MSK Flashcards
lateral epicondylitis tests
cozens and mills
medial epicondylitis tests
reverse cozens
valgus stress test of elbow indicates
medial or ulnar pain
laxity of ulnar collateral ligament
varus stress test of elbow indicates
lateral pain
laxity of radial collateral ligament
how long do you hold phalens and reverse phalens
60 sec
what are features of adhesive capsulitis
thickening and contraction
abduction and external rotation most limited
end feel may be soft
what ROM is limited the most in adhesive capsulitis
abduction and ER
what is neer classification of impingement syndrome
1 - edema and hemorrhage
2 - thickening and fibrosis
3 - tears and ruptures
what are features of supraspinatus lesion
painful arc
tenderness on AC and greater tub
weakness of AB and ER
difficult sleeping on side
what are positive signs of painful arc
crepitus
apprehension
pain
what are positive signs of empty can
weakness or pain
with or without resistance!
crepitus and apprehension may be present
what does yergasons test indicate
bicipital tendonitis
transverse humeral ligament
SLAP tears grading
1 - degenerated labrum and biceps intact
2 - detached labrum and bicep anchor from superior glenoid
3 - bucket handle tear
4 - bucket handle tear extending into bicep anchor
what does cross arm test indicate
AC
sprain
OA
what does apprehension and relocation test indicates what
anterior instability
what does sulcus sign indicate
inferior or multidirectional instability
what are the characteristics of fibromyalgia
chronic pain - widespread pain and stiffness
affects neck, back, shoulders, pelvis, and hands MC
11-18 multiple tender points
deep muscular tone and throbbing
numbness tingling burning
worse in the morning
cold and humid conditions worsen
IBD and bladder dysfunction
headache
anxiety stress
impaired memory
sleep disturbances - abnormal phase 4 (REM) sleep
fatigue / exhaustion
what is the new criteria for fibromyalgia
old 1990 criteria - 11-18 tender points
found to be a barrier for primary care setting
new 2010 criteria - perceived cognitive impairment, fatigue, sleep disturbance
what is the WPI
what is used for
what is criteria
widespread pain index
fibromyalgia
0-19 tender points
must have felt pain in the tender point in the past week!!!!
what is the criteria for DX of fibromyalgia
1a. WPI score greater than 7
AND
Symptom severity score is greater than 5
OR
1b. WPI score is between 3 and 6
AND
Symptoms severity score is greater than 9
- symptoms have been present for at least 3 months
- you dont have a disorder that would otherwise explain the pain
what are the common symptoms of cervical myelopathy
what are the common signs
symptoms - clumsy/weak hands, stiff or heavy legs, neck stiffness, pain in shoulders and arms, unsteady gait, cant walk at brisk pace, deterioation of fine motor skills (writing or buttoning shirt), intermittent shooting pains down the arm like electric shock, arm pain
signs - atrophy of the hands, hyperreflexia, hypertonic LE, Lhermittes sign, sensory loss, inability to tandem walk
what does the neuro exam look like with cervical myelopathy at C5-C6 level
biceps and supinator (C5/6) may be absent
brisk triceps reflex (C7) - pathognomonic of cord compression at C5-C6 interspace
ankle clonus and babinski present
hoffmans sign is indicator of spinal cord dysfunction
stiff or spastic gait - seen in later stages
what are the MSK findings in polymyalgia rheumatica
morning stiffness for more than 1 hour
proximal muscle weakness
muscle stiffness after inactivity
carpal tunnel syndrome - 15% of people
distal extremity swelling
arthalgia or myalgia up to 6 months after systemic symptoms
cervical distraction
increases ligamentous pain
decreases nerve root and facet pain
adsons test is used for what causes
scalenes
cervical rib
what is allens test used for
obstruction of vasculature to the hand
what is T4 syndrome
symptoms - paresthesia, numbness, UE pain, with or without upper back stiffness
no neuro signs
upper thoracic joint dysfunction around T4
how do you treat T4 syndrome
joint manip, stretching, strengthening excercises directed at upper back
C5 root
or
C4-C5 disc
deltoid
biceps reflex
C6 root
or
C5-C6 disc
biceps
wrist extension
brachiradialis reflex
C7 root
or
C6-C7 disc
triceps
wrist flexion
finger extensors
triceps reflex
C8 root
or
C7-T1
finger flexion
no reflex
T1 root
or
T1-T2 disc
interossei
L4 root
or
L3-L4 disc
tibialis anterior
patellar reflex
L5 root
or
L4-L5 disc
extensor hallucis longus
no reflex
S1 root
or
L5-S1 disc
peroneus longus
achilles reflex
what are the tight muscles in upper cross syndrome
tight - pecs, ant deltoid, levator scapulae, upper trap, subscap, lats, SCM, scalenes
weak - rhomboids, post deltoid, serratus anterior, lower trap, longus coli, capitus
what are the mechanical factors in cervical myelopathy in flexion and extension
flexion (anterior) - herniated discs and osteophytic ridges
extension (posterior) - ligamentum flavum buckling and hypertrophy
correct hip firing patterns
explain
hamstrings
glut max
contra erector
ipsi erector
what are the different grades of spondylolisthesis
normal 1 - <25% 2 - 25-50% 3 - 50-75% 4- >75%
what are characteristics of lumbar disc syndrome
dejerines triad minor sign flexion is more painful more painful in AM improve with mobilization better with activity sitting more painful - tripod sign antalgia sciatic pain
bechterews test is + for
lumbar disc
sciatica
kemps test is + for
lumbar sprain
facet
disc
sciatica
SLR is + for
sciatica
lumbar sprain
SI sprain
tight hamstrings
braggards tests is + for
sciatica
tight hamstrings
well leg raise is + for
sciatica
lumbar disc
patricks test is + for
hip pathology
SI lesion
yeomans test is + for
SI lesion
elys test is + for
SI lesion
hibbs test is + for
SI lesion
hip pathology
what is the most specific SI test
gaenslens test
what is a positive hip extension sign
ipsi erector fires first
neri bowstring sign is + for
sciatica
lumbar disc
hamstring
what does retrolisthesis mean
disc narrowing is greater than posterior joint degeneration
what does anterolisthesis mean
posterior joints are more degenerated than the disc
what is the difference in neurogenic and vascular pain
neuro - thighs, calves, back, (buttocks is rare), burning and cramping, erect posture/ambulation/extension make worse, squatting/bending forward/sitting make better, pulses normal, no skin changes, bladder incontinence
vascular - buttocks and calves, cramping, any leg exercise makes worse, rest makes it better, decrease pulses, skin and nail changes, impotence
osgood schlatters occurs when and due to what
11-14 years old
growth spurts and overuse
what is the most sensitive and specific test for meniscus
thessaly 20*
what is patella tendonitis
aka jumpers knee or sinding larsen johansson syndrome
inflammation of inferior border of patella
anterior knee pain over patella
pain worse when jumping, landing, or running
gradual onset due to overuse
sitff first thing in the morning or after sitting
what is pes anserine bursitis
inflammation of pes anserine
located anterior medial knee below the tibial tub
what is a synovial plica
snapping sensation or pain along the medial epicondyle
1-2 fingers away from patella
pain with knee flexed and then extended
what does pivot shift test for
acl and rotatory instability
what does apleys compression and distraction test for
compression - meniscus
distraction - cruciates and collateral sprain
patellar mobility
displaced less than one quadrant medially =
displaced more than 3 quadrants medially =
displaced less than one quadrant medially = tight lateral structures
displaced more than 3 quadrants medially = hypermobile
what is patellar inhibition or grind test for
patellar femoral syndrome
anterior drawer of ankle indicates what
anterior talofibular instability
varus stress, talar tilt, and inversion stress indicates what
valgus stress, talar tilt, and eversion stress indicates what
calcaneofibular lig
deltoid lig
how does avulsion of 5th metatarsal occur
inversion sprain
how does jones fracture occur
stress or acute fracture
difficult to heal
what are the different osteochondral defects of the ankle
lateral talar dome - inversion sprain
medial talar dome - unclear maybe trauma
how does a high ankle sprain occur
tibiofibular syndesmosis
dorsiflexion and eversion of the ankle
internal rotation of tibia
what are the tests used to diagnose high ankle sprain
squeeze test
external rotation test
cross leg test
what is a march fracture
stress fracture of a metatarsal
what is homans sign indicate
thrombophlebitis
