Musculoskeletal and Assessments Flashcards
Tendons
Connect muscles to bones
Tibial Torsion
Inward twisting of the tibia causing a child’s foot to turn inward
Gower’s Sign
Seen when a child rises from sitting to standing position with use of hands to push the trunk up indicating generalized muscle weakness.
Meniscal Injury
- athletes still able to compete despite injury likely caused by a twisting maneuver
- feel a “pop” during injury
- tends to “lock up” after the injury leading to reduced ROM
- delayed swelling
Apley Grind Test
Meniscal injury
- Patient lies prone and flexes the affected knee 90 degrees
- Examiner places their hand on the thigh for stabilization of the joint, then with the other hand, hold the heel and rotate internally and externally
- Click, pop, or pain is a positive test.
Anterior Cruciate Ligament (ACL)
- connects femur (thigh bone) to tibia (shinbone)
-stabilizes knee during rotational movements
- pain & swelling almost immediately
- “sudden popping” and knee gave way
Lachman Test
- ACL injury
- Knee joint laxity suggestive of anterior cruciate ligament (ACL) damage of the knee
- while supine, put one hand on lower thigh and one on lower leg, bed knee 20 degrees, pull lower leg forward while keeping thigh stable, assess for too much range of motion (laxity)
It is more sensitive than the anterior drawer test for ACL damage but not as specific
ACL Management
- refer to ortho
- Rest, Ice, Compression, Elevate (RICE)
- Physical Therapy (PT)
What is a meniscus?
Meniscus is a c-shaped piece of cartilage that acts as a cushion between the shinbone (tibia) and thighbone (femur), each knee has two menisci
McMurray Test
Meniscal Injury
Patient supine, grab patient’s heel with one hand and grab the knee with other hand, internally and externally rotate the knee
Knee pain, click upon manipulation of the knee suggests injury to medial meniscus
Meniscal Injury
Tx
- Rest, Ice, Compression, Elevate (RICE)
- refer to ortho
O’Brien Test
Assesses the labrum of the shoulder
Weakness during this maneuver may indicate labral (ball and socket joint) tear.
Trendelenburg Test (sign)
Assesses weak hip abductor muscles.
Done with having patient stand on one leg. If the pelvis drops on the opposite side, the hip abductor is weak on the leg the patient is standing on.
Varus/Valgus Stress Test
Varus = medal collateral ligament (MCL) injury
Valgus = lateral collateral ligament (LCL) injury
Osteoarthritis (Isolated)
Define
s/s
Degenerative joint disease
cartilage covering the articular surface of joints becomes damaged
- spine, hip, hand, foot, knee
- Joint Pain (weight bearing & hands)
- Stiffness in the morning, but pain usually resolves in an hour
- gradual onset, over the years
- asymmetrical, no warmth, no redness
- Heberden’s nodes (only here)
- Bouchard’s nodes
risk: older age overuse of joints, family history
Osteoarthritis Labs & xray
- ESR negative
- Rheumatoid Factor negative
- Xray shows joint space narrowing
Collateral Ligaments (Valgus and Varus)
Positive find is an increase in laxity of the damaged knee (ligament tear)
Varus stress test of the knee: a test for the medial collateral ligament (MCL)
Valgus stress test of the knee is a lateral collateral ligament
Finkelstein’s Test
De Quervain’s tenosynovitis
Pt grabs thumb and performs ulnar deviation, if this causes pain, test is positive
- inflammation of the tendon and its sheath at the base of the thumb
- abductor pollicis longus
- extensore pollicis brevis tendons
Genu Valgum
Knock knee where knees tilt inward toward each other while the ankles remain spaced apart
Carpal Compression Test
Durkan Test
Pressure with the examiner’s thumb over the patient’s carpal tunnel for 30 seconds elicits symptoms. A positive test will result in pain or numbness distal to the compression.
Carpel Tunnel
Tests (2)
Initial Tx
Phalen’s: think backward prayer hand, flexion wrist test where positive test will cause numbness/tingling in the affected extremity
Tinel’s: percussion / tap technique where tapping on inner wrist causes tingling sensation of median nerve
Tx: Splint or brace
Volar
Relating to the palm of the hand or the sole of the feet
Ligaments
Connect bone to bone
Carpel Tunnel Syndrome
Median nerve compression of the wrist beneath the transverse carpal ligament
Lordosis
Inward curvature of the spine, common in pregnancy and obesity
Phalanges
fingers and toes
Morton’s neuroma
- What is it?
- s/s
- risk factors
- feels like “pebble in their shoe”
- inflammation of the distal nerve of the foot between the third and fourth metatarsals
- factors causing a greater risk: high-heeled shoes, tight shoes obesity dancers runners
Mulder Test
Test for morton’s neuroma
- Grasp first and fifth metatarsals and squeeze the forefoot
- Positive test: hear a click along with a patient report of pain during compression
- Pain is relieved when compression is stopped
Genu Varum
Bowleggedness
Pes cavus
High arch of foot
Plantar fasciitis
Acute of recurrent pain on the bottom of the feet that is aggravated by walking, caused by microtears in the plantar fascia due to tightness of the achilles tendon.
Factors causing a greater risk: obesity, diabetes, flat feet prolonged standing aerobic exercise.
Tarsal (Tarso)
Refers to the bones of the feet or the ankle
Hawkins Test
Practitioner raises the patient’s arm to 90 degrees and internally rotates. Positive sign indicates subacromial impingement or rotator cuff tendinitis.
Carpal (Carpo)
refers to bones of hands and wrists
Pes Planus
flat foot
Neer Test
Assessment of subacromial impingement by flexing the shoulder, internally rotating, and applying pressure over the shoulder blade.
Straight leg test tests for?
Sciatica / Sciatica Neuritis where pain runs down one or both legs
- Passive evaluation of the leg in a supine position with the hip and knee extended
- Neurological pain between 30-70 degrees of hip flexion is a positive sign and suggestive of disc herniation
Drawer Sign (2 tests)
Tests for knee stability looking for a torn or ruptured ligament
- Anterior drawer sign shows anterior cruciate ligament (ACL) injury
- Posterior drawer signs shows posterior cruciate ligament (PCL) injuyr
Osteoporosis Diagnosis
Gold Standard: DEXA scan
Dual X-Ray Absorptiometry
Score: < - 2.5
Osteopenia Diagnosis
Gold Standard: DEXA scan
Dual X-Ray Absorptiometry
DEXA Score: -1.0 to -2.5
Drugs cause osteopenia/osteoporsis
Depro-Vera
Long-term steroids
Proton Pump Inhibitors
Osteoporosis Prevention
Vitamin D 800-1000 IU
Calcium 1200 mg
Weight bearing exercise
- swimming, bicycling
Osteoporosis Risk Factors
Smoking
Osteoporosis
- Tx
- Education
Bisphosphonate
- dronate
alendronate / Fosamax
ibandronate / Boniva
- upright for 30 min after consuming (minimize acid reflux that can erode esophagus)
- take alone before all other meds and foods
Drugs cause osteopenia/osteoporsis
Depro-Provera
Long-term steroids
Proton Pump Inhibitors
Patient has both osteoporosis and hypertension
Prescribe Thiazide Diuretics
- stimulate osteoblasts and decrease excretion of calcium
Rheumatoid Arthritis (systemic)
Systemic autoimmune
Affects women (8:1)
Systemic infection of joints, skin, heart, blood vessels, kidney, GI, brain, nerves, eyes
Rheumatoid Arthritis (systemic) Tx
Disease-modifying anti-rheumatic drugs (DMARDs)
DMARDs
methotrexate / Rheumatrex
Bouchard’s Nodes
Located in Proximal Inter-phalangeal Joint
PIP
- Bony enlargements of the middle joints associated with rheumatoid and osteoarthritis
Heberden’s Nodes
Located in Distal Inter-phalangeal Joint
DIP
Ankylosing Spondylitis diagnosis
stiff/rigid - ankylosing
- commonly known as bamboo spine
- Autoimmune arthritis and chronic inflammatory disease that primarily affects the spine
- xray first, possibly MRI
Snuff Box Tenderness
Diagnosis
Tx
Scaphoid fracture test
Diagnosis: takes 2 weeks to show up on xray
Tx: presumptively treat with thumb spica cast to immobilize wrist to prevent osteonecrosis in wrist
Lateral Epicondylitis
define
s/s
- tennis elbow (outside)
- elbow pain worsens with activity and assessment reveals painful tendon on outer part
Medial Epicondylitis
define
Tx
- golfer’s elbow (inner)
- tendon on inner part of elbow is inflammed
Tx: RICE, NSAIDs, PT
Rotator Cuff Tear Test
Drop Arm Test
suprapinatus tear and infraspinatus tear
abduct the arm and have patient lower arm slowly but if positive the arm just drops to the side
Empty Can Test
Supraspinatus Tear
patient shoulder is 90 degrees abduction fully internally rotated, 30 degrees of forward flexion is added and provider imposes downward pressure of elbow or wrist, if pain or weakness is reported then test is positive
Gout
s/s
diagnostics
Caused by increased uric acid / uric crystals, tophi (stone-like deposits in the joints)
s/s: commonly inflammation with big toe, shoulder, elbow, knee
Diagnostic
- uric acid (may be high, not during acute attack)
- ESR elevated
- C-reactive protein elevated
- WBC elevated
Gout
- Acute
- Prevention
Acute Attack
- NSAIDs such as
1) Indocin or Indomethacin
2) naproxen or Aleve
- corticosteroids
- colchicine
Prevention:
- low purine diet (red meats)
- no alcohol
- adequate hydration
- weight loss
- avoid diuretics, no thiazides
Side Effect: cause bone marrow suppression
Gout
-maintenance therapy
allopurinol / Zyloric (do not start or change during acute attack)
monitor CBC on allopurinol b/c it can cause true bone marrow suppression
More expensive options:
- colchicine (Colcrys)
- probenecid (Probalan)
- febuxostat (Uloric)
Fibromyalgia
- widespread pain
- diagnosis: pain, fatigue, waking up not feeling refreshed, cognitive problems for three months +
- Tx: duloxetine, Cymbalta, amitriptyline / Elavil (off market only generic is offered), pregabalin, Lyrica, cyclobenzaprine, Flexeril
Treat your-CELF
Hallux Valgus
bunion
- affects 1st metatarsal phalange joint
Diagnosis: xray
Plantar Fasciitis
s/s
Tx
- Sharp pain in heels, symptoms get better as day goes on
- common in runners
- rest, ice, stretching arches, wearing supportive shoes, changing shoes, changing sports, anti-inflammatories, and referral for surgery
Cauda Equina Syndrome
- severe low back pain
- numbness and tingling in perineum or saddle area
- new incontinence
- refer immediately to ED
Bursa
Sacs that cushion the joints
Bursitis
sacs that cushion joints become inflamed
Olecranon Bursitis
What is it?
Tx
sacs that cushion joints are inflamed in elbow (superficial) causes generalized pain on elbow
- rest, ice, NSAIDs (celecoxib / Celebrex)
- if rest, ice, NSAIDs provides no relief, aspirate the joint to check for pathogenic causes, then treat with antibiotics
Test for Sciatica
S1
walk on toes where diminished or absent ankle jerk
Test for sciatica
L4
Squat and rise exam where knee jerk is diminished
Test for Sciatica
L5
heel walking with numbness at big toe
