MSK 2 Flashcards
What is the Faber/Patrick test positive
Pain elicited with resisted adduction- pathology of hip/SI jt
Ballon sign- knee
moderate effusion
Place thumb and index finger of right hand on each side of patella
Compress suprapatellar recess and feel for fluid ejected out onto your fingers of your left hand
Balloting of the Patella
Large Effusion
Knee Extension
Push patella into femoral
Watch for fluid to fill suprapatellar pouch and feel for movement “floating” patella
ACL tear
Most commonly injured when the foot is planted while extreme rotational force is applied (e.g. a cleated foot caught in the turf while an athlete attempts to rotate towards that side). The ACL may also be injured from a direct force on the lateral knee while the foot is planted.
PCL tear
Much less commonly injured then the ACL. Posterior force on the tibia (e.g. the tibia striking against the dashboard in a motor vehicle accident) can lead to disruption.
LCL tear
Direct force on the medial aspect of the knee while the foot is planted
MCL tear
Direct force on the lateral aspect of the knee while the foot is planted
McMurray’s (for knee)
Used to detect a torn medial or lateral meniscus.
Palpable or audible click or lack of extension is positive sign for a torn lateral/medial meniscus
Apley Grind test (for knee)
This maneuver places direct pressure on the menisci. If injured, it will cause pain.
Medial Collateral Ligament (Valgus Stress) Test
If the MCL is completely torn, the joint will “open up” along the medial aspect
Knee – Lateral Collateral Ligament (Varus Stress) Test
If the LCL is completely torn, the joint will “open up” along the lateral aspect.
Additionally, palpation along the course of the ligament may also elicit pain if it has been injured
Knee – Lachman’s Test
ACL Test
If the ACL is completely torn, the tibia will feel unrestrained in the degree to which it can move forward . The intact ACL is described as providing a firm end point during Lachman testing.
Compare this to the other leg, reversing your hand position.
Knee – Anterior Drawer test
ACL
If the ACL is completely torn, the tibia will feel unrestrained in the degree to which it can move forward.
Knee – Posterior Drawer test
PCL
If the PCL is completely torn, the tibia will feel unrestrained in the degree to which it moves backwards.
Ankle Instability – Anterior Drawer test
A positive test includes increased translation of one foot compared to the other with loss of the endpoint of the anterior talofibular ligament.
Ankle – Thompson Test
Tests whether the Achilles tendon is intact. If the Achilles’ tendon is intact, when the calf muscle is squeezed, the foot will plantar-flex. If the Achilles’ tendon is ruptured, the foot will NOT plantar-flexed as the calf muscle is squeezed.
Leg length is measured from the ______________ to the ____________, crossing the knee on the medial side
anterior superior iliac spine , medial malleolus of the ankle
No more than________discrepancy in length or circumference between matching extremities.
1 cm
Full ROM in all joints. Heberden nodes noted at the DIP joints of hands, Bouchard nodes at PIP joints. Mild pain with flexion, extension and rotation of the hips bilaterally. Full ROM of knees with mod crepitus. No effusion but bony enlargement along tibiofemoral joint line bilaterally. Both feet with hallux valgus at the first MTP joints.
What is the likely pathology?
Osteoarthritis
Right knee with moderate effusion and tenderness over medial meniscus along the joint line. Mod laxity of ACL on Lachman. Moderate laxity with joint gapping noted on MCL stress testing. PCL and LCL intact with stress test. Negative posterior drawer or tenderness with varus stress. Patellar tendon intact without tenderness with patient able to extend lower extremity without difficulty. Hamstrings without tenderness to palpation. Good ROM without significant pain in the hip and ankle. No other deformity or swelling.
What is the likely pathology?
Could be MCL, ACL, meniscus tear due to tenderness over medial meniscus along the joint line over meniscus supports this.
What is Rotator Cuff Tendonitis (Impingement) caused by?
-repeated shoulder motion
-edema, hemorrhage > inflammation (supraspinatus)
-acute,recurrent, chronic > worse with activity
in older adults could be bone spurs
What tests would you do to confirm a rotator cuff tear?
+ Empty can + Weakness with external rotation + Gerber/Liftoff b
In calcific tendonitis, ______________ is most involved
Supraspinatus most involved
In bicipital tendonitis, tenderness is maximal in the _____________
bicipital groove
Adhesive capsulitis aka frozen shoulder, is ____ of the GH joint. It is mostly seen in ages ______ to _____.Prior shoulder injury or another event with lead to immobility. Can resolve with 6-24 mo of PT What are the symptoms associated with it?
fibrosis
40-60
Diffuse, dull, aching pain in the shoulder + progressive restriction of A/PROM esp with localized tenderness
What test would be positive for AC arthritis ?
+Cross Arm Test
Acute tenosynovitis is tenderness, swelling developing________________. It is a true hand surgery emergency!!
along the course of the tendon
Acute Tenosynovitis is inflammation of the _______. This most common part of the finger affected is the distal phalanx > _________ joint. Some examples of infections that can cause it are ________, _________, __________ and ___________. The finger is held in slight _______ as _______ very painful. TRUE HAND SX EMERGENCY
flexor tendon sheath
MCP
Staph, Strep, Gonorrhea, candida
flexion, extension
What characteristics would you see in osteoarthiritis?
-degnerate disease
-morning stiffness lasting less than 30 minutes
-heberden’s nodes
-asymmetrical
-cartilage loss
What characteristics would you see in rheumatoid arthirits?
-autoimmune disease
-morning stiffness lasting more than 30 minutes
-extra articular involvement
-symmetrical
-inflamed synovium
Acute gout
-associated with HTN, obesity, DM, old age
-Hyperuricemia leads to precipitation of uric acid and formation of needle-shaped crystals.
-extreme pain of the affected joint
-painful event associated with smoking/alcohol
-most common great toe
- Onset of pain in the middle of the night
-show signs of acute inflammation (redness, pain, swelling, tenderness, increased temp)
What would a person with rotator cuff tendonitis (impingement) complain of?
o sharp catch of pain, weakness, worse with overhead motions
L1
motor- hip flexion
sensory- groin
L2
motor- hip flexion
sensory- thigh
L3
motor- extension of knee
sensory- knee
L4
motor- dorsiflexion of ankle
sensory- medial calf
L5
motor- dorsiflexion of first toe
sensory- first dorsal web space between 1st and 2nd toes
S1
motor- plantar flexion of foot, knee, flexors, hamstrings
sensory- lateral foot
S2
motor- knee flexors or hamstrings
sensory- back of thigh
S2-S4
motor- external anal sphincter
sensory- perianal area
