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Advanced Assessment > Musculoskeletal > Flashcards

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
Q

Genu recurvatum

A

Excessive hyperextension of the knee with weight bearing = weak quads

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26
Q

Baker cyst

A

Popliteal cyst

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27
Q

Knee ROM

A

Bend = 130

Straighten and stretch = 15 hyperextension

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28
Q

Pes varus

A

In-toeing

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29
Q

Pes valgus

A

Out-toeing

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30
Q

Pes planus

A

Flat foot

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31
Q

Pes cavus

A

High instep

32
Q

Heat, redness, tenderness

A

Inflamed joint
Possible RA, gout, septic, fracture, tendonitis
Esp. inflamed metatarsophalangeal joint = gouty arthritis

33
Q

Foot ROM

A 
Dorsiflexion = 20
Plantar flexion = 45
Inversion = 30
Eversion = 20
Abduction = 10
Adduction = 20
34
Q

Thumb abduction test

A

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
Q

Phalen test

A

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
Q

Tinnel sign

A

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
Q

Neer test

A

Flex patient’s arm up to 150 while depressing the scapula

Increased shoulder pain = positive for rotator cuff inflammation or tear

38
Q

Hawkins test

A

Abduct shoulder to 90
Flex elbox to 90
Then internally rotate arm to limit
Increased shoulder pain = positive rotator cuff inflammation or tear

39
Q

Straight leg raising test

A

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
Q

Femoral stretch test

A

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
Q

Thomas test

A

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
Q

Trendelenberg test

A

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
Q

Ballottement

A

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
Q

Bulge sign

A

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
Q

McMurray test

A

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
Q

Drawer test

A

Identify instability of anterior and posterior cruciate ligaments
Pull tibia in and out
Movement of knee greater than 5 mm is unexpected

47
Q

Lachman test

A

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
Q

Varus abduction and valgus adduction stress tests

A 
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
Q

Infants

A

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
Q

Barlow-Ortolani maneuver

A

Detects hip dislocation or subluxation

Positive with a clunk

51
Q

Allis sign

A

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
Q

Children

A

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
Q

Gower sign

A

Proximal muscle weakness in which

Child rises to a standing position (from supine) by placing hands on legs and pushing the trunk up

54
Q

Ankylosing Spondylitis

A

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
Q

Lumbosacral Radiculopathy

A 
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
Q

Lumbar Stenosis

A

Narrowing of the spinal canal

Canal narrowing from the bone and ligament hypertrophy may lead to entrapment of the spinal cord

57
Q

Carpal Tunnel

A

Compression of the median nerve

Associated with RA, gout, acromegaly, hypothyroidism, hormonal changes of pregnancy

58
Q

Gout

A

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
Q

TMJ Syndrome

A

Congenital anomalies, malocclusion, trauma, arthritis, joint diseases
Unilateral facial pain
Click, pop, crepitus

60
Q

Osteomylelitis

A

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
Q

Bursitis

A

Inflammation of the bursa
Repetitive movement, infection, gout
Limited movement, point tenderness, erythema, soreness radiates to tendons at the site

62
Q

Paget Disease of the Bone

A

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
Q

Osteoarthritis

A

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
Q

Rheumatoid arthritis

A

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
Q

Tenosynovitis

A

Tendonitis
Inflammation of the synovium-lined sheath around a tendon
Repetitive action, inflammatory conditions like RA

66
Q

Talipes Equinovarus

A

Clubfoot
Fixed congenital defect of ankle and foot
Genetic, intrauterine compression

67
Q

Metatarsus Adductus

A

Metatarsus Varus
Most common
Caused by intrauterine position
Adduction of toes and forefoot

68
Q

Legg-Carlve-Perthes Disease

A 
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
Q

Osgood-Sclatter Disease

A

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
Q

Slipped Capital Femoral Epiphysis

A

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
Q

Muscular dystrophy

A

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
Q

Nursemaid’s Elbow

A

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
Q

Osteoporosis

A

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
Q

Dupuytren Contracture

A

Contractors involving the flexor hand tend ones
Flexion contractures
Men >40
Flexor tendons 4th-5th digits

75
Q

Epicondylitis

A

Upon exam there is no pain with Passive ROM but there is pain with Active ROM

Advanced Assessment (14 decks)

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