Musculoskeletal Flashcards
1
Q
Shoulder examination, impingement signs: (4)
A
Supraspinatus sign (empty can test)
Hawkins sign
Neers sign
90/90 sign
2
Q
Empty can test
A
Supraspinatus sign, position inhibits deltoid and mostly stresses the supraspinatus muscle, grade patients strength and pain
3
Q
Hawkins sign
A
Compresses the rotator cuff, subacromial bursa, and biceps tendon. Helps evaluate for rotator cuff impingement
4
Q
Assess the subscapularis with what test
A
Lift off test, eliminates the force of the larger muscles like pec major and lat dorsi
5
Q
Scarf sign
A
Assesses AC joint stress by applying direct pressure to the articular surfaces of the joint
6
Q
Testing the stability of the GH joint (shoulder)
A
Sulcus sign for laxity
Load and shift testing
Apprehension sign
Dislocation/relocation
7
Q
Testing for tears of the shoulder labrum
A
Obriens test, arm out and thumb to the floor, apply downward pressure and look for pain and or clicking
8
Q
Broken humerus can affect which nerves
A
Axillary, radial, or ulnar
9
Q
Position for postural realignment
A
Bruggers position, sitting with the legs slightly apart, back arched back, head back, and arms pulled back.
Mountain pose.
Active scapular retraction
10
Q
GH joint dislocation occurs in what two mechanisms
A
Apprehension position, and FOOSH
11
Q
5 E’s of posterior GH dislocation
A
Electricity, epilepsy, elderly, ECT, ethanol
12
Q
Bankart lesion
A
Avulsion of the anterior glenoid labrum from the glenoid
13
Q
Hill Sachs lesion
A
Dent in the Humoral head
14
Q
Mallet finger
A
Ruptured extensor tendon
15
Q
Boutonnière deformity
A
Sprained pip with central slip disruption, needs splinting in complete extension. Can lead to flexion contracture otherwise.
16
Q
Boxers fracture treatment
A
Ulnar gutter splint
17
Q
Scaphoid fracture treatment
A
Thumb spica cast
18
Q
MCP joint thumb dislocation
A
Thumb spica cast
19
Q
Bennett’s fracture
A
Broken 1st metacarpal, referral fracture of orif
20
Q
Muscles for supination
A
Biceps brachii and supinator
21
Q
Muscles for pronation
A
Pronator teres, pronator quadratus
22
Q
Allen’s test
A
Checks for occlusion of the ulnar or radial arteries
23
Q
Tenderness over the anatomic snuffbox may be a sign of
A
Scaphoid fracture
24
Q
Thenar innervation
A
Median
25
Hypothenar innervation
Ulnar
26
Hip dislocation can present clinically as
Internally rotated leg that appears shortened
27
Hip fracture can appear clinically as
Shortened leg and externally rotated
28
Third degree strain (complete tear) of the extensor mechanism of the knee
Will not recover spontaneously, test SLR, requires surgery
29
Feltys syndrome triad
RA, autoimmune leukopenia, splenomegaly
30
DDx lateral hip pain (3)
Greater trochanteric pain syndrome, SI joint disease, lumbar pain
31
If the patient is not able to continue sport or immediate swelling at the knee suspect
ACL issue
32
Inability to perform a straight leg raise indicative of what leg injury
Ruptured extensor mechanism
33
Positions of risk for the knee
Valgus, and pivot shift
34
ACL testing
Lachman, anterior drawer, pivot shift
35
MCL test
Medial stress at 0 and 30 degrees
36
PCL and LCL tests
Posterior drawer, lateral stress, palpation of the LCL, dial test
37
Patellar test
Patellar apprehension
38
Meniscal testing
Mcmurray test and apley
39
Ottawa ankle rules say you xray if any of:
Tenderness to medial or lateral malleolus, tenderness to 5th metatarsal, tenderness of navicular, inability to bear weight immediately and at the time of the assessment
40
Achilles rupture most commonly occurs at? How do we test for it?
5cm proximal to calcaneal attachment, test with Thompson’s test when patient is prone
41
Gout on microscopy
Aspiration shows negative strongly birefringement needle shaped crystals in keeping with gout
42
Achondroplasia occurs due to
Limited proliferation and function of chondrocytes
43
Patellar reflex nerves
L3-4
44
Achilles reflex nerves
L5-S1
45
Hamstrings reflex nerve
L5-S1
46
Dural tension signs
Straight leg raise and femoral stretch test
47
Quadriplegia indicates an injury in what spinal region
C spine
48
Paraplegia indicates an injury at what level of spine
Distal to the c7 vert `
49
Asia A
No motor or sensory
50
Asia E
Normal spinal cord function
51
Upper cervical segmental pain refers to
The head
52
Lower cervical segmental pain refers to
The shoulder girdle
53
Cellulitis organism and treatment
Staph aureus, cloxacillin
54
Necrotizing faciitis organism and treatment
Strep, penicillin or staph, clindamycin
55
Gas gangrene, organism and treatment
Clostridium perfringens, metronidazole or clindamycin
56
Tinels test
Tap at crease of effected wrist and note tingling in D1-3
| Percuss the flexor retinaculum over the median nerve
57
Phalens test
Press backs of hands together 30-60s looking for symptoms in D1-3
58
Finklesteins test
Pt makes fist with thumb curled inside fingers, ulnar deviation, pain felt on radius means DeQuervains tenosynovitis
59
Yergasons and speeds tests for
Bicipital tendinitis
60
Yergasons description
Elbow 90 degrees hand neutral, hold hand while pt tries to supinate, + for BT if painful
61
Speeds test
Patient flexes supinated arm against resistance, +BT if painful
62
Distinguish AC joint pain from impingement with the
Scarf test
63
Test the subscapularis with
Lift off test
64
Perform lift off test by
Arm bent behind back, patient attempts to push hand away from the spine against resistance, +for rotator cuff injury if painful
65
Test the infraspinatus with
Resisted external rotation
66
Resisted eternal rotation
Pt has elbow against side, 90’, tries to externally rotate. Pain positive for RC injury to infraspinatus
67
Subacromial impingement can be tested with
Neers test, Hawkins test
68
Neers test
Impingement if there is pain with arm more tha. 90 degrees raised
69
Hawkins test
Hold abducted arm in flexion 90/90, push up on elbow and down on wrist, look for pain
70
Ataxic gait
Uncoordinated, due to intoxication, cerebellar disease
71
Trendelenburg gait is a sign of
Abductor weakness
72
Antalgic gait
Painful gait
73
Valgus knee force tests the
MCL
74
Varus knee force tests the
LCL
75
Wrist injury - neurovascular assessment
Screen for radial, ulnar, and median nerve function in the hand.
Sensation to the back of hand, pointer, pinky
Muscular innervation
76
Shoulder injury neurovascular exam
Screen for sensation of radial, median, and ulnar nerve distributions, axillary nerve at lower deltoid
Muscle innervation with various movements of hands, wrists, elbow, shoulder
77
Ankle injury, neurovascular examination
Colour, temp, cap refill, pulses
| Sensory: tibial (plantar), peroneal (1st dorsal web space), sapenous (medial ankle/foot), Sural (lateral foot)
78
If a radiculopathy is suspected, what should be tested
Dermatomes, myotomes, and reflex examination
79
Signs of cauda equina
Saddle anesthesia, bowel or bladder dysfunction, recent infection, night pain
80
Neurovascular testing hip/lumbar
Motor: hip flex L2, knee extend L3, dorsiflex L4, extend big toe L5, plantar flex S1
81
Achilles special test
Thompsons
82
Ankle special tests
Anterior drawer, talar tilt
83
Test axillary nerve C7 at
Lower deltoid
84
Elbow inspection
Carrying angle valgus vs varus
85
VaLgus
Distal limb too lateral
86
Which muscles origainate at medial epicondyle
Flexors
87
Which muscle originate at the lateral epicondyle
Extensors
88
Special tests for the elbow
Lateral is resisted extension
| Medial is resisted flexion
89
Elbow stress testing
For the medial and lateral ligaments in varus and valgus positioning
90
Biceps reflex root
C5 c6
91
Triceps reflex root
C6 c7
92
Radial nerve sensation
1st interosseus space
93
Ulnar nerve sensation
Pinky
94
Median nerve
Pointer distal
95
Posterior butt pain
SI joint pathology
96
Groin pain
Hip pathology
97
Leg length discrepancy
True (ASIS to medial malleolus)
| Apparent (umbilicus to medial malleolus)
98
Faber test
Supine, figure 4 position, press down on flexed knee and opposite ASIS
Posterior pain = SI patho, groin pain = hip patho
99
Thomas test hips
Supine, flex one hip with bend knee and extend the other one
Positive if increased lumbar lordosis, or hip cannot extend fully
Indicative of hip flexion contracture
100
Hip OA ROM
Reduced PROM
101
Hip fracture rotation
Internal
102
Hamstring rupture
Weak knee flexion
103
General MSK physical mnemonic
GALs: gait, arms, leg, spine
104
Mcmurrays test is for the
Meniscus
105
Perform mcmurrays by
Supine, knee flexed
Palpate the two sides of the joint line
Rotate the knee as you extend it, with the heel to the side you’re testing
Positive is pain or clicking
106
Xray is required if pain and
Unable to bear weight for 4 steps (2 on each foot)
107
“Sciatica” is really
Lumbosacral radiculopathy
108
Most common cause of lumbosacral radiculopathy (sciatica)
Nerve root compression due to herniated disc
109
First line treatment for lumbosacral radiculopathy (sciatica)
NSAIDs and acetaminophen
110
Treating pes anserine bursitis
Quadriceps and hamstrings strengthening exercises
111
Diagnostic imaging for rotator cuff tear
Xray to rule out fracture, MRI to see soft tissue in cuff tear
112
Treatment of acute rotator cuff tear
Surgery
113
Bone scans can help diagnose
Infectious or metastatic disease
114
Injury mechanism for rotator cuff tears
FOOSH
115
Greater trochanteric pain syndrome is due to
Overuse involving the tendons of the gluteus medius and minimus
116
Adhesive capsulitis occurs due to contracture of
Glenohumeral capsule
117
Treatment of adhesive capsulitits
ROM exercises, NSAIDS, corticosteroid injections
118
Carpal tunnel can be diagnosed with
Nerve conduction studies
119
Nerve affected in carpal tunnel syndome
Median nerve
120
Chronic forefoot pain mechanically induced neuropathic degeneration of the interdigital nerves is called
Interdigital (Morton) neuroma
121
Crepitus on lateral compression of the metatarsal heads
Mudler sign
122
Female athlete triad
Excessive exercise, less periods, inadequate caloric intake, osteoporosis
123
Spastic contraction of the anal sphincter
Proctalgia fugax
124
Sub auricular systolic bruit is highly suggestive of
Fibromuscular dysplasia
125
Treating olecranon bursitis
Rest, ice, NSAIDs, padding. Abx if septic. Treat underlying gout or RA if inflammatory.
126
Within ten years of ACL injury most patients end up developing
Osteoarthritis
127
Calcaneal apophysitis is also called
Sever disease
128
Treating calcaneal apophysitis
Generally supportive - stretching, ice, NSAIDs, heel cup insert for cushioning
129
Treatment for plantar fasciitis
Activity modification, stretching, heel pads/orthotics
130
Degenerative condition of plantar aponeurosis at its insertion at the calcaneus caused by overuse
Plantar fasciitis
131
Fluctuating and fatiguable proximal muscle weakness
Myasthenia gravis
132
Treating myasthenia gravis
AChE inhibitors (pyridostigmine), immunotherapy, thymectomy
133
First drug of choice for myasthenia gravis
Pyridostigmine, long acting oral AchE inhibitor
134
Hallmark of ALS
Both upper (hyperreflexia, spasticity) and lower (atrophy, fasciculations) motor neuron signs
135
Hip pain in a young child following a viral illness
Transient synovitis
136
Diagnosing septic bursitis
Bursar fluid aspiration, xray
137
Treating septic bursitis
Systemic antibiotics, drainage in select cases
138
Low back pain radiating to thighs with posture dependent symptoms
Lumbar spinal stenosis
139
Confirming diagnosis of lumbar spinal stenosis
MRI of the spine
140
Acute back pain with unilateral radiation down the sciatic nerve to the foot, following an inciting event and worse with lumbar flexion
Lumbar disk herniation
141
Back pain that is dull, non radiating, worse at night, not related to position or activity
Vertebral metastasis is suspected
142
Distribution of pain in fibromyalgia
Chronic and widespread
143
Distribution of symptoms in polymyositis
Proximal muscle weakness, pain mild/absent
144
Characteristic symptoms of polymyalgia rheumatica
Stiffness>pain in shoulders, hip girdle, neck. Associated with giant cell arteritis
