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Advanced Clinical Assessment Across Lifespan > MSK > Flashcards

MSK Flashcards

1
Q

Osteoporosis Risk Factors

A 
Postmenopausal women 
age >50 
thin
low dietary calcium
Vitamin D deficient
Tobacco or alcohol use 
use of corticosteroids
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2
Q

Calcium recomendations

A

Men 50-70 : 1000mg/day

Women >50: 1200 mg/day

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3
Q

Vitamin D recomendations

A

All adults >50: 800-1000 units/day

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4
Q

Osteoporosis Screening Recomendations

A

All women >50
Younger women with risk factors
Men with risk factors

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5
Q

Inflammatory vs Non inflammatory pain

A

Inflammatory - red and warm

Non-inflammatory - cool to touch, edema or swelling around joint without warmth

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6
Q

Lupus

A

Autoimmune disorder

Joint pain with butterfly rash on the face

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7
Q

Psoriatic arthritics

A

Autoimmune disorder

Joint pain with scaly rash on elbows and pitting nails

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8
Q

Lyme

A

Infection
Joint pain with “bullseye rash” - expanding erythematous patch
Mental status changes, facial weakness or stiff neck indicate CNS involvement.

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9
Q

Serum sickness

A

Joint pain with hives

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10
Q

Reiter’s syndrome

A

Genetic disorder
Joint pain with erosion or scaling on the penis and crusted scaling papules on the soles and palms.
Red, burning, itchy eyes.

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11
Q

Gonococci arthritis

A

Infectious process
Joint pain with papules, pustules or vesicles with red base on extremities.
May start with a sore throat.

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12
Q

Ulcerative Colitis and Sclerodermaa

A

Joint pain with diarrhea, abd pain and cramping

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13
Q

Types of Swelling

A

Synovial membrane may feel boggy

Effusion from excess synovial fluid in joint or swelling

Soft-tissue structures like bursae, tendons, tendon sheaths

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14
Q

Muscle Strength Rankings

A

0 = no contraction, complete paralysis
1= slight contraction but severe weakness, extremity doesn’t move
2 = Full passive ROM
3= Full ROM with gravity but not against resistance
4=Full ROM with gravity and with some resistance
5= Full ROM, normal finding

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15
Q

Examination of TMJ (inspection, palpation, ROM)

A

Inspection-Facial symmetry
TMJ swelling or redness
Palpation - Muscles of Mastication
ROM - Open and close, protrusion and retraction, side to side

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16
Q

3 landmarks of the shoulder

A

A - Acromian process
B - Coracoid process
C - Greater tubercle

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17
Q

ROM of shoulder

A

Flexion, extension, abduction, adduction internal rotation (hands behind small of back) and external rotation (hands behind neck)

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18
Q

Apley Test

A

Touch opposite scapula over shoulder and around the back. Difficulty suggests rotator cuff problem or adhesive capsuilitis

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19
Q

Neer’s Test

A

Press scapula and raise patient’s arm on same side.

Difficulty is a + and indicates rotator cuff inflammation or tear

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20
Q

Hawkin’s Test

A

Flex patient’s shoulder and elbow 90degrees palm down. Rotate arm internally. Pain is + for inflammation or tear of rotator cuff

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21
Q

6 Tests for Rotator Cuff Injury

A 
Apley Test 
Neer's Test, 
Hawkin's Test
"Empty Can" Test
Forearm supination
Drop arm test
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22
Q

Suprapinatus “Empty Can” Test

A

Elevate pt’s arms, point their thumbs down, apply pressure. Weakness is + and indicates rotator cuff tear

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23
Q

Forearm Supination test

A

Flex forearm to 90 degrees at elbow and pronate wrist. Provide pressure as patient tries to supinate. Pain is + for inflammation at head of biceps tendon or rotator cuff gear

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24
Q

Drop Arm Test

A

Abduct arm to shoulder level. Ask pt to lower slowly as you tap it. If arm just drops, + for rotator cuff tear

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25
Q

Aprehension Test

A

Externally rotate shoulder with elbow bent. + patient becomes apprehensive. Indicates dislocated shoulder

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26
Q

What are common/concerning symptoms?

A 
Low back pain
Neck pain
Monoarticular/polyarticular joint pain
Joint pain with systemic features
Joint pain associated with symptoms from another organ system
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27
Q

Acute Rheumatic fever

A

Sore throat that precedes joint pain

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28
Q

What would crepitus sound like upon palpation?

A

Rice crispy sound over joints

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29
Q

What is rotator cuff tendinitis?

A
  • Caused by overuse or injury
  • common in young adults and middle aged athletes
  • minor pain with activity and rest
  • pain from front of shoulder to side of arm
  • sudden pain with lifting/reaching movements
  • tenderness below the acromion
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30
Q

What is a dislocated shoulder?

A
  • shoulder instability from anterior dislocation of the humerus. Joint “slipped out”
  • positive apprehension test
  • pain from any shoulder movement
  • rounded edge of lateral aspect of shoulder appears flattened
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31
Q

What is a rotator cuff tear?

A
  • injury from fall or repeated impingement
  • partial or complete tear, usually after 40yrs
  • weakness, atrophy, pain and tenderness of supraspinatus and infraspinatus muscles
  • positive drop arm test- will shrug to lift shoulder
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32
Q

What is adhesive capsulitis?

A
  • frozen shoulder
  • fibrosis of glenohumeral joint capsule, fibrosis builds up from overuse
  • diffuse, dull, aching pain
  • progressive restriction of activity/passive range of motion
  • no localized tenderness (is diffuse)
  • unilateral
  • usually 50-70 years old
  • antecedent painful disorder of the shoulder, that has decreased shoulder movement
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33
Q

What is acromioclavicular arthritis?

A
  • From prior injury, results in a degenerative change in the joint
  • common
  • pain with abduction
  • tenderness localized to the AC joint
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34
Q

ROM of elbow

A

Flex and extend elbow

Pronate and supinate hand

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35
Q

What is olecranon bursitis?

A
  • swelling and inflammation of the olecranon bursa
  • from trauma, rheumatoid arthritis, gouty arthritis
  • If RA: warm, balloon filled w/ water
  • If gout: will feel the crystals
  • swelling is superficial to the olecranon process
  • no pain/discomfort
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36
Q

What is arthritis?

A
  • synovial inflammation or fluid felt b/w olecranon process and epicondyles
  • boggy, soft, fluctuant swelling, tender
  • Causes: rheumatoid, gout, osteoarthritis, trauma
  • pain, stiffness, restricted movement
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37
Q

What are rheumatoid nodules?

A
  • subcutaneous nodules along pressure points on exterior ulnar surface
  • seen in rheumatoid arthritis and acute rheumatic fever patients
  • firm, non-tender, fixed
  • located more distally from the olecranon bursa
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38
Q

What is lateral epicondylitis?

A
  • tennis elbow, common
  • pain with extension of the elbow, esp. against resistance
  • tender 1cm distal to the lateral epicondyle
  • from repetitive extension of wrist or forearm pronation-supination
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39
Q

What is medial epicondylitis?

A
  • pitcher/golfers elbow
  • pain with flexion, esp. against resistance
  • tender lateral and distal to medial epicondyle
  • from repetitive wrist flexion, like throwing
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40
Q

ROM of wrist

A

flexion
extension
ulnar abduction
radial adduction

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41
Q

ROM of fingers

A

flexion
extension
abduction (fingers spread apart)
adduction (finger back together

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42
Q

ROM of thumb

A 
flexion 
extension
abduction (thumb moves away from palm)
adduction (thumb moves towards palm)
opposition (thumb touches each finger)
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43
Q

What is carpal tunnel syndrome?

A
  • pain/numbness of first 3 fingers (but not palm), esp. at night
  • loss of sensation in distribution of the medial nerve
  • Signs: weak abduction of the thumb (thenar wasting) , Tinel’s sign (tapping), Phalen’s sign (flexing)
44
Q

Tinel’s sign

A

tingling with tapping over the median nerve as it enters the carpal tunnel

45
Q

Phalen’s sign

A

numbness or tingling with pressing the back of the hands together in acute flexion for 60 seconds

46
Q

De Quervan’s Tenosynovitis

A
  • pain with palpation over the tendon sheath of the thumb
  • may see swelling
  • more common in women 3-4 weeks after pregnancy
  • Test: Finklestein test
47
Q

What is the Finklestein test?

A
  • make a fist with thumb enclosed and flex wrist

- tenderness along the outer edge of wrist is positive

48
Q

What is Dupuytren’s Contracture?

A
  • thickened plaque overlying the flexor tendon on the ring finger at the palmar crease level
  • skin in the area puckers and thickened fibrotic cord develops between palm and finger
  • flexion contractors may ensue
49
Q

What is trigger finger?

A
  • painless nodule in a flexor tendon in the palm, near the metacarpal head
  • finger extends and flexes with a palpable and audible snap, as the nodule pops into the tendon sheath
50
Q

ROM of neck

A

flexion- chin to chest
extension- look up to ceiling
rotation- look over the shoulder
lateral bending- ear to shoulder

51
Q

ROM of spine

A

flexion- bend to touch toes
extension- bend backwards
rotation- rotate trunk
lateral bending- bend to side from waist

52
Q

Mechanical neck pain

A
  • aching pain of cervical paraspinal muscles/ligaments with movement
  • spasm, stiffness, tightness in shoulder and upper back
  • lasts weeks
  • no radiation, paresthesia, weakness
  • ROM- same
  • may have headache
53
Q

Whiplash neck pain

A
  • aching paracervical pain and stiffness
  • starts day after injury, can be chronic
  • occipital headache, dizziness, malaise, fatigue
  • from injury: forced hyperflexion/extension
  • ROM- decreased
  • perceived weakness of upper extremities
54
Q

Cervical Radiculopathy

A
  • sharp burning/tingling pain in neck/ one arm
  • parasthesia and weakness in affected arm
  • nerve root compression, usually C7
  • from herniated disc
  • weakness of triceps (if C7 involved) or biceps (if C6 involved)
55
Q

Cervical Myelopathy

A
  • cord compression EMERGENCY
  • neck pain with bilateral weakness and paresthsia in upper and lower extremities
  • hand clumsiness, urinary frequency
  • from degenerative disc or cervical stenosis or trauma
  • hyperreflexia, pos. Babinski, gait changes
  • must immobilize neck immediately
56
Q

What are red flags with back pain?

A
  • over 50 years old
  • hx cancer or IV drug use
  • unexplained weight loss
  • pain lasting longer than 1 month or not responding to treatment
  • Pain at night or at rest (malignant pain)
  • Presence of infection (fever, chills, malaise)
57
Q

Mechanical low back pain

A
  • aching pain in lumbar sacral area, may radiate to lower leg
  • acute, idiopathic, benign, self-limiting
  • worse with standing or twisting motion
  • usually 30-50 years old and work related
  • no motor or sensory impairment
58
Q

Sciatica (Radicular low back pain)

A
  • shooting pain below the knee with low back pain
  • asso. with numbness and weakness
  • bending, sitting, sneezing, coughing, straining worsens pain
  • disc herniation, esp if calf muscle wasting
  • negative straight leg test makes dx unlikely
59
Q

Straight-leg test

A
  • patient is supine, raise relaxed, straightened leg, flexing at the hip and then dorsiflex the foot
  • will cause pain in pt. with a herniated disc
60
Q

Lumbar spinal stenosis

A
  • “pseudoclaudication” pain in back of legs with walking, improves with rest or lumbar flexion
  • vague pain, usually bilateral in legs
  • hypertrophic degenerative disease: thickening of ligament causing narrowing of spinal canal
  • Common over 60 years
61
Q

Chronic back stiffness: ankylosing spondylitis

A
  • Chronic inflammatory disease

- Age onset

62
Q

Chronic back stiffness: Diffuse idiopathic hyperostosis (DISH)

A
  • Non-inflammatory disease
  • Calcification and ossification of spinal ligaments
  • Age onset >50
  • Decreased range of spinal motion, particularly thoracic movement
63
Q

What to consider if there is nocturnal back pain, unrelieved by rest?

A

metastatic malignancy

64
Q

Cauda Equina Syndrome

A
  • Low back pain associated with bladder symptoms, saddle anesthesia
  • Compression of the spinal nerve root
  • Surgical emergency as the compression is often caused by a tumor, ruptured disk, infection, fracture, or narrowing of the spinal canal
65
Q

Sarcoilitis

A
  • Lumbosacral pain radiates to the buttocks, groin or posterior thigh
  • Aggravated by extensive use prolonged exercise
  • PE: tenderness at SI joint
  • Can be an overuse injury or related to systemic illnesses
66
Q

ROM of Hip

A 
Flexion
Extension
Abduction
Adduction
External and Internal Rotation
67
Q

Bursitis

A
  • an inflammation or degeneration of the sac-like structures that protect the soft tissues from underlying bony prominences
  • Pain with movement and rest
  • Swelling
  • PE: Localized tenderness over the site of inflammation when palpated
  • If effusion present aspirate fluid to assess for infection vs gout
68
Q

Excess Iordosis

A
  • flexion deformity of the hip
  • As the opposite hip is flexed (with the thigh against the chest), the affected hip does not allow full leg extension
  • the affected thigh appears flexed
69
Q

Hip osteoarthritis

A
  • flexion deformity of the hip
  • Restricted abduction
  • Restrictions of internal and external rotation
70
Q

ROM of knee

A

bend knee
extend knee
- check while ambulating

71
Q

Bulge sign

A
  • minor effusion

- milk down on marginal side to find fluid

72
Q

Balloon sign

A
  • major effusion

- feel for extra pressure or fluid

73
Q

Ballottement of patella

A
  • major effusion

- press on relaxed patella

74
Q

How to test for a meniscal injury?

A

McMurray’s test

75
Q

McMurray’s Test

A
  • With the patient supine, grasp the heel and flex the knee.
  • Cup your other hand over the knee joint with fingers and thumb along the medial and lateral joint line.
  • From the heel, rotate the lower leg internally and externally.
  • Then push on the lateral side to apply a valgus stress on the medial side of the joint.
  • At the same time, rotate the leg externally and slowly extend it.
  • If a click is felt or heard at the joint line during flexion and extension of the knee, or if tenderness is noted along the joint line, further assess the meniscus for a posterior tear.
76
Q

How to test for the ligament laxity or a tear of the medial collateral ligaments?

A

Valgus stress test

77
Q

Valgus stress test

A
  • With the patient supine and the knee slightly flexed, move the thigh about 30° laterally to the side of the table.
  • Place one hand against the lateral knee to stabilize the femur and the other hand around the medial ankle.
  • Push medially against the knee and pull laterally at the ankle to open the knee joint on the medial side (valgus stress).
  • Pain or a gap in the medial joint line points to ligamentous laxity and a partial tear of the medial collateral ligament. Most injuries are on the medial side.
78
Q

How to test for the ligament laxity or a tear of the lateral collateral ligaments?

A

Varus or adduction stress test

79
Q

Varus stress test

A
  • Place one hand against the medial surface of the knee and the other around the lateral ankle.
  • Push laterally against the knee and pull medially at the ankle to open the knee joint on the lateral side (varus stress).
  • Pain or a gap in the lateral joint line points to ligamentous laxity and a partial tear of the lateral collateral ligament.
80
Q

How to test for an ACL tear?

A
  • Anterior drawer test

- Lachman test

81
Q

Anterior drawer test

A
  • With the patient supine, hips flexed and knees flexed to 90° and feet flat on the table, cup your hands around the knee with the thumbs on the medial and lateral joint line and the fingers on the medial and lateral insertions of the hamstrings.
  • Draw the tibia forward and observe if it slides forward (like a drawer) from under the femur.
  • Compare the degree of forward movement with that of the opposite knee.
  • A forward jerk showing the contours of the upper tibia is a positive anterior drawer sign, for an ACL tear
  • ACL= pull
  • PCL = push
82
Q

Lachman test

A
  • Place the knee at 15 degree flexion and externally rotated
  • Grasp the distal femur on the lateral side with one hand and the proximal tibia with the other
  • Simultaneously, pull the tibia forward while pushing the femur back.
  • Estimate the degree of forward excursion of the tibia
  • Forward excursion indicates ACL tear
83
Q

Posterior Drawer test

A
  • Position the patient and place your hands in the positions described for the anterior drawer test.
  • Push the tibia posteriorly and observe the degree of backward movement in the femur.
  • Isolated PCL tears are rare, result from a direct blow to the proximal tibia
84
Q

How to test PCL tear?

A

Posterior drawer test

85
Q

ROM of ankle

A

Ankle/Plantar flexion (point foot to floor)
Ankle extension/ dorsiflexion (point foot to ceiling)
Inversion (bend heel inward)
Eversion (bend heel outward)

86
Q

Gout

A
  • Very painful and tender, hot, dusky red big toe
  • swelling that extends beyond the margin of the joint. Usually on great toe
  • easily mistaken for a cellulitis.
  • Acute gout may also involve the dorsum of the foot.
  • Caused by build up of sodium urate or uric acid which is a by product of purines and dehydration
  • can erode bone over time
87
Q

Pseudo- gout

A
  • Calcium pyrophosphate deposition (CPPD)
  • Mono or poly-articular joint pain caused by build of calcium pyrophosphate in the joint
  • Inflammation of the joint and periarticular area
  • Older population >60 yrs of age
  • Difficult to distinguish between gout
  • Requires aspiration of synovial fluid for definitive diagnosis
88
Q

Pes Planus

A
  • flat feet- longitudinal arch is flat and touches floor
  • may only be seen when pt. stands
  • foot becomes convex, not concave like normal
  • may have tenderness on medial malleolus down to medial- plantar surface of the foot
  • swelling develops anteriorly to malleoli
  • inspect pt. shoes for inner side excess wear
89
Q

Plantar fasciitis

A
  • Inflammation of a the plantar fascia
  • common causes of heel pain.
  • Age 40-60 younger in runners
  • Risk factors:
    Obesity
    Prolonged standing or jumping
    Flat feet
    Reduced ankle dorsiflexion
    Heal spurs
90
Q

Hallux Valgus

A
  • the great toe is abnormally abducted in
  • the head of the first metatarsal may enlarge on its medial side, and a bursa may form at the pressure point, which may become inflamed.
91
Q

Pes Varus

A

toes point inward

92
Q

Pes Valgus

A

toes point outward

93
Q

Foot corn

A
  • painful, red, conical thickening of skin that results from recurrent pressure on normally thin skin.
  • The apex of the corn points inward and causes pain.
  • occur over bony prominences such as the 5th toe.
  • called soft corns when located in moist areas such as pressure points between the 4th and 5th toes
94
Q

Callus

A
  • an area of greatly thickened skin that develops in a region of recurrent pressure, like the sole of the foot
  • Involves skin that is normally thick, such as the sole
  • usually painless
  • If a callus is painful, suspect an underlying plantar wart.
95
Q

Plantar Wart

A
  • Caused by HPV
  • Common on the ball of the foot
  • Can be tender to touch and painful with ambulation
96
Q

Osteoarthritis

A 
Degenerative joint disease
Breakdown of the cartilage in the joint
Age related
Non-inflammatory, can be unilateral
Affects, knees, hips, hands, spine, wrists
Morning stiffness
97
Q

PE findings of Pt. with osteoarthritis

A

Heberden’s Nodes of DIP
Bouchard’s Nodes of PIP
Does not affect the MCP

98
Q

Herberden’s Node

A

bony swelling of DIP

99
Q

Bouchard’s Node

A

bony swelling of PIP

100
Q

Rheumatoid Arthritis

A
  • Autoimmune disorder with chronic inflammation of the synovial membrane and surrounding tissue
  • Symmetric involvement of hands and feet, wrist, ankle, elbows, ankles
  • Occurs at any age
  • Morning stiffness >1 hour
  • Joints tender, warm, red, swollen
  • runs in families
  • Fatigue
101
Q

PE findings of pt. with rheumatoid arthritis

A

Boutonneire Deformity of PIP

Swan neck deformity

102
Q

Reiter’s Syndrome

A
  • Arthritic disorder causing inflammation of the joints, commonly the spine
  • Inflammation of the intestinal, urinary tract, eyes and skin (have red eyes)
  • Symptoms do not occur all at once and are not always present with the joint pain
  • More common in men
103
Q

Swan neck deformity

A

DIP flexes

PIP bends in, looks concave

104
Q

Polymyalgia Rheumatica

A
  • Chronic self limiting pain with unclear etiology
  • Insidious or abrupt onset, can be night time pain
  • Usually >50 occurs with giant cell arteritis (temporal arteritis)
  • Symmetric Pain around hip, shoulders, neck
  • Swelling and edema maybe present over dorsum of hands, wrist and feet
  • Muscles tender but not warm or red
  • Joint stiffness in am
  • Pain will limit movement
  • May have associated depression, anorexia, weight loss
105
Q

Fibromyalgia

A
  • Chronic MS pain disorder affecting the soft tissue
  • Felt to be related to aberrant pain signaling that amplifies the pain response
  • Pain “all over” neck, shoulders, hands, low back and knees, trigger points on exam
  • Pattern can shift, maybe exacerbated by cold, immobility,
  • Associated with fatigue, depression/anxiety, headaches, cognitive fogginess
  • no changes in joints or muscles

Advanced Clinical Assessment Across Lifespan (12 decks)

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