Musculoskeletal Flashcards
Lateral Epicodylitis
Radial side. Remember anatomical position. Tennis elbow.
Medial Epicondylitis
Golfer elbow. Ulnar side.
synovial joint
freely movable; knee-shoulder
cartilaginous joint
slightly movable; vertebral bodies of the spine
fibrous joint
immovable; skull sutures
spheroidal joint
synovial joint-ball and socket
- convex surface in concave cavity; wide ranging flexion, extension, abduction, adduction, rotation, circumduction
example: shoulder, hip
hinge joint
synovial joint
- flat, planar
- motion in one plane; flexion and extension
- interphalangeal joints of hand and foot, elbow
condylar joint
synovial joint
-covex or concave
movement of two articulating surfaces not discernible
-knee, temporomandibular joint
bursae
disc-shaped synovial sacs that allow adjacent muscles or muscles and tendons to glide over each other during movement
exam specifics
- inspection: symmetry
- inspection and palpation: assess the surrounding tissues
- test range of motion and maneuvers to demonstrate limitations in rom or joint instability from excess mobility of joint ligaments
- test muscle strength
signs of inflammation and arthritis
swelling: 1. synovial membrane (boggy or doughy
2. effusion from excess synovial fluid within the joint space
3. soft-tissue structures such as bursae, tendons, tendon sheaths
-warmth, tenderness, redness
TMJ joint structures
Temporal bone zygomatic arch articular disc ext auditory meatus condyle of mandible articular tubercle
TMJ ROM and maneuvers
Glide and hinge motions.
ROM: opening and closing; protrusion and retraction(jutting jaw forward); lateral
Shoulder: bony structures
Acromioclavicular joint Acromion Scapula Clavicle Glenohumeral joint
Glenohumeral joint
glenohumeral joint: head of the humerus articulates with the shallow glenoid fossa of the scapula. deeply situated and not normally palpable. Ball-and-spocket joint. wide range of motion-flexion, extension, abduction, adduction, rotation, circumduction
Sternoclavicular joint
the convex medial end of the clavicle articulates with the concave hollow in the upper sternum
Acromioclavicular joint
lateral end of the clavicle articulates with the acromion process of the scapula
Scapulohumeral muscle group
“SITS” muscles of rotator cuff:rotates shoulder laterally. depresses and rotates the head of the humerus
- supraspinatus: runs above the glenohumeral joint-inserts on greater tubercle
- infraspinatus and teres minor cross the glenohumeral joint posteriorly; insert on greater tubercle
- subscapularis
axioscapular group
attaches the trunk to the scapula and includes the trapezius, rhomboids, seratus anterior, levator scapulae–rotate the scapula
axiohumeral group
attaches the trunk to the humerus and incldes the pectoralis major and minor and the latissimus dorsi. produce internal rotation of the shoulder
Exam shoulder: Inspection
inspection: note any swelling, deformity, atrophy/fasiculations, abnormal positioning
- look for swelling of the joint capsule anteriorly or a bulge in the subacromial bursa under the deltoid muscle
Exam shoulder: palpation
bony landmarks-page 592
-tenderness over the “SITS” muscle insertions and inability to lift arm above shoulder level are seen in sprains, tears, and tendon rupture of the rotator cuff
ROM: Shoulder flexion
raise arm in front of and overhead
ROM shoulder: extension
raise arms behind you
ROM shoulder: abduction
raise arms out to the side and overhead
ROM shoulder: adduction
cross arm in front of body. “crossover test”. tests ac joint. localized tenderness or pain suggests inflammation or arthritis
ROM shoulder: internal rotation
place one hand behind your back and touch your shoulder blade: pain =rotator cuff
ROM shoulder: external rotation
- raise your arm to shouldder level, bend elbow and rotate forearm toward the ceiling
- place one hand behind neck or head as if you are brushing hair. Pain=rotator cuff
Neer’s impingement sign- rotator cuff
press on the scapula to prevent scapular motion with one hand, and raise the patient’s arm with the other-compresses greater tuberosity of humerus against acromion
hawkin’s impingement sign-rotator cuff
flex pt shoulder and elbow to 90 degrees with the palm facing down. then with one hand on the forearm and one on the arm, rotate the arm internally. compresses the greater tuberosity against the coracoacromial ligament
supraspinatus strength- rotator cuff
empty the can test-rotate the arms internally and place downward pressure
infraspinatus strength- rotator cuff
arms at side and flex the elbow to 90 deg with the thumns turned up. provide resistance as the patient presses the forearms outward
forearm supination- rotator cuff or inflamed long head of biceps tendon
flex oatient forearm to 90 deg at the elbow and pronate the patient’s wrist. provide resistance when the patient supinates the forearm
drop arm sign- rotator cuff
if the patient cannot hold the arm fully abducted at shoulder level, the test positive
ELBOW: Bony structures
Humerus medial epicondyle (ulnar side) lateral epicondyle (radial side) ulna radius olecranon process-bursa is between process and skin
ELBOW: ROM/maneuvers
Flexion: “bend elbow
extension: straighten elbow
supination: turn palm up as if carrying bowl
pronation: turn palms down
WRIST AND HANDS: Bony structures
distal interphalangeal joint: DIP Proximal interphalangeal joint: PIP metacardophalangeal joint: MCP carpals metacarpals phalanges padius ulna
Flexor retinaculum
transverse ligament holding the tendons and tendon sheath in place. the median nerve lies between the flexor retinaculum and the tendon sheath.
Wrists and hands exam
Inspection: poor finger alignment seen in flexor tendon injury
-thenar/hypothenar eminences:atrophy=median nerve compresion
palpation-joints
anatomical snuffbox
hollowed depression just distal to the radial styloid process-tenderness in scaphoid fracture
wrists: ROM and maneuvers
- flexion: palms down point finger toward the floor
- extension: palms down point fingers at the ceiling
- adduction: palms down bring fingers to the midline(radial deviation)
- abduction: palms down bring fingers away from midline (ulnar deviation)
carpal tunnel syndrome testing
test sensation:
pulp of index finger (median nerve)
pulp of 5th finger (ulnar)
dorsal web space of the thumb and index finger (radial)
hand grip
have patient grasp your fingers: decreased grip strength is a positive test for weakness of the finger flexors and intrinsic muscles of the hand
-wrist pain and grip weakness in deQuervain’s tenosynovitis, arthritis, carpel tunnel, epicodylitis, cervical radiculopathy
thumb movement
patient grasp thum against palm and them move the wrist toward the midline in ulnar deviation
-pain identifies de Quervain’s tenosynovitis from inflammation of the tendons
Carpel tunnel-thumb abduction
rasie thumb straight up as you apply downward pressure-weakness is positive test
carpel tunnel-Tinel’s sign
median nerve compression by tapping lightly over the course of the median nerve. aching and numbness =positive
carpel tunnel-Phalen’s sign
hold wrists in flexion for 60 sec. numbness and tingling w/in 60 sec =positive
Fingers and thumbs: flexion and extension
flexion: tight fist with each hand, thumb across the knuckles
extension: extend and spread the fingers
Fingers and thumbs: abduction and adduction
spread fingers apart dorsal (abduction) and back together palmar (adduction)
thumb: flexion, extension
flexion: thumb across hand to fifth digit
extension: away from fingers
thumb: abduction, adduction, opposition
abduction: fingers and thumb in neutral position w palm up, then have the patient move the thumb anteriorly away from the palm to assess abduction and back down for adduction.
opposition: touch thumb to each of the fingers
spine muscle groups
trapezius
deltoid
gluteus maximus
latissimus dorsi
exam: inspection
posterior superior iliac spine
iliac crest
ischial tuberosity
sciatic nerves
side view
cervical concavity
thoracic convexity
lumbar concavity
behind view
alignment of the shoulders, iliac crest, skin creases below buttocks
Neck: ROM
flexion: chin to chest
extension: look up at ceiling’
rotation: look over one shoulder and then the other
lateral bending: bring ear to shoulder
Spinal column ROM
flexion: bend forward and try to touch toes. note smoothness and symmetry of move, range of motion
extension: bend back as far as possible
rotation: rotate from side to side
lateral bending: bend to the side from the waist
the hip structures
iliac crest level of L4 iliac tubercle abt superior iliac spine greater trochanter pubic sympysis
hip muscle groups
flexor: iliopsoas
extensor: gluteus maximus
adductor
abductor
inspection: stance
heelstrike
foot flat
midstance
push-off
Hip : ROM
flexion: bend knee to chest and pull to abd
extension: lie face down, bend knee and lift it up
abduction: laying flat move lower leg away from midline
adduction: laying flat, bend knee and move lower leg toward midline
external rotation: laying flat prone bend knee and turn lower leg and foot across midline
internal rotation: laying flat prone bend your knee and turn lower leg and foot away from midline
Knee structures
medial epicondyle lateral epicondyle ant cruciate lig post cruciate ligament medial meniscus lateral meniscus tibia tibial tuberosity
knee muscles
quadriceps: extends leg
hamstrings: flex knee
gastrocnemius muscle in calf
knee ROM
flexion: bend or flex knee
extension: straighten
internal rotation: while sitting swing lower leg toward midline
external rotation: while sitting swing lower leg away from midline
meniscus exam
McMurray test: if a click with flexion or extension in knee or tenderness in joint:
patient supine: grasp heel and flex knee. cup other hand over the knee joint with fingers and thumb along the medial and lateral joint line. from the heel, rotate the lower leg internally and externally. then push on the lateral side to apply a valgus stress on the medial side of the joint. at the same time rotate the leg externally and slowly extend it
MCL: medial cruciate lig-most injuries on medial
abduction or valgus stress: patient supine and the knee slightly flexed, move the thigh about 30 degrees laterally to table. place one hand against the lateral knee to stabilize the femur and the other hand around the medial ankle. push medially agaiinst the knee and pull laterally at the ankle to open the knee joint on the medial side
Lateral collateral ligament
adduction/varus stress: hand against medial surface of knee and the other around the lateral ankle. push medially against the knee and pull laterally at the ankle to open knee joint on lateral side
ant cruciate ligament
ant drawer sign: knees flexed to 90-feet flat on table. draw tibia forward and observe if it slides forward like a drawer under the femur
post cruciate ligament
post drawer sign: same as ant push tibia posteriorly under femur
ankle and foot structures
achilles
tibia: inside
calcaneous: heel
ankle
lateral malleolus first metatarsal metatarsophalangeal joint proximal phalanx distal phalanx
exam ankle
inspect, palpate
ankle ROM
ankle plantar flexion: point foot toward floor
dorsiflexion: point foot toward ceiling
inversion: bend heel inward
eversion: bend heel outward
Attempting to open knee at medial side. Tests MCL
Valgus stress
Placing pressure on LCL. Opens lateral side of knee.
Varus stress
