MSK Advanced Differential Diagnosis Flashcards
Subacromial impingement
Ant/lat pain
Pain at night
Painful arc 60-120 deg
Special tests:
Neer
Hawkins
Yocum
Jobe (empty can)
Rotator cuff tear
Age >40 (overuse) or traumatic MOI
Ant/post/sup shoulder pain w/ loss of strength
Pain during sleep, worst at night
Weakness and atrophy
Special tests:
ER lag
Drop arm
Hornblower’s
IR lag
Lift off
Belly press
Bear hug
SLAP - labrum tear
Traumatic MOI
Deep anterior shoulder pain
Click/clunk/locking
Pain w/ throwing, biceps loading
Special tests:
Biceps load
Active O’Brien
Clunk
AC Joint Injury
Trauma that displaces the shoulder girdle inferiorly or heavy weightlifting
Pain at sup shoulder
Painful arc 170-180
Pain w/ horizontal add
Step deformity
Special tests:
horizontal adduction
Paxinos sign
AC sheer
Bicipital tendinitis
DDx against adhesive capsulitis
Age 20-40
Common in throwers
Anterior shoulder pain
Agg w/ overhead mvmts
Limited active ER is when arm is at 90 abd
Pain on combined passive shoulder and elbow extension
Special tests:
Speed’s
Yergason’s
Adhesive capsulitis
DDx against biceps tendinitis
Age 35-70
Common in pts w/ thyroid abnormalities and diabetes
Poorly localized shoulder/upper arm pain
Agg w/ all A/PROM shoulder mvmts
All motions limited especially ER (ER > ABD > IR)
Capsular end feel
Lateral epicondylitis
Lateral aspect of elbow pain
Extensor carpi radialis brevis involved - activities involving repeated wrist ext/grasping increases pain (gradual overuse)
Special tests:
Cozen’s
Mills
Maudsley
Medial epicondylitis
Anteromedial aspect of elbow pain
Pronator teres + flexor carpi radialis involved - activities involving repeated wrist flexion increases pain (gradual overuse)
Special test:
medial epicondylitis test
Olecranon bursitis
Student’s elbow
Posterior aspect of elbow pain and swelling
Inflammation of olecranon bursa - contact w/ posterior elbow aggs
Pain w. full elbow flexion/extension
De Quervain’s tenosynovitis
Tenderness over lateral wrist and thumb
Abductor pollicis longus and extensor pollicis brevis (APL, EPB) affected
Severe pain w/ ulnar deviation and thumb flexion and add
Special tests:
Finkelstein’s
Carpal tunnel syndrome
n/t in median n. distribution of hand
repetitive aactivities and sustained positioning of wrist aggravates pain
thenar muscle atrophy seen in later stages
night pain
special tests:
phalen’s
tinel’s
Colle’s fracture
MOI FOOSH
Dorsal displacement of distal fragment of radius
Dinner fork deformity
Smith fracture
MOI fall on flexed wrist
Volar displacement of distal fragment of radius
Garden spade deformity
TMJ mouth opening
Depression of mandible
35-55 mm
Lateral pterygoid
“La” = opening
TMJ mouth closing
Elevation of mandible
Temporalis
Masseter
Medial Pterygoid
“MMT” > “mmm” > closed mouth
TMJ hypomobility
Decreased mouth opening and deviation to the same side
TMJ hypermobility
Increased mouth opening and deviation to opposite side
TMJ disc displacement with reduction
Clicking heard
No deviation
No difficulty with mouth opening
TMJ synovitis
Pain, swelling
Limited opening
No deviation
TMJ capsulitis
Pain
Limited opening
Deviation to same side
Iliotibial band syndrome
Age 25-55 years
Pain over lateral aspect of thigh and lateral aspect of knee
Snapping sensation over the greater trochanter as IT band passes
Pain w/ active knee ext to flexion
Tenderness over lat epi of femur and lateral aspect of knee
Special test:
Noble compression
Piriformis syndrome
Age 25-55
Pain over butt, posterior thigh, back of leg
Pain may radiate down leg mimicking radicular sxs
TTP sciatic notch
Pain w/ active ER, passive IR
Special test
FAIR
Avascular necrosis of hip
Age 30-50
Males > females
Often bilat, can be unilat
Dull aching/throbbing in groin/lat hip/butt
Pain inc w/ activity
Dec ROM in capsular pattern
FABIR especially limited
Osteoarthritis of hip
Age > 50
Females > males
Can be unilat/bilat
Anterior thigh and anteromedial thigh pain which increases with weight bearing
Progressive pain and morning stiffness < 60 min
Most limited and painful - IR < 20, reproduced by passive rotation of hip
