Musculoskeletal - Bates Flashcards
Articular means…
of or relating to the joint
This structure includes the capsule, cartilage, synovium, fluid, ligaments, and the bone
Articular structure
These rope-like bundles of collagen connect bone to bone
Ligaments
These collagen fibers connect muscle to bone
Tendons
These are pouches of synovial fluid that cushion movement of structures over bone or joints
Bursae
What are the three types of joint articulation and their extent of movement?
1) synovial (freely moveable)
2) cartilaginous (slightly moveable)
3) fibrous (immovable)
What are some examples of synovial joints?
Shoulder, elbow, hip, and knee
What are some examples of cartilaginous joints?
The vertebral bodies of the spine, pubis symphysis, and the sternocostal joints
What is an example of a fibrous joint?
The sutures of the skull
What are the classes of synovial joints?
1) spheroid (ball and socket)
2) hinge
3) condylar
Synovial means?
Moveable
What are some examples of spheroidal joints?
Shoulder and hip
What are some examples of hinge joints?
Elbow, phalanges of hand and foot
What are some examples of condylar joints?
Knee, radiocarpal (wrist), metacarpophylangeal (knuckles)
What is the ROM in a spheroidal joint?
Multiaxial: flexion, extension, abduction, adduction, rotation
What is the ROM in a hinge joint?
Uniaxial: flexion and extension only
What is the ROM in a condylar joint?
Biaxial: flexion, extension, rotation
This is radicular gluteal and posterior leg pain in the S1 dermatome that increases with cough or valsalva
Sciatica
What is the general term for pain that arises from spinal nerve compression?
Radicular pain
The term for pain in one joint
Monoarticular pain
The term for pain that involves several joints
Polyarticular pain
What is the term for bones, muscles and tissues around the joint?
Extra-articular
What is the term for generalized aches and pains in muscles?
Myalgia
What is the term for joint pain?
Arthralgia
What is the term for inflammation of bursae?
Bursitis
What is the term for inflammation of tendons?
Tendonitis
What is the term for inflammation of tendon sheaths?
Tenosynovitis
What is the term for inflammation in a joint?
Arthritis
What is the term for stiffness and limited motion after inactivity?
Gelling
This involves swelling and tenderness of the entire joint and limits both active and passive ROM
Articular joint pain or articular disease
This involves tenderness outside the joint and may involve loss of active but not passive motion
Nonarticular pain or extra-articular disease
What are some systemic features of joint problems
Fever, chills, rash, anorexia, weight loss and weakness
What are the three targets for Healthy People 2020 that involve the musculoskeletal system?
1) arthritis
2) chronic back pain
3) osteoporosis
What is a key outcome predictor of low back pain?
Depression
What is the term for a systemic skeletal condition characterized by low bone mass and microarchitectural deterioration of bone tissue?
Osteoporosis
Bone strength depends on three things, what are they?
1) bone quality
2) bone density
3) bone size
What is the optimal standard for measuring bone density?
Dual energy x-ray absorptiometry (DEXA) scan
Bone density at what location is considered the best predictor of hip fracture?
Femoral neck
Peak bone mass is reached by what age?
30
What is the most abundant mineral in the body?
Calcium
In what functions are calcium levels important?
1) Bone health
2) Muscle function
3) Nerve transmission
4) Vascular function
5) Intracellular signaling
6) Hormonal secretion
What percent of calcium if free and stored?
1% free and 99% stored
What is the normal serum calcium level?
8.5-10.3 mg/dL
What is required to absorb dietary calcium?
Vitamin D
Vitamin D is a what?
Hormone
Decreased levels of free calcium stimulate the secretion of what hormone?
Parathyroid hormone (PTH)
Increased PTH release has what effects
1) Kidneys reabsorb calcium
2) Kidneys excrete phosphate
3) More Vit D is converted to help absorb calcium
4) Osteoclastic activity is increased (dissolve)
5) Ionized calcium is released
Which type of calcium should people with reduced levels of stomach acid take?
Calcium citrate
What are the two oral forms of calcium?
Calcium carbonate and calcium citrate
What is the process by which osteoclasts break down bone and release the minerals, resulting in a transfer of calcium from bone fluid to the blood?
Bone resorption
What class of drugs inhibit osteoclast activity?
Antiresorptive agents
What is the term for bowed legs?
Genu varium
What is the term for knock-knees?
Genu valgum
What is the term for audible or palpable crunching during palpation?
Crepitus
What is the term for bony fixation in or around a joint?
ankylosis
What are the signs of inflammation and arthritis?
1) swelling
2) warmth
3) tenderness
4) redness (least common of the 4)
What is the name of the most active joint in the body?
The temporomandibular joint (TMJ)
TMJ is what type of joint?
A condylar synovial joint
What muscles open the mouth?
The external pterygoids
What muscles close the mouth?
The masseter, the temporalis and the internal pterygoids
What CN is involved in closing the mouth?
CN V, the trigeminal nerve
What are the four dynamic (moveable) stabilizers of the shoulder? Clue: SITS
1) supraspinatus
2) infraspinatus
3) teres minor
4) subscapularis
What are the four static (non-moveable) stabilizers of the shoulder?
1) the bony structures of the shoulder girdle
2) the labrium
3) the articular capsule
the glenohumeral ligaments
What three joints articulate at the shoulder?
1) glenohumeral joint
2) sternoclavicular joint
3) acromioclavicular joint
What three groups of muscles attach at the shoulder?
1) scapulohumeral groups (SITS) (rotate shoulder laterally)
2) axioscapular (rotate scapula)
3) axiohumeral (rotate shoulder internally)
The most common cause of shoulder pain involves what group of muscles?
Rotator cuff
What are the three best predictors of a rotator cuff tear?
1) supraspinatus weakness on abduction
2) infraspinatus weakness on external rotation
3) a positive impingement sign
What is the name of the test?
Adduct the patient’s arm across the chest
Crossover test
What is the name of the test?
Touch the opposite scapula from above and below
Apley scratch test
What is the name of the test?
Press on the scapula while raising the arm
Neer’s impingement sign
for impingement of posterior rotator cuff
+ if pain
What is the name of the test?
Flex shoulder to 90 degrees, while arm internally rotated, provider flexes to 180 degrees
Hawkin’s impingement sign
for impingement of rotator cuff
+ if pain
What is the name of the test?
Arms elevated at 90 degrees
Internally rotate with thumbs down
Empty can test
What is the name of the test?
Abduct arm to shoulder level
Lower slowly
Drop arm test
for rotator cuff tear
+ if arm drops independently or with light pressure
What three joints articulate at the elbow?
1) humeroulnar joint
2) radiohumeral joint
3) radioulnar joint
What is responsible for the movement?
Elbow flexion
Biceps and brachioradialis
What is responsible for the movement?
Elbow extension
Brachialis and triceps
What is responsible for the movement?
Forearm pronation
Pronator teres
What is responsible for the movement?
Forearm supination
Supinator
Lateral epicondylitis is also called what?
Tennis elbow
Medial epicondylitis is also called what?
Pitcher’s or golfer’s elbow
How many carpal bones are in the wrist?
8
What are the joints of the hand?
1) DIPs - distal interphalangeal joints
2) PIPs - proximal interphalangeal joints
3) MCPs - metacarpophylangeal joints (knuckles)
What is responsible for the movement?
Abduction of the fingers
Dorsal interossi
What is responsible for the movement?
Adduction of the fingers
Palmar interossi
What lies in the carpal tunnel?
1) Flexor retinaculum
2) Medial nerve
3) Tendon sheath
Osteoarthritis causes nodes at the DIPs and PIPs that are called?
Herberden’s nodes and Bouchard’s nodes respectively
What is responsible for the movement?
Wrist extension
Extensor carpi ulnaris, extensor carpi radialis longus, extensor carpi radialis brevis
What is responsible for the movement?
Wrist flexion
Flexor carpi radialis and ulnaris
What is responsible for the movement?
Radial deviation
Flexor carpi ulnaris
What is responsible for the movement?
Ulnar deviation
Flexor carpi radialis
Where can you test for sensation of the median nerve?
Pulp of the index finger
Where can you test for sensation of the ulnar nerve?
Pulp of the fifth finger
Where can you test for sensation of the radial nerve?
Web space of the thumb and index finger
What is the name of the test?
Tapping on the median nerve in the carpal tunnel
Tinel’s sign
for CTS, + if numbness and tingling along medial nerve
What is the name of the test?
Press the backs of the hands together to form right angles for 60 seconds
Phalen’s sign
for CTS, + if numbness and tingling along median nerve
What is the name of the soft mucoid central core of the vertebral disc?
Nucleus pulposus
What is the name of the tough fibrous tissue rim of the vertebral disc?
Annulus fibrosis
What is the term for slippage?
Subluxation
What is the term for lateral and rotatory curvature of the spine?
Scoliosis
What is responsible for the movement?
Neck flexion
Sternocleidomastoid, scalene
What is responsible for the movement?
Neck extension
Splenius capitis and cervicis
What is responsible for the movement?
Back flexion
Psoas minor and major, quadratus lumborum, abdominal muscles
What is responsible for the movement?
Back extension
Erector spinae and transversospinalis groups
What are the bones of the pelvis?
1) acetabulum
2) ilium
3) ischium
What are the four muscle groups that move the hip?
1) flexor group
2) extensor group
3) adductor group
4) abductor group
What is the major muscle of the flexor group?
Iliopsoas
What is the major muscle of the extensor group?
Gluteus maximus
What are the three principal bursa of the hip?
1) Psoas bursa (anterior to hip)
2) Trochanteric bursa (posterior to the hip)
3) Ischial bursa (under the tuberosity)
What is it called when the foot is on the ground and bearing weight?
Stance (60% of cycle)
What is it called when the foot moves forward and does not bear weight?
Swing (40% of cycle)
What is a normal width of the base in a gait?
2”- 4”
What is the mnemonic for the lateral to medial sequence of the structures along the inguinal ligament?
NAVEL
Nerve, Artery, Vein, Empty space, Lymph node
What is responsible for the movement?
Hip abduction
Gluteus medius and minimus
What is responsible for the movement?
Hip adduction
Adductor brevis, longus and magnus
What is responsible for the movement?
Hip external rotation
Internal and external obturators
What is responsible for the movement?
Hip internal rotation
Iliopsoas
What is the largest joint in the body?
The knee joint
What are the two menisci of the knee?
Medial and lateral
What are the two pairs of ligaments in the knee?
Medial and lateral collateral (MCL & LCL)
Anterior and posterior cruciate (ACL & PCL)
What provides medial and lateral stability to the knee?
The MCL and the LCL
What prevents the tibia from sliding forward on the femur?
ACL
What prevents the tibia from slipping backward on the femur
PCL
What provides anteroposterior stability to the knee?
The ACL and the PCL
What are the bursa that are near the knee?
1) prepatellar
2) anserine (below knee medially)
3) semimembranosus (posterior medial)
What is the name of the test?
Compress patella against the femur and move side to side
Patellofemoral grinding test
What is the name of the test?
Knee extended, pressure to suprapatellar pouch, milk down, tap for fluid wave
Bulge sign
+ is mild effusion
What is the name of the test?
Thumb and index finger on sides of patella, push pouch to side to feel for moving fluid
Balloon sign
+ is medium effusion
What is the name of the test?
Push the patella sharply against the femur, watch for fluid return
Ballotting the patella
+ is maximum effusion
What is responsible for the movement?
Knee flexion
Hamstring group, biceps femoris
What is responsible for the movement?
Knee extension
Quadriceps, rectus femoris, vastus femoris and lateralis
What is responsible for the movement?
Knee internal rotation
Sartorius, gracilis
What is responsible for the movement?
Knee external rotation
Biceps femoris
What is the name of the test?
Patient supine, grasp heel, flex knee, cup other hand over knee, valgus stress to medial joint, varus stress to lateral joint
McMurray Test for medial meniscus
+ if clicking
What is the name of the test?
Patient supine, knee slightly flexed, move thigh 30 degrees laterally, valgus stress to lateral joint
Valgus stress test for MCL
Tests for collateral ligament injury
+ if instability/movement
What is the name of the test?
Patient supine, knee slightly flexed, move thigh 30 degrees laterally, varus stress to lateral joint
Varus stress test for LCL
Test for collateral ligament injury
+ if instability/movement
What is the name of the test?
Patient supine, hips flexed, knees bent to 90 degrees, feet flat on table, grasp knee, slide out like a drawer
Anterior drawer test for ACL
+ if instability/movement
What is the name of the test?
Knee at 15 degree flex, external rotation, pull tibia forward and tibia back
Lachman test for ACL
+ if translation
What is the name of the test?
Patient supine, hips flexed, knees bent to 90 degrees, feet flat on table, grasp knee, push tibia back
Posterior drawer test for PCL
+ if instability/movement
What are the bones of the foot?
1) Tibia
2) Fibula
3) Talus
4) Calcaneus
What are the principal joints of the ankle?
1) tibiotalar joint
2) subtalar joint
What is responsible for the movement?
Foot plantar flexion
Gastrocnemius, posterior tibial muscle, toe flexors
What is responsible for the movement?
Foot dorsiflexion
Anterior tibial muscle, toe extensors
What ligament protects the foot against stress from eversion?
Deltoid ligament
Which ligaments protect the foot against stress from inversion?
1) anterior talofibular
2) calcaneofibular
3) posterior talofibular
What is the name of the test?
Inability to bear weight after four steps and tenderness over the posterior aspects of either malleolus
Ottawa ankle rule
