Musculoskeletal Flashcards by Dylan Null

Structures that include the joint capsule and articular cartilage, synovium, and synovial fluid, intra-articular ligaments, and juxta-articular bones.

Articular

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Structures include periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin.

Extra-Articular

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Rope-like bundles of collagen fibril that connect BONE to BONE.

Ligaments
(injury = sprain)

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Collagen fibers that connect MUSCLE to BONE

Tendons
(Injury = sTrain)

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Pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures.

Bursae

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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)

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SLIGHTLY MOVEABLE. Contain fibrocartilaginous discs that separate bony surfaces. Have a central nucleus pulposus of discs that cushions bony contact.

Cartilaginous Joint
(Vertebral Bodies)

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IMMOVABLE. Consists of fibrous tissue or cartilage. Lack joint cavity.

Fibrous Joint
(Skull Sutures)

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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)

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FLAT or PLANTAR. Motion in one plane that allows for flexion and extension.
- Synovial Joint

Hinge
(Elbow and Fingers)

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CONVEX OR CONCAVE. Movement of 2 articulating surfaces that are not dissociable.
- Synovial Joint

Condylar
(TMJ, Wrist, and Knee)

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Asking your patient to do this may save considerable time because the patient’s verbal description is often imprecise.

“Point to the Pain”

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Internal rotation of the knees that causes them to be close together.
“Knock Knee”

Valgus

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External rotation of the knees that cause them to be far apart.
“Bow-Legged”

Varus

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Motion where the patient moves on their own.

Active Motion

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Motion where the examiner moves the patient. If movement is impeded painful, it can help identify the cause.

Passive Motion

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What are the muscles of the rotator cuff?

Supraspinatus
Infraspinatus
Teres Minor
Subscapularis

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What muscle is most commonly injured with a rotator cuff tear?

Supraspinatus

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Raising your arm in front and overhead.

Flexion

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Normal range of flexion

180°

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Move your arm behind you

Extension

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Normal range of extension

60°

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Raise your arms to to the side and overhead

Abduction

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Normal range of abduction

180°

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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