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NUNP 540 (Kelly's flashcards) > MSK > Flashcards

MSK Flashcards

1
Q 
Characteristics/quality of pain: 
Nerve
Bone
Vascular
Muscle
A

Nerve: sharp, burning, follows a nerve
Bone: deep, localized
Vascular: diffuse, aching, poorly localized, many be referreed
Muscle: dull and aching, poorly localized, may be referred

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2
Q 
Referred sites of pain: 
Neck 
Back
Appendix 
Heart/diaphragm
A

Neck: arm
Back: leg
Appendix: (hip) right iliac fossa
Heart/diaphragm: shoulder

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3
Q

Inflammatory versus degenerative pain characteristics

A

Inflammatory: morning stiffness > 30 min, pain w/ erythema, warmth, swelling, responds to NSAIDS

Degenerative: pain worse at end of day, after activity, morning stiffness < 30 min if present

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4
Q

Neurologic symptoms

A

cauda equina symptoms, bowel/bladder incontinence or retention, headaches, weakness

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5
Q

Claudication: vascular symptoms

A

Exercise-induced, no pain at rest, pain stops within 10 min of stopping activity. Calf, buttocks, thigh, foot pain. Must differentiated from neurogenic symptoms (spinal stenosis, sciatica)

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6
Q

SEADS

A 
Swelling
Erythema
Atrohpy
Deformity 
Skin changes
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7
Q

WETCJ

A 
Warmth 
Effusion 
Tenderness
Crepitus 
Joint stability
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8
Q

Causes of hypermobile joints

A

Ligament
Collegen disorders
Tendinitis
RA

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9
Q

Causes of hypomobile joints

A

muscle strains
pinched nerves
tendinitis
OA

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10
Q

What is end-feel? What are the different types?

A

End-feel is felt by the examiners hand at the end of passive ROM.

Bone - bone: cold stop, elbow extension

Soft tissue approximation: muscles coming together like pillows squishing, elbow flexion

Tissue stretch: springy/firm with slight give, tendons stretching, wrist flexion

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11
Q

ADLS (DEATH)

A 
dressing 
eating
ambulating 
toileting 
hygiene
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12
Q

Trendelenburg sign

A

contralateral hip drop (lift good leg)

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13
Q

Trendelenburg gait

A

waddle

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14
Q

Circumduction gait

A

leg swings around

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15
Q

Limp

A

Antalgic

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16
Q

Impingement syndrome (shoulder) characteristics

A

night pain
dull ache
weakness with arm drop test
atrophy of rotator muscles

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17
Q

Rotator cuff injury

A

Weakness with arm drop
Atrophy of rotator cuff muscles
Night pain

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18
Q

Subacromial bursitis

A

Tenderness at anterior-inferior acromion

Limited ACTIVE ROM but full PASSIVE ROM

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19
Q

Bicipital tendon rupture (Proximal)

A

Asymmetry with bulge deformity

Sharp ache

Hx trauma

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20
Q

Bicipital tendonitis

A

Overuse injury

Dull ache

Tenderness over biceps groove

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21
Q

Labral tear

A

Hx trauma (dislocation) or overuse (throwing injury).

Mimics rotator cuff!!

Instability.

Suspect based on demographic, hx, lack of response to conservative treatment.

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22
Q

AC pathology

A

Painful Arc

Painful and tender over AC

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23
Q

Adhesive capsulitis

A

Frozen shoulder.
Early phase pain may be the only symptom.
Pain at night or with movements to constant pain.
Later phase global restriction in active or passive ROM
Consider fasting glucose - prevalent in DM.

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24
Q

Axillary nerve mononeuropathy

A

shoulder flexion/abduction/external rotation (FEAR) weakness. Atrophy deltoid teres minor.

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25
Q

Suprascapular nerve palsy

A

overhead abduction, external rotation weakness (OAR)

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26
Q

Long thoracic nerve injury

A

Shoulder flexion and overhead. Scapular winging and atrophy of serrates anterior.

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27
Q

Rotator cuff tear

A

unable to raise arm overhead, positive arm drop test/empty can test

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28
Q

Cervical nerve root lesion

A

myotome weakness. Pain and sensation reduction in dermatome distribution, Reduced DTR.

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29
Q

Spinal accessory nerve pathology

A

Traps, SCM, scapular winging. Reduced flexion and abduction.

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30
Q

SITS

A

supraspinatus
infraspinatus
teres minor
subscapularis

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31
Q

Shoulder ROM

A 
Forward flexion 180
Backward flexion 60
Abduction 180
Adduction 50
ER 90
IR 70
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32
Q

Shoulder assessment:

Inspection and Palpation

A

Inspection: contours, clavicles, SC/AC joints, scapulae, SEADS

Palpation: SC/AC/GH joints. Biceps groove, subdeltoid bursa, AC joint and rotator cuff insertion. Check GH for crepitus by palpation of subacromial bursa and passive circumduction

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33
Q

Special tests for: General shoulder instability

A

o Anterior apprehension: push forwards (anteriorly) on humeral head while externally rotating shoulder passively. Popping or fear of pain/dislocation = positive.
o Relocation test: posterior pressure on humeral head = resolved apprehension (positive)
o Anterior release test: positive if when releasing hand (from postrior pressure above) = pain/apprehension
o Load and shift: compress into glenoid (stabilize) and stabilize scapula then move humeral head anterior/posterior… shift should be < 25% ant and < 50% posterior
o Sulcus: pull arm vertically down (anatomic position), if humeral head slides inferiorly or gap = positive

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34
Q

Special tests for: Glenoid labral pathology

A

o O’Brien’s: adduct and internally rotate arm, then apply downward pressure against resistance… then repeat w/ externally rotate. Postive = pain with supination, relief with pronation.
o Anterior slide: hands on hips, stabilize clavicle and scapula, push up and forwards on elbow

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35
Q

Special tests for: Rotator cuff tears:

A

o Drop arm test
o Empty can test: arms 45 degrees, thumbs down, push up against force
o External rotation resistance
o Internal rotation lag: arms behind back, 90 degrees, examiner lifts hand off back. Positive test = patient cannot hold.
o Gerber lift-off test – same set up as internal rotation but patient lifts their hand off back against resistance, pain or cannot lift.

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36
Q

Special tests for: Impingement syndrome:

A

o Neer’s test: stabalize scapula. Internally rotate and forward flex arm. Anterolateral shoulder pain = positive test.
o Hawkins-Kennedy test – with shoulder and elbow flexed at 90 degrees, passively internally rotate shoulder. Pain = supraspinatus impingement.
o Painful arc test: posive test pain at 60-120 degrees abduction

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37
Q

Special tests for: AC joint pathology

A

o Scarf test (across body adduction test): adduct on horizontal plane. Positive test: pain in AC

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38
Q

Special tests for: Bicipital tendonitis:

A

o Yergason test: patient attempt to supinate arm and flex elbow against resistance. Pain = biceps tendonitis
o Speed’s test: patient flexes shoulder to 60 degrees, elbow extended, arm supinated. Resists downward pressure. Positive = pain in bicipital groove.

39
Q

Shoulder dislocation: anterior vs posterior

A

Anterior: slight abduction & IR (Anterior = AIR)

Posterior: sulcus adduction and ER

40
Q

AC joint pathology characteristics

A

swelling, bruising, prominent clavicle
AC joint separation common in sports
Poor ROM and moderate pain when raising arm
SCARF test
Rare complication = brachial plexus injury => assess neurovasc

41
Q

Elbow assessment: Inspection and Palpation

A

Inspection: swelling, masses, note carrying angles,, symmetry, flexion contractures, hyperextension

Palpate:
Cubital fossa contents: biceps tendon, brachial artery, median nerve

Muscles: biceps, pronator teres, flexor carpi radialis and ulnaris, palmaris longus, flexor digitorum superficialis

Medial and lateral epicondyles, medial and lateral collateral ligaments, ulnar head and radial head

olecranon, olecranon bursa, triceps

42
Q

Elbow ROM

A

Flexion 180
Extension 0
Supination 80-90
Pronation 80-90

43
Q

Special tests for radial or cubital tunnel syndrome

A

Tinel test (tap the ulnar nerve, or the ‘funny bone’… between olecranon process and medial epicondyle)

44
Q

Special tests for medial epicondylitis

A

1) Active resisted D3 flexion
2) Palpate medial epicondyle and passively supinate and extend elbow then extend wrist. Pain at medial epicondyle = positive

45
Q

Special test for lateral epicondylitis

A

Extend elbow and wrist in pronation. Have patient actively resist {extension against resistance) while trying to flex the wrist
• Positive test = pain with lateral epicondyle
????

46
Q

Olecranon bursitis

A

Minor trauma. Focal swelling at posterior elbow. Aseptic (gradual); septic (sudden).

47
Q

Ulnar nerve subluxation

A

Medial elbow pain, snapping sensation, ulnar distribution parenthesis

48
Q

Wrist ROM

A 
flexion 80
extension 70
radial deviation 20 
ulnar deviation 30
supination 80-90
pronation 80-90
49
Q

Carpal tunnel

A 
night-time 
median nerve distribution 
tinel and phalen 
Katz hand diagram 
pertinent negative: normal thumb abduction strength
50
Q

De Quervain’s

A

weakness of grip and pain at base of thumb

Finkelstein test! flex thumb and close fingers over it, then move into ulnar deviation… pain = positive

51
Q

Extensor carpi ulnaris tendinopathy:

A
  • Ulnar/radial deviation = snapping
  • Can tear the ECU subsheath, causing instability/subluxing of the tendon
  • Press thumbs together  pain on ulnar side
52
Q

Ganglion cyst:

A
  • Dorsal or volar hand mass, maybe be painful

* Palpable, firm, transilluminates, vascular exam to exclude arterial impingement

53
Q

TFCC (triangular fibrocartilage complex) injury:

A
  • Pain with turning doorknob. MOI fall on extended/pronated wrist.
  • Soft spot volar to styloid process
54
Q

Keinbock’s disease:

A
  • lunate bone AVN
  • Progressive dorsal wrist pain with activity, hx wrist trauma
  • Decreased ROM, grip. Effusion. Tender radiocarpal joint.
55
Q

Ulnocarpal abutment syndrome

A

dorsal/ulnar sided wrist pain, worse with ulnar deviation and grip

56
Q

FOOSH injuries (3)

A

Distal radius (Colle’s): pain, fork-like deformity

Distal radioulnar joint subluxation (DRUJ): Snapping/crepitus, pronation with compression of the ulna against the radius, decreased grip strength

Scaphoid:
snuffbox pain/tenderness/swelling
Can result in AVN –> painful radoiocarpal & CMC ROM. Hx trauma with or without fracture

57
Q

What motor responses do the radial, median and ulnar nerves control?

A

Radial: finger extension, thumb and wrist

Median Thumb IP flexion, index/finger flexion, wrist flexion

Ulnar: finger ab/adduction

58
Q

Long flexor tendon avulsion

A

pain after eccentric forced DIP flexion

Finger rests at slight extension compared to other digits

unable to actively flex DIP, tender solar distal finger

59
Q

What are some differentials for spine pain?

A
  • Degenerative (90%)
  • Spinal stenosis (claudication-like pain… caused by osteophyte, central disc, congenital… neural involvement of a particular root)
  • Peripheral nerve compression (radiculopathy from disc herniation)
  • Infection
  • Cauda equina
  • Fracture
  • Spondyloarthropathies
  • Referred pain (aorta, renal ureter, pancreas).
60
Q

Radiculopathy (spine)

A

L4/L5 or S1S2

pain worse with back movement, constant pain (at some point)

61
Q

Neck ROM

A

flexion 90
Extension 70
side flexion 20-45
rotation 70-90

62
Q

Cervical spine myotomes

A 
Neck flexion 	C1-C2
Neck side flexion	C3
Shoulder elevation	C4
Shoulder abduction	C5
Elbow flexion and/or wrist extension 	C5/C6
Elbow Extension and/or wrist flexion 	C7
Thumb extension and/or ulnar deviation 	C8 
Abduction and/or adduction of hands	T1
63
Q

upper extremity reflexes

A

Biceps C5, C6
Triceps C6, C7, C8
Brachioradialis C5, C6

64
Q

Wainner’s criteria for cervical radiculopathy

A

3/4 of the following:

  • cervical rotation < 60
  • Spurling’s test (side flex neck toward affected side, positive test is reproduction of radicular symptoms)
  • distraction test (pull on head = relief of symptoms)
  • upper limb tension sign: reproduction of symptoms = positive test)
65
Q

What does Adam’s forward bend test demonstrate?

A

scoliosis if prominent rib

66
Q

Thoracic outlet syndrome

A
  • Thoracic outlet ring is formed by top three ribs, just below collarbone.
  • TOS occurs when nerves or blood vessels are compressed by ribs.
  • Arterial, venous, neurogenic
  • Often caused by a cervical rib – which compresses subclavian artery
  • Ischemia one hand (bilateral  reynold’s)
  • Palpate radial pulse while applying traction to arm. Obliteration of pulse  positive test
  • Paresthesia is usually severe
  • May have hypothenar wasting.
67
Q

lower extremity reflexes

A

Patellar L3, L4
Medial hamstring L5, S1
Achilles S1, S2

68
Q

Ectomorphic
Mesomorphic
Endomorphic

A

Ectomorphic – little body fat
Mesomorphic – heavily muscles – little body fat
Endomorphic – large amt body fat

69
Q

what might café au lait spots indicate?

A

neurofibromatosis

70
Q

lower extremity myotomes

A 
Hip flexion 	L2
Knee extension 	L3
Ankle dorsiflexion 	L4
Great Toe Extension 	L5
Ankle Plantar Flexion, Ankle Eversion, Hip Extension 	S1
71
Q

Tests for lumbar disc herniation

A
  • Straight leg test
  • Ankle dorsiflexion against resistance is more precise than heel stand test
  • Calf wasting
  • Can also measure: femoral stretch test (prone – hip extension = pain = L2-L4), rib to pelvis distance (normal is 3 fingerbreadths)
72
Q

Cervical spondylosis:

A

cervical pain and suboccipital headache. Cervical radiculopathy – sensory dysfunction and/or motor dysfunction.

73
Q

Whiplash symptoms:

A

suboccipital HA. Progressive onset of neck pain (peak 12-72 hrs post-trauma)

74
Q

Ankylosing spondylitis

A

insidious onset, back pain > 3 months, patients < 40. Pain worse in AM, improves with exercise and NSAIDS.

75
Q

spinal stenosis

A

back pain walking or standing, relieved with sitting or flexed position, focal weakness o sensory changes.

76
Q

Hip ROM

A 
Hip ROM 
Flexion 	120
Extension 	30
Abduction 	45
Adduction 	30
Rotation (Flexion/Extension, Internl/External)	45
77
Q

FADIR

A

flexed, adducted, internally rotated… anterior impingement syndrome

78
Q

FABER (Figure 4)

A

Hip, SI joint, iliopsoas spasms

79
Q

Ober’s

A

Pt side lying… Passively move leg to hook the IT band over greater trochanter and their leg remains elevated…

80
Q

snapping hip (iliopsoas bursitis)

A

audible snap/clunk at inguinal crease when extending hip from flexed position… can be painful

81
Q

Piriformis syndrome

A

leg and buttock pain with radiation to lower extremity consistent with sciatic nerve impingement. Decreased internal rotation.

82
Q

Special knee tests or fluid/effusion:

A

o Patellar: displace suprapatellar pouch by sliding hand down then press on patella, click = positive
o Ballotment: ballot the fluid between medial and lateral patellar fossa
o Bulge test: move fluid from medial to lateral, back to medial. Positive if small effusion, negative if large

83
Q

Special knee tests for ligament pathologies:

A

o Anterior drawer (mvt > 1.5cm = ACL tear)
o Lachman: push femur/pull tibia. 84% sensitive for ACL
o Posterior drawer: PCL tear (mvt > 1 cm)
o Posterior Sag sign:
o MCL
o LCL

84
Q

Special knee tests for menisci:

A

o McMurray: flex knee, externally rotate foot, and extend knee, if click or pain = positive
o Lateral meniscus: same as McMurray but internally rotate foot

85
Q

patellofemoral syndrome (runner’s knee)

A

anterior pain, dull ache, worse when going down stairs.

86
Q

Patellar tendinopathy (jumper’s knee)

A

overuse… anterior pain with jumping localized to patellar tendon

87
Q

Foot ROM

A 
Plantar flexion 	50
Dorsiflexion	20
Inversion of heel	35
Eversion of heel 	15
Supination of forefoot 	35
Pronation of forefoot	15
88
Q

plantar fasciitis

A

gradual onset, posteromedial heel pain with chronic overuse, worst when getting out of bed and at the end of day

89
Q

Lisfranc fracture (tarsometatarsal fracture/dislocation)

A

hyperplantarflexed forefoot

90
Q

Morton’s neuroma

A

pain 2nd and 3rd metatarsal heads, web space paresthesia, worse with tight shoes

91
Q

Bunion

A

hallux valgus deformity

92
Q

Charcot foot

A

foot and ankle swelling, may be painless. Deformity (rocker bottom), sensory deficit

93
Q

6 P’s of compartment syndrome

A
  • Pain
  • Pallor
  • Paresthesia
  • Paralysis
  • Pulselessness
  • Poikilothermia

NUNP 540 (Kelly's flashcards) (10 decks)

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