Muscle Flashcards
concern with teenage girl and backpain
UTI –> pylonephritis
bone pain characteristics
deep, aching, throbbing, worse at night
muscle pain characteristics
crampy, stiff, sore, achy
joint pain characteristics
synovial inflammation, tenderness
concern with landscaper?
Lyme disease
NSAIDS and ASA chronic use concerns
ulcers, increase BUN and creatinine
rheumatoid arthritis
autoimmune disease, symmetrical
- morning stiffness >1hr
- profound fatigue
- improves with activity
- worse with rest
- systemic
osteoarthritis
due to wear and tear
- <30min morning stiffness
- minimal fatigue
- worse with activity
- improves with rest
- not systemic
Gout
d/t increased uric acid
Ankylosing Spondylitis
HLAB27 test for genetic disorder that causes bones in the spine to fuse
concerning signs of a serious pathology
- erythema, warmth, effusion, decreased ROM
- fever, rash, chills, acute joint pain
- underlying bleeding disorder with anticoag use
- bone pain, weight loss, night pain
acute joint pain in a sexually active young adult could indicate?
syphilis or gonorrhea
articular structures
connects bones - consists of joint capsule, articular cartilage, synovium, and synovial fluid
extra articular structures
ligaments, tendons, nursae, muscle, fascia, bone, nerve, overlaying skin
Synovial Joints
freely moveable, covered by articular cartilage
- self lubricating, almost frictionless
- able to withstand compression and maintain heavy loads
- knee or shoulder
(diathrosis)
Fibrous Joints
immobile, connected by fibrous connective tissue between bones
- skull
(synarthrosis)
cartilaginous joints
connected by cartilage. less movement than synovial yet more than fibrous.
- discs allow flexion and extension, cushion/shock absorber
- protects spinal cord, brain, and nerves
(amphiarthrosis)
types of synovial joints
- spheroidal
- hinge
- condylar
spheroidal joint
ball and socket
- convex within a concave cavity
- wide range of motion
- shoulder/hip
hinge joint
flat, planar
- motion in one plane: flexion, extension
- hand, foot, elbow joints
condylar joint
convex or concave articulating surfaces
- movement of two surfaces
- knee, TMJ
Bursae
disc-shaped synovial sacs
- cushions movement of tendons and muscle over bone
- lie b/w skin and convex surface of bone/joint and where muscles or tendons run against bone
Rotator Cuff muscles
- Supraspinatus.
- This holds your humerus in place and keeps your upper arm stable. - Infraspinatus.
- This is the main muscle that lets you rotate and extend your shoulder. - Teres Minor.
- This is the smallest rotator cuff muscle. - Subscapularis.
Tendons
collagen fibers that connect muscle to bone
ligaments
rope like bundles of collagen fibrils
bone - bone
Cartilage
firm tissue that is softer and more flexible than bone
- connects bones together
muscle grading system
0 = contraction/paralysis 1 = feel contraction yet no movement 2 = passive ROM 3 = full ROM against gravity 4 = full ROM some resistance 5 = full ROM with resistance
flexion
decreasing joint angle
extension
increasing joint angle
abduction
motion away from midline
adduction
motion toward midline
rotation
pivotal
internal - towards midline
external - away from midline
Temporal Arteritis (TA)
- systemic vasculitis, “giant cell”
- Present = new headache, 50+ yrs old, with a high ESR (erythrocyte sedimentation rate)
- jaw pain –> blindness d/t compression and inflammation
bones of the shoulder
humerus
scapula
clavicle
sternum
parts of scapula
glenoid
acromion
coracoid
scapular body
shoulder joint parts
- acromion = “ceiling” of shoulder
- glenoid fossa = “saucer”
- bursa = membrane cushion
- supraspinatus = tendon and muscle that help form the rotator cuff
- humeral head = ball of upper arm
shoulder impingement
inflammation of the subacromial space
- under the acromion and above the glenohumeral joint
- affects the supraspinatus and the subacromial/subdeltoid bursa
- hurts with seatbelt, hair brushing, bra
scarf test
The scarf test, also known as the cross-body adduction test, is used to assess the integrity of the acromioclavicular (AC) joint.
Labral Tear
young athletes
- clicking or catching inside
- SLAP = superior labrum anterior-posterior pattern
need MRI, PT, or surgery
muscles with arm abduction
infraspinatus and teres minor
Rotator cuff muscles
4 = SITS Supraspinatus Infraspinatous Teres Minor Subscapularis stabilize humerus
shoulder supportive muscles
pectoralis
deltoid
biceps
Cranial nerve 11 test
shoulder shrug
external rotation, lateral tests what muscle?
infraspinitus and teres minor
painful arc test
slowly bringing arm up and increasing the angle
+ test = shoulder pain between 60 and 120 degrees means a subacromial or rotator cuff disorder
Hawkins test
with elbow bent at 90 degrees, then move the elbow up and wrist down
+ = pain, indicating impingement of shoulder
Neers Test
pt arm in front and thumb down, with providers hand on the scapula, the arm is raised in forward flexion
+ = pain
Empty can test
tests for supraspinatus weakness
- 90 degrees of shoulder flexion, internal rotation and 30 degrees of horizontal adduction with downward pressure applied
+ = pain
Elbow - bones and joints?
bones = humerus, radius, ulna joints = humeroulnar, humeroradial, radioulnar
elbow flexion
bend - biceps, brachialis, brachioradialis muscles
elbow extension
straighten
- triceps and anconeus
elbow supination
palms up, biceps and supinator muscles
elbow pronation
palms down
pronator teres, pronator quadratus muscles
Lateral Epicondylitis
tennis elbow
“TEL me about that”
Medial Epicondylitis
Golfers elbow
“You’re a GEM golfer”
Hand joints
DIP
PIP
MCP
distal interphalangeal joint
proximal interphalangeal joint
metacarpophalangeal joint
wrist and hand muscle groups
- flexion - 2 carpal muscles (radial and ulnar)
- extension - 2 radial 1 ulnar
- supination and pronation = forearm contraction
Thenar crease
crease in palm
If there is pallor there = anemia
Carpal Tunnel
- median nerve compression causing numbness, tingling, or weakness in hand
- affects inner aspect of thumb, through ring finger
Spares ulnar nerve, pinky is NOT affected
Tinel Test
“TAP”
- taps over wrist where median nerve passes through
+ = electric/sharp pain/tingling in the hand
Phalen Test
“FLAP”
- flexes wrists with elbows raised and backs of hands pressed together for 1 min
+ = pain or tingling in median nerve area
3 spinal curvatures
- scoliosis = curvature
- kyphosis = thoracic spine curves outward
- lordosis = lumbar spin curves inward
Back pain test
Straight Leg Raise (SLR) for sciatica
- pt lay on back and leg is raised
+ = 30-70 degrees of raise causes pain that radiates down the leg to below the knee, or to toes
dorsiflex worsens pain
Hip bones and cartilage
Bones:
- Ileum
- Sacrum
- Femur
- Ischial tuberosity
Cartilage: symphysis pubis
Knee –bones
femur
patella
tibia
fibula
knee joints
patello-femoral (gliding motion of patella in femoral groove)
femero-tibial (hinge) with ligaments meniscus and bursas
knee landmarks
patella patellar tendon quad tendon femoral condyles tibial tuberosity medial and lateral joint line popliteal space collateral ligament quads/hamstrings
front knee pain could mean:
chronodomalacia patella
patella tracking
bursitis
arthritis
pain above the knee could indicate:
quadricep tendon or swelling
pain behind the knee could indicate:
Bakers Cyst or arthritis
Elderly person with posterior knee pain without trauma –
think bakers cyst
pain on inside or outside of knee could indicate:
meniscus or collateral ligament tears
arthritis
pain below the knee =
osgood-schlatter disease which occurs in teens that are growing
ACL injury
Anterior
non-contact rotational injury
How to test for ACL injury?
Anterior Drawer test
Lachmans Test
PCL injury
fall with flexed knee
posterior
PCL tests
Posterior drawer test
posterior sag test
how do you conduct the anterior drawer test? the posterior?
anterior = lower leg is pulled up to check the knee joint laxity (ACL) posterior = lower leg is pushed down to check knee joint (PCL)
How is the lachmans test done?
one hand on the femur, knee at 20 degree angle, the other hand pulls the tibia anteriorly to check stability (ACL test)
MCL injury
occurs with blow to the knee LATERAL or by rotational stress
how to test for MCL injury
valgus stress test – pt on back, bring knee inward
“Lateral knee to vaLgus”
more common
LCL injury
blow to medial knee with varus tension forces –
how to test for LCL injury?
varus stress test – pt on back, knee rotated externally
meniscus injury
d/t flexion or hyperflexion with knee rotation, often occurs with a ligament injury
S&S = joint line pain, clicking or locking
bones of the ankle
tibia
fibula
talus
lateral/medial malleolus
most common ankle sprain?
inversion, “rolling” of the ankle out and foot inward
strain? sprain?
Strain = injury to muscle or tendon and is stretched too far.
most common = hamstring, calves, achilles tendon
Sprain = injury to ligament and it stretches or tears
most common = ankles, knees, and wrist joints
bunion
bony bump that forms on the joint at the base of the big toe, can cause hammer toes
mortons neuroma
thickening of the tissue around one of the nerves leading to the toes between the 3rd and 4th toes …
causing a sharp burning pain in the ball of the foot
#1 cause = high heels
