Musculoskeletal System Flashcards
1
Q
What are we going to ask when we have a patient that comes in with joint pain?
A
Joint Pain (OLDCART) Mechanism Stiffness-think osteoarthritis(unilateral, wear and tear discrete, geriatrics), bone spurs, cartilage not a lot of nerve fibers. Edema Erythema/heat Deformity Decreased movement
2
Q
Rheumatoid Arthritis
A
bilateral, systemic, inflammatory,hands and smaller joints, edema, erythema, thickening of synovial membrane, distorted, deformity, late stage or fractures, dislocations or subluxations, come out all the way.
3
Q
ligament
A
bone to bone.
sprain a ligament
4
Q
tendon
A
bone to muscle
strain a tendon or a muscle
5
Q
muscle
A
Myalgia-statins for cholesterol can cause these. zithro cause achilles tendon rupture
Muscle weakness
6
Q
Past health history/family history
A
Past Health History
Orthopedic surgery
Autoimmune disorders
Fractures-osteoporosis prone to these in vertebrae, hip, low bone density
Medications
Alcohol use
Smoking history - these last two impair healing
7
Q
Gait/balance
A
Ambulates on own, steady gait Ambulates on own, unsteady gait Ambulates with assistance, cane Ambulates with assistance, walker Walker and wheelchair Wheelchair only Bedfast
8
Q
Range of Motion (ROM)
Active Vs. Passive
A
Active vs. Passive ROM
Active: Patient moves joints through ROM
Passive: You move relaxed joints through ROM
9
Q
Upper and Lower extremities ROM
A
Normal: Full ROM Abnormal: Limited ROM Immoble: contracture-post stroke-hypertension of muscle, pt should be doing passive stretching, tendon shortens needs to wear splint Flaccid- no tone Contractured -if not moving properly do full assesment -if moving well do not
10
Q
Shoulder ROM
A
Flexion Extension Abduction Adduction-full goes all the way across body External Rotation Internal Rotation
11
Q
Elbow ROM
A
Flexion
Extension
Supination
Pronation
12
Q
Wrist/hands/fingers ROM
A
Wrist Wrist Flexion Wrist Hyperextension Radial deviation Ulnar deviation Fingers Finger flexion Finger hyperextension Finger abduction Make a fist Finger opposition
13
Q
Hip ROM
A
Flexion Hyperextension Internal rotation External rotation Abduction Adduction
14
Q
Knee ROM
A
Flexion
Extension
Extension can also be demonstrated by success in rising from low chair or rising from squat without support
15
Q
Ankles/feet ROM
A
Plantar flexion-down Dorsiflexion-up Eversion-toe down Inversion-pinky down Toe flexion Toe extension
16
Q
Spine ROM
A
-Cervical Flexion Extension Left Rotation Right Rotation Left Lateral Flexion Right Lateral Flexion -Lumbar Flexion Hyperextension Left Rotation Right Rotation Left Lateral Flexion Right Lateral Flexion
17
Q
Postoperative-Orthopedic
A
document which joint
18
Q
The C in CMS
A
C = Color/Circulation Color Expected color, cyanotic, mottled, reddness Capillary Refill Brisk, sluggish <3 seconds Temperature Warm to touch, cool to touch Peripheral pulses
19
Q
The M in CMS
A
M = Movement/Motor
Able to move fingers, able to move toes
20
Q
The S in CMS
A
S = Sensation
Sensation to touch intact, numbness/tingling to touch, no sensation to touch
21
Q
Postoperative-Orthopedic Special Tests: Homan’s sign
Plantar/flexion Pain
A
presence of calf pain, sharply dorsi flex foot.
-Pain/no pain
22
Q
Additional assessments
A
Inspection/Palpation of Extremities Muscle Testing of Extremities Inspection/Palpation of Spine Specialized Testing Drop Test- RTC Tear Assessment Carpal Tunnel Assessment Scoliosis Assessment Straight Leg Raise-Herniated Disc Assessment
23
Q
Shoulder Inspection: size, contour, color, and swelling
A
Size and Contour
Size/Length
Shortened limb, amputation
Contour: Deformity or masses
Fractures, dislocations, subluxations, contractures, ankylosis
Color or swelling
Color
Erythema, ecchymosis, cyanosis
Swelling-osteoarthritis could have swelling
Excess joint fluid, thickening of synovial lining, inflammation of soft tissue, or bony enlargements
24
Q
Shoulder-Palpation-Pain
A
- Clavicle
- acromioclavicular joint(most susceptable football players FOOSH injury “fall on outstretch hand”) -subacromial bursa area
- greater tuberacle of humerus-rotator cuff tear at insertion
- biceps groove-tenderness inflammed biceps groove, popeye arm ruptured tendon, biceps tendon bulging muscle.
- anterior aspect of glenohumeral joint
- scapula-chk wing feel for tenderness
25
Shoulder-Palpation-Temp.
Temperature
| Inflammation-feel for warmth
26
Shoulder-Palpation-Masses or Swelling
Crepitus-Bone on bone, hand over joint move joint, listen for sound through passive ROM.
27
Shoulder Muscle Testing
```
Muscle Testing
Muscle testing- Repeat motions with ROM, but apply resistance
Flexion
Extension
Abduction
Adduction
External Rotation-These last two bent arm 90 deg. angle totate arm and try to push inward
Internal Rotation
Muscle strength 5/5 bilaterally
```
28
Drop arm test (specialized testing)
Drop Arm Test
Have patient fully abduct their arm, then ask to slowly lower it to their side.
Positive- Arm drops to side from a position of about 90º abduction
Negative- Able to lower arm all the way to side slowly and smoothly
-Rotator cuff superspanatus wont be able to hold arm at 90 deg.
29
Elbow-Inspect= size, contour, color, and swelling
- make sure no edema
- bursitus red warm swollen at the tip
- gouty arthritus- epicondyles come in contact, fingers wont fit in groove.
- assess for tenderness
- feel over groove and bursa sac
30
lateral epicondyl
tennis elbow, excessive pronation/supination ext of elbow and wrist
31
medial epicondyl
golfers elbow. palmer flexion of the wrist
32
Elbow-Palpate-Pain
Pain
Olecranon process, olecranon bursa area, grooves on side of olecranon process
With thumb in lateral groove and index and middle finger in medial groove palpate either side of olecranon process
-Temp
-Masses or Swelling
-Crepitus
33
Elbow- Muscle Testing
```
Muscle Testing
Flexion
Extension
Supination
Pronation
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34
Wrist/hands/fingers: inspect: size, contour, color, or swelling
- osteoarthritis
- PIP joint: Bouchards- hard non tender2-3mm bony overgrowth
- DIP-Herbendens nodes
- RA: painfull swelling stiffness in joint
- Swan neck-flexion, contracture-later stage RA
- ulnar deviation-stretching & muscle imbalance
35
Wrist/hands/fingers: Palpate Pain, Temp, Masses or Swelling
Wrist
Support hand with fingers under it and palpate wrist with both thumbs
Fingers
Use thumb and index finger in pinching motion to palpate sides of interphalangeal joints.
Temperature
Masses or swelling
36
Wrist/Hand muscle testing
-Isolate writst, lock down forearm
-Wrist
Wrist Flexion
Wrist Hyperextension
Ulnar deviation
Radial deviation
- Hand
Finger flexion
Finger hyperextension
Finger abduction
Make a fist
Finger opposition- no resistance
37
Specialized Testing: Carpal Tunnel
Thenar eminence atrophy
Phalen's Test
Have pt hold both hands back to back while flexing at wrists at 90 degrees.
Normal: No symptoms in hands after 60 seconds (-)
Abnormal: Numbness and burning along median nerve distribution within 60 seconds (+)
-Carpal Tunnel:medial nerve & tendons enter through this tunnel, inflammation causes compression.
-pain in fingers, numbness, swelling.
-beefy fat pad normal, missing in CT
-who gets this: people that type all the time, checkout person, bending at the wrist.
38
Specialized Testing: Carpal Tunnel
| Tinel's Sign
Directly percuss over median nerve at wrist
Normal: No symptoms with percussion (-)
Abnormal: Burning and tingling along median nerve distribution (+)
39
Hip-palpate-muscle testing
```
Palpate-push over greater trochanter, bursa CMS test
Pain
Temperature
Masses or swelling
Crepitus
Muscle Testing-lay down prone
Flexion
Hyperextension
Abduction
Adduction
External rotation
Internal rotation
```
40
Knee- Inspect
```
Inspect
Gait
Size and Contour
Lower leg alignment
Should extend in same axis as thigh
Genu varum (bowleg)
Genu valgum (knock knee)
Color or swelling
```
41
Knee- Palpate for pain
Pain
Tibiofemoral joint, joint line, patella
-feel where femur comes together w/tibia feel for joint tenderness, this is a meniscus tear/ meniscus shock absorber.
-assess for patella pain
-buckling in knee is ligament
-catching is meniscus tear
-ACL planted rotated knee gets hyperextended
42
Knee-Temp-Masses, Swelling
| Muscle Testing
Temperature-heat
Masses or swelling
Crepitus-you would feel in knee, bend and straighten, hear grading. popping isn't crepitus. chondralmalasin is usually crepitus
Muscle Testing-pt. lying down or sitting on edge of bed
Flexion
Extension
43
Hammer Toes
PIJ inflammation, improper fitting shoes
44
Haluxvalgus
turn signal, prominance of first metatrsal, bunion.
| -improper fitting shoes
45
Gout
MTP, redness swelling, increased uric acid, men in their 40's
46
Ankles/Feet Palpate for pain
-Ankle-not as much crepitus in ankle- palpate metatarsals too!
Grasp heel with fingers while palpating ankle with thumbs
-Toes
Palpate metatarsophalangeal joints between thumb and dorsum of fingers on plantar surface
Using pinching motion of thumbs and forefingers to palpate interphalangeal joints
Temperature
Masses or swelling
47
Ankle/Feet Muscle Testing
```
Ankle
Plantar flexion
Dorsiflexion
Eversion
Inversion
Foot
Toe flexion
Toe extension
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48
Inspect The Spine
Inspect
Upright spinal column
From the side: cervical concavity, thoracic convexity, lumbar concavity
Posture erect with normal spinal curvature; no lateral deviation noted
49
Normal curvature of the spin
- Cervical(concave)-Posterior
- Thoracic(convex)-Anterior
- Lumbar(concave)-Posterior
- Sacral(convex)-Anterior
- These are shock absorbers
50
Specialized Testing-Scoliosis Testing
Scoliosis screening:
Standing from behind assess for symmetrical alignment of the shoulders, the iliac crests, and the skin creases below the buttocks
-put hands on top of illiac crest, are hands symmetrical?
-take fingers run up spine for deviations
-hands on shoulder blades are thy symmetrical
Have bend over and touch toes and assess for lateral curvature
-creases in buttocks should be @ symmetrical height
-lateral thoracic excessive
51
Kyphosis
excessive thoracic
52
Lordosis
excessive lumbar
53
Spine-Palpate
Palpate
Spinous processes-use thumb palpate each vertebrae, do you feel pain?
Muscles:palpate for tenderness, cervical strains
Cervical:
Sternomastoid and trapezius muscles
Lumbar:
Paravertebral muscles spasms-hard knot
54
Herniated Lumbar Disk
Straight Leg Raise
With knee extended and patient supine raise affected leg just short of point where it produces pain then dorsiflex foot.
Positive: Sciatic pain (sharp pain radiating down the leg) when leg raised 30-60 degrees
Highly suggestive of presence of herniated nucleus pulposus
-protrusion of disk material against spinal nerve
-switch and do it to other leg
