Musculoskeletal Flashcards
Structures that include the joint capsule and articular cartilage, synovium, and synovial fluid, intra-articular ligaments, and juxta-articular bones.
Articular
Structures include periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin.
Extra-Articular
Rope-like bundles of collagen fibril that connect BONE to BONE.
Ligaments
(injury = sprain)
Collagen fibers that connect MUSCLE to BONE
Tendons
(Injury = sTrain)
Pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures.
Bursae
FREELY MOVEABLE within limits of surrounding ligaments. Separated by articular cartilage and a synovial cavity. Lubricated by synovial fluid and surrounded by a joint capsule.
Synovial Joint
(Knee and Shoulder)
SLIGHTLY MOVEABLE. Contain fibrocartilaginous discs that separate bony surfaces. Have a central nucleus pulposus of discs that cushions bony contact.
Cartilaginous Joint
(Vertebral Bodies)
IMMOVABLE. Consists of fibrous tissue or cartilage. Lack joint cavity.
Fibrous Joint
(Skull Sutures)
CONVEX SURFACE IN A CONCAVE CAVITY. Wide-ranging flexion and extension, abduction and adduction, rotation and circumduction.
- Synovial Joint
Spheroidal (Ball and Socket)
(Shoulder and Hip)
FLAT or PLANTAR. Motion in one plane that allows for flexion and extension.
- Synovial Joint
Hinge
(Elbow and Fingers)
CONVEX OR CONCAVE. Movement of 2 articulating surfaces that are not dissociable.
- Synovial Joint
Condylar
(TMJ, Wrist, and Knee)
Asking your patient to do this may save considerable time because the patient’s verbal description is often imprecise.
“Point to the Pain”
Internal rotation of the knees that causes them to be close together.
“Knock Knee”
Valgus
External rotation of the knees that cause them to be far apart.
“Bow-Legged”
Varus
Motion where the patient moves on their own.
Active Motion
Motion where the examiner moves the patient. If movement is impeded painful, it can help identify the cause.
Passive Motion
What are the muscles of the rotator cuff?
Supraspinatus
Infraspinatus
Teres Minor
Subscapularis
What muscle is most commonly injured with a rotator cuff tear?
Supraspinatus
Raising your arm in front and overhead.
Flexion
Normal range of flexion
180°
Move your arm behind you
Extension
Normal range of extension
60°
Raise your arms to to the side and overhead
Abduction
Normal range of abduction
180°
Weakness on abduction of the shoulder would indicate what?
Rotator Cuff Tear
What is the primary muscle of shoulder abduction?
Supraspinatus
Cross your arm in from of your body, keeping the arm straight.
Adduction
Normal range of adduction
75°
Cross-over test is performed when asking the patient to adduct the shoulder. Pain caused by this action would indicate what?
Acromioclavicular Joint Arthritis
Place your arm behind your back and touch your shoulder blades
Internal Rotation
Normal range of internal shoulder rotation
70°
Limited internal shoulder rotation could indicate what?
Rotator Cuff Tear
Adhesive Capsulitis
Raise your arm to shoulder level and rotate your forearm to the ceiling
External Rotation
Normal range of external rotation
100°
What is the primary muscle involved with external rotation
Infraspinatus
Limited external rotation could indicate what?
Rotator Cuff Tear
Adhesive Capsulitis
What is the most common cause of shoulder pain?
Rotator Cuff Tear
What is the best predictor of a torn rotator cuff?
Supraspinatus weakness on abduction
Pain with forward flexion and stabilizing the scapula.
Neer’s Impingement
(Neer to the Ear)
What does pain with Neer’s Test indicate?
Rotator Cuff Tear
Flex shoulder and elbow to 90° with palm down and internally rotate.
Hawkins Impingement
What does pain with Hawkins Impingement indicate?
Rotator Cuff Tear
Internally rotate arms with thumbs down as if holding a can. Push down on patients arm.
Empty Can Test
What does weakness during an Empty Can Test indicate?
Rotator Cuff Tear
Abduct arm to 90° and see if the patient is able to hold their arm at shoulder level.
Drop Arm Test
What does the inability to hold arm at shoulder level during a Drop Arm Test indicate?
Rotator Cuff Tear
Adduct the patients arm across their chest. “Touch Shoulder”
Acromioclavicular Joint Test
(Cross over or Crossed Body Adduction Test)
What does pain during an Acromioclavicular Joint Test indicate?
Rotator Cuff Tear
Adhesive Capsulitis
Test where you ask the patient to touch the opposite scapula using (abduction and external rotation) and (adduction and internal rotation)
Apley Scratch Test
(Over Shoulder Rotation)
What does pain during an Apley Scratch Test indicate?
Rotator Cuff Tear
Adhesive Capsulitis
What is the technical term for the boney part of your elbow?
Olecranon Process
Pain or tenderness of the Medial Epicondyle.
Pitcher’s Elbow
Pain or tenderness of the Lateral Epicondyle
Tennis Elbow
What should you be looking for when assessing the extensor surface of the ulna?
Rheumatoid Nodules
What does pain in the grooves between the epicondyles and olecranon indicate?
Arthritis
What is considered the normal range of motion when you bend (flex) your elbows?
140°
Boney growths seen in osteoarthritis that occur at the distal interphalangeal joint (DIP)
Heberden’s Node
Boney growths seen in osteoarthritis that occur at the proximal interphalangeal joint (PIP)
Bouchard’s Node
Cutaneous Innervation of the Hand
Bones of the Hand
Atrophy of the Thenar and Hypothenar eminences may indicate what?
Carpal Tunnel Syndrome
Tenderness when palpating the snuff box would suggest?
Scaphoid Fracture
Boggy metacarpals may indicate what?
Rheumatoid Arthritis
(Rarely involved in Osteoarthritis)
Pain with thumb movement
De Quervain’s Tenosynovitis
(Gamer’s Thumb)
Have patient grasp their own thumb and ulnar deviate. (adduction)
Finkelstein Test
Radial pain during a Finkelstein Test would indicate what?
Tenosynovitis
Movements of the Thumb
Tap lightly over median nerve at volar wrist.
Tinel’s Sign
(Discomfort in 2nd, 3rd, or 4th finger is positive test)
Patient flexes wrist for 60 seconds.
Phalen’s Sign
(Discomfort in 2nd, 3rd, or 4th volar finger is positive)
Used specifically to test for weakness of the median nerve.
Thumb aBduction Test
Number of Vertebrae in each region of the spine.
7 - Cervical
12 - Thoracic
5 - Lumbar
5 - Sacral
4 - Coccyx
When palpating the Spinous Processes you feel a “step off” what might this indicate?
Spondylolisthesis
When palpating the Sciatic Nerve (midway between greater trochanter and ischial tuberosity) you note discomfort. What might be wrong?
Herniated Disc
Nerve Root Compression
What is the 2nd most common reason for office visits?
Low Back Pain
Where does most lower back pain occur?
L5 - S1
Bladder or Bowel Dysfunction with lower back pain or “saddle anesthesia” from perianal numbness may be caused by what two things?
Cauda Equina Syndrome from S2 - S4 Tumor
Disc Herniation
(S2-S4 keeps your shit and dick off the floor)
Most common cause of C6 or C7 spinal nerve compression.
Foraminal Impingement
Lateral curvature of the spine typically affecting adolescents
Scoliosis
Type of Scoliosis that disappears with forward flexion of the spine.
Postural Scoliosis
Type of Scoliosis that persists with forward flexion of the spin or a RIB HUMP presents.
Structural Scoliosis
What does the Costovertebral Angle Tendeness test assess?
Pyelonephritis
What type of imaging should be done if you suspect Cauda Equina Syndrome?
MRI
Lift the patient’s leg while the knee is straight.
Straight Leg Test
(Pain = Lumbar Herniated Disc)
Turn patient’s head to affected side and apply downward pressure to the top of the head.
Spurling’s Test
(Pain Radiating = Cervical Radiculopathy)
Bone disease that causes bones to become less dense and more porous.
Osteoporosis
Who has the greatest risk for developing osteoporosis?
Postmenopausal Women
Age 65+
When your foot is on the ground and bearing weight.
Stance
When your foot moves forward and doesn’t bear any weight.
Swing
Most hip problem arise from weight bearing during what phase?
Stance Phase
What are the four phases seen during gait analysis
Heelstrike
Foot Flat
Midstance
Push-Off
Type of gait with a stiff, foot dragging walk caused by a long muscle contraction on one side.
Spastic Gait
Type of gait where legs are flexed slightly at the hips and knees like crouching, with the knees and thighs hitting or crossing in a scissor like movement.
Scissor Gait
(Cerebral Palsy)
Type of gait where the person is stooped with a stiff posture and the head and neck are bent forward.
Propulsive Gait
(Parkinson’s and Back Problems)
Type of gait where the foot hangs with the toes pointing down, causing the toes to scrape the ground while walk, requiring them to lift the leg higher than normal when walking.
Steppage Gait
(Weakness of Anterior Tibial Muscles)
Type of gait where the person has a duck-like walk that may appear in childhood or later.
Waddling Gait
(Childhood or Dislocation)
When palpating inguinal structures, what should you be assessing for?
Bulges in Inguinal Hernia
Aneurysm
Lymphadenopathy
Arthritis or Infection
When palpating Trochanteric Bursa, what should you be assessing for?
Focal Tenderness in Trochanteric Bursitis
(Described as “Low Back Pain”)
When palpating the Ischiogluteal Bursa what should you be assessing for?
Tenderness from prolonged sitting
(Weaver’s Bottom)
Bending your knee
Knee Flexion
Straightening your knee
Knee Extension
Knee flexed 90° and sit on the patient’s foot. Place thumbs on medial and lateral joint Lin and place fingers on hamstrings insertions. PULL TIBIA FORWARD and OBSERVE IF TIBIA SLIDES FORWARD
Anterior Drawer Test
(ACL)
Anterior Movement = Positive Test
Knee flexed 15° Grab the distal femur with one hand and the proximal tibia with the other. PULL TIBIA FORWARD AND PUSH FEMUR BACK.
Lachman Test
(ACL)
Movement = Positive Test
PUSH MEDIALLY ON LATERAL KNEE & PULL LATERALLY AT ANKLE.
Valgus (ABduction)
(MCL)
Pain or Gap = Positive Test
PUSH LATERALLY ON MEDIAL KNEE and PULL MEDIALLY AT ANKLE
Varus (Adduction)
(LCL)
Pain or Gap = Positive Test
Knee flexed at 90° and sit on the patient’s foot. Place thumb on medial and lateral joint lines with fingers on the hamstrings. PUSH TIBIA PACK and OBSERVE IF TIBIA SLIDES POSTERIORLY
Posterior Drawer Test
(PCL)
Posterior Movement = Positive Test
Patient prone and knee flexed at 90° then apply compression force.
Apley’s Grind Test
(Meniscus)
Pain = Positive Test
Grasp the heel and rotate it internally and externally while flexing the knee with internal and external rotation. (Like you’re giving some an Indian Burn)
McMurray Test
(Meniscus)
Clicking, Popping, Locking = Positive Test
Grab the heel of the foot and pull forward.
Anterior Drawer
(Anterior Talofibular Ligament Injury)
Grab talus and invert it.
Talar Tilt
(Calcaneofibular Ligament Injury)
Grab the calf muscle and squeeze.
Thompson Test
(Achilles Rupture)
NO MOVEMENT with SQUEEZE = Positive Test
