MSK Flashcards
The following are examples of what? Joint capsules, articular cartilage, the synovium and synovial fluid, intra-articular ligaments, and juxta-articular bone
Articular structures
The following are examples of what? periarticular ligaments, tendons, bursa, muscle, fascia, bone, nerve, and underlying skin
Extra-articular structures
What are rope-like bundles of collagen fibrils that connect BONE TO BONE?
ligaments
What are collagen fibers connecting MUSCLE TO BONE?
tendons
What are the pouches of synovial fluid that cushion the movement of the tendons and muscle over bone or other joint structures. They lie between the skin and the convex surface of the bone or joint?
bursae
What is a synovial joint? Explain movement and examples
a. Do not touch each other
b. Freely moveable
c. Knee (largest joint in the body), shoulder, hip
3 types of synovial joints
- Spheroidal (Ball and socket)
- Convex surface in concave cavity
- Wide-range flexion and extension, abduction, adduction, rotation, circumduction
- Shoulder, hip
- Hinge
- Flat, planar
- Motion on one plane→flexion and extension only
- Interphalangeal joints of hand and foot, elbow
- Condylar
- Convex or concave→knee
- Movement of two articulating surface - Articulating→ temporomandibular joint
What is a cartilaginous joint? Movement & examples
a. Slightly moveable b. Between the vertebrae and symphysis pubis c. Pivot-neck d. Gliding-wrist
What are fibrous joints? Movement and examples
a. No movement-Immobile
b. Sutures of the skull
c. Almost in direct contact
aches and pains that occur in the *muscles*
myalgia
pain in the *joints* but no evidence of arthritis
Arthralgias
What are some of the red flags for a serious underlying systemic disease?
o Age older than 50
o History of cancer
o Unexplained weight loss
o Pain lasting more than 1 month or not responding to treatment
o Pain at night or increased by rest
o History of intravenous drug use
o Presence of infection
o Swan neck deformities
What are these S/S?
o Degeneration and progressive loss of cartilage within the joints
o Only *one joint* may be involved
o Swelling, warmth, tenderness, redness
o Heberden nodes at the DIP
o Bouchard nodes at the PIP
o No fever
Osteoarthritis
What are these S/S?
o Inflammation of the synovial membranes
o Several joints, *symmetrically distributed*, muscle atrophy or weakness
o Symmetric deformity in the PIP, MCP and wrist joints with ulnar deviation
o Weakness, fatigue, weight loss, and low fever may be present
Rheumatoid arthritis
What are these S/S?
o Inflammatory reaction to microcrystals of the sodium urate
o Base of the big toe
Gouty arthritis
What are these S/S?
o Widespread MSK pain and tender points
o “All over”
o Usually associate with morning fatigue
Fibromyalgia syndrome
Audible or palpable cronching during movement of tendons or ligaments over bone
Crepitus
What is the difference between passive and active ROM?
o Passive→ by the examiner
o Active→by the patient
What is Isometric ROM? What does it help with?
by the patient by contracting and relaxing muscles while keeping the part in a fixed position. Done to maintain muscle strength when patient is immobile, full ptn cooperation
How would you grade someone who has active movement against gravity?
3/5
0 No muscular contraction detected
1 A barely detectable flicker or trace of contraction
2 Active movement of the body part with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity with some resistance
5 Active movement against full resistance without evident fatigue. This is NORMAL muscle strength
How would you grade someone who has barely a detectable flicker or trace of contraction?
1/5
0 No muscular contraction detected
1 A barely detectable flicker or trace of contraction
2 Active movement of the body part with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity with some resistance
5 Active movement against full resistance without evidence of fatigue. This is NORMAL muscle strength
How would you grade someone w/ active movement against full resistance w/o evidence of fatigue? (Normal)
5/5
0 No muscular contraction detected
1 A barely detectable flicker or trace of contraction
2 Active movement of the body part with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity with some resistance
5 Active movement against full resistance without evidence of fatigue. This is NORMAL muscle strength
How would you grade someone with active movement against gravity AND some resistance?
4/5
0 No muscular contraction detected
1 A barely detectable flicker or trace of contraction
2 Active movement of the body part with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity with some resistance
5 Active movement against full resistance without evidence of fatigue. This is NORMAL muscle strength
How would you grade someone w/ active movement of the body part with gravity eliminated?
2/5
0 No muscular contraction detected
1 A barely detectable flicker or trace of contraction
2 Active movement of the body part with gravity eliminated
3 Active movement against gravity
4 Active movement against gravity with some resistance
5 Active movement against full resistance without evidence of fatigue. This is NORMAL muscle strength
How would you describe muscle tone?
o Flaccidity or hypotonic→marked floppiness
o Spasticity or hypertonic→increased resistance that worsens at the extremes of range
Which joint is the most active joint in the body? What kind of joint is it? What is the ROM of this joint?
TMJ
- condylar synovial joint
ROM is three fold
- Opening and closing
- Protrusion and subtraction
- Lateral or side-to-side motion
What is the drop-arm sign? How do you test it and what does it mean?
ask patient to fully abduct the arm to shoulder level if cannot hold arm fully abducted, test is positive indicating rotator cuff tear
How do you test Tinel’s sign? What is it testing for?
test for median nerve (index finger) compression by tapping lighly over the course of the median nerve in the carpal tunnel area
Tests for carpal tunnel syndrome
What is phalen’s sign and how do you test for it?
Ask the patient to hold the wrists in flexion for 60 seconds. Alt, ask the patient to press the backs of the hands together to form right angles. These maneuvers compress the median nerve.
How do you measure bone strength?
bone density (70%) and bone quality
What is the difference in bone density in a ptn with osteopenia and an ptn with osteoporosis?
Osteopenia is bone density 1.0–2.5 standard deviations below the mean for young adult white women (T score between –2.5 and –1.0).
Osteoporosis is bone density 2.5 or more standard deviations below the mean for young adult white women (T score less than –2.5).
What does a Z score compare against?
What % drop would indicate increased risk for fracture?
age matched controls (similar age, height, and weight)
A 10% drop in bone density, equivalent to 1.0 standard deviation, is associated with a 20% increase in risk for fracture
At what age should you do routine bone density screenings?
65+
What is the SINGLE best predictor of low bone density?
Low body weight
What is the best predictor of subsequent hip fracture?
bone density of the femoral neck
What interventions are good in a ptn w/ high risk of osteoporosis?
- regular, weight bearing exercises
- don’t drink alcohol - prevents absorption of calcium. Women should drink no more than 1 per day, men no more than 2
- Caffeine causes increased calcium excretion
- Don’t drink carbonated beverages.
nearest the trunk or from the point of origin
proximal
away from the trunk or from the point of origin
distal
elbow is distal to shoulder
elbow is proximal to the wrist
Does the positioning of an appendage ever change proximally or distally?
Newp.
