Musculoskeletal Flashcards
Balloting the patella assesses for what
Major effusion
A patient reports knee pain when walking up stairs. What would be a finding in a positive patellofemoral grinding test?
Crepitus
A forward jerk showing the contours of the upper tibia is a positive test, or anterior drawer sign and suggests which diagnosis?
ACL injury/tear
The FNP should be suspicious for which diagnosis in an obese child with an acute onset of a limp without know trauma?
Slipped capital femoral epiphysis (SCFE)
Upon examination of the newborn, pigmented spots, hairy patches, or deep pits within 1cm of midline may indicate abnormalities of what structure?
The spinal cord
Pushing the tibia posteriorly and observing the degree of backward movement
Posterior drawer sign
If the proximal tibia falls back while performing the posterior draw sign test, what injury is expected?
Posterior cruciate ligament (PCL) injury
A positive Lachman test indicates what?
significant forward excursion of the knee is a positive test for an ACL (anterior cruciate ligament) tear
Inversion of the foot
Varus
Flat feet from laxity of the soft tissue structures of the foot
Pes planus
The most serious cause of lower back pain, due to risk of limb paralysis or bladder/bowel dysfunction.
Cauda Equina Compression - spinal compression of S2 to S4 - also know as saddle anesthesia
Tests for carpel tunnel syndrome
Thumb abduction
Tinel sign
Phalen sign
This test checks for a supraspinatus rotator cuff tear by asking the patient to hold arms out at 90 degress with arms internally rotated and thumbs facing down - then asking the patient to resist as you place downward pressure.
Inability of the patient to hold the arm fully abducted @ shoulder level or control lowering the arm is a positive result
Empty Can Test (shoulder composite test)
This test checks for glenohumeral disease or adhesive capsulitis by asking the patient to adduct and flex the arm to 90 degrees with thumbs turned up then applying pressure proximal to the wrist while asking the pt to press outward to external rotation - pain or weakness is a positive result
External rotation resistance test (shoulder composite test)
This test for supraspinatus rotator cuff tear or bicipital tendinitis is done by asking the patient to fully abduct the arm to shoulder level up to 90 degrees and lowering it slowly. Weakness during this maneuver is a positive result.
Drop arm test (rotator cuff strength test)
This test checks for s subscapularis disorder by having the patient place the dorsum of the hand on the low back with elbow flexed to 90 degrees, then lifting the hand off the back and asking the patient to hold it there. Inability of the patient to hold the hand in this position is a positive result.
Internal rotation lag test (rotator cuff strength test)
This test checks for a supraspinatus or infraspinatus disorder by having the patient bend his arm to 90 degrees with palm up & rotating the arm from 20 degrees abduction to 90 degrees flexsion
External rotation lag test (rotator cuff strength test)
This test checks for a subacromial impingement/rotator cuff tendonitis disorder by pressin gon the scapula to prevent scapular movement with one hand and raising the patients arm with the other - compresses the greater tuberosity of the humerus against the acromion
Neers Impingement Sign (rotator cuff provication test)
Maneuvers/tests for checking for rotator cuff/impingement issues
Pain provication tests: painful arc test
Strength tests: internal rotation lag test; external rotation lag test; drop arm test
Composite tests: external rotation resistance test; empty can test
Articular joint pain characteristics
is there pain or stiffness, decreased AROM & PROM; am stiffness, “gelling”
Extra-articular pain characteristics
Involves bones, muscles, and tissues around the joint periarticular tenderness- only PROM remains intact
Mono articular
pain in a single joint - suggests injury, monoarticular arthritis or tendonitis or bursitis (extra-articular)
4 Key Features of MSK disorders
- Is this articular or extra-articular?
- Is this an acute symptom (<6wks) or chronic (>12wks)?
- Is this inflammatory or non-inflammatory?
- Is this localized (monoarticular) or diffuse (polyarticular)?
4 Cardinal signs of inflammatory joint disease
- swelling
- warmth
- redness
- pain
Causes of inflammatory joint disease
infectious, crystal-induced, immune-related, reactive, ideopathic
gonorrhea, gout, RA/Lupus
S/S of inflammatory joint disease
Fever & chills (septic arthritis) - morning stiffness that gradually improves with activity (RA)
Causes of non-inflammatory joint disease
trauma (rotator cuff tear), repetitive use (bursitis, tendinitis), degernarative changes or fibromyalgia
S/S of non-inflammatory joint disease
intermittent stiffness and “gelling” (consistent with OA)
Determining acute or chronic
-onset is very important
-duration
-quality
-severity
Gradual onset over days, weeks, or months, or rapid onset?
Has pain progressed or fluctuated?
How long has pain lasted?
What is the pattern?
Acute joint disease
lasts up to 6 weeks
Chronic joint disease
lasts longer that 12 weeks
Sarcopenia
Loss of muscle mass, strength , and function as we age
Determining localized or diffuse
Which joints are painful (monoarticular or polyarticular)?
Asymmetric or symmetric involvement?
Monoarticular: trauma, crystalline, or septic
Oliguarticular arthritis: infection from gonorrhea or rheumatic fever
Polyarthicular: viral, inflammatory
