MSK exam Flashcards
Synovial Joints
what are they
3 types and associated movements
Synovial Joints
- freely moveable; articular cartilage lines each boney promince & contain a synovidal cavity
- knee, shoulders
Types of Synovial Joints
Spheroidal (ball & socket joints)
- convex & concave in shape
- allow for a wide range of motion: felx,extend, ab/add, rotate and circumduction (3 degrees of freedom)
- these rely on fibrocartialge on the bones for support
- examples: shoulder and hip
Hinge
- flat, planar motion & shape
- motion occurs within one plane, flexion and extension
- examples: elbow, joints of the hand/foot
Condylar/Condyloid
- convex and concave in shape
- movement of two articulating surfaces: not dissociable
- move with flex/extend and add/abd
- example: wrist
Cartilagnous Joint
2 kinds
Cartilagnous Joints
- slightly moveable
- examples: vertebral bodies, pubic symphysis & sternomanubrial joint
Fiberocartilaginous Discs
- separate bony surfaces
- compressible
- abosrb shock well: like the nucleus pulpous in vertebrae
Hylaine (Articular) Cartilage
- cover the surfaces of bone on either side of a joint
- help to decrease friction & distribute load/weight properly
Fiberous Joint
Fibrous
- immovable
- skull sutures
Spinal Anatomy
33 vertebrae
- protect, support and remain flexible
- contain IV discs & allow for proper ROM (extension, flexion, rotation & side to side bending
- primary curvature: kyphotic (thoracic and sacral) ( when baby: curve over)
- secondary curvature: lordotic (happens with movement)
Cervical Spine
- small, extensive articuar surface
- increased ROM (increased risk of injury)
Thoracic Spine
- rigid, long spinous process & demifacets
- limited mobility
Lumbar Spine
- strong and weight-bearing
- flexibility returns at L3(weight distribution through)
Bursae
other intra-articualr strucutres
Bursae
- disc-shaped synovial sacs between muslces and articualr surfaces: prevent friction
- faciliate motion
- decrease friction
- elbows and knees and shoulders
Other Intra-articular structures
- joint capsule
- articaulr cartialge
- synvoium
- synovial fluid
- intra-articualr ligments
- periarticualr ligaments (LIgament = Bone to Bone)
- tendons (Muscle to bone)
Joint Pain: history taking
monoarticular, oligo and poly
- point with 1 finger to pain
- establish MOA of trauma
- determine if arthralgia (joint) v myalgia (muscle)
if the pain is….
Monoarticuar
- one joint invovled
- trauma
- monoarticualr OA
- bursitis
oligoarticualr
- 2-4 joints
- infection or septic arthritis
- connective tissue issue
- OA
Polyarticualr
- 4+ joints
- suggests viral or inflammatory RA SLE or psoriasis
questions to ask
- symmertical, intermittent, migrate?
Rhumatic fever/gonococcal arthriis = migrate from one joint to other
RA: additive, starts at one then adds another symmetrically
psoriatic arthriis, reactive or IBD = asymmertric
acute = days/months
chronic - months to years
inflammatory joint issues (RA) = worse with rest, activity is better
mehanical issue (OA) = worse with activity, better with rest
inflammatory pain will be worse than mechanical pain
Features of Inflammation in the joints
calor= heat
dolor = pain
rubor = redness
tumor = swelling
ask about constitutional = fever/chills
high fever = septic arthritis
lowe fever = RA/crystal-induce arthritis
other inflammation = bursitis, tendonitis, tenosynovitis, sprains
Decreased ROM : things to ask
Stiffness: percived or resisted motion
temporal pattern of decreased ROM
- worse in teh AM (RA)
- intermittent (OA)
change to ADLS
ask about PROM and AROM in articular pain and periarticualr pain
how to approach the MSK exam
IPPA = IPROMS inspect, palpate ROM then special tests
- look at posturing when they walk in
Inspection
- look at joints for deformities and malalignment
- crepitus
- inflammation
- compare bilaterally
ROM
- active (the pt. does it)
- passive (you do it)
TMJ
- some snapping is common WNL
- can do a strength test of the muscles too
Spine
- ROM
Spurlings Test : cervical nerve root impingment
Straight Leg Test
- tests for lumbar radiculopathy L4-S2
- a Positive sign is between 35-70 degrees of hyperextension of the hip pain is felt posteriorly = nerve impingment
Waddell Sign
- a test for patients who were likely to experience a poor outcome with psychogenci factors of low back pain
- 5 categories: tenderness, simulation, distraction, reginal, overreation
- + sign = psychological alert that the paitnet may warrent a complete psych eval.
Mechanial V radicular v systemic pain in the spine
Mechanial = axial pain
- caused by facet joing degeneration and micro/macro instability
- worse with activity and lifting/prolonged standing
Musculogenic: muscle pain
- stiffness
- pain with bending
Neurogenic/radicualr pain
- unilateral pain
- dermatomal pain
neurogenic claudication
- spinal stenosis
- pain worse with standing in the legs and butt
systemic pain
- constitutional symptoms
- think of systemic illnesses
The Shoulder
bones, joints, muscles
ROM tests
three bones
- humerus, clavicle and scapula
three joints
- AC
- sternoclav.
- glenohumeral
Subacromial bursa
- abduction = compression of this bursa
SITS muscles
- supraspinatus
- infraspinatus
- subscap
- teres minor
ROM Tests
Cross Body Adduction Test
- AC joint pathology
- passive adducting the arm
- + = pain at AC joint
Hawkins Impigment Sign
- tests for rotator cuff disorder or adhesive capsulitis
- felx elbow to 90 degrees, palm down and internally rotate
Shoulder ROM test
Apley Scratch Test
Assessment of the compound movements of the shoulder, ROM of GH joint and assess RTC tears
- pt. reaches behind head and touches opposite scapular and other hand from underneath
- + = uncoordinated movement or ROM defict when they switch sides
Scapular Winging Test
Pt. pushes against a wall : look at medial scapula boarder for winging
Painful Arc Test
tests for subacromial impingement syndrome
pt: abducts arm up to 180 degrees
- + test = pain between 60-120 degrees
- pain should go awaya once past 120
Neers Test
tests for subacromial impingment syndrome
- stabilze the pt. scapula and have them flex arm in internal rotation (bring up to raise hand)
- = pain
External and Internal Lag Test
External
test for supra/infraspinatus tears or subacromial impingment
- flex arm to 90, bring outwards and hold there
- + = dropped arm
Internal (“Lift Off”)
- Tests for subscapular pathology
- hand to small of their back, lift off and hold
- + = unable to hold it there
Drop Arm Test
Empty Can Test
tests for supraspinatus and biceps tendinitis
- ask them to abduct arm to shoulder level and lower slowly
- = unable to slowly lower = will just drop the arm
Empty Can Test
- test supraspinatus tear
- -arms out front, thumbs to floor; put pressue as pt. resists
- + = weakness
External Rotation Resistnace Test
test infraspinatus pathology
- pt arms to their sides at 90 degrees, thumbs up & you push from inside to out & have them resist the external rotation
- = weakness
Rotato Cuff Tendinitis (Impigment Syndrome)
- repettive shoulder motions like throwing/swiming which overtime impinge and inflame the tendon
- pt. complain of = catches of pain, weakness of lifting arm
- see pain at the tip of acromion
- neers test
- painful arc
Rotator Cuff Tear
chronic impingement or trauma
- can be full or partial thickness tear
- commonly supraspinatus tear
PT. Complains
- chronic pain
- nighttime pain
- weakness
- pseudo-paralysis (if traumatic)
PE
- extreme pain and weakness
- + drop arm test
- atrophy crepitus
Biceps Tendonitis
- inflammation of the biceps tendon (long head) and the tendon sheath
- can be associated with rotator cuff tendinitis
- can be the result of long standing impingment injuries
Compliants of
- anterior shoulder pain
- pointing to the bicipital groove
PE
- preserved ROM
- TTP at the grooce
- + Yeargasons test (pain with resisted supanation)
- + speed test (forward flexion)
