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MSK Flashcards

1
Q

What is this movement

A

Flexion

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2
Q

What movement is this

A

Extension

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3
Q

What is this movement

A

ABDuction

“Raise your arms out to the side and overhead”

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4
Q

Whats this movement

A

ADDuction

“Cross your arm infront of your body”

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5
Q

What is this movement?

A

Internal rotation

“Place one hand behind your back and try to touch your shoulder blade”

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6
Q

What is this movement

A

External rotation

“Raise your arm to shoulder level; bend your elbow and rotate your forearm toward the ceiling”

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7
Q

What is this maneuver

A

Crossover or crossed body test

Adduct the patients arm across the chest (AC joint)

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8
Q

What is this maneuver

A

Apley scratch test (overall shoulder rotation)

Ask the patient to touch the opposite scapula using these 2 motions

Pain: could suggest rotator cuff disorder or adhesive capsulitis

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9
Q

What is this maneuver

A

Painful arc test

Fully ABDuct the patients arm from 0-180 degrees

If painful: suggestive of subacromial impingement syndrome/rotator cuff tendonitis)

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10
Q

What is this maneuver

A

Neer Impingement sign

Examiner presses on the patient’s scapula to prevent scapular motion with one hand, and raises the patients arm with the other hand.

+ test for a subacromial impingement syndrome/rotator cuff tendonitis disorder)

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11
Q

When both neer and hawkins tests are negative

A

Very LOW likelihood of rotator cuff disorder

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12
Q

What is this maneuver

A

Hawkins impingement

Flex the patients shoulder and elbow to 90 degrees with the palm facing down. Then with one hand on the forearm and one on the arm rotate the arm internally

+ sign for supraspinatus impingement syndrome/rotator cuff impingement

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13
Q

What is this maneuver

A

External rotation lag test

With the patients arm flexed to 90 degrees and palm up rotate the arm into full external rotation and ask the patient to keep their arm in this position

INABILITY TO MAINTAIN: positive test suggestive of tears to the supraspinatus and infraspinatus muscles/ shoulder impingement syndrome

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14
Q

Whats this maneuver

A

Internal rotation lag test (lift off test)

With you standing to the patients rear, bring the dorsum of the hand behind the low back with the elbow flexed to 90 degrees. Then grip the wrist and lift the hand off the back which further internally rotates the shoulder. Ask the patient to keep the hand in the position as you release the wrist.

Inability to maintain = + tests indicates subscapularis tendinopathy or torn muscle

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15
Q

What is this maneuver

A

Drop arm test

Ask the patient to fully Abduct the arm to the shoulder level up to 90 degrees and lower it slowly (after you release your hand)

The abduction above the shoulder level from 90-120 degrees reflects action of the deltoid muscle

+ sign: if they are unable to slowly lower the arm (itll just DROP)
This suggests supraspinatus rotator cuff tear or bicipital tendinitis

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16
Q

What is this maneuver

A

External rotation resistance test

Ask the patient to flex the arms to 90 degrees with the thumbs turned up. Stabilize the elbow with one hand and apply pressure to proximal to the patients wrist as the patient presses the wrist outward in external rotation.

+ if mobility is limited OR it illicits pain
Suggests infraspinatus disorder
Limited extension suggests glenohumeral disease or adhesive capsulitis

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17
Q

Whats this maneuver

A

Empty can test

Elevate the arms to 90 degrees and internally rotate the arms with the thumbs pointing down as if emptying a can. Ask the patient to resist as you place downward pressure on the arms.

+test: inability of the patient to hold the arm fully abducted at the shoulder or control lowering the arm

Suggests supraspinatus rotator cuff tear

NOT a stand alone test less specificity

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18
Q

What are the four key features for the MSK exam?

A

IPROMS
INSPECTION: evaluate visually for signs of deformity, swelling, scars, inflammation or atrophy

PALPATE: use surface anatomy landmarks to localize points of tenderness or fluid collection

Range of motion: have the patient actively move the involved joints, then passively move them as the examiner.

Special maneuvers: perform stress maneuvers (if indicated) to evaluate joint stability and the integrity of ligaments, tendons or bursae especially if pain or trauma is present.

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19
Q

Acute vs chronic joint pain

A

Acute: last from days to weeks

Chronic: lasts months to years

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20
Q

Whats a monarticular disease?

A

Pain localized to ONE joint

Ie, injury, monoarticular arthritis

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21
Q

What is a polyarticular disease

A

More than 4 joints

Ie. RA, systemic lupus and OA

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22
Q

What is crepitus? What does it indicate?

A

Crepitus is audible or palpable crunching during the movement of tendons or ligaments over bone or areas of cartilage loss.

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23
Q

What are the 4 cardinal signs of inflammation

A

Swelling
Warmth
Redness
Pain

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24
Q

Swelling

A

Palpable swelling may involve
1. Synovial membrane may feel boggy or doughy
2. Effusion from excess synovial fluid in the joint space
3. Soft tissue structures, such as bursae, tendons, and tendon sheaths

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25
Warmth
Use the backs of your fingers to compare the involved joint with its unaffected joint or with nearby tissues if both joints are affected
26
Redness
Redness of the overlying skin the LEAST common sign of inflammation near the joints and is usually seen in superficial joints like fingers, toes and knees.
27
Pain
Try to identify the anatomic structure that is tender. “Can you point to exactly where the pain is”
28
Rheumatoid arthritis
Chronic inflammation of the synovial membranes with secondary erosion of adjacent cartilage and bone and damage to the ligaments and tendons. SYMMETRICAL Frequent swelling of synovial tissue in joints Tender, often warm seldom red Stiffness (especially in the morning) with inactivity IMPROVES with movement
29
Common locations for RA
Hands feet ankles wrists elbows and knees
30
Generalized symptoms of RA
Weakness, fatigue, weight loss and low grade fever are common
31
Osteoarthritis
Degenerative and progressive loss of joint cartilage from mechanical stress with damage to the underlying bone and formation of new bone at the cartilage margins Activity increases pain Rest improves pain Intermittent stiffness or “gelling” throughout the day Brief stiffness after inactivity or in the morning lasting (5-10 min) No generalized symptoms
32
Locations for OA
Knees hips hands Cervical and lumbar spine Wrists And joints previously injured or diseased
33
Which muscle groups make up the rotator cuff?
1. Supraspinatus 2.infraspinatus 3.tres minor 4. Subscapularis The SITS muscles
34
Lateral epicondylitis
(Tennis elbow) Follows repetitive extension of the wrist of pronation-supination of the forearm Pain and tenderness develop 1cm distal to the lateral epicondyle and possibly in the extensor muscles close to it. Pain most commonly caused by chronic tendonitis of the extensor carpi and radialis brevis. *when a patient tried to extend the wrist against resistance, pain increases*
35
Medial epicondylitis
(Pitchers, golfers or little league elbow) Follows repetitive wrist flexion such as throwing Tenderness is maximal just lateral and distal to the medial epicondyle Wrist flexion against resistance increases the pain Pain is most often caused by tendonitis of the pronator teres or flexor carpi radialis
36
Olecranon bursitis
Swelling and inflammation of the olecranon bursa may result from; trauma, gout, or RA. The swelling is superficial to the olecranon process and may reach 6cm in diameter. Consider aspiration for both diagnosis and symptom relief
37
Heberden nodes
Hard dorsolateral nodules on the DIP joints
38
Bouchard nodes
Hard dorsolateral nodules on the PIP joints
39
Heberden nodes and bouchard nodes are common findings in a patient with what condition?
Osteoarthritis
40
What is this
Heberden nodes
41
What is the examiner doing
Palpating MCP joints
42
What is this exam
Palpation of the snuff box
43
What symptoms are associated with carpal tunnel?
Starts with a dull ache, but can increase to sharp pins and needles “parasthesias” This pain can also extend up the arm Patients may also have muscle weakness Difficulty holding small objects Turning doorknobs or holding keys Or fine motor tasks like buttoning a shirt Difficulty opening a jar
44
What are the 3 carpal tunnel assessments?
1. Reduced thumb abduction 2. Tinel sign 3. Phalen
45
What is this test
Reduced thumb abduction Ask the patient to touch the thumb to the fifth fingertip as you apply outward pressure against the base of the thumb Positive test: weakness is present
46
What is this test
Tinel sign To test: repeatedly tap over the course of the median nerve in the carpal tunnel Positive test: shooting pain, aching, or worsening numbness in the median nerve distribution
47
What is this exam
Phalen sign Ask the patient to hold the wrists in full flexion and juxtaposing the dorsum of each hand against eachother for 60 seconds Positive test: numbness and tingling in the median nerve distribution in the 60s seconds
48
Tinel and phalen signs do or do not predict carpal tunnel syndrome?
DO NOT reliably predict the electrodiagnosis of carpal tunnel syndrome
49
What exam is this?
The finkelstein test Grasp the thumb and move wrist down to midline Positive test: pain with ulnar deviation (tilt wrist down)
50
What is snuffbox tenderness? What does it indicate?
Tenderness in the wrist with ULNAR deviation and pain at the scaphoid tubercle Suspicious for occult scaphoid fracture Poor blood supply increases risk of scaphoid bone avascular necrosis
51
Dupuytren flexion contractures
First sign: a thickened band overlying the flexor tendon of the fourth finger and possibly the little finger near the distal palmar crease. SUBSEQUENTLY, the skin in this area puckers and a thickened fibrotic cord develops between the palm and finger. Finger EXTENSION is limited but FLEXION is usually normal. This usually develops gradually
52
Colles fracture
Tenderness over the distal radius after a fall
53
Stenosing tenosynovitis
“Trigger finger” Caused by a painless nodule in a flexor tendon in the palm, near the metacarpal head. The nodule is too big to enter easily into the tendon. With extra effort and assistance the finger extends and flexes with a palpable or audible snap as the nodule pops into the tendon sheath. (Watch listen and palpate the nodule as the patient flexes and extends the fingers)
54
What is this exam
Testing for scoliosis Have the patient bend at the waist and look for lateral bending
55
What are the muscle groups of the hips?
1.flexor group 2.extensor group 3. Adductor group 4. Abductor group
56
Whats do the Ortolani and Barlow tests assess for?
Development of hip dysplasia
57
Barlow assessment
Flex the leg to form right angles @the hips and knees Place your fingers at the greater trochanter of each femur and thumbs over the lesser trochanter Pull the leg forward and ADDUCT with posterior force (Opposite direction with your thumbs moving down toward the table and outward) Positive test: palpable dislocation
58
What is this assessment?
Ortolani assessment
59
Ortolani assessment
Hands in the same position, ABDUCT hips simultaneously until the lateral aspect of each knee touches the examination table Positive ortolani: an audible clunk
60
What is this assessment?
Barlow assessment
61
For the barlow and ortolani exams kids over 3 months may have what result?
A negative exam but STILL have a dislocated hip d/t tightening of the hip muscles and ligaments. In children great than 3 months with limited hip ABDUCTION be concerned for hip dysplasia.
62
When do you stop hip exams for babies?
When they start walking
63
What maneuver is this and what is it testing?
McMurray Testing: medial meniscus and lateral meniscus Positive test: a palpable click or pop along the medial or lateral joint line is a positive test for a tear of the posterior portion of the medial meniscus
64
What is this maneuver? What is it testing?
Abduction (or valgus) stress test Positive test: pain or a gap in the medial joint line (medial collateral ligament injury)
65
What is this maneuver and what is it testing?
Adduction (or varus) stress test Positive test: pain in the lateral joint line (indicates an LCL injury)
66
What is this maneuver? What is it testing?
Anterior drawer sign Positive test: anterior jerk showing the contours of the upper tibia (indicating ACL tear)
67
What is this maneuver? What is it testing?
Lachman test Positive test: significant forward excursion is a positive test for an ACL tear
68
What is this maneuver? What is it testing?
Posterior drawer sign Positive test: if the proximal tibia falls back + for pcl injury
69
What is the NP assessing?
Bulge sign Step1: displace or “milk the fluid down” Step2: force fluid to lateral area by applying pressure on the medial knee Step 3: tap the bulge formed by the fluid + test: a fluid wave (positive for effusion)
70
What is this test
Balloon sign (for major effusions) Displacing fluid while compressing both sides of the knee to observe the patella “ballooning up” Positive sign: palpable fluid wave (confirms major effusion)
71
What is this exam?
Balloting of the patella (for major effusions) Pushing sharply (balloting) the patella against femur in a fluid filled knee Positive test: palpable fluid wave (indicates major effusion)
72
What symptoms and exam findings indicate prepatellar bursitis?
An inflammation of the bursa infront of the kneecap. It occurs when the bursa becomes irritated and produces too much fluid, which causes it to swell and put pressure on the adjacent parts of the knee. Often triggered by extensive kneeling
73
Pt complaining about pain in the toe. The sharp edge of the toenail has dug into the lateral nail fold, is red and tender with purulent discharge.
Ingrown toenail
74
A patient reports their second toe is hyperextended, with a corn over it causing the toe to be flexed.
Hammer toe
75
A patient has painful thickening of the skin on the fifth toe.
A corn
76
A diabetic patient has a wound on the bottom of their food. They have little to no sensation on that foot and the wound is infected.
Neuropathic ulcer
77
Plantar warts
Lesion caused by hpv located on the sole It may look like a callus but has a dark spot It hurts if pinched side to side
78
Callus
An area of greatly thickened skin that develops in an area of recurrent pressure: Unlike a corn a callus involves skin that is normally thick such as the sole and is usually painless
79
Articular
Within the joint
80
Extraarticular
Outside the joint
81
Osteoarthritis is a ______ aging process
Normal We lose the synovial fluid as we get older
82
Snuffbox tenderness is suspicious for what type of fracture?
Scaphoid fracture
83
Tenderness over the distal radius after a fall is suspicious for what
Colles fracture
84
A joint that is RED and swollen is usually
Infectious or gout
85
Mcp joints are commonly inflammed with what type of arthritis?
RA
86
During the painful arc test pain in which degrees of movement is positive for a subacromial impingement/rotator cuff tendonitis?
60-120 degrees
87
Deformity of the thorax on forward bending, especially when the height of the scapulae is unequal suggests what condition?
Scoliosis
88
When measuring scoliosis with a scoliometer when would you refer the patient to ortho?
A curvature greater than or equal to 7 degrees
89
Ortolani and barlow
B comes before O Barlow you want to dislocate the hip Ortolani to relocate the hip
90
What type of joint is the hip?
Ball and socket
91
What type of joint is the knee?
Hinge joint
92
What is an example of a fibrous joint?
Sutures of the skull
93
What is this pedi foot
Metatarsus adductus
94
What are these pedi feet?
Pronation
95
What is this pedi foot
Inversion of the foot Varus
96
What is this pedi foot
Pes plantus or flat feet
97
What is this testing for
Sports exam Any prior knee or ankle injury
98
Ortolani test
Adducts the hips (brings em back in)
99
Barlow test
Abducts the hips dislocates then
100
What signs may indicate a clavicle fracture in a bebe
While palpating if theres any lumps, tenderness or crepitus (This can happen with a difficult birth)
101
Most newborns are
Bowlegged
102
Torsion of the tibia in an infant
The babies usually toeing in or toeing outward Usually corrects itself within the second or third year of life
103
Suprling test
Have patient look over their shoulder then up at the ceiling next position yourself behind the patient and carefully apply downward pressure on the patient’s head and check if the maneuver reproduces the neck pain with radiation to the same side + test suggest cervical root compression
104
If an infant has a lil tuft of hair or dimpling above their bum what should the NP do?
Get a spinal ultrasound
105
What are the two phases of gait?
1. Stance 2. Swing
106
Most hip problems appear during what phase?
The weight bearing stance phase
107
Trendelenburg gait
Waddling gait The pelvis drops to the opposite side while in the swing phase
108
The width of the base while ambulating should be
2-4 inches from heel to heel
109
Uneven or asymmetric hips can be a sign of
Leg shortening Their legs arent the same length:)
110
What is this testing
Hip ADDuction
111
What is this testing?
External rotation of the hip
112
What is this test and what is it testing for?
FARBER or patrick test For groin strain
113
If an old lady has leg shortening what are we concerned about?
Hip fracture!
114
Inability to bear weight for 4 steps is indicative of
An ankle fracture
115
Valgus
Knock knees Knees point in
116
Verus
Knees point out of bowlegged
117
Nurse maids elbow
Radial head dislocation Happens frequently to kids when swinging and stuff They guard the arm and wont use it
118
Slipped caital femoral epiphysis SCFE
Happens in pre teens early adolescence Sublaxation of the femoral head with issues with the growth plate Common in obese kids Might have a painful hip or limp Requires surgical intervention
119
Adams test
Bending over and touching toes Test for scoliosis
120
How to assess for gait strength and coordination in a child?
Gait: observe the child walking Strength: have the child lie on the floor and then stand up and closely observe. Most normal kids will first sit up then flex the knees and extend the arms to the side to push off from the floor and stand up. Coordination: heel to toe walking
121
Gower sign
Present in certain forms of muscular dystrophy w/ weakness of the pelvic girdle muscles Children will rise to standing by rolling over prone and pushing off the floor with their arms while the legs remain extended

Advanced Health Assessment (5 decks)

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