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Clin Med Year 1 > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

1
Q

physical exam order

A
  1. preliminary: neuro screening
  2. inspection
  3. ROM eval
  4. muscle strength
  5. reflex and other neuro evals
  6. special tests
  7. palpation
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2
Q

joint locking/crepitus

specific symptoms

A

= meniscal injury

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3
Q

give-way

specific symp

A

= ligamentous or meniscal injury

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4
Q

weakness

specific symp

A

neurological
myopathy
tendinopathy
muscle injury

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5
Q

clicking/popping/tearing

specific symp

A

= soft tissue injury or tear

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6
Q

tremor/spasm/weakness

A

= neurologic or muscle injury

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7
Q

tendon-

definitions

A

-itis = inflammation of tendon (acute)
-osis = degeneration (chronic)
-opathy = disease of a tendon, painful overuse
-synovitis = inflammation of sheath (de quervains)

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8
Q

tremor

definition

A

involuntary, rhythmic, jmuscle move to-and-fro movements/oscillations of 1+ body parts

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9
Q

spasticity

definition

A

velocity dependent resistance to muscle stretch

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10
Q

physical exam why

A
  1. inspect for gross deformities
  2. ROM either active (general function/pain) or passive (specific info)
  3. resistance/strenght for localizing specific muscles/tendons
  4. ligaments pulled to assess tears
  5. joint surfaces rubbed together for diease or injury
  6. palpate for heat/swelling/tenderness (tests all joint structures except for inside)

4 and 5 special tests-another card

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11
Q

ROM testing

A

estimate normal ranges and compare side to side with goniometer to precisely measure angle

test active (pt) first so pain and guarding observed before passive
-passive usually greater

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12
Q

resistance tests

A

pain on resistance = specific muscle or tendon injured

smooth weakness = neurologic
vs
break-away weakness = poor effort or pain inhibiton, less likely to be neurologic

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13
Q

muscle strength grading

MMT

A

0= no evidence of movement
1= trace move
2= full ROM w/ gravity eliminated
3= full ROM vs gravity but not vs resistance
4=full ROM vs gravity + some resistance but weak
5=full ROM vs gravity + full strength

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14
Q

special tests

provocative maneuvers

A
  1. ligaments by pushing or pulling bones they stabilize, partial or complete tears
  2. joint surfaces, by rubbing vs each other, pain due to trauma/arthritis/degeneration
  3. cartilages/menisci, by gently squeezing b/t bones or trying to find move of the menisci that are xs/limited/painful
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15
Q

shoulder ROM

A

apley scratch test for quick active ROM assess

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16
Q

shoulder special tests

A
  1. instability/chronic dislocations: apprehension test, relocation test
  2. rotator cuff: arm drop test, empty can/jobe/supraspinatus, lift off/gerber test
  3. biceps tendon: speeds test (teninopathy), yergason test (tendinopathy or instability)
  4. impingement: neer test, hawkins test
17
Q

shoulder impingement

A

ST getting pinched by bone usually where inflammation

hx: older or athlete, no overhead activities, type III acromion (hooked)

tests: Neer, Hawkins

18
Q

elbow inspection

A

for cubitus, valgus, cubitus, varus atrophy, bursitis

valgus angle/carrying angle greater than 20 degrees abnormal (5-10 men and 10-15 women normal)

19
Q

elbow special tests

A
  1. varus: radial collateral lig instability
  2. vlagus: ulnar collateral lig instability
  3. tinel sign: ulnar groove, cutibal tunnel syndrome (ulnar entrapment neuropathy)
  4. cozen: lateral epicondylitis/tennis elbow
  5. maudsley: 3rd finger test, lateral epicondylitis
20
Q

wrist special tests

A
  1. phalen; carpal tunnel syndrome
  2. tinel sign: @ant wrist, carpal tunnel
  3. finkelstein: de quervain tenosynovitis (swelling/stenosis of sheath around abductor pollicis longus and extensor pollicis brevis tendons)
21
Q

osteoarthritis of the hand

A

from cartilage degeneration, trauma, progessive degeneration of PIP and DIP

DIP= heberden nodes, palpable nodules
PIP= bouchard nodes, abnormal enlargements
1st CMC= thumb grind test

22
Q

rheumatoid arthritis

A

inspection: swan neck deformity, doutonniere deformity, ulnar deviation

23
Q

trigger finger

A

direct or repetitive trauma to flexor tendons = sheath thickens + tendon swells = nodule

difficulty flexing until sudden snap but can’t extend

24
Q

hip special tests

A
  1. straight leg raise: sciatic nerve root irritation, hamstring, SI pain
    -confirm with bragard test
  2. FABER/patrick: SI joint vs hip joint pathology
  3. FADIR: hip impingement/femoroacetabular
  4. Thomas sign: psoas, hip flexor tightness or contracture
  5. Tendelenburg: weak/non function glute med
  6. ober: tight IT or TFL
25
Q

alleviating factors

A
  1. flick sign: shake hand, carpal tunnel
  2. bakody’s sign: should abduction, cervical radiculopathy
26
Q

standing observations

A
  1. genu valgum (knocked knees)
  2. genu varus (bow legged)
  3. pes planus (flat feet)
  4. pes cavus (high arches)

Clin Med Year 1 (4 decks)

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