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Clin Med Exam 5 > Musculoskeletal System > Flashcards

Musculoskeletal System Flashcards

1
Q

Order of MSK exam

A
  1. Inspection
  2. ROM
  3. Muscle strength
  4. Reflexes/neuro
  5. Special tests
  6. Palpation
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2
Q

Joint locking or crepitus suggests…

A

Meniscal injury

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3
Q

Give-way injury suggests…

A

Ligamentous or meniscal injury

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4
Q

Weakness suggests…

A

Neurological, myopathy, tendinopathy, muscle injury

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5
Q

Clicking, popping, tearing sensation suggests…

A

Soft tissue injury or tear

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6
Q

Tremor, spasm, weakness suggests…

A

Neurological or muscle injury

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7
Q

MSK ROS

A
  • -Numbness, tingling, weakness
  • -Incontinence or changes in bowel or bladder function
  • -Weight loss
  • -Night time pain
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8
Q

Tendonitis

A

Inflammation of the tendon

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9
Q

Tendonosis

A

Degeneration of a tendon

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10
Q

Tenosynovitis

A

Inflammation of the sheath of a tendon

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11
Q

Tendinopathy

A

Disease of a tendon, often painful overuse tendon condition

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12
Q

Tremor

A

Involuntary, somewhat rhythmic, muscle movement involving oscillations of one or more body parts

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13
Q

Spasticity

A

Velocity dependent resistance to muscle stretch

Neurological impairment

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14
Q

Strain

A

Trauma to a muscle

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15
Q

Sprain

A

Trauma to a ligament

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16
Q

Arthritis

A

Joint inflammation

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17
Q

Arthrosis

A

Joint degeneration

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18
Q

Arthralgia

A

Joint pain

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19
Q

Arthropathy

A

Disease of a joint

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20
Q

Bursitis

A

Inflammation of the bursa

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21
Q

Crepitus

A
  • -Crunching or grating sound
  • -Degenerative bony changes
  • -“Bone on bone”
  • -Inflammation of tendon sheaths
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22
Q

When testing ROM, which is first?

A
  • -Assess active (patient-controlled) first

- -Assess passive (physician-controlled) second

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23
Q

What are the two red flags in resistance testing?

A
  1. Pain

2. Weakness

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24
Q

What kinds of weakness are there and what do they suggest?

A

Smooth weakness - neurological

Break-away weakness - MSK problem

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25
Q

MSK exam for C5

A

Elbow flexion and shoulder abductors

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26
Q

MSK exam for C6

A

Wrist extensors

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27
Q

MSK exam for C7

A

Elbow extensors

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28
Q

MSK exam for C8

A

Long finger flexor

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29
Q

MSK exam for T1

A

Finger abductors

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30
Q

MSK exam for L2

A

Hip flexors

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31
Q

MSK exam for L3

A

Knee extensors

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32
Q

MSK exam for L4

A

Ankle dorsiflexors

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33
Q

MSK exam for L5

A

Long toe extensors

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34
Q

MSK exam for S1

A

Ankle plantar flexors

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35
Q

Muscle strength grade 0

A

No evidence of movement

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36
Q

Muscle strength grade 1

A

Trace movement

37
Q

Muscle strength grade 2

A

Full ROM with gravity eliminated

38
Q

Muscle strength grade 3

A

Full ROM against gravity, but not against resistance

39
Q

Muscle strength grade 4

A

Full ROM against gravity and against resistance, but weak

40
Q

Muscle strength grade 5

A

Full ROM against gravity and against resistance, full strength

41
Q

Special tests for MSK evaluation

A

Ligaments – elongate and push/pull bones

Joint surfaces – rub them against each other to assess for pain

Cartilages – gently squeeze them between bones, look at ROM

42
Q

Trendelenburg sign

A
  • -Unaffected hip drops down with gait

- -Other hip held up as a result of weakness in hip abductors

43
Q

Signs indicating osteoarthritis

A

Heberden’s node

Bouchard’s node

44
Q

Signs indicating rheumatoid arthritis

A

Swan-neck deformity

Boutonniera deformity

45
Q

Straight leg raise

A

Flex pt’s hip to see if there is any impinging on a nerve

46
Q

Bragard’s test

A

If straight leg raise is positive, lower the leg until pain goes away, then dorsiflex foot
If this causes pain, then it’s a nerve impinging problem

47
Q

Gibbus

A

Sharp, angular deformity associated with collapsed vertebra due to atherosclerosis

48
Q

Goniometer

A

Apparatus to measure joint movements and angles

49
Q

Spurling’s test and distraction maneuver

A

Tests for nerve root compression – positive Spurling’s is pain past mid-humerus

50
Q

Apley Scratch Test

A

Quick active ROM assessment using usually both arms at the same time – evaluates abduction and external rotation as they reach up, adduction and internal rotation as they hug themselves, and internal rotation and adduction as they reach back up their spine

51
Q

Neer’s test

A

Internally rotate shoulder, fully extend arm, assess for pain

52
Q

Hawkins test

A

Abduct shoulder, flex arm, internally rotate forcibly

53
Q

Lift off test

A

Wing scapula, stabilize elbow, have patient push hand against you to test subscapularis

54
Q

Arm drop test

A

Abduct patient’s arm, ask patient to lower slowly to see if the rotator cuff is damaged (arm would suddenly drop at a little higher than 90 degrees)

55
Q

Apprehension test

A

Abduct shoulder, flex elbow, apply external rotation to test for shoulder dislocations

56
Q

Yergason’s test

A

Palpate interturbicular groove, have pt supinate against resistance

57
Q

Speed’s test

A

Arm is supinated, shoulder is flexed, have patient press arm down against resistance to test for biceps tendinitis

58
Q

Empty can test

A

Abduct shoulder, palm facing back, have patient push arm down against resistance

59
Q

How is the patient situated during elbow MSK exam?

A

Elbows held in close to body

60
Q

What valgus angle would be abnormal?

A

Greater than 20 degrees

61
Q

Varus and valgus tests

A

Flex arm about 20-30 degrees, apply varus or valgus force

Assessing RCL and UCL, respectively

62
Q

Tinel sign

A

Tapping between medial epicondyle and olecranon causes symptoms

63
Q

Lateral epicondylitis

A

“Tennis elbow”

Inflammation at the origin of the wrist extensors and supinator muscle

Repetitive wrist extension and supination

64
Q

Cozen’s test

A

Pronation of pt forearm, wrist extension, radial deviation, assess resistance

65
Q

Maudsley’s test

A

Have pt resist pushing their 3rd finger down, assessing for pain

66
Q

Phalen’s test

A

Flex the pt’s wrist, positive if pt gets symptoms in

67
Q

Tinel’s sign for CTS

A

Tapping at base of thumb, assessing for pain

68
Q

de Quervain’s tenosynovitis

A

Swelling or stenosis of the sheath around the APL and EPB

69
Q

Finkelstein’s test

A
  • -Thumb flexed and fingers fisted around it
  • -Ulnar deviation
  • -Positive if pain produced over radial wrist
70
Q

Assess for scaphoid fracture

A

Assess tenderness in the snuff box

71
Q

Thumb grind test

A

(1st CMC) Carpo-metacarpal joint and joint and metacarpo-phalangeal joint for OA

72
Q

Causes of osteoarthritis in the hand

A
  • -Cartilage degeneration, trauma

- -Progressive destruction of PIP and DIP, especially DIP and CMC of thumb

73
Q

Heberden’s nodes

A

DIP bony nodules

74
Q

Bouchard’s nodes

A

PIP abnormal enlargements, synovitis

75
Q

RA inspection

A

Look for swan neck deformity, Boutonniere deformity, Ulnar deviation, MCP swelling/thickening

76
Q

Dupuytren’s contracture

A

Painless, flexion contractures of ring finger and pinky

77
Q

Mallet finger

A

“Baseball finger,” forced DIP flexion of finger

78
Q

Thumb grind test

A
  • -Pushing/twisting thumb metacarpal against the trapezium

- -Positive with pain/grinding

79
Q

Thomas’ sign

A

Hyperflex one leg, and positive if the other leg lifts up (tightness of hip flexors on the other side)

80
Q

Ober test

A

Pt lays on their side, extend hip and leg pt’s leg fall, positive if the leg stays up (IT band tightness)

81
Q

Ballottement

A

Compress thigh down towards knee, then tap patella to see if it’s floating in excess fluid

82
Q

Apley’s compression

A

Pt is prone, knee is flexed, push on heel and twisting to test menisci

83
Q

Apley’s distraction

A

Pt prone, flex knee, pull ankle up and rotate, to assess collateral ligaments

84
Q

McMurray’s test

A

Flex hip, flex knee, externally/internally rotate tibia, exaggerate hip flexion, apply valgus/varus stress, then return leg to neutral position to assess for MCL/LCL, respectively

85
Q

Anterior drawer test (ankle)

A

Support calcaneus and apply posterior pressure to assess ATFL

86
Q

Talar tilt

A

Support calcaneus, slight plantar flexion, invert and evert the foot to assess for AFTL and CFL

87
Q

Squeeze test

A

Squeeze at the distal part of the knee joint, looking for fractures

88
Q

External rotation stress

A

Fully dorsiflex, rotate the ankle

Clin Med Exam 5 (6 decks)

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