Musculoskeletal Flashcards
What do articular structures include?
joint capsule + articular cartilage, synovium, fluid, intra-articular ligaments, and juxta-articular bone
What do extra-articular structures include?
periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, skin
What are the ropelike bundles of collagen fibrils that connect bone to bone?
ligaments
What connects muscles to bone?
tendons
What are the pouches of synovial fluid that cushion the movement of tendons and muscles over bone?
bursae
What are common/concerning symptoms of MSK?
- low back pain
- neck pain
- mono/poly joint pain
- systemic features + joint pain
With MSK pain what should you always ask of your patient?
point to the pain
What are you inspecting for in the MSK?
- swelling
- skin changes
- adjacent structures
- deformity
What are you palpating for in the MSK?
- Swelling
- erythema
- tenderness
- temp
- crepitus
What type of joint pain is trauma, tendonitis, or bursitis?
monoarticular
What type of joint pain is rheumatic fever, gonococcal arthritis, rheumatoid arthritis?
polyarticular
What type of joint pain is bursitis, tendonitis, tenosynovitis?
extra-articular
What are inflammatory symptoms of joint pain?
fever, chills, warmth, redness
What are systemic symptoms of joint pain?
fever, chills, rash, anorexia, weight loss, weakness
high fever and chills = infectious cause
What is dynamic in the shoulder?
SITS
What is static in the shoulder?
labrium, capsule, glenohumeral ligaments
What joints are in the shoulder?
glenohumeral, sternocalvicular, acromioclavicular
What does asymmetrical shoulder heights indicate?
scoliosis
What does atrophy of supraspinatus and infraspinatus indicate?
RTC tear
What’s the normal shoulder flexion range?
180
What’s the normal range of the shoulder extension?
60 degrees
What’s the normal range of shoulder internal rotation?
70 degrees
Place your arm behind your back and touch your shoulder blade
What’s the normal range for shoulder’s external rotation?
100 degrees
“Raise your arm to shoulder level and rotate your forearm to the ceiling”
What’s the normal shoulder range for abduction?
180 degrees
What’s the normal range for adduction of shoulder?
75
“Cross your arm in front of your body keeping arm straight”
What’s the MCC of shoulder pain?
RTC tear
What’s the best predictor of RTC tear?
supraspinatus weakness on abduction, infraspinatus weakness on external rotation
positive impingement
What’s Neer’s impingement?
Pain with forward flexion and stabilizing the scapula
Near to the ear !!!
What is Hawkin’s impingement?
Flex shoulder-elbow to 90 w/ palm down - rotate internally and see if there is pain
What’s the empty can test?
internal rotation arms with thumbs down, push down
Weakness = positive
What’s the drop arm test?
Help patient abduct arm to 90, if patient can’t hold it, positive
What is the elbow made of?
troclea, capitulum, ulna, radius with ulnar, radial and median nerves
What does tenderness distal to epicondyle indicate?
epicondylitis
medial = pitcher’s
lateral = tennis
What do nodules on the extensor surface of the ulnar indicate?
rheumatoid nodules
What do grooves between the epicondyles and olecranon indicate?
arthiritis
What’s the elbow’s normal flexion range?
140 degrees
What nerve supplies the majority of your palm?
median
What does tenderness of the snuff box indicate?
scaphoid fx
What does bilateral swelling/tenderness indicate?
RA
where are your Heberden’s nodes in OA?
distal finger joint
where are your Bouchard’s nodes in OA?
proximal finger joint
Why are you inspecting the thenar and hypothenar eminences?
for carpal tunnel
Is wrist flexion towards the floor or the ceiling?
Floor
What should you remember with wrist ROM?
stay in anatomical position for abduction and adduction!
What’s the Finkelstein test?
Patient grasps thumb in fist and flexes wrist joint
pain = positive
What does decreased grip strength indicate?
weakness of finger flexors, intrisnic hand muscles
What is Tinel’s sign?
tap lightly over median nerve at volar wrist with aching, tingling, and numbness in 2nd, 3rd, 4th fingers = + sign
What is Phalen’s sign?
patient flexes wrists for 60 seconds (put tops of hands against each other)
aching, tingling, + numbness in 2nd, 3rd, 4th = + sign
How else can you test for carpal tunnel testing?
thumb adduction against resistance
weakness specific to median nerve = + sign
In what views do you need to observe the spine?
side and back
What are you looking for in a spine inspection?
asymmetric heights of shoulders, iliac crests, buttocks
What do tender spinous processes indicate?
trauma, infection, “step-offs” in spondylolisthesis
What does tenderness in sacroiliac joints indicate?
sacroiliitis, ankylosing spondylitis
What do issues with paravertebral muscles indicate?
spasms, degenerative and inflammatory muscle disorders, overuse
What could issues with the sciatic nerve indicate?
herniated disc or nerve root compression
What should you check with low back pain?
check for bladder or bowel dysfunction
What should you ask with neck pain?
location, radiation, arm/leg weakness, bladder/bowel dysfunction
What’s more common than disc herniation with C6 or C7 spinal nerve compression?
foraminal impingement
What is the CVAT?
pylelonephritis test
What test should you do with cauda equina issues, S2-S4?
MRI
What is the straight leg raise?
testing for lumbar herniated disc
lift patient’s leg while the knee is straight
pain = positive
What is the Spurling’s test?
Cervical radiculopathy
Turn patient’s head to affected side and apply downward pressure
pain radiating = positive
What are you palpating for in the hip?
Inguinal structures, trochanteric bursa, ischiogluteal bursa
What’s in the medial section of the knee?
adductor tubercle, medial epicondyle of femur/tibia
What’s in the anterior portion of the knee?
patella, patella/quad, tibia tuberosity
What’s in the lateral portion of the knee?
lateral epicondyle of femur/tibia, fibula
How can you test the cruciate ligaments?
anterior and posterior drawer tests
fix foot and pull and push
How can you test the ACL?
anterior drawer test with knee flexed 90 degrees, pull tibia forward
What’s the Lachman’s test?
knee flexed 15 degrees, grasp femur in one hand, tibia in the other, move femur back and pull tibia forward
What’s the valgus test?
MCL – push medially against lateral surface of knee with one and pull laterally at ankle with other
What’s the varus test?
LCL – pull laterally along medial surface of knee and push medially at ankle with another
How do you test the PCL?
posterior drawer – knee at 90 degrees, push tibia back
What’s the McMurray test?
Meniscus!
Grasp heel and flex knee with external/internal rotation
Click, popping, locking = positive
What’s the Apley’s grind test?
testing MENISCUS – patient is prone, and knee is flexed, with compression force applied with rotation
What are you palpating in the foot and ankle?
ankle joint, achilles, heel, medial/laeral malleous, MTP joints
What’s the anterior drawer of the foot?
pulling ankle and pushing on tibia
testing ATFL
What’s the talar tilt?
testing CFL
grasping tibia, turning ankle inwards
What’s the Thompson test?
Testing achilles – prone patinet, squeeze tendon in calf, if no movement = tendon rupture
When do you screen for osteoporosis?
> 65
postmenopausal women
What are risks for osteoporosis?
- post menopause
- > 50
- <70kg
- lower dietary calcium
- vitamin D defiecency
- tobacco and alcohol use
- family history of fracture
- corticosteroid use
*comorbidities
What is the cross over test for?
testing AC joint –> pain = AC arthritis
What could bowel/bladder dysfunction indicate?
cauda equina damage, S2-S4, disc herniation
In what illness do you have a spastic/scissor-like gait?
cerebral palsy
In what illness do you have a propulsive gait?
Parkinson’s, back problems
In what illness do you have a steppage gait?
weakness of anterior tibial muscles
