Musculoskeletal Flashcards
1
Q
Humeroulnar open/closed packed position
A
Open- 70 flexion, 10 supination
closed- full extension and supination
2
Q
Humeroradial open/closed packed position
A
open- full extension and supination
closed- 90 flexion 5 supination
3
Q
Hip open/closed (bony and ligamentous) packed position
A
open-30 flexion, 30 abduction, slight ER
closed ligamentous- full extension, abduction, and IR
closed bony- 90 flexion, slight abduction, slight ER (captain morgan)
4
Q
Knee open packed position
A
25 flexion
5
Q
Glenohumeral capsular pattern
A
- greater limitation in ER, followed by abduction and IR
6
Q
Elbow capsular pattern
A
loss of flexion more than extension
7
Q
Hip capsular pattern
A
limited flexion and IR, some limited abduction
8
Q
Knee capsular pattern
A
flexion limited, slight extension limitation
9
Q
Scapula bony landmarks
A
- covers 2nd-7th ribs
- glenoid fossa faces anteriorly, laterally and superiorly, this causes true abduction(scaption) to be at 30 degrees anterior to frontal plane
10
Q
C4 myotome
A
shoulder shrug (upper traps)
11
Q
C5 myotome
A
shoulder abduction, flexion, extension (deltoid)
12
Q
C6 myotome
A
elbow flexion and forearm supination (biceps)
13
Q
C7 myotome
A
wrist ulnar flexion and elbow extension
14
Q
C8 myotome
A
finge flexion, thumb MCP abduction
15
Q
C5 reflex
A
biceps
16
Q
C6 reflex
A
brachioradialis
17
Q
C7 reflex
A
Triceps
18
Q
Ulnar nerve innervations (6)
A
Flexor carpi ulnaris, adductor pollicis, abductor digiti, opponens digiti, flexor digiti quinti, interossei
19
Q
Median nerve innervations (8)
A
Pronator group, flexor carpi radialis, palmaris longus, flexor digitorum, flexor pollicis longus, abductor pollicis brevis, flexor pollicis brevis, opponens pollicis
20
Q
Radial nerve innervations (9)
A
brachioradialis, triceps, extensor carpi radialis, extensor digitorum, extensor carpi ulnaris, supinator, abductor pollicis longus, extensor pollicis longus/brevis, extensor indici
21
Q
Ulnar nerve cord segments
A
C7-1
22
Q
Median nerve cord segments
A
C6-T1
23
Q
Radial nerve cord segments
A
C6-C8
24
Q
Scapulothoracic and glenohumeral rhythm
A
-2:1 ratio
-first 30-60 occurs in glenohumeral
-120 at glenohumeral
60 at scapulothoracic
25
Normal angle of inclination and coxa vara/valga
Normal - 115-125
Coxa Vara- < 115
Coxa valga > 125
26
Femoral neck anterior rotation
normal - 10-15
Anteversion- 25-30
Retroversion - <10
27
L2 myotome
hip flexion and sartorious
28
L3 myotome
knee extension
29
L4 myotome
ankle dorsiflexion
30
L5 myotome
great toe extension
31
S1 myotome
foot eversion (fibularis longus/brevis)
32
SI joint nutation
flexion of sacrum with posterior rotation of Ilium
33
SI joint counter nutation
extension of sacrum with anterior rotation of Ilium
34
TMJ functional ROM (3 components
- 40mm opening
- 25mm rotation
- 15mm translatory glide
35
SI joint nutation
flexion of sacrum with posterior rotation of Ilium
36
SI joint counter nutation
extension of sacrum with anterior rotation of Ilium
37
TMJ functional ROM (3 components
- 40mm opening
- 25mm rotation
- 15mm translatory glide
38
Ankylosing spondylitits
- morning stiffness
- PROM and AROM loss
- mostly male
- flexed posture of entire spine
- normal reflexes and sensation
39
Gout
- deposit of uric acid crystals onto peripheral joints
- often at knee or great toe
- early ID is important
40
Psoriatic arthritis
- Erosive degeneration in digits and axial skeleton
- both sexes
- acetaminophen, NSAID, corticosteroids
41
Rheunatoid arthritis
- usually MCP and PIPs, can get ulnar drift
- women 2-3x more likely
- Juvenile RA= onset prior to 16 with 75% remission
42
Osteoporosis
- metabolic disease depletes bone mineral density/mass
- women 10x more
- common fx sites= T/L spine, femoral neck, humerus, radius
- Meds=calcium, vitamin D
43
Osteomalacia
-decalcification of bones d/t Vitamin D deficiency
| sxs= severe pain, fxs, weakness, deformities,
44
Osteomyelitis
- inflammatory response w/in bone caused by infection (usually staph)
- more common in children and immunosuppressed adults, males>females
45
Myofascial pain syndromee
-trigger points w/ characteristic referral pain pattern
46
Bursitits
-inflammation of busa
| sxs= pain w/ rest, PROM and AROM limited d/t pain no capsular pattern
47
Myositis ossificans
- painful abnormal calfication w/ muscle belly
- usually direct trauma resulting in hematoma and calcification of muscle
- frequent locations-quads, biceps, brachialis
- surgery when mature lesion (6-24m) and loss of joint movement/nerve function
- avoid aggressive stretching and MT
48
Complex regional pain syndrome
-related to trauma or precipitating event
-dysfunction of sympathetic nervous system to include pain, claudication, vasomotor disturbances
CPRS 1= tissue injury, no nerve involvment
CPRS 2= clearly nerve injury
-long term sxs= muscle wasting, trophic skin changes, decreased bone density, weakness
49
Paget's disease (osteitis deformans)
- unknown etiology, possibly viral infection
- metabolic bone disease resulting in abnormal osteoclast/blast activity
- spinal stenosis, facet arthropathy, possible spine fx
50
Glenohumeral dislocations
- 95% occur in anterior-inferior direction
| - occurs with UE forced into ER, tears inferior glenohumeral ligament
51
Hill Sachs vs Bankart lesion vs SLAP
- Hill Sachs= compression fx of post. humeral head
- SLAP= tear of rim above middle of socket, may include biceps tendon
- Bankart= tear of rim below middle socket and inferior glenohumeral ligament
52
Glenohumeral instability
- traumatic=young throwing athletes
- atraumatic= congenitally loose CT
- shoulder in sling 3-4 post surgery
53
Shoulder Labral tear sxs
- non localized pain
- pain worse w/ overhead or arm behind back
- weakness and instability
- pain w/ biceps resistance
54
Thoracic outlet syndrom
- compression areas= superior thoracic outlet, scalene triangle, clavicle and 1st rib, pec minor and thoracic wall
- possible referred pain, possible parathesia, palor/coolness in hands
55
AC/SC disorders
- fall onto adducted shoulder
| - avoid shoulder elevation during acute phase
56
Rotator cuff tendonosis
- impingement of insertion of RC on anterior acromion
- 30-50 years, pain/weakness after eccentric load
- weak abduction, rotation
- tenderness to palpation RC
57
Internal (posterior) shoulder impingement
- irritation b/w RC and greater tuberosity or posterior glenoid/labrum
- overhead athletes
- pain in posterior shoulder
58
Adhesive capsulitis (frozen shoulder)
- inflammation/fibrosis in shoulder capsule usually d/t disuse after injury
- ER greatest limited, followed by abduction/flexion
- common with DM and thyroid
- 45+ y/o, shoulder hiking
59
Distal humeral fx
- supracondylar fxs examine quickly d/t neurovascular status
| - lateral epicondyle fxs common in young people, require ORIF
60
Osteochondrosis of humeral capitellum
- bone fragment detached, common in 12-15 y/o
| - Panner's disease= avascular necrosis of capitellum, <10 y/o
61
Elbow dislocations
- posterolateral are most common d/t FOOSH w/ elbow ext
- can cause medial epicondyle avulsion fx d/t traction on UCL ligament
- rapid swelling
62
Dequervains tenosynovitis
- abductor pollicis brevis
| - extensor pollicis longus
63
Colle's fx
- most common wrist fx
| - dinner fork deformity w/ posterior displacement of radius fragment
64
Smith's fx
- distal fragment of radius dislocates in volar (anterior) direction
- garden spade deformity
65
Scaphoid fx
- most common carpal fx
- high incidence of avascular necrosis
- immobilized 4-8 weeks
66
Dupuytrens contracture
- banding in palm and digit flexion
- men > women
- MCP and PIP of 4-5 digits in non diabetes
- 3-4 digits of diabetes
67
Boutonniere deformity
- rupture of central tendon of extensor hood
- MCP and DIP ext, PIP flexion
- trauma, RA, degeneration of central tendon
68
Swan neck deformity
- contracture of intrinsic muscles, dorsal sublux of lateral extensor tendons
- flexion of MCP and DIP, extension of PIP
- trauma, RA
69
Ape hand deformity
- thenar muscle wasting, 1st digit moves dorsally in line with 2nd
- median nerve dysfunction
70
Mallet finger
- rupture of extensor tendon at insertion
- flexion of DIP
- trauma
71
Gamekeepers thumb
- sprain/ruture of MCP ULC ligament of 1st digit
| - fall while skiing w/ poles
72
Boxers fx
-fracture of 5th metacarpal
73
Avascular necrosis of hip
- decreased flexion, IR, abduction
| - pain in groin and/or thigh, tenderness to palpation
74
Trochanteric bursitis
- inflammation of deep trochanteric bursa
| - common with Ra
75
Piriformis syndrome sxs
- restriction in IR
- pain w/ palpation to piriformis
- pain referred to posterior thigh
- weakness in ER
76
Meniscal injury sxs
- lateral/medial joint pain and effusion
- joint popping
- knee giving way during walking/joint locking
- limited flexibility
77
Knee fxs
- medial femoral condyle most common, fall w/ shearing force to knee
- tibial plateau, valgum and compression forces to knee, can occur with MCL injury
78
Anterior compartment syndrome
- chronic ACS sxs produced by exercise, deep/cramping feeling
- acute ACS sxs produced by trauma causing swelling. this is medical emergency
79
Anterior tibial periositits (shin splints)
-anterior tibialis and extensor hallucis longus
80
Medial tibial stress syndrome
- overuse of posterior tibialis/ soleus
| - etiology may be excessive pronation
81
Stress fxs
- 49% of all stress fxs involve tibia
| - 10% involve fibula
82
Tarsal tunnel syndrome
- entrapment of posterior tibial nerve w/in tarsal tunnel
- over/excessive pronation causing tendonitis of posterior tibialis, may decrease tarsal tunnel space
- sxs = pain, numbness, parathesia to medial ankle and plantar surface of foot
83
Equinus
-plantar flexed foot caused by neuro disorder (CP)
84
Hallux valgus
-normal metatarsophalangeal angle is 8-20
85
Charcot-Marie-Tooth disease
- peroneal muscular atrophy affecting motor and sensory nerves
- initially affects lower leg/foot muscles, progresses to m. of hands and forearms
86
Spinal stenosis
- narrowing of spinal canal or intervertebral foramen
- sxs= bilateral pain/parathesia in back, buttocks, thighs, calves, feet
- better w/ flexion, worse w/ extension/walking
87
Internal disc disruption
- internal annulus is damaged w/ external structures normal
- common in L spine
- sxs= constant deep achy pain, increased pain w/ movement, no neuro findings, may have referred pain in LE
- spinal manip may be contraindicated
88
Esophageal cancer
pain to back, pain w/ swallowing, dysphagia, weight loss
89
Pancreatic cancer
deep, gnawing pain radiates from chest to back
90
Acute pancreatitis
mid epigastric pain radiating through to the back
91
Cholecystitis
abrupt, severe abdominal pain
| - RUQ tenderness, nausea, vomiting, fever
92
Heart and lung disorders
can refer pain to chest, back, neck, jaw and UE
93
Abdominal aortic aneurysm
usually appears as nonspecific lumbar pain
94
Kidney, bladder, ovary, uterus
refer to trunk, pelvis, and thighs
95
Transient synovitis in children
- acute onset of sudden hip pain age 3-10
- decreased abduction and IR
- hip/groin pain, crying at night, antalgic gait
96
Legg calve perthes disease
blood supply interrupted to femoral head
-age 2-13, 4x more in males
-weakness of psoas major,
cast 4-6 weeks
97
Slipped capital femoral epiphysis
most common hip disorder in adolescents
- femoral head displaced posteriorly/inferiorly
- 2x more males, age 13, females age 11
- decreased abduction, flexion, IR
- vague pain at knee thigh hip
98
Flexor tendon injuries of hand
- immobilize 3-4 weeks w/ wrist and finger flexion IPs at 30-50 flexion
- pt can perform resisted extension and passive flexion w/ splint
- AROM at 4 weeks, extension first then flexion
99
Extensor tendon repairs
- immobilized with DIPs neutral for 6-8 weeks
| - AROM at 6 weeks, extension first then flexion
100
THA
- cemented hips WFB immediately, used for fragile elderly/dementia
- noncemented better for younger active, may be TDWB-WBAT
101
Cementless THA weight bearing
- 25% weeks 1-7
- 50% week 8
- 75% week 10
- 100% week 12 w/o AD
102
Hamstring graft ACLR
- fewer sxs postoperatively
- greater return to preinjury level
- earlier rehab
- more expensive
- slower rehab
103
Patella tendon ACLR
- better maintaining graft tension postop
- less expensive
- faster healing
- increased risk for AKP and lateral knee OA
- increased risk for knee ext deficit
- delayed rehab d/t quad atrophy
104
ACLR ROM
- CPM at 0-70 post surgery
- 0-120 by week 6
- hinged brace at 20-70 for 2-4 weeks
- NWB for one week
- wean pt from brace at 2-4 weeks
105
Maitland grade 1-2
improve joint lubrication/nutrition
| -decreased pain and muscle guarding
106
Maitland grade 3-4
stretch ligaments, muscles, capsules
107
Mailtland grade 5
regain normal joint mechanics
| -decrease pain and muscle guarding
108
Cervical headaches
thrust can be indication and contraindication
| -ask females about birth control and smoking, combo can be vascular accident
