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Musculoskeletal Flashcards

1
Q

Adolescents

A

Decreased strength in the epiphyses, overall decreased strength and flexibility lead to potential for injury
Bone growth is completed at 20 years
Peak bone mass reached at 35 years

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2
Q

Pregnancy

A

Increased hormone levels contribute to the elasticity of ligaments and softening of cartilage in the pelvis at 12-20 weeks
Lordosis may cause low back pain

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3
Q

Older adults

A

By 80 years, woman can lose up to 30% of bone mass

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4
Q

Risk factors for osteoporosis

A 
Race (white, Native American)
Thin
Family hx
Nulliparous
Sedentary lifestyle
Menopause before 45 years
Scoliosis, RA, CA, MS, fractures
Dieting, inadequate Vit D, excess carbonated beverages
Drugs: thyroxine, corticosteroids, heparin, lithium, anticonvulsants, antacids
Cigarettes, alcohol
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5
Q

Inspection

A

Lordosis, kyphosis, scoliosis
Skin and subQ tissues overlying muscles, cartilage, bones, joints
Muscle wasting - s/p injury
Fasciculation occurs after injury to muscle’s motor neuron

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6
Q

Palpation

A

Note heat, tenderness, swelling, crepitus, pain, resistance to P
Synovial thickening sometimes felt in joints that are close to the skin surface when the synovium is edematous or hypertrophied

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7
Q

Muscle Function Level Score

A

0 - No evidence of movement
1 - Trace of movement
2 - Full ROM but not against gravity
3 - Full ROM against gravity NOT against resistance
4 - Full ROM against gravity and SOME resistance, weak
5 - Full ROM against gravity, FULL resistance

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8
Q

Heberden nodes

A

Located along distal interphalangeal joints

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9
Q

Bouchard nodes

A

Located along proximal interphalangeal joints

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10
Q

Hands/wrist ROM

A

Bend the fingers forward at the metacarpophalangeal joint, then stretch the fingers up and back and the knuckle
Flexion = 90
Hyperextension = 30
Touch thumb to all fingertips and to the base of the little finger, make a fist
Spread fingers apart and then touch together
Bend the hand at the wrist up and down
Flexion = 90
Extension = 70
Palm side down, turn hand right and left
Radial = 20
Ulnar = 55

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11
Q

Unexpected hand findings

A

Ulnar deviation and subluxation of metacarpophalangeal joints
Swan neck
Boutonniere deformity

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12
Q

Unexpected elbow findings

A

SubQ nodules = RA or gouty tophi
Boggy, soft, fluctuant swelling = epicondylitis or tendonitis
Point tenderness at the lateral epicondyles

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13
Q

Elbow ROM

A 
Elbox fully extends, bend and straighten the elbow
Flexion = 160 up
Extension = 180 down
Rotate hand in/out
Pronation = 90
Supination = 90
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14
Q

Inspect/palpate elbow

A

Flex to 70, palpate the extensor surface of the ulna, olecranon process, medial and lateral epicondyles of the humerus

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15
Q

Shoulders

A

Inspect contour, shoulder girdle, clavicles, scapulae, surrounding musculature

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16
Q

Suspect shoulder dislocation

A

Contour is asymmetric, one shoulder hollows in the rounding contour, winged scapula (outward prominence of the scapula)

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17
Q

Shoulder ROM

A

Shrug - symmetrical
Raise both arms forward and straight up over the head = 180
Extend and stretch both arms behind back = 50 hyperextension
Lift both arms laterally and straight up over head = 180 abduction
Swing each arm across front of body = 50 adduction
Arms behind hips elbows out = 90 internal rotation
Arms behind head elbows out = 90 external rotation
CN XI = shrug against resistance

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18
Q

Temporomandibular joint

A

Open/close space 3-6 cm between upper and lower teeth
Laterally move side to side 1-2 cm in each direction
Protrude and retract chin
CN V clench teeth palpate contracted muscles

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19
Q

Cervical spine ROM

A 
Chin to chest = 45 
Extension = 45
Bend head side to side = 40
Turn head side to side = 70
Do above with resistance checks CN XI
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20
Q

Gibbus

A

Sharp angular deformity

Associated with collapsed vertebra from OA

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21
Q

Thoracic and lumbar ROM

A

Bend at waist = 75-90 no knee bend
Hyperextension = 30
Side to side lateral = 35
Rotate upper trunk while stabilize hips = 30 front and back

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22
Q

Hips ROM

A

Supine, raise leg with knee extended = 90
Standing or prone, swing straight leg back = 30
Knee to chest = 120
Adduction = 30 straight leg across body
Abduction = 45 straight leg out
Knee bent, internal rotation = 40
Flexed knee to table (FABER) = 45 Flex ABduct Externally Rotate

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23
Q

Gena valgum

A

Knock knees

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24
Q

Genu varum

A

Bow legs

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25
Genu recurvatum
Excessive hyperextension of the knee with weight bearing = weak quads
26
Baker cyst
Popliteal cyst
27
Knee ROM
Bend = 130 | Straighten and stretch = 15 hyperextension
28
Pes varus
In-toeing
29
Pes valgus
Out-toeing
30
Pes planus
Flat foot
31
Pes cavus
High instep
32
Heat, redness, tenderness
Inflamed joint Possible RA, gout, septic, fracture, tendonitis Esp. inflamed metatarsophalangeal joint = gouty arthritis
33
Foot ROM
``` Dorsiflexion = 20 Plantar flexion = 45 Inversion = 30 Eversion = 20 Abduction = 10 Adduction = 20 ```
34
Thumb abduction test
Isolates the strength of the abductor policies bravis muscle innervated by the median nerve Apply downward pressure to thumb to check strength Weakness = carpal tunnel
35
Phalen test
Patient holds both wrist in a fully palmar-flexed position with the dorsal surfaces pressed together x 1 minute Numbness and paresthesia = carpal tunnel Reverse Phalen = palms and fingers together with full wrist extension
36
Tinnel sign
Strike the wrist with index or middle finger where the median nerve passes under the flexor retinaculum and solar carpal ligament Tingling = positive Tinnel = carpal tunnel
37
Neer test
Flex patient's arm up to 150 while depressing the scapula | Increased shoulder pain = positive for rotator cuff inflammation or tear
38
Hawkins test
Abduct shoulder to 90 Flex elbox to 90 Then internally rotate arm to limit Increased shoulder pain = positive rotator cuff inflammation or tear
39
Straight leg raising test
Tests for nerve root irritation or lumbar disk herniation at L4, L5, S1 levels Lie supine, neck flexed, raise leg (straight) Radicular pain below the knee = herniation Crossover pain = sciatic nerve impingmetn
40
Femoral stretch test
Or Hip extension test detects inflammation of the nerve root L1, L2, L3 and sometimes L4 Presence of pain on extension is positive of nerve root irritation
41
Thomas test
Detects flexion contractors of the hip masked by lumbar lordosis Extend one leg flat on the examining table, flex the other leg with knee to chest Observe patient's ability to keep extended leg flat on the examining table Lift extended leg = hip flexion contracture
42
Trendelenberg test
Detects weak hip and abductor muscles Balance one foot then other Note asymmetry of iliac crests If iliac crest drops on side of lift leg, the hip abductor muscles on the weight bearing side are WEAK
43
Ballottement
Determine excess fluid of knee effusion Push patella down to femur, if effusion present a tapping will be sensed when the patella is pushed against the femur Release pressure, if effusion present the patella will float like a wave is pushing it
44
Bulge sign
Milk medial aspect of the knee up two-three times then milk lateral side of the patella Observe for bulge of returning fluid to the hollow
45
McMurray test
Detect torn medial or lateral meniscus Lie supine and flex one knee Thumb and fingers on either side of joint space Extend and flex knee, any palpable or audible click, grinding, pain, limited extension of knee = torn medial meniscus Repeat turning to others side = torn lateral meniscus
46
Drawer test
Identify instability of anterior and posterior cruciate ligaments Pull tibia in and out Movement of knee greater than 5 mm is unexpected
47
Lachman test
Evaluate anterior cruciate ligament integrity Flex the knee 10-15 degrees with the heel on the table Place one hand above the knee to stabilize the femur and place other hand around proximal tibia Pull the tibia anteriorly increased laxity > 5 mm indicates injury to ligament
48
Varus abduction and valgus adduction stress tests
``` Identify instability of the lateral and medial collateral ligaments Supine, extend knee Stabilize femur and hold ankle Apply force in and rotate Apply force out and rotate ```
49
Infants
From 2 months, infant should lift head and trunk from the prone position Kyphosis of thoracic and lumbar spine until infant can sit without support Flat foot, knock nee, forefoot adduction (metatarsus adductus) Palpate clavicles and long bones
50
Barlow-Ortolani maneuver
Detects hip dislocation or subluxation | Positive with a clunk
51
Allis sign
Detects hip dislocation and short femur Supine, flex both knees, feet flat on the table and femurs aligned with each other Observe height of knees for symmetry
52
Children
Observe wear of shoes W position places stress on joints of hips/knees/ankles = common with in-toeing associated with femoral anteversion Assess for tibial torsion
53
Gower sign
Proximal muscle weakness in which | Child rises to a standing position (from supine) by placing hands on legs and pushing the trunk up
54
Ankylosing Spondylitis
Hereditary, chronic inflammatory disease, affects cervical, thoracic and lumbar spin Inflamed vertebral disks and longitudinal ligaments ossify Eventual fusion and severe deformity of the vertebral column Men 20-40 Low back/buttock pain
55
Lumbosacral Radiculopathy
``` Herniated Lumbar Disk Degenerative changes of the disk L4, L5, S1 nerve roots Greatest 31-50 y/o Maybe associated with lifting objects Down the leg in the dermatome of the nerve root - numbness, tingling ```
56
Lumbar Stenosis
Narrowing of the spinal canal | Canal narrowing from the bone and ligament hypertrophy may lead to entrapment of the spinal cord
57
Carpal Tunnel
Compression of the median nerve | Associated with RA, gout, acromegaly, hypothyroidism, hormonal changes of pregnancy
58
Gout
Form of arthritis Disorder of purine metabolism that results from elevated serum uric acid Acute inflammatory attacks - sudden onset of hot, swollen joint Men > 40
59
TMJ Syndrome
Congenital anomalies, malocclusion, trauma, arthritis, joint diseases Unilateral facial pain Click, pop, crepitus
60
Osteomylelitis
Infection of the bone Purulent matter through the cortex of the bone and into the soft tissue Decreased blood flow may lead to necrosis
61
Bursitis
Inflammation of the bursa Repetitive movement, infection, gout Limited movement, point tenderness, erythema, soreness radiates to tendons at the site
62
Paget Disease of the Bone
Osteitis Deformans Focal metabolic disorder of the bone Persons > 45 Excessive bone resorption and bone formation produce a mosaic pattern of lamellar bone Esp. skull bones = vertigo, HA; progressive deafness Frequent fractures
63
Osteoarthritis
Deterioration of the articular cartilage covering ends of bone in synovial joints Cartilage abrasion = bone surfaces start to rub on bone > 40 y/o Crepitus and limited ROM Enlarged joints due to osteophytes (bone growths)
64
Rheumatoid arthritis
Chronic systemic inflammatory disorder of the synovial tissues surrounding joints Leukocytes aggregate at inflamed synovial tissue Inflammatory cytokines released that damage bone, cartilage, tissues Fatigue, myalgia, weight loss, low-grade T Nodules and deformities Mod-severe joint enlargment
65
Tenosynovitis
Tendonitis Inflammation of the synovium-lined sheath around a tendon Repetitive action, inflammatory conditions like RA
66
Talipes Equinovarus
Clubfoot Fixed congenital defect of ankle and foot Genetic, intrauterine compression
67
Metatarsus Adductus
Metatarsus Varus Most common Caused by intrauterine position Adduction of toes and forefoot
68
Legg-Carlve-Perthes Disease
``` Avascular necrosis of the femoral head Decrease femoral head blood flow Common boys 3-11 pain in medial thigh, knee, groin Painless limp, loss of internal rotation Muscle weakness upper leg ```
69
Osgood-Sclatter Disease
Traction apophysitis = inflammation of bony outgrowth of the anterior aspect of the tibial tubercle Inflammation of the anterior patellar tendon Self limiting boys 9-15 Limp Knee pain Pain with palpation over tibial tuberosity
70
Slipped Capital Femoral Epiphysis
Capital femoral epiphysis slips over neck of the femur 8-16 Majority unilateral Knee pain and limp Leg weakness, reduced internal hip rotation Radiograph shows slippage
71
Muscular dystrophy
Group of genetic disorders involving gradual degeneration of muscle fibers Progressive symmetric weakness and muscle atrophy from fatty muscle infiltrates Skeletal muscles, heart Mild to severe Clumsiness, fall down Muscle atrophy, waddling, Gower, loss of function (progressive)
72
Nursemaid's Elbow
Dislocation injury Caused by jerking the arm upward while the elbow is extended Pulls apart the elbow joint and tears the margin of the annular ligament around radial head Common 1 -4
73
Osteoporosis
Decrease in bone mass bone resorption is more rapid Dowager hump = hallmark Commonly postmenopausal female Glucocorticoid excess and hypogonadism = risk Lose heigh, abdominothouacic space
74
Dupuytren Contracture
Contractors involving the flexor hand tend ones Flexion contractures Men >40 Flexor tendons 4th-5th digits
75
Epicondylitis
Upon exam there is no pain with Passive ROM but there is pain with Active ROM

Advanced Assessment (14 decks)

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