Musculoskeletal Flashcards
three types of joints
synovial - freely movable joint, such as for knee or shoulder
cartilaginous - slightly movable, ex vertebral bodies
fibrous - immovable, ex skull sutures
synovial joints
the bones do not touch each other, the articulations are freely movable. Bones are covered by articular cartilage and separated by a synovial cavity which cushions movements. A synovial membrane lines the cavity and secretes a small amount of synovial fluid, which is viscous and lubricates. a joint capsule surrounds the synovial memberne.
cartaliginous joints
slightly movable joints where bony surfaces are separate by fibrocartilaginous discs. at the center of each disc is the nucleus pulposa. a fibrocartilagionus material that serves as cushion or shock absorber.
fibrous joints
the bones are held together by intervening layers of fibrous tissue or cartilage. The bones are almost in direct contact which allos no appreciable movement
bursae
roughly disc-shaped synovial sacs that allow adjacent muscles or muscles and tendons to glide over each other during movement.
three joints of the shoulder
glenohumeral joint -head of humerus articulates with the glenoid fossa of scapula. ball and socket joint
sternoclavicular joint - convex medial end of the clavicle articulating with the concave hollow int he upper sternum
acromioclavicular joint - the lateral end of the clavicle articulates with the acromion process of the scapula
muscle groups of the shoulder
the scapulohumeral, axioscapular and axiohumeral groups
scapulohumeral muscle group
extends from scapula to humerusincludes deltoid, teres major and SITS muscles (Supraspinitus, Infraspinitus, Teres minor, Subscapularis) which insert directly on the humerus (rotator cuff muscles)..
axioscapular muscles group
attach to teh trunk of the scapula and includes trapezius, rhomboids, serratus anterior and levator scapulae. rotate and fix the sapula adn pull shoulder back
axiohumeral muscle group
attaches the trunk to the humerus, includes pectoralis major, pectoralis minor, and latismus dorsi. responsible for internal rotation of shoulder
principle bursa of shoulder
subacromonial bursa
joints of the elbow
jumeroulnar, radiojumeral and radioulnar joints
muscles groups of the elbow
biceps and brachioradialis (flexion)
the triceps (extension)
pronator teres (pronation)
supinator (supination)
olecranon bursa
between olecranon process and the skin
ulnar nerve
runs posteriorly between the medial epicondyle and the olecranon process
effects of aging
tendons less elastic, decrease ROM, increase bone resporption, decrease bone density, deterioration of cartilage around joints
common systemic MS problems
RA, lupus, polymyositis, lyme disease, SSA
common local MS problems
lumbar strain, tennis elbow
Joint point with inflammation
RA, SLE, scleroderma
joint pain without inflammation
osteoartritis
monoarticluar joint invovlement
gout, trauma, septic arthritis, lyme disease
polyarticular joint involvement
RA
SLE - can affect mulitsystems
scleroderma- CREST syndrome (Caclinsis Raynauds pehnomenon, esophageal dysfuntionc, sclerodyctle, and telangiectasisias)
neck range of motion
Chin to chest (flexion)
“look at ceiling” (extension)
Chin to each shoulder (lateral rotation)
Ear to each shoulder (lateral flexion, i.e., head tilt)
components of the shoulder exam
Inspection Palpation Passive Range of Motion Active Range of Motion Appley scratch test for internal/external rotation Impingement Signs Bicep Tendonitis/Crossarm adduction/apprehension Neck exam: compression test Adson’s manuever
osteoarthritis
Affects ¼ of population—over age 50 Degeneration of articular cartilage Wt bearing & distal finger joints Pain worsens with exercise Morning stiffness or immobility Heberdon’s nodes Usually + family hx, obesity, hx of trauma
rheumatoid arthritis
Chronic inflammatory condition Insidious onset over wks. to months Fatigue, malaise, morning stiffness Swelling of joints, polyarticular, PIP, MCP joints commonly affected, symmetrical movement ROM may be limited, tenderness of joints
SLE
The ‘great imitator’ 10 x more common in women than men Mainly affects joints, kidneys and skin Can present with oral lesion, rash, hair loss urinary symptoms (blood or foamy urine), etc… Best managed by rheumatologist
lower back pain differential dx
Acute lumbar-sacral sprain Postural backache Lumbar disk syndrome Osteoarthritis IBS
risk factors LBP
Repetitive lifting Exposure to vibration Cig smoking Osteoporosis-spinal stenosis Obesity Lack of exercise Increased age Urinary disorders Gyn disorders Ankylosing spondylitis Tumors
lumbar disc syndrome
With repetitive trauma: progressive degeneration of nucleus pulposus leading to protrusion or complete extrusion of portion of disc contents into neural canal
95% at 4 & 5 spaces
Most common between 3 & 4 decades
LBP, Restriction ROM, Radicular pain, Paresthesias and Local tenderness
acute lumbar sacral strain
Related to muscular, ligament strain 2nd to specific trauma or continuous mechanical stress
Most common in age 20-40
Obesity & lack of exercise
features LBP, Muscle spasm, Local tenderness or swelling, Neurol exam negative
Cauda equina syndrome
Massive midline protrusion
Medical emergency
Presentation: weakness to legs, urinary changes, impotence, loss of sphincter tone & saddle anesthesia
From trauma, lumbar spinal stenosis, or chronic inflammatory conditions (like Paget’s disease or ankylosing spondylitis)
knee exam
Lachman’s test Ballottement Bulge sign Post drawer Valgus & varus stress Apley’s Sign McMurray’s Sign Patellar apprehension test
meniscus injury clinical features
Walking up and down stairs difficult Joint effusion Limited ROM Positive McMurray Nl xray
Osgood-Schlatter disease
Involves the growing tibial tuberosity, occurs in Adolescents 8-15 yrs, Bilateral, Males > females, Self-limited
Features Local pain & swelling over tibial tuberosity
Pain with stair walking, exercise, squatting on knee
Lat xray may reveal variable degrees of separation & fragmentation of tibial epiphysis
gout
common in older men. Involvement of monoarticular, usually proximal phalanx of great toe. Exquisite tenderness of jt, marked edema, swelling, warmth, Topi or urate crystals can occur on the ears and joints.
