MUSCULOSKELETAL Flashcards
SYNOVIAL JOINTS (FJBA)
- Freely movable with ROM
- Jt. Capsule –> Synovial fluid
- Bones w/ articular cartilage
Non-synovial (TNB)
- Immovable (ex. Skull sutures)
- No capsule
- Bones joined by fibrous tissue/cartilage
Order of examination
Inspection
Palpation
Color, masses, Swelling
- ↑ joint fluid (effusion)
- Thickened synovium
- Bursitis, tendonitis, tenosynovitis
Deformities
- Dislocation (Humerus out of fossa)
- Subluxation (partial)
- Contracture
- Ankylosis (fusing)
Palpable fluid is
abnormal. Pushing on one side of the capsule = fluid shift which causes visible bulging on the other side.
• Jt. Capsule
- Not normally palpable
- Inflamed Synovial membrane
- Feels “doughy” or “boggy”
Note any:
• localize to specific anatomic structure
•
heat, swelling, masses, pain
- Skin • Muscle • bursae/ligaments/tendons • Fat pads • Capsule
Ask pt. move through full range
•
If see limitation, gently attempt passive motion
• Normal range of active & passive s/b same
• Note limitation/hyperflexion/hyperextension
• If any ↓ ↑ measure w/ goniometer
Crepitation
- Audible/palpable crunching/grating
- Occurs when articular surfaces are roughened
- Ie. Rheumatoid arthritis
Normal incisor space
3-6cm
Normal lateral ROM
1-2cm
Cervical spine
• Pt. should have minimum of
45° flexion; 55° extension
Palpate with elbow flexed at
70 degrees - Extensor surface • Olecranon process • Medial & lateral epicondyles of humerus • Head of Radius • Extensor tendons
Common sites of inflammation & Tennis Elbow
Medial & lateral epicondyles of humerus
• Head of Radius
• Extensor tendons
• Gout
• Consolidated deposits
• Rheumatoid Nodules
Single or multiple nodules
- Nodules
- Heberden’s nodes =
- Bouchard’s nodes =
OA
RA
Phalen’s Test
•
Ask pt. hold hands back to back
• Flexing @ wrist 90 °
• Hold for 60 sec.
• *Pain, numbness, burning = carpal tunnel syndrome
Tinel’s Sign
•
Direct percussion of Median N.
• Tingle, burning, “electrical shock” type pain = carpal tunnel
Gait pattern s/b smooth & even
Trendeleburg Sign = weak or paralyzed hip abductors
• Damage to Superior Gluteal N. (L4, L5, S1)
Palpation
- Symmetric
* No pain or crepitance
Prepatellar bursa
• Swelling = prepatellar bursitis
Suprapatellar pouch
• Swelling = effusion
• Lesions
(ie. Psoriasis)
Angulation deformities:
• Genu varum
• Genu valgum
(bow-legs)
knock knees
Tibiofemoral articulation (jt.)
• Pain @ jt. Line / Irregular bony margins = OA
osteophytes
Check patella for crepitance
•
Hand on patella during flexion/extension
• Small crepitus in asymptomatic pt. usually ok
•* Pronounced crepitus = DJD*
Knee sudden locking is
Sudden Locking = meniscus tear
Audible or Palpable “click” = (
+) for torn meniscus
Difference in shoulder level, ribs, scapulae & iliac crests =
scoliosis
• Lateral tilting and forward bending =
herniated intervertebral disc
LaSegue’s Test Straight LEG RAISE
• If sciatic pain reproduced = herniated disc
LaSegue’s Test for
Herniated DISC
• Sometimes true limb length is equal, but looks unequal. This is due to (PAF)
pelvic obliquity or
adduction or
flexion deformity of the HIP.
For true length,
measure 2 fixed points
For Leg discrepancy measure ______to _______crossing __________of _____
ASIS to Medial Malleolus crossing medial side of knee
McMurray’s Test
• Pt. supine
• Stand on affected side
• Hold heel; flex knee & hip)
MedExROpu-in-val
In-Var-out-La
Internally rotate tibia & VARUS (OUT) stress on knees tests LATERAL meniscus (Va
Ex-Valg-IN-Me
• Externally rotate Tibia & push valgus (inward) stress on knee (tests medial meniscus
What is rotate in mcMurrays
Tibia
Test Muscle Strengtht – ask seated pt. to maintain flexion while you pull forward (FF)
• Flexion test
Test Muscle Strength– ask pt. to rise from seated position w/o hands______ test (RSE)
Extension test
