MSK Upper body Flashcards
Full ROM in TMJ is demonstrated when the patient is able to open mouth wide and insert ______ fingers vertically between the front teeth
Three
Most used joint in the body
TMJ
If only two fingers are inserted vertically between front teeth indicates _____ ROM
Adequate
When asking the patient to jut the lower jaw forward, _____ ROM is demonstrated when the bottom teeth are easily and smoothly placed in front of the top teeth
Full
Limitations of TMJ (3)
Brushing of teeth
Chewing
Dental procedures
Beginning at the base of the skull, the first ____ bones of the spine are identified as the ____
Seven
Cervical spine
Numbers of vertebrea: Total: Cervical: Thoracic: Lumbar: Sacral: Coccygeal:
33 7 12 5 5 4
ROM in cervical rotation
60-80 degree
ROM in Lateral cervical flexion
45
To flex the hand and wrist you will:
Make a fist
To extend the hand and wrist:
Straighten and stretch the fingers
Ability to grasp objects between thumb and index finger or the index finger and other finger
Fine precision pinch
Skills using the hands
Dexterity
The diseases found in the following joints:
- DIP
- PIP
- MCP
- Wrist joint
- 1st CMC
- OA, REACTIVE, PSORIATIC
- OA, SLE, RA, PSORIATIC
- RA, PSEUDOGOUT, HEMOCHROMATOSIS
- RA, PSEUDOGOUT, GONOCOCCA ARTHRITIS, JUVENILE ARTHRITIS, CARPAL TUNNEL SYNDROME
- OA
5.
Prevention of normal mobility of a joint due to abnormal formation of fibrous tissue
Contracture
Partial or incomplete displacement of bones of the joint
Subluxation
Complete joint displacement with no contact
Dislocation
Slowly over an extended period of time (chronic synovitis)
Dislocation
Supernumerary fingers
Polydactyly
Associated with syndromes and congenital problems
Polydactyly
Flexion deformity in the tightness of the skin
Sclerodactyly
Associated with Raynaud’s phenomenon nearly always present with skin calcinosis
Sclerodactyly
Tight skin may be due to Scleroderma
Sclerodactyly
Webbed fingers
Syndactyly
This is the test in which you ask the patient to grasp 2-3 fingers of each of the examiner hands
Grip strength
PIP bone enlargement
Bouchard’s node
Bouchard’s node usually associated with _____
Osteoarthritis
DIP joints bony enlargement
Heberden’s node
Hard nodules 2-3mm dm. One on either side of the dorsal midline
Heberden’s node
Usually painless, motion slightly limited, progressive deformity, but function is preserved
Heberden’s node
Heberden’s node is more pronounced on the ___
Dominant hand
If only a single heberden’s node this is just usually due to ____
Trauma
Despite active flexion, index finger DIP still rests in flexion
Mallet’s finger
Lateral aspect of the wrist and the thumb
De quervain’s tenosynovitis
Inflammation of the tendon sheath of the extensor pollicis brevis and abductor pollicis longus
De quervain’s tenosynovitis
The test for De quervain’s tenosynovitis
Finkelstein test
Extension deformity of the PIP joint
Swan neck deformity
Chronic swelling at the PIP which cause the displacement and pulling of extensor tendon
Swan neck
PIP is hyperextended and DIP develops flexion contracture
Swan neck
Disease associated with swan neck
RA and SLE
Flexion deformity of the PIP
Boutonniere
Chronic swelling weakens the supporting structures
Boutonniere
Extensor tendon slides to the palmar aspect of the finger, PIP develops a flexion contracture
Boutonniere
DIP is hyperextended
Boutonniere
Patient unable to extend the fingers actively but can passively
Extensor tendon rupture
This is the result of bony changes and inflammation at the wrist
Extensor tendon rupture
Tendon sheath which pass the wrist, become swollen and tender
Extensor tendon rupture
In extensor tendon rupture, chronic inflammation of arthritis causes ______ to become jagged
Ulnar styloid
Thumb is flexed into the palm and wrist and MCP flexed
Carpal spasm
IP is hyperextended
Carpal spasm
Carpal spasm is associated with ____
Tetany
Hyperextension of the MCP with flexion of the PIP and DIP
Claw hand
Claw hand is associated with:
Ulnar nerve and Brachial plexus injuries
Chronic fibrotic process of palmar fascia in one or both hands with resulting contracture of the ring finger and the little finger
Dupuytren’s contracture
Is Dupuytren hereditary? Yes / No
Yes
Painless nodule devlops on a flexor tendon in the palm of the hand near the head of metacarpal
Trigger finger
Patient tries to extend the fingers from a flexed position, nodule is too big to enter easily into the tendon sheath
Trigger finger
With extra effort or assistance, the finger extends with a audible snap
Trigger finger
Trigger finger this usually affects the _____, _____ finger
Middle and ring
Cause of trigger finger:
Inflammation
Repetitive trauma
Long axis of the fingers deviate or drift in an ulnar direction from the MCP joints
Ulnar deviation
In ulnar deviation, due to _______ this leads to the atrophy of the supportive muscles, tendons and ligaments
Chronic synovitis
Pronated wrist drop is due to the weakness of the ______
Extensors
Wrist drop is usually seen in _____
Radial nerve palsy
In hypothenar atrophy this includes the following muscles:
Bellies of palmaris brevis
Abductor digiti quinti
Flexor digiti quinti
Opponens digiti quinti
Hypothenar atrophy is caused by:
Ulnar nerve lesion
If both thenar and hypothenar it is considered:
Cervical myelopathy
Thenar atrophy this includes the wasting of:
Opponens pollicis
Abductor pollicis brevis
Flexor pollicis brevis
Flattening or wrinkling of the muscle mass
Thenar atrophy
Thenar atrophy is due to:
Median nerve damage
Thenar atrophy os associated with:
Carpal tunnel syndrome
Severe OA
Aging
Palpable bulge of muscle on palm of the hand at the base of the thumb
Thenar eminence
When examiner presses on ulnar styloid it lowers and bounces back
Piano key sign
Piano key sign suggest ligaments and tendons weakened by:
Synovitis
Arthritis
Tingling or numbness along distributiin of median nerve when examiner taps over the median nerve
Tinel’s sign
Tinel’s sign is diagnositic of:
Carpal tunnel syndrome
The range of motion of the elbow
Flexion
Extension
Pronation
Supination
The normal carrying angle of the elbow is at:
170 degrees
Less than 170 degrees, forearm is angled away from the body
Cubitus valgus
More than 170 degrees, forearm deviated towards the midline fo the body
Varum
Accumulation fo fluid in the Olecranon bursa
Olecranon bursitis
Injury of ulnar nerve which cause pain on the little finger and ulnar half of ring finger and palm
Ulnar tunnel syndrome
Tenderness over the common extensor origin at the lateral epicondyle , resisted active wrist extension
Tennis elbow
Tenderness over the medial epicondyle at the common origin of wirst flexors, resisted active wrist flexion with the hand supinated
Golfer’s elbow
Multi axial spheriodal joint with spherical head and and shallow glenoid cavity
Shoulder
Insert the degree of the shoulder per ROM: Flexion Adduction Abduction Internal rotation External rotation Forward flexion Extension
90 45 180 90 90 180 50
Pain located on anterior and lateral aspect of the shoulder and may radiate into the lateral deltoid
Rotator cuff tendinitis
Impingement catch as arm is brought to overhead position
Roattor cuff tendinitis
Painful arc between 70-110 degree abduction
Rotatir cuff tendinitis
May be initiated by ischemia or degeneration of the tendon
Calcific tendinitis
Common on the right side with 6% bilaterality in DM cases
Calcific tendinitis
Pain is out of proportion to the physical findings, often with associated difficulty of sleeping on the shoulder or falling asleep
Calcific tendinitis
Palpated between acromion process and head of the humerus at the tipof the shoulder
Subdeltois bursa
Generally, only visible when inflamed and swollen
Subdeltoid bursa
Pain, swelling and or tenderness over the shoulder tip suggest
Busitis
Shoulder pain that radiates down the biceps into to the forearm
Bicipital tendon
Just below the bicipital head in the bicipital groove
Bicipital tendon
The test: anterior shoulder pain may be due to bicipital tendonitis.
Abduction and external rotation of the arm is painful and limited
Yergasen’s test
Pain is generalized and referred to the upper arm, back and neck
Adhesive capsulitis
Three disease associated with adhesive tendonitis:
Diabetics
Thyroid disease
Parkinson
Diffuse inflammatory synovitis with subsequenrt adherence of the capsule and loss of joint volume
Adhesive capsulitis
Deposition of calcium salts primarily hydroxyapatite within a tendon
Calcific tendinitis