Musculoskeletal Flashcards
How do you grade muscle strength (MS) and what does each grade mean
0 = no muscle contraction 1 = flicker/trace of contraction 2 = Active movement possible with gravity eliminated 3 = Active movement possible against gravity 4 = active movement possible against gravity & resistance 5 = normal muscle power
What is proximal muscle weakness more suggestive of
Myopathy
What is distal muscle weakness more suggestive of
Polyneuropathy of disorder of peripheral nerve
What are the 3 types of joints
Synovial
Cartilaginous
Fibrous (immovable)
What is active ROM
Pt does the motion on their own
What is passive ROM
The examiner does/provides the motion for the pt
What is the degree of active flexion for the hea/neck? What about active extension?
Active flexion = 40 degrees
Active extension = 30 degrees
What is the degree of active lateral flexion of head/neck
Active lateral flexion = 30 degrees
What is the degree of passive roatation of the head/neck
60 degrees
What is radicular pain?
Pain caused by spinal nerve root compression
What is the usual cause of radicular pain? What nerve roots are most commonly involved?
Usual cause = foraminal impingement from degenerative joint changes
Most commonly involves C6 &C7
Which muscle is paralyzed in “winged scapula”
Serratus anterior
What nerve is paralyzed in “winged scapula”
Long thoracic nerve
What is torticollis
Lateral deviation and rotation of the head due to SCM contraction
What can cause torticolis
Hematoma, tear, or dystonic reaction from pheothiazines
What are the SxS of TMJ syndrome
Unilateral TMJ/jaw pain, bruxism, HA, creptius
Whan muscle opens the mouth? What muscles close the mouth?
Open = pyerygoids Close = masseter & temporalis
What part of the spine is most mobile
Cervical spine
What may unequal height of the iliac crests or pelvic tilt suggest
Leg length discrepancy, scoliosis, or hip abduction
What is the degree of spinal flexion?
90 degrees
What is the degree of spinal extension
30 degrees
What is the degree of lateral flexion of spine
30 degrees
Radicular symptoms with spinal flexion, extension, or lateral flexion warrant you to do what?
A thorough neuro exam
Step offs in the spine upon palpation suggest
Spondylolisthesis
TTP of SI joints suggests
Sacroillitis
TTP of spine suggests
Fx, infection, arthritis
Which region of the spine is particularly susceptible to compression fractures
Thoracic spine
What are the muscles of the rotator cuff
Subscapularis
Infraspinatous
Supraspinatous
Teres minor
Pt presents with inability to abduct arm and TTP over bicipital grove. What do they have?
Rotator cuff tear
Restricted range of motion of the shoulder may indicate…
Bursitis, adhesive capsulitis, tendonitis, cuff injuries, or Fx
Localized pain of the shoulder may suggest…
Subacromial bursitis, subdeltoid bursitis, or arthritis
What are possible causes of bursitis
Impingement
Rotator cuff tendonitis
Rotator cuff strain
Inflammation
The “cross over test” tests for….
AC separation
Which rotator cuff muscle is most commonly injured
Supraspinatous
What is the diagnostic modality of choice for rotator cuff injury
MRI
How does an anterior shoulder dislocation occur?
FOOS arm causes humerus dislocation anteriorly and inferiorly
What is the apprehension test
Pt lies on their back and you pull their arm back & over head; positive test illicits pain
What is Neer’s sign
Press scapula and push head of humerus against the acromion
What is Hawkin’s sign
Raising the arm forward and above head causes impingement with rotator cuff injury
What is Yergason’s test
Palpate the bicipital groove of the elbow while it is flexed at 90 and pt attempts to supinate the forearm against resistance
What is a positive Yergason’s test
Pain/popping; sign of biceps tendonitis
What are the major joints of the elbow
Radiohumeral, humeroulnar, radioulnar
What muscles are affected in lateral epicondylitis (tennis elbow)
Tendonitis of the wrist extensors
Medial epicondylitis is AKA
Golfers elbow
TTP over the snuff box indicates
Scaphoid Fx
Complication of scaphoid Fx is…
Avascular necrosis
PIP inflammation is seen with what condition
Acute RA
What deformities/clinical findings are seen with chronic RA
Ulnar deviation
Swan neck deformity
Boutonniere deformity
What deformities are seen with OA
Herberden’s nodes (DIP)
Bouchard’s nodes (PIP)
Condition where forcible hyperflexion at the DIP causes tearing of the tendon sheath
Mallet finger
What is the Finkelstein test
Test for DeQuervain’s Tenosynovitis; pt grasps thumb in hand and adducts wrist; positive sign is pain in the wrist
What tendons/muscles are involved in DeQuervain’s
Extensor pollicis brevis and abductor pollicis longus
What is dupuytren’s contracture
Palmar fascia hyperplasia with nodules & contractures
What are the RFs for Dupuytren’s
Men > 50 y/o, EtOH, & fibrosing diseases
What is the Trendelenburg Test
Pt asked to stand on one hip and the opposite hip (one off the ground) should point upward
What is an antalgic gait
Slow, shuffling gait (think zombies lol)
What is genu varum and when is it normal
Bowlegged; normal from infancy - 3 y/o
Abnormal with tibial rotation
What is genu valgus and when is it normal
Knock-knee; normal until ~ 8 y/o
Abnormal with skeletal dysplasia or rickets
What is the Lachman Test
Tests ACL integrity; flex knee 20-30 degrees while stabilizing the femur and displacing the tibia anteriorly
Pt presents with inflammation at the front of the knee and pain what is it
Prepatellar bursitis
What is the anterior drawer test
Tests ACL integrity (laxity of ACL)
What is the posterior drawer test
Tests PCL integrity (laxity of PCL)
What is mechanism of injury for meniscus injury
Forceful internal femur rotation on WB leg
What are SxS of meniscus injury
Joint line pain in flexion, clicking, locking, effusion
What is the McMurray Test
Test for meniscal injury; knee flexed at 90 then rotate external/internal and extend knee listening for click or pain
How do you get a MCL injury and what test do you use to check it
Blow to lateral side of knee during weight bearing; test with valgus stress
How do you get an LCL injury and what test do you use to check it
Blow to medial side of knee during weight bearing; test with varus stress test
What is the patellar grind test
Place downward pressure on patella compressing it against the patellofemoral groove; grinding suggestive of patellofemoral syndrome
What are common joint findings of OA
Effusion, crepitus, deformities, narrowing of joint space
What is the most common ankle injury? What ligament is involved
Lateral sprain; ATF ligament is damaged
What are the 3 lateral ligaments of the ankle
ATFL, CFL, an PTFL
What are the rules/criteria for use of x-rays in ankle injuries
Ottawa ankle rules
What is pes planus
Flat feet due to valgus heel while standing
What does pes planus make you more susceptible to
Plantar fascitis
What is the Thompson test
Test for achilles tendon integrity
What causes achilles tendon injury
Sudden acceleration or jumping
Older pt attempting unusual vigorous exercise
What are SxS of achilles tendon injury
Immediate pain, inability to walk, inability to dorsiflex
