Musculoskeletal Exam 1 Flashcards
PE Question
Any discomfort or problems with your extremities or back?
How should our examination for musculoskeletal be?
Systematic
What should we look for on inspection?
Looking for symmetry, deformities, malalignments, skin changes, subcutaneous nodules, and muscle atrophy
What do we look for in palpation?
For crepitus (an audible or palpable crunching during movement of tendons or ligaments over bone or areas of cartilage loss) or tenderness, bogginess, warmth, etc
What do we assess for?
Range of motion and special maneuvers to test specific movements.
What is range of motion in terms of fold?
3 fold
How many fingers can normally be inserted into the mouth?
3
Can bottom teeth normally be placed in front of upper t
Yes
How does it appear in anterior dislocation of the shoulder?
The rounded lateral aspect of the shoulder appears flattened.
What 7 things do we palpate in the shoulder?
- Sternoclavicular joint
- Spine of the scapula
- Acromion
- Acromioclavicular joint
- Coracoid process
- Greater tubercle
- Biceps tendon in the intertubercular groove
Do we examine the subacromial and subdeltoid bursae and the SITS muscles?
Yes
Is the subscapularis palpable?
No
What does localized tenderness in the shoulder arise from?
Subacromial or subdeltoid bursitis, degenerative changes, or calcific deposits in the rotator cuff
When is tenderness over the SITS muscle insertions and inability to abduct the arm above shoulder level are seen?
Sprains, tears, and tendon rupture of the rotator cuff, most commonly the supraspinatus
What does tenderness and effusion suggest?
Synovitis of the glenohumeral joint
What are the 6 motions of the shoulder girdle?
Flexion, extension, abduction, adduction, and internal and external rotation
What 4 things does shoulder restricted ROM occur in?
Bursitis, capsulitis, rotator cuff tears or sprains, and tendinitis
What is the most common cause of shoulder pain?
Rotator cuff
What does compression of the rotator cuff muscles and tendons between the head of the humerus and the acromion cause?
“Impingement signs” or pain during maneuvers such as Neer’s, Hawkin’s, and the empty-can tests, described below
What 3 things cause swelling over the olecranon process?
Olecranon bursitis; inflammation or synovial fluid occurs in arthritis
Tenderness distal to epicondyle is common in what and not common in what?
Lateral epicondylitis (tennis elbow)and less common in medial epicondylitis (pitcher’s or golfer’s elbow)
When is the olecranon displaced posteriorly?
Posterior dislocation of the elbow and supracondylar fracture
Do we palpate grooves between epicondyles?
Yes
What does ROM include?
Fexion and extension at the elbow and pronation and supination of the forearm
How should the wrist and hands be when the fingers are relaxed?
Slightly flexed; the fingernail edges should be in parallel
When is diffuse swelling in the hands and fingers common? Local swelling?
Arthritis or infection; local swelling suggests a ganglion
What do we palpate at the wrist?
Distal radius and ulna
Do we palpate the groove of each wrist joint with your thumbs on the dorsum of the wrist?
Yes
Do we palpate the radial styloid bone and the anatomical snuffbox?
Yes
Colles Fracture
Tenderness over the distal radius
De Quervain’s tenosynovitis and gonococcal tenosynovitis
Tenderness over the extensor and abductor tendons of the thumb at the radial styloid
How do we test thumb function if there is wrist pain? What is it commonly called?
Grasp the thumb against the palm and then move the wrist toward the midline in ulnar deviation (commonly called Finkelstein’s test)
What does tenderness over the snuffbox suggest?
Scaphoid fracture
3 tests for Carpel Tunnel
- Abduction of thumb
- Tinel’s Sign
- Phalen’s Sign
Positive Abduction of Thumb Test
Weakness
Abductus Pollicis Longus Innervation
Only by median nerve
Tinel’s Sign process
Median nerve compression by tapping lightly over the course of the median nerve in the carpal tunnel as shown
What is a positive Tinel?
Aching and numbness in the median nerve distribution
Phalen’s Sign Process
Median nerve compression by asking the patient to hold the wrists in flexion for 60 seconds
Positive Phalen
Numbness and tingling in the median nerve distribution within 60 seconds is a positive test.
How do we compress the MCP joint?
Squeezing the hand from each side between the thumb and fingers
Do we palpate the medial and lateral aspects of each PIP joint?
Yes
PIP changes are seen in what?
Rheumatoid arthritis; Bouchard’s nodes in osteoarthritis
What are Heberden’s nodes? Common in?
Hard dorsolateral nodules on the DIP joints; osteoarthritis
Do we palpate along tendons in areas of swelling and inflammation?
Yes
Tenosynovitis
Tenderness and swelling in tendon sheaths
What ROM do we test in fingers?
Flexion, extension, abduction, and adduction
