Musculoskeletal Flashcards
physical exam order
- preliminary: neuro screening
- inspection
- ROM eval
- muscle strength
- reflex and other neuro evals
- special tests
- palpation
joint locking/crepitus
specific symptoms
= meniscal injury
give-way
specific symp
= ligamentous or meniscal injury
weakness
specific symp
neurological
myopathy
tendinopathy
muscle injury
clicking/popping/tearing
specific symp
= soft tissue injury or tear
tremor/spasm/weakness
= neurologic or muscle injury
tendon-
definitions
-itis = inflammation of tendon (acute)
-osis = degeneration (chronic)
-opathy = disease of a tendon, painful overuse
-synovitis = inflammation of sheath (de quervains)
tremor
definition
involuntary, rhythmic, jmuscle move to-and-fro movements/oscillations of 1+ body parts
spasticity
definition
velocity dependent resistance to muscle stretch
physical exam why
- inspect for gross deformities
- ROM either active (general function/pain) or passive (specific info)
- resistance/strenght for localizing specific muscles/tendons
- ligaments pulled to assess tears
- joint surfaces rubbed together for diease or injury
- palpate for heat/swelling/tenderness (tests all joint structures except for inside)
4 and 5 special tests-another card
ROM testing
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
resistance tests
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
muscle strength grading
MMT
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
special tests
provocative maneuvers
- ligaments by pushing or pulling bones they stabilize, partial or complete tears
- joint surfaces, by rubbing vs each other, pain due to trauma/arthritis/degeneration
- cartilages/menisci, by gently squeezing b/t bones or trying to find move of the menisci that are xs/limited/painful
shoulder ROM
apley scratch test for quick active ROM assess
shoulder special tests
- instability/chronic dislocations: apprehension test, relocation test
- rotator cuff: arm drop test, empty can/jobe/supraspinatus, lift off/gerber test
- biceps tendon: speeds test (teninopathy), yergason test (tendinopathy or instability)
- impingement: neer test, hawkins test
shoulder impingement
ST getting pinched by bone usually where inflammation
hx: older or athlete, no overhead activities, type III acromion (hooked)
tests: Neer, Hawkins
elbow inspection
for cubitus, valgus, cubitus, varus atrophy, bursitis
valgus angle/carrying angle greater than 20 degrees abnormal (5-10 men and 10-15 women normal)
elbow special tests
- varus: radial collateral lig instability
- vlagus: ulnar collateral lig instability
- tinel sign: ulnar groove, cutibal tunnel syndrome (ulnar entrapment neuropathy)
- cozen: lateral epicondylitis/tennis elbow
- maudsley: 3rd finger test, lateral epicondylitis
wrist special tests
- phalen; carpal tunnel syndrome
- tinel sign: @ant wrist, carpal tunnel
- finkelstein: de quervain tenosynovitis (swelling/stenosis of sheath around abductor pollicis longus and extensor pollicis brevis tendons)
osteoarthritis of the hand
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
rheumatoid arthritis
inspection: swan neck deformity, doutonniere deformity, ulnar deviation
trigger finger
direct or repetitive trauma to flexor tendons = sheath thickens + tendon swells = nodule
difficulty flexing until sudden snap but can’t extend
hip special tests
- straight leg raise: sciatic nerve root irritation, hamstring, SI pain
-confirm with bragard test - FABER/patrick: SI joint vs hip joint pathology
- FADIR: hip impingement/femoroacetabular
- Thomas sign: psoas, hip flexor tightness or contracture
- Tendelenburg: weak/non function glute med
- ober: tight IT or TFL
alleviating factors
- flick sign: shake hand, carpal tunnel
- bakody’s sign: should abduction, cervical radiculopathy
standing observations
- genu valgum (knocked knees)
- genu varus (bow legged)
- pes planus (flat feet)
- pes cavus (high arches)