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Advanced Clinical Assessment > MSK > Flashcards

MSK Flashcards

1
Q

Subjective Data

  1. Joint
    • P___
    • S____ness
    • S_____, H_____, R______
  2. Muscles
    • P____ (c___)
    • W_______
  3. Bones
    • P____
    • De_____
    • T_____ (fractures, sprains, dislocations)
  4. _______ Assessment (ADL’s)
  5. Self-care ______ (Alcohol, tobacco, athlete that uses proper protective equipment)
  6. Family Hx (2)
  7. ______ exposure (Occupation, hobbies, rock climber?)
A
  1. Join
    • Pain
    • Stiffness
    • Swelling, heat, redness
  2. Muscles
    • Pain (cramps)
    • Weakness
  3. Bones
    • Pain
    • Deformity
    • Trauma
  4. Functional
  5. Behaviors
  6. Osteoporosis, RA, osteogenesis imperfecta, other genetic disorders
  7. Environmental
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2
Q

Assessing Joint Pain

  • Ask patient to ____ to pain
  • Be specific with _____ of pain, associated mechanism of injury if present (ie MVA)
  • Is the pain l_____ or d_____
  • Is it ____ or ____ articular (inside or outside of joint)
  • Is it a____ or ch____
  • Is it in_____ or ___-inflammatory (is it hot, swollen, red)
A
  • point
  • onset
  • localized, diffuse
  • intra, extra
  • acute, chronic
  • inflammatory, non-inflammatory
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3
Q

Common and/or Concerning Symptoms

  • ___ back pain
  • N___ pain
  • Monoarticular or Polyarticular ____ pain
  • In_____ or In____ joint pain (arthritis vs. septic joint)
  • Joint pain with ____ features such as fever, rash, chills, anorexia, weight loss, weakness
  • Joint pain with associated with symptoms from another ____ system (ex Hep C can cause liver failure, arthritis type sx, muscle pain, weakness, and vascular issues)
A
  • Low
  • Neck
  • Joint
  • Inflammatory, Infectious
  • systemic
  • organ system
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4
Q

Joint Pain with the Following = What Systemic Disorder?

  1. Butterfly Rash =
  2. Scaly rash and pitted nails of psoriasis =
  3. Papules, pustules or vesicles on reddened base found on distal extremities =
  4. Expanding erythematous patch =
  5. Hives =
A
  1. Lupus
  2. Psoriatic arthritis
  3. Gonococci arthritis
  4. Lyme
  5. Serum Sickness
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5
Q

Joint pain with the following = what Systemic Disorder?

  1. Erosion or scaling on the penis and crusting scaling papules on the soles and palms of the feet =
  2. Red bruning itching eyes =
  3. Preceding sore throat =
  4. Diarrhea, abdominal pain, cramping =
  5. Mental status changes, facial weakness, stiff neck =
A
  1. Reiter’s syndrome
  2. Reiter’s syndrome
  3. Acute rheumatic fever, gonococci arthrtis
  4. Arthritis with ulcerative colitis, sclerodema
  5. Lyme with CNS involvement
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6
Q

Osteoporosis

  • Screening for all women > __ or
  • Younger with increased ____ factors
    • Post _____ women
    • _____ or ____ ethnicity
    • Th__ build, weight < _____ lbs
    • Low dietary ______
    • Vitamin ___ deficiency
    • T____ or A____ use
    • Use of _______* ex) i had a pt addicted to prednisone, fractures -> couldn’t walk
A
  • 65
  • risk
    • menopausal
    • Caucasian, Asian
    • Thin, 154
    • calcium
    • D
    • Tobacco, Alcohol
    • Corticosteroids*
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7
Q

Recommended Dietary Intake Vitamin D and Calcium

  • Age 19-50
    • Calcium mg/day =
    • Vit D IU/day =
  • Age 50-71
    • Calcium mg/day =
    • Vit D IU/day =
  • Age >71
    • Calcium mg/day =
    • Vit D IU/day =
A
  • 19-50
    • 1,000
    • 600
  • 50-71
    • W 1,200 M 1,000
    • 600 both M/W
  • >71
    • 1,200
    • 600
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8
Q

Physical Exam

Techniques of Examination: Overview of Each of the Major Joints

  • Inspect for joint s_____, al____, or any bony d_____
  • Inspect and palpate surrounding tissues for any skin ch___, no____, or muscle _____
  • Palpate for c_____ (crunching or grinding sensation esp over patella)
  • Assess any deg_____ or inf_____ changes, especially sw_____, w____, te____, or r______
  • Perform range of ____; use spoint specific m______ to test:
    • Joint function and stability
    • Integreity of l_____ tendons, and b_____
A
  • symmetry, alignment, deformities
  • changes, nodules, atrophy
  • crepitus
  • degenerative, inflammatory, swelling, warmth, tenderness, redness
  • motion, maneuvers
    • ​ligaments, bursae
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9
Q

Techniques of Joints Examination of Major Joints (cont.)

  • Be alert to signs of inflammation and _____
    • Swelling
      1. ​​The s_____ membrane, which can feel b___ od doughy
      2. Effusion from excess synovial f___ within the joint space; or
      3. Soft tissue structures such as b____, t____, and tendon sheaths
    • Warmth
    • Tenderness
    • Loss of Function
    • Deformity
A
  • arthritis
    1. synovial, boggy
    2. fluid
    3. bursae, tendons
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10
Q

Order of the Examination

  • Inspection
    • S___ and Con___ of joint
    • Sk___ and ti____ over joint
  • Palpation
    • Skin t_____
    • M____, b___ articulations, area of joint c____
  • Range of _____
  • Muscle s_____
  • No percussion or auscultation but test ROM and muscle strength
A
  • Inspection
    • Size, Contour
    • Skin, tissue
  • Palpation
    • temperature
    • Muscles, bony, capsule
  • Motion
  • Strength
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11
Q

Test Muscle Strength

  • Apply _____ force
  • Grade muscle strength: grade __-__
  • Full ROM with gravity eliminated (passive motion) =
  • Full ROM with gravity but not against resistance (moderate weakness) =
  • No contraction, complete paralysis, no visible or palpable movement =
  • Full ROM against gravity, with full resistance (normal muscle strength) =
  • Full ROM against gravity, with some resistance =
  • Slight contraction, but very severe weakness, weak contraction visible but extremity doesn’t move =
A
  • opposing
  • 0-5
  • 2
  • 3
  • 0
  • 5
  • 4
  • 1
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12
Q

Cervical Spine

  • Inspect: _____ of head and neck
  • Palpate: _____ processes and muscles
  • Motion: and Expected R____
    • Chin to ____
    • Lift ____
    • Each ___ to shoulder
    • Turn ___ to each shoulder
A
  • alignment
  • spinous
  • Range
    • chest
    • chin
    • ear
    • chin
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13
Q

Neck Pain

(4)

A
  • Mechanical
  • Whiplash/Cervical Strain
  • Cervical Radiculopathy (herniated disc)
  • Cervical Myelopathy (cord compression)
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14
Q

Mechanical

  • Aching pain, cervical _____​ muscles and ligaments
  • Spasm, stiffness, tightness in sh____ and ___ back
  • Duration ____
  • Any radiation, paresthesia, weakness?
  • __ maybe present
  • PE: p____ tenderness along paraspinal muscles, pain with ____ but usally no decreased _ _ _, no n_____ deficits
A
  • paraspinal
  • shoulder, upper
  • weeks
  • No
  • HA
  • point, movement, ROM, neurologic
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15
Q

Whiplash/Cervical Strain

  • Aching _____ pain and stiffness (involving the ligaments of cervical spine, fairly common after ___ even slow 25-30 mph)
  • Begins ___ after the injury
  • O_____ HA, dizziness, malaise, and fatigue present
  • Can be ____ lasting > 6 months
  • Caused by forced h_____/e____
  • Decreased _ _ _, perceived weakness, or upper extremities
A
  • Paracervical, MVA
  • day
  • Occipital
  • chronic
  • hyperflexion/extension
  • ROM
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16
Q

Cervical Radiculopathy (Herniated disc)

  • ____ burning or tingling pain in neck and ___ arm
  • P_____ and weakness in affected arm
  • Nerve root compression C_ most affected
  • Caused by h_____ d___
  • PE: weakness of ___ceps if C7 involved, weakness in __ceps if C6 involved
A
  • Sharp, one
  • Parasthesia
  • C7
  • herniated disc
  • triceps, biceps
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17
Q

Cervical Myelopathy (cord compression)

  • ___ pain with __lateral weakness and paresthesia in ___ upper and lower extremities
  • H___ clumsiness, p____ parasthesia and g___ changes possible, urinary f_____
  • Neck ____ exacerbates symptoms
  • Caused by cervical sp______ from degenerative disc or cervical stenosis or trauma
  • PE: ____reflexia, _____ Babinski’s, g___ changes
  • Requires neck i______ and n______ evaluation
A
  • Neck, BL, both
  • Hand, palmar, gait, frequency
  • flexion
  • spondylosis
  • hyperreflexia, positive, gait
  • immobilization, neurosurgical
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18
Q

Spine

  • Inspect: while person s_____
  • Palpate: _____ processes
  • Motion and expected r____
    • Bend ___ways, ___ward
    • ____ shoulders to each side
  • Straight leg R_______ (while laying on back)
  • Measure leg length dis______
A
  • stands
  • spinous
  • range
    • sideways, backwards
    • Twist
  • Raising
  • discrepancy
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19
Q

ROM Spine

How many degrees lateral bending? and twisting/rotation?

A
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20
Q

Back Pain

  • ____ is the pain?
    • ______ (over the vertebrae)
      • Consider injury, disc herniation, vertebral collapse, spinal cord mets and rarely epidural abscess
    • ____ the midline
      • Consder muscle strain, sacroiliac inflammation (sacroilitis), trochanter bursitis, sciatica, hip arthritis and possibly renal causes such as pyelonephritis or stones
  • Does it ____?
    • If so where? Do you have any n______ or t____?
  • Do you have any ______ symptoms with the pain?
    • _____ retention or overflow incontinence
    • C______ symptoms
A
  • Where
    • Midline
    • Off the Midline
  • Radiate
    • numbness, tingling
  • associated
    • urinary
    • constitutional
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21
Q

Red Flags for Back Pain

  • Age > __
  • History of ______
  • Unexplainted weight ___
  • Pain lasting longer than a ___ or not _____ to treatment
  • Sudden loss of b___/b___ control
  • Hx of __ d___ use (potential for sepsis)
  • Presence of in_______
A
  • >50
  • Cancer
  • weight loss
  • month, responding to tx
  • bowel/bladder
  • IV drug
  • infection
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22
Q

Low Back Pain​

(4)

A
  • Mechanical Low Back Pain
  • Sciatic (Radicular Low Back Pain)
  • Lumbar Spinal Stenosis
  • Chronic Back Stiffness
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23
Q

Mechanical Low Back Pain

  • Aching pain in the l______ area; may ____ into lower leg, especially along L5 or S1
  • Usually ____ (<3 months), ___pathic, b____ and self-l_____
  • Usually worse s_____ and t____ motion
  • 97% of low back presentations, __-__yo and w___ related
  • PE: paraspinal muscle t______, pain with _____, loss of lumbar l_____ (curvature)
  • ___ motor or sensory impairment
A
  • lumbosacral, radiate
  • acute, idiopathic, benign, self-limiting
  • standing, twisting
  • 30-50, work
  • tenderness, movement, lordosis
  • Not

  • most common: spinal stenosis, herniated discs, vertebral fractures, sacroiliac joint pain*
  • Mechanical - arises from spinal structures: bones, ligaments, joints, discs, nerves, meninges*
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24
Q

Sciatica (Radicular Low Back Pain)

  • Sh_____ pain below the knee, commonly into the L5 or S1 typically accompanies low back pain (ppl will say starts in the middle of my butt cheeks)
  • Associated n_____ and weakness
  • Bending, sitting, sneezing, coughing, straining during bowel movements often ____ pain
  • Disc ______ common especially if calf _____ is present
  • PE: ___ straight leg (test for herniated disc at L5, pain present between 30-70 degrees when bending leg)
  • Negative straight leg makes dx ______
A
  • Shooting
  • numbness
  • worsen
  • herniation, wasting
  • positive
  • unlikely
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25
Q

Lumbar Spinal Stenosis

  • “_______” pain in the back or legs with walking that can improve with rest or lumbar _____ (hard to differentiate from sciatica)
  • Pain vague but usually __lateral, with numbness in one or both legs (not able to walk long distances without resting-if severe enough can get dropfoot)
  • Hypertrophic degenerative disease, ____ning of the ligament causing ______ of the spinal canal
  • Common age > __
  • PE: posture flexed ___ward, lower extremity w_____ ,_____ reflexes
A
  • “pseudoclaudication”, flexion
  • bilateral
  • thickening, narrowing
  • >60
  • foward, weakness, diminished
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26
Q

Chronic Back Stiffness

  • ______ _______
    • ​Chronic inflammatory disease, progressive stiffness of the spine
    • Age onset < 40
    • Insidious onset
    • Progressive postural changes
A

Ankylosing Spondylitis

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27
Q

Chronic Back Stiffness

  • _____ _____ ____ ____ (____)
    • ​Non-inflammatory disease
    • Calcification and ossification of spinal ligaments
    • Age onset > 50
    • Decreased range of spinal motion, particulary thoracic movement
    • No cure but PT, weight control, pain relievers, sometimes surgery recommended
A

​Diffuse idiopathic skeletal hyperostosis (DISH)

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28
Q

Nocturnal Back Pain, Unrelieved by Rest

  • Consider ______ _______ to the spine from cancer of p_____, b____, l____, th_____, k_____, M_
  • PE: loss of normal lumbar l_____, muscle s_____, l_____ immobility of spine
  • C______ E_____ S______
A
  • metastatic malignancy, prostate, breast, lung, thyroid, kidneys, MM
  • lordosis, spasm, lateral
  • Cauda Equina Syndrome
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29
Q

Cauda Equina Syndrome

  • ___ back pain associated with _____ symptoms, _____ anesthesia (major red flag: numbness in all areas that touch saddle of the horse)
  • _______ of the spinal nerve root
  • Surgical ______ as the compression is often caused by a tumor, ruptured disk, infection fracture, or narrowing of the spinal canal
  • May get __ before surgery if not yet available to shrink
A
  • low, associated, saddle anesthesia
  • Compression
  • emergency
  • RT
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30
Q

Sacroilitis

  • L_______ pain radiates to b____, g____, and _____ thigh
  • ______ by extensive use, prolonged exercise (sitting, standing, exacerbation from getting up from chair)
  • PE: t______ at ___ joint
  • Can be an _____ injury or related to _____ illness
  • Systemic inflammatory conditions that can cause (3): usually an earlier symptom of these
  • Traumatic injury causes (2)
A
  • Lumbosacral, buttocks, groin, posterior
  • Aggravated
  • tenderness at SI joint
  • overuse, systemic
  • Ankylosing spondylitis, Psoriatic arthritis, OA
  • MVA, fall
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31
Q

Shoulders

  • Inspect: j___ (look for any swelling, asymmetry, muscle atrophy, deformities)
  • Palpate: sh_____ and ax____ (see if you can palpate underlying structures: acromion process, bursa, down the humerus, rotator cuff tendons under axilla)
  • Motions: and expected r____
    • Arms f____ and __
    • Arms b____ back and hands __
    • Arms to sides and up over ____
    • Touch hands ____ head
A
  • joint
  • shoulders, axilla
  • range
    • forward and up
    • behind back, hands up
    • side -> over head
    • behind
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32
Q

Rotator Cuff Tendonitis (Impingement Syndrome)

  • Usually caused from ______ or ___
  • Common in (2)
  • ____ pain that is present both with _____ and at ____
  • Pain radiating from the ___ of the _____ to the ___ of the ___
  • Sudden pain with ____ and _____ movements
  • Tenderness just below the ___ of the _____
A
  • overuse, fall
  • young adults, middle age athletes
  • minor, activity and rest
  • front of shoulder - side of arm
  • lifting, reaching
  • tip, acromion
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33
Q

Drop Arm Test

  • What does it test for?
  • Fully ____ arm to _____ level
  • Ask pt to ____ it slowly
  • (___ arm briskly)
    • test =
A
  • Rotator cuff injury/tear
  • abduct, shoulder
  • lower
  • tap
  • Pt cannot hold or control lowering their arm

Assesses for weakness in supraspinatus muscle (1/4 of rotator cuffs)

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34
Q

Empty Can Test

  • What does it test for?
  • Elevate arms to ___ degrees
  • _____ rotate so thumbs point ___ward
  • Apply ___ward pressure
  • Positive test =
A
  • Rotator cuff tear or impingement of the supraspinatus tendon, tendonitis
  • 90
  • internally, downward
  • downard
  • weakness
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35
Q

Aply Test

  • What does it test for?
  • Ask pt to touch opposite _____ using these two motions
  • Assesses ROM of glenohumoral joint
A
  • rotator cuff disorder or adhesive capsulitis
  • scapula
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36
Q

Rotator Cuff Tears

  • Injury from a f___ or repeated im_____ may weaken the rotator cuff
  • Causing a partial or complete ___, usually after age __
  • Weakness, _____ of supraspinatus and infraspinatus muscles, pain, and tenderness may ensue
  • In a complete tear of the supraspinatus tendon, active ____ and forward ____ at the g___h____ joint are severely impaired, producing characteristics of a ______ shoulder and a ____ drop arm test
A
  • fall, impingement
  • tear, >40
  • atrophy
  • abduction, flexion, glenohumeral, shrugging, positive
  • Athletes such as rowers, weightlifters, construction, assembly line workers - any with repetitive motions*
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37
Q

Dislocated Shoulder

  • Shoulder instability from _____ dislocation of _____ bone
  • The shoulder seems to “___ out of the joint”
  • Any shoulder movement may cause ___, and pts hold the arm in _____ position
  • The rounded lateral aspect of the shoulder appears _____
  • Common causes: t____, f____ players
  • Tx: usually sedation, then ____ of shoulder
A
  • anterior, humerus
  • slip
  • pain, neutral
  • flattened
  • trauma, football
  • relocation
38
Q

Adhesive Capsulitis (Frozen Shoulder)

  • F____ of the g_____ joint c____
  • Manifested by d____, d___, aching pain in the shoulder and p____ restriction of active and passive range of motion
  • Usually no _____ tenderness
  • Usually ___lateral and occurs in ppl aged __-__
  • Antecedent painful disorder of the shoulder and other condition that has ______ shoulder movements
A
  • Fibrosis, glenohumeral, capsule
  • diffuse, dull, progressive
  • localized
  • unilateral, 50-70
  • decreased

Sometimes seen after pt has a sling for awhile

39
Q

Acromioclavicular Arthritis

  • Is it rare?
  • Occurs from ___ injury resulting in _____ changes in the joint
  • Tenderness localized to _ _ joint
  • Pain with ___duction
A
  • Not un-common
  • prior, degenerative
  • AC
  • Adduction
40
Q

Elbow

  • Inspect: joint in f____ and e_____ positions
  • Palpate: j____ and b___ prominences
  • Motion and expected r____
    • B___ and s____ elbow
    • P____ and s_____ hand
A
  • flexed, extended
  • joint, bony
  • range
    • Bend, straighten
    • Pronate, supinate
41
Q

Olecranon Bursitis

  • S_____ and I_____ of O_____ B____
  • May result from t____ or be associated with rh____ or g____ arth_____
  • ____ __ appearance or redness due to inflammation of bursa
  • The swelling is s_______ to the olecranon process
A
  • Swelling, Inflammation, Olecranon Bursa
  • trauma, rheumatoid, gouty arthritis
  • Goose egg
  • superficial
42
Q

Arthritis

  • S_____ inflammation or fluid, felt in the g____ between the olecranon process and epicondyles on either side
  • Palpate for b____, soft or fluctuant swelling and for tenderness
  • Causes can be rh____, g____, osteo_____, t____
  • Pain s_____ or restricted movement
A
  • Synovial, grooves
  • boggy
  • rheumatoid, gout, osteoarthritis, trauma
  • stiffness
43
Q

Rheumatoid Nodules

  • Sub_____ nodules may develop at pressure _____ along the extensor surface of the u____ in pts with RA or Acute rheumatic fever
  • They are f___ and __tender, and are ___ attached to overlying skin
  • They may or may not be attached to underlying peri____
  • They may develop in area of the olecranon bursa, but often occurs more d______
A
  • Subcutaneous, points, ulna
  • firm, nontender, not attached to skin
  • periosteum
  • distally
44
Q

Lateral Epicondylitis

  • Also known as a “_____ elbow”
  • Follows r_____ ex____ of the w___ or p___-s____ of the f_____
  • Pain and tenderness develop _cm d___ to lateral epicondyle and possibly in the extensor muscles close to it
  • When the patient tries to ____ the wrist against r____, pain _____
A
  • “Tennis elbow”
  • repetitive extension, wrist, pronation-supination of the forearm
  • 1cm distally
  • extend, resistance, pain increases
45
Q

Medial Epicondylitis

  • p____’s, g_____’s, or Little _____ elbow
  • Follows repetitive wrist _____, as in th_____
  • Tenderness is maximal just l____ and d___ to the medial epicondyle
  • Wrist flexion against resistance increases _____
A
  • pitcher’s, golfer’s, little league
  • flexion, throwing
  • lateral, distal
  • pain
46
Q

Techniques of Examination: Overview for Wrist and Hand

  • Inspect: p____ and d___ surfaces of wrist and hand for swelling, deformities, surface contour, alignment of wrist and fingers, and any bony deformities
    • At rest, the fingers should be slightly f____ and aligned almost in p____
  • Palpate
    • Distal radius and ulna at the wrist on lateral and medial surfaces, the g____ of each wrist, radial styloid bone anatomical s____, the eight ___ bones, compress the ____ joints by s_____, an palpate the MCP, PIP, and DIP joints for swelling or tenderness
A
  • Inspect: palmar, dorsal
    • flexed, parallel
  • Palpate
    • groove, snuffbox, carpal, MCP, squeezing
47
Q

Techniques of Examination: Wrist and Hand

  • ​Range of Motion
    • ​_____: flexion, extension, ulnar (_____) and radial (_____) deviation
    • _____: flexion, extension, abduction (fingers spread ____), adduction (finger back ____)
    • _____: flexion, extension, abduction (thumbs move away from ____), adduction (thumb moves ____ palm), o____ (thumb touches each finger)
  • Test hand ____ strength (____ your fingers to not hurt yourself)
  • Test s______ on the palmar and dorsal surfaces innervated by the median, ulnar, and radial nerves
A
  • Range of Motion
    • ​Wrist: abduction, adduction
    • Fingers: apart, together
    • Thumb: palm, toward, opposition
  • Grip, cross
  • Sensation
48
Q

Dupuytren’s Contracture

  • The first sign of thickened p______ overlying the f____ tendon on the ____ finger and possibly the l_____ finger at the level of the distal palmar crease
  • Subsequently the skin in this area p_____, and a thickened fibrotic____ develops between palm and finger
  • Flexion c______ of fingers may gradually ensue
  • Increased risk in alcohol ____ disease, D _, thy____ issues, ep_____
  • May be mild with skin _____ or if severe enough may require surgery to ____ tension from the fibrotic cord
A
  • plaque, flexor, ring, little
  • puckers, cord
  • contracture
  • liver, DM, thyroid, epilepsy
  • changes, release
49
Q

Trigger Finger

  • Caused by a painless n____ in a flexor ____ in the palm, near the metacarpal ____
  • The nodule is too big to enter easily into tendon _____ during ____ of the fingers from a flexed position
  • The finger extends and flexes with an audible ___; as the nodule pops into the tendon sheath
  • Watch, listen, and palpate the nodule as the patient flexes and extends the fingers
A
  • nodule, tendon, head
  • sheath, extension
  • snap (can be loud and violent snap)
50
Q

De Quervan’s Tenosynovitis

  • Pain with ______ over the tendon sheath of what finger?
  • ____ may be present
  • N_____ of thumb and index finger
  • More common in what gender? Can occur 3-4 wks after _____
  • F_____ test
    • Make a ____ with the thumb _____
    • F___ the wrist, tenderness along the ___ edge of the wrist
  • Fairly c_____, usually t_____, caused by the overuse - gardening, racket sports, carrying a baby around
  • Tx = _ _ _ _ - tends to be self-limiting
A
  • palpation, thumb
  • Swelling
  • Numbness
  • Females, pregnancy
  • Finklestein test
    • fist, enclosed thumb
    • Flex, outer
  • common, temporary
  • RICE
51
Q

Carpal Tunnel Syndrome

  • _______ of the ______ nerve as it travels through the carpal ____
  • Pain, n______, and t_____ along the distribution of the median nerve
  • Th____ atrophy may be present
  • Ph____ test: hold for __ sec, compresses median nerve, illicit pain tingling
  • Tinels t_____ over the median nerve produced numbness or tingling
A
  • Compression, median, tunnel
  • numbness, tingling
  • Thelnar
  • Phalen, 60 sec
  • tapping
  • Bottom left = thelnar muscle - atrophy of this when severe*
  • Phalen test: back of hands together, within 60 sec will feel pain or tinger = + test*
  • Tx: initially splints to keep wrists from flexing downward, surgery if severe*
52
Q

Hip

  • Inspect: as person ____, pay attention to their g___
  • Palpate: with person in what position?
  • Motion and expected range
    • Raise leg (Should be able to get up to ___ degrees)
    • Knee to ____
    • Flex knee and hip, swing foot ___ and ___
    • Swing leg l____, m____
    • Stand and swing leg ____ (hyperextension of hip, should get at least __ degrees)
A
  • stands, gait
  • supine
  • Range
    • 90
    • Chest
    • in, out
    • laterally, medially
    • back, 15
53
Q

Assess Gait

  • ____ = the time the foot is on the ground bears weight
  • Most hip problems appear during what phase?
  • _____ = movement of the foot foward, non-weight bearing
    • Wide base suggests _____ disease or ____ problems
    • Swinging; due to lack of ___ flexion
    • Pelvic ___ on opposite side: Hip dislocation, arthritis, leg length discrepancy
A
  • Stance
  • Stance phase
  • Swinging
    • Cerebellar dx, foot problems
    • knee
    • drop
54
Q

Bursitis

  • Bursitis is an inflammation or degeneration of the ___-like structures that protect the ___ tissues from underlying ___ prominences
  • Pain just with movement?
  • Sw_____
  • _______ tenderness over site of inflammation
  • If effusion present - ____ fluid to assess for infection, gout
A
  • sac, soft, bony
  • movement and rest
  • Swelling
  • Localized
  • aspirate
55
Q

Hip Abnormalities

  • Flexion Deformity
    • ​Excess ____
    • As the opposite hip is _____ (with the thigh against the chest), the affected hip does not allow for full leg _____, and the affected thigh appears _____
  • Hip osteoarthritis
    • ​Restricted ___duction
    • Restrictions of internal and external _____
A
  • Flexion Deformity
    • lordosis
    • flexed, extension, flexed
  • Hip osteoarthritis
    • abduction
    • rotation
56
Q

Knee

  • Inspect: j____ and m____
  • Palpate
  • Motion and expected range
    • _____ knee
    • _____ knee
    • Check knee while ____
A
  • joint, muscle
  • ROM
    • bend
    • extend
    • ambulate
57
Q

Specific Tests for Effusion of the Knee

(2)

A

Bulge Sign
Ballottement of Patella

58
Q

Bulge Sign

  • Have pt ____ knee joint, you want to ___ the fluid to the suprapatellar pouch and apply ____ pressure -> ____ and watch for fluid w____
A
  • extend, milk, medial, tap, wave
59
Q

Ballottement of Patella

  • Apply pressure ___wards towards foot, with one hand while pushing patella ___wards towards femur - if present of fluid you should see fluid ___ as well
A
  • downwards, backwards, wave
60
Q

Test for Stability of the

Lateral Collateral Ligaments (LCL)

(1)

Medial Lateral Ligaments (MCL)

(1)

A

Varus Test

Valgus Test

61
Q

Varus Test

  • ______ (or Varus) Stress Test
  • Place one hand against the _____ surface of the knee and the other around the ____ ankle
  • Push _____ against the knee and pull ____ at the ankle to open the knee joint on the lateral side (varus stress)
  • Pain or gap in the lateral joint line points to ligamentous l____ and a partial ___ of the lateral collateral ligament.
A
  • Adduction
  • medial, lateral
  • laterally, medially
  • laxity, tear
62
Q

Valgus Test

  • With the patient supine and the knee slight flexed, move the thigh about ___ degrees laterally to the side of the table
  • Place one hand against the ____ knee to stabilize the femur and the other hand around the ____ ankle
  • Push _____ against the knee and pull _____ at the ankle to open the knee joint on the medial side (valgus stress)
  • Pain or gap in the medial joint line points to ligamentous _____ and a partial ___ of the medial collateral ligament.
  • MCL or LCL more common?
A
  • 30
  • lateral, medial
  • medially, laterally
  • laxity, tear
  • MCL injuries more common
63
Q

ACL Tests

(2)

A

Lachman’s Test

Anterior Drawer Test

64
Q

Lachman’s Test

  • Assesses the integrity of the ____
  • Place the knee at __ degree flexion and ____ rotated
  • Grasp the distal femur on the ____ side with one hand and the proximal ____ with the other
  • Pull the tibia ___ward while stabilizing the femur
  • Estimate the degree of forward ______ of the tibia
  • Forward excusion = ACL ____
A
  • ACL
  • 15, externally
  • lateral, tibia
  • forward
  • excursion
  • ACL tear
65
Q

Test for Stability of the Anterior Cruciate Ligaments

(1)

A

Anterior Drawer Test

66
Q

Anterior Drawer Test

  • With the patient supine, hips flexed and knees flexed __ degrees and feet __ 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 ____ and observe it it slides forward (like a ____) from under the _____
  • Compare the degree of forward movement with that of the _____ knee
  • Positive Anterior Drawer Sign = A forward j____ showing the contours of the upper tibia, making an ____ tear 11.5x more likely
A
  • 90, flat
  • foward, drawer, femur
  • opposite
  • jerk, ACL tear
67
Q

Test for Stability of the Posterior Cruciate Ligament

(1)

A

Posterior Drawer Test

68
Q

Posterior Drawer Test

  • Position the patient and place your hands in the positions described as the anterior drawer teset
  • Push the tibia ______ and observe the degree of ____ movement in the femur
  • Isolated PCL tears are _____
A
  • posteriorly, backward
  • rare
69
Q

McMurray’s Test

What does it test for?

A

Meniscal Injury

70
Q

McMurray’s Test for Meniscal Injury

  • With the patient supine, grasp the ____ and flex the ____
  • Cup your other hand over the ____ joint with fingers and thumb along the medial and lateral joint line
  • From the heel, rotate the lower leg ____ and _____
  • Then push on the ____ side to apply a ____ stress on the medial side of the joint
  • At the same time, rotate the leg _____ and slowly ____ it
  • If a _____ 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 _____ for a posterior ____
A
  • heel, knee
  • knee
  • internally, externally
  • lateral, valgus
  • externally, extend
  • click, meniscus, tear
71
Q

Ankle/Foot

  • Inspect: with person s____, s_____, and w_____
  • Palpate: j____
  • Motion and expected range
    • Point ___ down, up
    • Turn ___ out, in
    • Flex and straighten ___
A
  • sitting, standing, walking
  • joints
  • ROM
    • toes
    • soles
    • toes
72
Q

Thompson Test

  • Assess for a complete?
  • Position of patient
  • Examiner _____ the ____ muscles
  • Squeezing the calf should cause the tendon to _____ and the foot will ___
  • What indicates a Achilles tendon rupture?
A
  • Achilles Tendon rupture
  • Face down on exam table, foot hanging off the edge
  • squeezes, calf
  • contract, flex
  • None or reduced movement
73
Q

Gout

  • The metatarsophalangeal of the ___ toe may be the first joint involved in a_____ gouty a_______
  • It is characterized by a very painful and tender, h__, dusky r__ swelling that extends ______ the margin of the joint
  • It is easily mistaken for ______
  • Acute gout may also involve the d_____ of the foot
  • Caused by buildup of s____ u____ or u___ a___ which is a by product of ______
    • For an acute episode - probably just ___ modification
    • Tx: _____ for inflammation
A
  • great toe, acute gouty arthritis
  • hot, dusky red, beyond
  • cellulitis
  • dorsum
  • sodium urate, uric acid, purines
    • ​diet
    • steroids
74
Q

Pseudo-Gout

  • From ______-_______ deposition (CPPD)
  • ____ or ____-articular joint pain caused by a build up c_____ p_____ in the joint
  • Inflammation of the joint and p___articular area maybe present
  • Older population > __ yrs of age
  • Difficult to distinguish between ____
  • Requires _____ of synovial fluid for definitive diagnosis
A
  • calcium-pyrophosphate
  • Mono, poly, calcium-pyrophosphate
  • peri
  • >60
  • gout
  • aspiration
75
Q

Flat Feet (PesPlanus)

  • Signs of flat feet may only be apparent when patient ____, or may become ______.
  • The longitudinal arch _____ so that the sole approaches or touches the f____.
  • The normal concavity on the medial side of the foot becomes c_____
  • Tenderness may be present from the medial m_____ down along the medial plantar surface of the foot
  • Swelling may develop _____ to the malleoli
  • Inspect the shoes for excess ____ on the inner sides of the soles and heels
A
  • stands, permanent
  • flattens, floor
  • convex
  • malleolus
  • anterior
  • wear
76
Q

Plantar Fasciitis

  • What is it?
  • Planta fasciitis is one of the most common causes of?
  • Age __-__, younger in r_____
  • Risk factors
    • O_____
    • _____ standing or jumping
    • ____ feet
    • ______ ankle dorsiflexion
    • Heal s_____
A
  • Inflammation of the plantar fascia
  • heel pain
  • 40-60, runners
  • Risk factors
    • Obesity
    • Prolonged
    • Flat
    • Reduced
    • spurs
77
Q

Hallux Valgus

  • In Hallux valgus - the great toe is abnormally __ducted in relationship to the first metatarsal, which itself is deviated _____.
  • The head of the first metatarsal may _____ on its ____ side, and a ___ may form at the pressure point
  • This bursa may become in____
A
  • abducted, medially
  • enlarge, medial , bursa
  • inflamed
78
Q

Other Feet Abnormalities

  • Pes Varus =
  • Pes Valgus =
A
  • Developmental condition that results in limb deformity and foot turned inward, these pts tend to have flat feet
  • Feet turned slightly outward, somewhat common 20% in adults
79
Q

A painful conical thinkening of skin that results from recurrent pressure on normally thin skin =

  • The apex of the corn points __ward and causes ___
  • Corns characteristically occur over ___ prominences such as the __ toe
  • When located in moist areas such as pressure points between the 4th and 5th toes, they are called ___ corns
A

Corns

  • inward, pain
  • bony, 5th
  • soft
80
Q

Callus

  • Like a corn, a callus is an area of greatly thickened skin that develops in a region of recurrent p_____
  • Unlike a corn, a callus involves skin that is normally ____, such as the sole, and is usually _____
  • If a callus is painful especially in one particular spot, suspect an underlying p____ w____
A
  • pressure
  • thickened, painless
  • plantar wart
81
Q

Plantar Wart

  • Caused by?
  • Common on the ___ of the foot
  • Can be tender and painful with ______
A
  • HPV
  • ball
  • ambulation
82
Q

Arthritis

(2)

A

Osteoarthritis

Rheumatoid Arthritis

83
Q

Osteoarthritis

  • D______ joint disease
  • Breakdown of c_____ in the joint
  • ___ related
  • ___-inflammatory, can be __lateral
  • Affects kn___, h___, h____, sp____, w_____
  • _____ stiffness < 1 hr and ___ day pain, pain after a____
  • _______ Nodes at DIP
  • _______ Nodes at PIP
  • _______ Nodes at MCP
A
  • Degenerative
  • cartilage
  • Age
  • NON-inflammatory, unilateral
  • knees, hips, hands, spine, wrists
  • Morning, late, activity
  • Heberden’s
  • Bouchard’s
  • NONE
84
Q

Rheumatoid Arthritis

  • _______ disorder with chronic ______ of the _____ membrane and surrounding tissue
  • S_____ involvement of hands and feet, wrist, ankle, elbows, knees
  • Occurs at what age?
  • Morning stiffness how long?
  • Joints are t____, w___, r___, sw_____
  • ____ hx
  • F_____
  • _________ Deformity of PIP
  • S____ n____ deformity of finger
A
  • Autoimmune, inflammation, synovial
  • Symmetric
  • any age
  • > 1 hour
  • tender, warm, red, swollen
  • Family
  • Fatigue
  • Boutonniere
  • Swan neck

Muscular atrophy as disease progresses

85
Q

Arthritic disorder causing inflammation of the joints

Inflammation of the intestinal, urinary tract, eyes and skin

A

Reactive Arthritis (Reiter’s Syndrome)

86
Q

Reactive Arthritis (Reiter’s Syndrome)

  • Symptoms do not occur all at ____ and are not always present with joint ____
  • Most commonly found organism: Ch_____ Trachomatis, Y____, Sa_____, Sh____, Camp____, Escheria ____, C____ d____, and Ch____ pneumoniae
  • Diagnosis based on good ___ and ____ exam
  • Tx (2)
A
  • once, pain
  • Chlamydia, Yersinia, Salmonella, Shigella, Campylobacter, E.coli, C.diff, Chlamydia
  • history, physical
  • abx and anti-inflammatories
87
Q

MSK Complain: “Joint Pain”

  1. You decide is it
    • ___ or ___ articular
    • Is it a____ or ch____
    • Is ______ present
    • How ____ joints involved
  2. Non-articular condition-consider
    • T____/F____
    • F_____
    • P____ rheumatic
    • Bu____
    • Ten____
A
  1. You decide is it
    • Intra, Extra
    • acute, chronic
    • inflammation
    • many
  2. Non-articular
    • Trauma/Fracture
    • Fibromyalgia
    • Polymyalgia
    • Bursitis
    • Tendinitis
88
Q

MSK Complain: “Joint Pain”​​ cont

  • Intra articular < 6 weeks
    • (5)
  • Intra articular > 6 weeks
    • Is i_____ present
    • Is there prolonged _____ stiffness
    • Is there s____ tissue swelling
    • Are there s____ symptoms
    • Is the _ _ _ or _ _ _ elevated
  • No for inflammation
    • Think non-inflammatory arthritis such as (1)
  • Yes for inflammation
    • Ask how ____ joints involved?
    • > 3 joints increased risk for (1)
    • < 3 joints think (2)
A
  • Intra-articular < 6 weeks
    • Acute arthritis
    • Infectious arthritis
    • Gout or Pseudo-gout
    • Reiter’s syndrome
    • Early presentation of chronic arthritis
  • Intra-articular > 6 weeks
    • inflammation
    • morning
    • soft
    • systemic
    • ESR, CRP
  • No inflammation
    • Osteoarthritis
  • Yes inflammation
    • many
    • RA
    • Psoriatic or Reiters arthritis
89
Q

Pain Syndromes

(2)

A

Polymyalgia Rheumatica

Fibromyalgia

90
Q

Polymyalgia Rheumatica

  • Chronic self-limiting pain with _____ etiology
  • Usually >__ yo, can occur with (1)
  • _____ pain around hips, shoulders, neck
  • Onset (2), Can be ___ time pain
  • Swelling and edema maybe present over dorsum of h___, w___, f____
  • Muscles t____ but not inflamed, warm or red
  • Joint _____ in arm
  • Pain will not limit ______
  • May have associated de_____, an_____, weight ____
  • Can resolve spontaneously, but usually ppl will be on _____ for 1-2 years
A
  • unclear
  • >50, giant cell arteritis (temporal arteritis)
  • Symmetric
  • Abrupt or Insidious, night
  • hands, wrist, feet
  • tender
  • stiffness
  • movement
  • depression, anorexia, weight loss
  • steroids
91
Q

Fibromyalgia

  • Chronic MS pain disorder affecting the ___ _____
  • Felt to be related to a_____ pain signaling that amplifies pain response
  • Pain “___ ____” neck, shoulders, hands, low back and knees, Sometimes have trigger points on exam + _____ of pain
  • ______ can shift, maybe exacerbated by ___, imm_____
  • Associated with fatigue, depression/anxiety, headaches, cognitive f____ “fibromyalgia f___”
  • Tx: Pain ___, physical _____, _____ modification - whatever helps
A
  • soft tissue
  • aberrant
  • “all over”
  • region
  • Pattern, cold, immobility
  • fogginess “fibromyalgia fog”
  • meds, therapy, lifestyle

Advanced Clinical Assessment (4 decks)

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