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Clin Skills > musculoskeletal: part 1 > Flashcards

musculoskeletal: part 1 Flashcards

1
Q

which plane passes through body vertically parallel to median plane?

A

sagittal plane

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2
Q

which plane passes vertically through midline of body dividing it into right and left sides

A

median plane

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3
Q

which plane passes horizontally through body at right angles to frontal and sagittal planes?

A

transverse plane

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4
Q

which plane passes longitudinally through body dividing into front and back?

A

frontal (coronal) plane

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5
Q

which plane? “sections are slices of the body or any of its parts that are not cut along the previously listed anatomical planes”

A

oblique plane

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6
Q

ipsilateral vs contralateral

A

Ipsilateral-occurring on the same side of the body

Contralateral-occurring on the opposite side of the body

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7
Q

flexion vs extension

A

Flexion-bending or decreasing the angle between bones or parts of the body
Extension- straightening, increasing the angle between the bones or parts of the body.

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8
Q

what is “circumduction”?

A

circular movement that involves sequential flexion, abduction, extension, and adduction (or in the opposite order) in such a way that the distal end of the part moves in a circle

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9
Q

medial rotation vs lateral rotation

A 
Medial rotation (internal rotation) brings the anterior surface of a limb closer to the median plane 
Lateral rotation (external rotation) takes the anterior surface away from the median plane.
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10
Q

pronation vs supination

A

Pronation- elbows flexed, palms facing down

Supination- elbows flexed, palms facing up.

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11
Q

plantar flexion vs dorsiflexion

A

Plantar flexion- of the foot, extension of the ankle joint, distal foot is pointed
Dorsiflexion- flexion of the ankle joint, distal foot moves up

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12
Q

eversion vs inversion

A

Eversion-moves the sole of the foot away from the median plane, turning the sole laterally
Inversion-moves the sole of the foot toward the median plane, facing the sole medially

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13
Q

articular vs extra-articular structures

A

Articular structures
Joint capsule and articular cartilage, synovium/synovial fluid, intra-articular ligaments, juxta-articular bone
Extra-articular structures
Periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, overlying skin
Ligaments + tendons

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14
Q

ligaments vs tendons

A

Ligaments – bone to bone

Tendons – muscle to bone

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15
Q

joint articulation: what is the mobility differences between synovial, cartilaginous, + fibrous

A

synovial- freely move
cartilaginous - slightly move
fibrous- immovable

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16
Q

examples of synovial, cartilaginous + fibrous joints

A

Synovial – Knee, shoulder * Bones do not touch
Cartilaginous –Vertebral bodies *Discs with nucleus pulposus
Fibrous – Skull sutures * Bones almost in direct contact

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17
Q

3 types of synovial joints

A

ball + socket (spheroidal), hinge, condylar

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18
Q

describe the 3 synovial joints (ball+socket, hinge, condylar) +examples of each

A

Ball+socket: Flexion, extension, abduction, adduction, rotation, circumduction (wide-ranging)
ex/ Shoulder, hip
Hinge: Flat, planar – move in one plane (flex/extend)
ex/ IP joints, elbow
Condylar: Convex or concave
ex/ Knee, TMJ

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19
Q

define bursae

A

a synovial sac that allow adjacent muscles or muscles and tendons to glide over each other during movement.

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20
Q

what two places can bursae be found?

A
  1. between the skin and the convex surface of a bone or joint
  2. In areas where tendons or muscles rub against bone, ligaments or other tendons or muscles
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21
Q

2nd most common reason for office visits

A

low back pain

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22
Q

low back pain that is midline vs off midline: what things could it be from?

A

Midline: Musculoligamentous injury, disc herniation, vertebral collapse, spinal cord mets, epidural abscess (rare)
Off Midline: Sacroiliitis, trochanteric bursitis, sciatica, hip arthritis

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23
Q

low back pain w/ radiation (paresthesias/numbness) could be cause by what?

A

-Radicular pain arises from spinal nerve compression
Low back- herniated disc
Neck – degenerative changes

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24
Q

low back pain w/ bowel/bladder disruption is likely from what?

A

Bowel/bladder function

cauda equina syndrome

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25
Q

health history: red flags for serious underlying condition causing BACK PAIN

A

<20 years or >50
Hx of Cancer
unexplained weight loss
pain > 1 year, or not responding to treatment
pain at night or present at rest
Hx of IV drug use
Presence of active infection or HIV infection
Long-term steroid use
Saddle anesthesia, bowel or bladder incontinence
Neurologic symptoms or progressive neurologic deficit

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26
Q

joint pain: monoarticular, polyarticular, vs extra articular

A
  1. Monoarticular – localized to one joint
  2. Polyarticular – several joints
    Pattern? Migrating? Symmetric?
  3. Extraarticular
    Myalgias – muscle pain
    Arthralgia – pain but no evidence of arthritis
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27
Q

Can assume it is _______ if they have swelling, stiffness or decreased range of motion

A

articular

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28
Q

_________pain- loss of active but not passive range of motion (always from patient’s perspective)

A

nonarticular

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29
Q

what is “inspected” for in exam

A

Joint symmetry, alignment, deformities, surrounding tissues, nodules, atrophy

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30
Q

what is “palpated” for in exam ?

A

Skin changes, nodules, muscle atrophy, crepitus, tenderness

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31
Q

how is ROM/joint fxn and stability tested in exam?

A

Active vs. passive ROM (always from patient’s perspective)

Ligaments, tendons, bursae

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32
Q

signs of inflammation in exam

A

Swelling, warmth, tenderness, redness (least common sign of inflammation)

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33
Q

most active joint in the body

A

TMJ

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34
Q

what type of joint is TMJ? what muscles does it involve? nerve?

A

Condylar synovial joint
External (lateral) pterygoids (open mouth) and masseter, temporalis, and internal pterygoids
- nerve: trigeminal

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35
Q

how do you palpate for swelling of TMJ?

A

Tips of index fingers just in front of tragus of each ear
“Open and close your mouth several times.”
Smooth? Tenderness?

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36
Q

TMJ ROM- (4)

A

Glide and hinge
Open and close mouth
Protrude and retract jaw
Lateral side-to-side motion

37
Q

glenohumeral joint: contact less than ___ of surface area of glenoid fossa. attached by what?

A

Contact less than 1/3 of surface area of glenoid fossa

Attached by joint capsule, intra-articular capsular ligaments, glenoid labrum, and meshwork of muscles and tendons

38
Q

shoulder girdle: dynamic stabilizers vs static stabilizers

A 
Dynamic stabilizers (move): 
Rotator cuff (SITS) – moves humerus, stabilizes humeral head within glenoid fossa
Static stabilizers (do not move): 
Labrum, articular capsule, glenohumeral ligaments
39
Q

what is the labrum?

A

fibrocartilaginous ring, surrounds glenoid to deepen socket

40
Q

what anchors the shoulder joint to the axial skeleton ?

A

sternoclavicular joint and scapulothoracic articulation (inserting muscles, not true joint)

41
Q

shoulder: structures you need to ID on exam (6)

A 
Manubrium
Sternoclavicular joint
Clavicle
Tip of acromion
Greater tubercle of humerus
Coracoid process
42
Q

shoulder: ___ joints, ___large bones ____ principle muscle groups

A

Interconnection of 3 joints, 3 large bones, 3 principal muscle groups

43
Q

what are the 3 joints within the shoulder?

A

Glenohumeral
Sternoclavicular
Acromioclavicular (AC)

44
Q

what is each like? Glenohumeral, Sternoclavicular, Acromioclavicular (AC)

A

Glenohumeral: Deep, not normally palpable
(Ball-and-socket)
Sternoclavicular: Convex medial end of clavicle articulates with concave hollow in upper sternum (manubrium)
Acromioclavicular (AC): Lateral end of clavicle articulates with acromion of scapula

45
Q

what 3 muscle groups are involved in the shoulder?

A

scapulohumeral, axioscapular, axiohumeral

*biceps + triceps as well

46
Q

scapulohumeral muscle group: what does it do? what 4 muscles are included?

A

rotate shoulder laterally and depresses and rotates the head of the humerus
-supraspinatus, infraspinatus+ teres minor, subscapularis

47
Q

axioscapular muscle group: what does it do? what 4 muscles are included

A

Attaches trunk to scapula + rotates scapular

trapezius, rhomboids, serratus anterior, and levator scapulae

48
Q

axiohumeral muscle group: what does it do? what 3 muscles are included?

A

Attaches trunk to humerus + internal rotation of shoulder pectoralis major and minor and latissimus dorsi

49
Q

how to find to biceps tendon on exam

A

Rotate arm externally and find tendinous cord that runs just medial to greater tubercle = tendon of long head of biceps that runs in bicipital groove between greater and lesser tubercles
(can also start at elbow and track up)

50
Q

subacromial bursa: where is it? what action compresses it? when might it be palpable?

A

Between acromion and head of humerus and overlying supraspinatus tendon
Compressed by abduction
Bursa may be palpable if inflamed

51
Q

inspection of shoulder: what do inspect anteriorly vs posteriorly?

A

Inspect shoulder/shoulder girdle anteriorly

Inspect scapulae and related muscles posteriorly

52
Q

what are you inspected shoulder muscles FOR? what do you want to inspect about the general appearance of the shoulder?

A

Look for swelling, deformity, muscle atrophy, fasciculations, abnormal positions
Inspect upper extremity for color, skin changes, unusual bony contours

53
Q

palpation of bony landmarks of shoulder

A
  1. Trace clavicle laterally
  2. Bony spine of scapula from behind laterally and up to acromion and ID anterior tip
  3. Pointer finger on acromion, press medially with thumb to find elevated ridge of distal clavicle at AC joint
  4. Move thumb down and medial to next bony prominence, coracoid process
  5. Leave thumb on coracoid process and allow fingers to locate lateral aspect of humerus to palpate greater tubercle (SITS insertion site)
54
Q

palpation of subacromial + subdeltoid bursae + SITs muscles: how do you want to position the arm?

A

Passively extend humerus by lifting elbow posteriorly to rotate structures anterior to acromion. Then palpate bursae + SITS muscles

55
Q

what are the locations of the SITS muscles?

A

Supraspinatus – directly under acromion
Infraspinatus – posterior to supraspinatus
Teres minor – posterior and inferior to supraspinatus
Subscapularis inserts anteriorly and is not palpable

56
Q

what is included in ROM of the shoulder?

A

Flexion + Extension
Abduction + Adduction
Internal rotation + External rotation

57
Q

extra tests for shoulder: what does the “crossover test” and “apley scratch test” each look for?

A

crossover test : compression of AC joint

apley scratch test: shoulder Rotation

58
Q

what are the two signs for impingements of the rotator cuff?

A

Neer’s impingement sign: stabilize pts shoulder while putting in max elevation (shoulder near ear). pain = positive
Hawkin’s impingement sign: flex arm at 90 degrees + medially rotate shoulder (forward flex + horizontal adduct). pain = positive

59
Q

test for supraspinatus vs infraspinatus strength

A
  • Suprapinatus strength “empty can test”
  • Infraspinatus strength – arms at side at 90 degrees with thumbs up, provide resistance as patient presses forearms outward (rotator cuff or bicipital tendonitis)
60
Q

forarm supination test

A

Provide resistance as patient tries to rotate wrist from pronation to supination (elbows at 90 degrees) (rotator cuff or bicipital tendonitis)

61
Q

what is the “drop arm test” for?

A

rotator cuff tear

62
Q

what are the 3 articulations in the elbow ?

A

Humeroulnar joint
Radiohumeral joint
Radioulnar joint
All 3 in large common articular cavity with extensive synovial lining

63
Q

muscles of the elbow?

A 
Biceps
Brachioradialis (flexion)
Triceps (extension)
Pronator teres (pronation)
Supinator (supination)
64
Q

olecranon bursa : where is it? is it palpabe?

A

between olecranon process and skin

Usually not palpable (May become swollen, inflamed, and tender)

65
Q

3 nerves of the elbow

A

Ulnar nerve – posterior in ulnar groove between medial epicondyle and olecranon process
Median nerve – ventral forearm just medial to brachial artery
Radial Nerve – Anterior medial aspect at elbow

66
Q

elbow exam: inspection

A

Support forearm and flex elbow to about 70°
ID medial and lateral epicondyles and olecranon process
Inspect for abnormal contours, nodules, swelling

67
Q

elbow exam: palpation (4)

A
  1. Olecranon process – note tenderness, swelling, inflammation, displacement
  2. Epicondyles – note tenderness, swelling
  3. Grooves between epicondyles and olecranon – note tenderness, swelling, thickening
  4. Ulnar nerve between olecranon process and medial epicondyle (SENSITIVE!)
68
Q

elbow ROM (4)

A

Flexion + Extension . (radial + ulnar deviation)

Pronation+ Supination

69
Q

how many carpal bones? what are they?

A

8 carpal bones
Trapezium , Trapezoid, Capitate, Hamate
pisiform, Triquetrum, Lunate, Scaphoid

70
Q

wrist- includes what? hand?

A

wrist: carpals
hand: metacarpals + phalanges (proximal, middle, distal)

71
Q

3 joints of the wrist

A
  1. Radiocarpal – note groove on dorsal aspect of wrist; provides most of flexion and extension at wrist
  2. Distal radioulnar
  3. Intercarpal
72
Q

3 joints of the hand

A
  1. Metacarpophalangeal (MCPs) – flex hand and find groove distal to knuckle, felt best on either side of extensor tendon
  2. PIPs
  3. DIPs
73
Q

how many muscles are involved in wrist flexion, extension, supination/pronation?

A

Two carpal muscles on radial and ulnar surfaces = flexion
Two radial and one ulnar muscle = wrist extension
Forearm muscle contraction = supination/pronation

74
Q

muscles involved in flexion, abduction, opposition, + extension

A

Three muscles form thenar eminence and provide flexion, abduction, and opposition of the thumb
Muscle base of thumb along radial margin = thumb extension

75
Q

muscles of digit movement

A

Flexor and extensor tendons of muscles in forearm and wrist = digit movement
Intrinsic hand muscles that attach to metacarpals provide digit flexion (lumbricals), abduction (dorsal interossei), and adduction (palmar interossei)

76
Q

what is the carpal tunnel?

A

Channel beneath palmar surface of wrist and proximal hand containing sheath and 2 flexor tendons of forearm muscles and median nerve

77
Q

where is the flexor retinaculum and median nerve?

A

Flexor retinaculum – hold tendons and tendon sheath in place (over carpal tunnel)
Median nerve between sheath and retinaculum

78
Q

inspection of the wrist and hand (5)

A
  1. Observe position, motion
    Rest = slightly flexed fingers aligned almost parallel
  2. Palmar and dorsal surfaces for joint edema
  3. Deformities / Radial or ulnar deviation
  4. Contours of palm (thenar and hypothenar eminences)
  5. Flexor tendon thickening, flexion contractures in fingers
79
Q

which nerve is damaged for thenar atrophy vs hypothenar atrophy?

A

Thenar atrophy – median nerve

Hypothenar atrophy – ulnar nerve

80
Q

palpation of the wrist: 1st three parts. what 3 things do you palpate grooves of joints for?

A
  1. Palpate distal radius and ulna laterally and medially
  2. Palpate grooves of joints placing thumbs on dorsum of wrist and fingers on ventral aspect
    (Swelling, boggy, tender)
  3. Palpate radial styloid and anatomical snuffbox (hollow distal to radial styloid )
81
Q

palpation of wrist: last 4 parts

A
  1. Palpate eight carpal bones and then each metacarpal and proximal, middle, and distal phalanges
  2. Palpate suspected abnormality
  3. MCP Compression –
  4. Palpate medial and lateral PIP and DIP
  5. Palpate along tendons of each digit especially if inflammation noted
82
Q

MCP compression

A

squeeze hand from each side between thumb and fingers and palpate MCP
Note swelling, boggy, tender

83
Q

palpation of PIP and DIP for what?

A

PIP + DIP: Swelling, boggy, tender and bony enlargement

84
Q

3 part test for sensation of nerves in the hand/wrist (which hand to check for which nerve)

A

Pulp of index finger (median)
pulp of 5th finger (ulnar)
dorsal web space of thumb and index finger (radial)

85
Q

3 maneuvers to test for hand/wrist

A
  1. Hand grip
  2. Thumb movement (Finkelstein’s test) – DeQuervain’s tenosynovitis
  3. Carpal tunnel
86
Q

what are the 3 tests for carpal tunnel?

A

thumb abduction: pt raises thumb as you apply resistance
Tinel’s test: tapping over course of median nerve
Phalen’s test (60 sec): hold wrists at flexion for 60 seconds
* for all: numbness/weakness = positive

87
Q

what is finkelstien’s test for?

A

deQuervain’s tensynovitis- hold thumb into palm and ulnar deviate. pain = positive

88
Q

what is the distribution of nerves in the hand?

A

dorsal hand + lateral thumb: radial nerve
palm + distal ventral/dorsal fingers: median nerve
pinky + 1/2 ring finger: ulnar nerve

89
Q

ROM of fingers and thumb

A

ROM of fingers: Flexion, extension, abduction, adduction

ROM of thumbs: Flexion, extension, abduction, adduction, opposition

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