: muscle atrophy + weakness w/ waddling gait
  b. Stroke

Question 6

Damage to the motor neuron:

List three potential causes of muscle wasting (atrophy) and explain their clinical significance.

Answer 6

Fasciculation (muscle twitching) occurs after injury to a muscle’s motor neuron

Question 7

AROM

Distinguish between active and passive range of motion (AROM & PROM), and explain how these are used together to distinguish between an intra-articular (joint) vs. extra-articular (soft-tissue) problem.

Answer 7

Patient will move joints on their own until end of range of motion is felt.
● Passive range of motion often exceeds active range of motion by 5 degrees.
● Range of motion with active and passive maneuvers should be equal between contralateral joints.
● Pain, limitation of motion, spastic movement, joint instability, deformity, or contracture suggest a problem with the joint, related muscle group, or nerve supply

Question 8

PROM

Distinguish between active and passive range of motion (AROM & PROM), and explain how these are used together to distinguish between an intra-articular (joint) vs. extra-articular (soft-tissue) problem.

Answer 8

● PROM: Ask the patient to relax and allow you to passively move the same joints until the end of the range of motion is felt.
○ Do not force the joint if there is pain or muscle spasm.
○ Muscle tone may be assessed by feeling the resistance to passive stretch.
○ During passive range of motion, the muscles should have slight tension.

Question 9

Discuss expected differences between active and passive ranges of motions when measured with a goniometer

Answer 9

● Passive range of motion often exceeds active range of motion by 5 degrees.
● Range of motion with active and passive maneuvers should be equal between contralateral joints.

Question 10

Describe and demonstrate the correct use of a goniometer to measure joint range of motion (ROM).

Answer 10

Goniometer: precisely measure the angle when a joint appears to have an increase or limitation in its range of motion

1. Begin with the joint fully extended or neutral position
2. Flex the joint as far as possible
3. Measure the angles of greatest flexion and extension, comparing these with the expected joint flexion and extension values

Question 11

muscle strength

Grading

Answer 11

● When muscle strength is grade 3 or less, disability is present; activity cannot be accomplished in a gravity field, and external support is necessary to perform movements.
○ Weakness may result from an underlying muscle disorder, pain, fatigue, or overstretching.

Question 12

Dislocation of the Shoulder

Differentiate between the changes in the normal shoulder contour caused from dislocation of the shoulder versus winging of the scapula associated with nerve damage.

Answer 12

● When the shoulder contour is asymmetric and one shoulder has hollows in the rounding contour, suspect a shoulder dislocation

Question 13

Winging of Scapula associated with Nerve Damage

Answer 13

● Observe for a winged scapula, an outward prominence of the scapula, indicating injury to the nerve of the anterior serratus muscle

Question 14

cubitus valgus

Answer 14

Cubitus valgus: Variations in carrying angle; a lateral angle exceeding 15 degrees, and cubitus varus, a medial carrying angle

Question 15

· List the significance of subcutaneous nodules on the extensor surface of the forearm near the elbow.

Answer 15

● The significance of subcutaneous nodules along the pressure points of the ulnar surface may indicate a rheumatoid nodule or gouty tophi (symptom of gout)

Question 16

Heberden Nodes

· Describe physical examination findings of Heberden’s and Bouchard’s nodes and swan neck deformities and discuss their associated clinical conditions.

Answer 16

Heberden Nodes
Hard bony overgrowths along the distal interphalangeal joints (DIP)
● Associated with osteoarthritis

Question 17

Bouchard Nodes

· Describe physical examination findings of Heberden’s and Bouchard’s nodes and swan neck deformities and discuss their associated clinical conditions.

Answer 17

Bouchard Nodes
Hard bony overgrowths along the proximal interphalangeal joints (PIP)
● Associated with osteoarthritis
● Can cause spindle shape fingers which are associated with acute stage of RA

Question 18

Swan neck deformities

· Describe physical examination findings of Heberden’s and Bouchard’s nodes and swan neck deformities and discuss their associated clinical conditions.

Answer 18

Swan Neck Deformities
a bending in (flexion) of the base of the finger, a straightening out (extension) of the middle joint, and a bending in (flexion) of the outermost joint.
● Usually indicates RA

Question 19

Question 20

· List the expected range of the angle between the femur and tibia

Answer 20

● The expected range of angle btwn the femur and tibia is to be less than 15 degrees

Question 21

define the terms genu varum and genu valgum

Answer 21

● Genu valgum: a variation in lower leg alignment; knock-knees
● Genu varum: a variation in lower leg alignment; bowlegs

Question 22

· Differentiate between the terms pes valgus, pes varus, and heel pronation.

Answer 22

Pes varus: alignment variations for feet/ankles; in-toeing

Pes valgus: alignment variations for feet/ankles; out-toeing

Heel pronation: aka overpronation; outer edge of your heel hits the ground first, and then your foot rolls inward onto the arch – overly flatten your feet
- cause a shift in weight-bearing position (weight bearing should be on the midline of the foot, on an imaginary line from the heel midline btwn the 2nd and 3rd toes).

Question 23

· Describe the appearance of a normal longitudinal arch, and define the terms pes planus and pes cavus.

Answer 23

Normal Longitudinal Arch
An arch in the sagittal plane formed by the calcaneus and the metatarsals. Although the foot may flatten with weight bearing

Pes Planus
Foot that remains flat even when not bearing weight

Pes Cavus
Foot with a high instep; aka clawfoot

Question 24

· Describe the proper technique to measure leg length, arm length, and limb circumference, and define the degree of deviation from symmetry considered within normal limits.

Answer 24

● Leg length is measured from the ASIS to the medial malleolus of the ankle, crossing the knee on the medial side.
● Arm length is measured from the acromion process through the olecranon process to the distal ulnar prominence.
● The circumference of the extremities is measured in centimeters at the same distance on each limb from a major landmark
● For most people, no more than a 1-cm discrepancy in length and circumference between matching extremities should be found.