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Musculoskeletal Flashcards

1
Q

Joint Pain: Leading complaint for seeking health care
Duration may be? Location may be?

A

Acute vs chronic
Localized vs diffuse

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2
Q

Joint Pain: Leading complaint for seeking health care
May be associated with?

A

constitutional symptoms and systemic manifestations from other organ systems, injury, previous surgery or repetitive motion

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3
Q

Joint Pain: Leading complaint for seeking health care
Common complaint areas are?

A

Neck
Low back

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4
Q

MSK Overview:
Symptoms can be ___ vs ___ joints

A

single vs multiple

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5
Q

MSK Overview:
If there is injury, what do you ask?

A

What was the Mechanism of Injury

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6
Q

MSK Overview:
Additional questions?

A

Were there prior issues with specific areas?
Systemic symptoms?

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7
Q

Joint Pain
Ask the patient to?
joint pain may be?
One joint = ?

A

“point to the pain”
Articular or extra-articular
monoarticular

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8
Q

Joint Pain
Hands and feet tend to be more?
Multiple joints = ?
Pattern of involvement:?

A

localized than in larger joints
polyarticular, typically four or more
migrating, steadily spreading, symmetric, affecting similar joints on both sides of the body?

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9
Q

Joint Pain
Extraarticular means?
Myalgia means?
Arthralgia means?

A

joint pain w/ involvement of bones, muscles, and tissues around the joint (tendon, bursae, or even overlying skin)
Generalizes “aches and pains” if muscular in origin
joint pain is present, and no evidence of arthritis

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10
Q

Joint Pain
Decreased or limited movement - ask about?

A

any changes in activity related to the involved joint, especially ADLs

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11
Q

Joint Pain
Musculoskeletal stiffness is?

A

tightness or resistance to movement

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12
Q

Joint Pain
Acute joint pain lasts up to?
Chronic pain?

A

6 weeks
>12 weeks

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13
Q

Joint pain
Assess what of the joint symptom?

A

site
onset
duration
quality
severity

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14
Q

Joint Pain
Check for sings of inflammation?

A

swelling
warmth
redness

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15
Q

Joint Pain
Patterns of stiffness questions

A

worse in Am?
better with activity?
worse with activity?

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16
Q

Joint Pain
Localized or diffuse:

A

Which joints are painful?
Monoarticular vs Oligoarticular vs Poly articular?
Axial?

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17
Q

Joint Pain
Pain in more than one joint, is it?

A

Symmetric vs asymmetric

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18
Q

What is axial joint pain?

A

Spine is primarily affected

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19
Q

Joint Pain
If patient is < 60 y/o consider what?

A

repetitive strain or overuse syndromes (tendinitis or bursitis)
Crystalline arthritis (gout)
RA
Psoriatic arthritis
Infectious arthritis from gonorrhea, Lyme disease or viral or bacterial infections

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20
Q

Joint Pain
What type of arthritis is considered for patients < 60 with IBD?

A

Reactive (Reiter)

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21
Q

Joint Pain
If patient is >60 y/o consider what?

A

OA
gout
pseudo gout
polymyalgia rheumatica
osteoporotic fracture
septic bacterial arthritis

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22
Q

Four Cardinal Features of Inflammation

A

Swelling
Warmth
Redness
Pain

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23
Q

Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems:
Skin Conditions: Butterfly (malar) rash on the cheeks is a sign of?

A

SLE

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24
Q

Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems:
Papules, pustules or vesicles with reddened bases on the distal extremities are a sign of?

A

Gonococcal arthritis

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25
Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems: Expanding erythematous "target" or "bulls eye" patch early in an illness is a sign of?
Lyme's disease
26
Neck Pain Rarity? Always ask if what was a precursor? Ask about radiation into the? is the arm feeling what?
Common trauma arm, scapular area weakness, numbness, or parasthesia
27
Neck Pain Nexus Criteria:
Normal alertness no posterior midline cervical spine tenderness no focal neurologic deficits no evidence of intoxication no painful distracting injury
28
Low Back Pain Three groups Nonspecific accounts for ___% of cases Nerve root entrapment with radiculopathy or spinal stenosis ____% Pain from a specific underlying disease ___%
90 5 1-2
29
Low Back Pain Ask what about the location?
Is the pain on the midline, over the vertebrae, or off the midline?
30
Low Back Pain If there is radiation into the buttock or lower extremity ask about?
is there associated numbness or parasthesia?
31
Low Back Pain If there is any associated bladder or bowel dysfunction, what does this indicate? What should you immediately do?
Cauda equina pursue immediate imaging and surgical evaluation
32
Red Flags for Lower Back Pain from underlying systemic disease
Age <20 years to >50 years Hx of CA Unexplained weight loss, fever, or decline in general health Pain lasting more than 1 month and not responding to treatment
33
Red Flags for Lower Back Pain from underlying systemic disease Part 2
Pain at night or present at rest Hx of IV drug use, addiction, or immunosuppression Presence of active infection or HIV infection Long-term steroid use Saddle anesthesia, bladder or bowel incontinence Neurologic symptoms or progressive neurologic deficit
34
Health Promotion Nutrition? Healthy weight does what for joints?
Calcium intake reduced mechanical stress on weight-bearing joints (hips and knees)
35
Health Promotion Physical Activity helps with?
Improved sleep quality cognitive function risk reduction of early death CV disease HTN DMT2 Breast and Colon CA Obesity Osteoporosis falls depression
36
When should women be screened for osteoporosis?
age >/= 65 years w/o previous known fxs or secondary causes of osteoporosis age /= a 65 y/o white woman w/o additional risk factors
37
How much Calcium should men and women 19-50 yrs old intake? Vitamin D?
1000mg/d 600 IU/d
38
How much Calcium should women 51-70 yrs old intake? Vitamin D?
1200mg/d 600 IU/d
39
How much Calcium should men 51-70yrs old intake? Vitamin D?
1000mg/d 600 IU/d
40
How much calcium should men and women >71 yrs old intake? Vitamin D?
1200mg/d 800 IU/d
41
Examination of the MSK system Inspect the joint for?
symmetry alignment bony deformities swelling
42
Examination of the MSK system Inspect and palpate what?
surrounding tissue
43
Examination of Specific Joints What are you looking for in the temporomandibular joint?
looking for pain and tenderness with palpation
44
Shoulder Inspection should be looking at?
Shoulder and shoulder girdle anteriorly Scapulae and related muscles posteriorly
45
Shoulder Palpation should feel for?
bony contours palpate any areas of pain
46
Shoulder ROM in what movements?
flexion extension abduction adduction internal rotation external rotation
47
Shoulder What are the most common disorders?
Rotator cuff
48
Shoulder What is the cross-chest adduction test?
Push AC joint Adduct shoulder Patient pushes elbow up against resistance Pain in AC = + test
49
Shoulder What is a false positive in the cross-chest adduction test?
RC Pathology
50
Shoulder What is the Apley Scratch test?
A series of movements that tests the patients ROM, flexion, extension, internal and external rotations, flexibility and strength
51
Shoulder Painful arc test is positive if? A positive test shows?
shoulder pain from 60* to 120* subacromial impingement / rotator cuff tendonitis
52
Elbow Palpate where?
the olecranon process and over the epicondyles
53
Elbow ROM in what movements?
flexion extension supination pronation
54
Elbow What is medial epicondylitis?
Pitcher's elbow
55
Elbow What is lateral epicondylitis?
Tennis elbow
56
Elbow What is Olecranon bursitis?
inflammation of the olecranon bursa causes a golf ball sized area of swelling over the olecranon
57
Hands Heberden nodes occur where?
on the distal interphalangeal joint
58
Hands Bouchard's nodes occur where?
In the proximal interphalangeal joint
59
Hands What is a Tinel sign?
Tapping the skin on the anterior wrist A positive sign is paresthesia in the distal fingers
60
Hands What is Phalen's Sign?
Pushing the posterior hands together to increase pressure in the carpal tunnel which increases pressure on the median nerve. A positive test occurs when the patient experiences pain or tingling in the thumb, index finger, middle finger, and sometimes the lateral half of the ring finger
61
Spine Assess all low back pain for? This happens most commonly at? increases risk for?
Potential herniated intervertebral disks L4-L5 or L5-S1; bladder bowel dysfunction
62
Spine ROM for these movements When is neurological testing advised with these maneuvers?
flexion, extension, rotation, lateral bending pain or tenderness, especially with radiation
63
Spine Inspection checking for?
Alignment overall alignment of shoulders alignment of iliac crests alignment of gluteal folds
64
Spine How to correctly palpate the spine?
Palpate the spinous process of each vertebrae with your thumbs
65
Hip Observe what?
Patient's gait Heelstrike foot flat midstance push off
66
Hip Palpation of bony landmarks includes what?
iliac spine greater trochanter ischial tuberosity sacroiliac joint
67
Hip ROM of what movements?
flexion extension abduction adduction external and internal rotation
68
Hip What is the FABER test?
AKA Patrick's test Patient lays ankle across opposite knee Examiner applies downward pressure at the flexed knee while stabilizing the opposite hip
69
Hip What is a positive FABER test show?
The presence of hip or sacroiliac joint pathology
70
Knee Inspect the gait for?
smooth rhythmic flow any loss of hollow space around the patella
71
Knee Palpate the knee in what postion? Feeling for what?
while sitting on the edge of the exam table the tibiofemoral joint
72
Knee Bony enlargement at the tibiofemoral joint margins, genu varum deformity, and stiffness lasting <30 min are typical findings in what?
Osteoarthritis
73
Knee Inspect which bursa for effusion?
suprapatellar pouch prepatellar bursa anserine bursa
74
Knee Bulge sign present in? How to test for it?
Minor effusions Milk downward on medial and lateral sides of patella apply medial pressure tap and watch for fluid wave
75
Knee Balloon sign present in? How to test for it?
Major effusions Compress the suprapatellar pouch against the femur with the fingers and thumb pressing the raised patella downward against the femur
76
Knee What is a positive balloon sign?
if there is a lot of space between the kneecap and the femur, and swelling pushes off to both sides the test is positive.
77
Knee How to perform McMurray Test
Examiner applies one hand at knee along medial meniscus Examiners other hand holds the foot and ankle Externally rotate the foot and apply valgus stress at the knee Slowly extend the knee
78
Knee What is a positive test for the McMurray Test?
a palpable click or pop along the medial or lateral joint line is a positive test for a tear of the posterior portion of the medial meniscus
79
Knee What is Valgus Stress Test?
Abduction Perform maneuver at 0* and 30* Examiner applies inward pressure at lateral thigh with one hand Examiner applies outward pressure from medial ankle with other hand
80
Knee What is Varus Stress Test?
Adduction Perform maneuver at 0* and 30* Examiner applies outward pressure at medial thigh with one hand Examiner applies inward pressure at lateral ankle with the other hand
81
Knee What does a positive Valgus Stress test show?
MCL injury
82
Knee What does a positive Varus Test Show?
LCL injury
83
Knee What is the anterior drawer signs?
Examiner grasps upper calf with both hands. Fingers clasped behind the calf. Both thumbs on the tibial plateau region Examiner pulls the tibia anteriorly in a sudden firm forward motion. Assess for laxity (>6-8mm shift) Compare to laxity with the opposite knee.
84
Knee What does a positive anterior drawer sign show?
Anterior cruciate ligament injury
85
Knee What is the Lachman Test?
Examiner grasps upper calf with the dominant hand, thumb over the anterior joint line. The other hand stabilizes the distal femur Examiner pulls the tibia anteriorly in a sudden firm forward motion. Assess for laxity (>6-8mm shift) Compare to laxity with the opposite knee.
86
Knee What does a positive Lachman Test show?
Anterior cruciate ligament injury
87
Knee What is a posterior drawer sign?
Have the patient lie on their back with their hip flexed to 45* and their foot flat on the bed (knee angle should be 90*) Lean lightly on the patient's foot to stabilize the leg Wrap you hands around the knee's joint line and gently apply a firm force to move the tibia backward Assess for Laxity (>6-8mm shift) Compare to laxity with the opposite knee
88
Knee What does a positive posterior drawer sign show?
Posterior Cruciate Ligament injury
89
Ankle and Foot Localized tenderness often presents with?
arthritis ligamentous injury infection
90
Ankle and Foot Plantar fasciitis is?
focal heel tenderness
91
Ankle and Foot Acute inflammation of the first MTP joint is common in?
Gout
92
Ankle and Foot Palpate what joints for what?
anterior aspect of each ankle joint metatarsophalangeal (MTP) joints Metatarsal heads tenderness
93
Ankle and Foot ROM of what movements?
Flexion extension inversion eversion
94
Pain in and around the joints Which disease tends to have pain more in the PICP and MCP joints, feet (MTP) joints, wrists, knees, elbows, and ankles?
Rheumatoid arthritis
95
Pain in and around the joints Which disease tends to have pain in knees, hips, hands (usually distal), cervical and lumbar spine, and wrists, also previously injured or diseased joints?
Osteoarthritis
96
Pain in and around the joints Which disease tends to have pain in the base of the big toe (first MTP joint), instep or dorsa of feet, the ankles, knees, and elbows?
Gouty arthritis
97
Pain in and around the joints Which disease tends to have pain in the feet, ankles, wrists, fingers, and elbows?
Chronic tophaceous gout
98
Gouty Arthritis What are the bumps called?
tophi

AHA (10 decks)

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