Musculoskeletal System Flashcards
Order of MSK exam
- Inspection
- ROM
- Muscle strength
- Reflexes/neuro
- Special tests
- Palpation
Joint locking or crepitus suggests…
Meniscal injury
Give-way injury suggests…
Ligamentous or meniscal injury
Weakness suggests…
Neurological, myopathy, tendinopathy, muscle injury
Clicking, popping, tearing sensation suggests…
Soft tissue injury or tear
Tremor, spasm, weakness suggests…
Neurological or muscle injury
MSK ROS
- -Numbness, tingling, weakness
- -Incontinence or changes in bowel or bladder function
- -Weight loss
- -Night time pain
Tendonitis
Inflammation of the tendon
Tendonosis
Degeneration of a tendon
Tenosynovitis
Inflammation of the sheath of a tendon
Tendinopathy
Disease of a tendon, often painful overuse tendon condition
Tremor
Involuntary, somewhat rhythmic, muscle movement involving oscillations of one or more body parts
Spasticity
Velocity dependent resistance to muscle stretch
Neurological impairment
Strain
Trauma to a muscle
Sprain
Trauma to a ligament
Arthritis
Joint inflammation
Arthrosis
Joint degeneration
Arthralgia
Joint pain
Arthropathy
Disease of a joint
Bursitis
Inflammation of the bursa
Crepitus
- -Crunching or grating sound
- -Degenerative bony changes
- -“Bone on bone”
- -Inflammation of tendon sheaths
When testing ROM, which is first?
- -Assess active (patient-controlled) first
- -Assess passive (physician-controlled) second
What are the two red flags in resistance testing?
- Pain
2. Weakness
What kinds of weakness are there and what do they suggest?
Smooth weakness - neurological
Break-away weakness - MSK problem
MSK exam for C5
Elbow flexion and shoulder abductors
MSK exam for C6
Wrist extensors
MSK exam for C7
Elbow extensors
MSK exam for C8
Long finger flexor
MSK exam for T1
Finger abductors
MSK exam for L2
Hip flexors
MSK exam for L3
Knee extensors
MSK exam for L4
Ankle dorsiflexors
MSK exam for L5
Long toe extensors
MSK exam for S1
Ankle plantar flexors
Muscle strength grade 0
No evidence of movement
Muscle strength grade 1
Trace movement
Muscle strength grade 2
Full ROM with gravity eliminated
Muscle strength grade 3
Full ROM against gravity, but not against resistance
Muscle strength grade 4
Full ROM against gravity and against resistance, but weak
Muscle strength grade 5
Full ROM against gravity and against resistance, full strength
Special tests for MSK evaluation
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
Trendelenburg sign
- -Unaffected hip drops down with gait
- -Other hip held up as a result of weakness in hip abductors
Signs indicating osteoarthritis
Heberden’s node
Bouchard’s node
Signs indicating rheumatoid arthritis
Swan-neck deformity
Boutonniera deformity
Straight leg raise
Flex pt’s hip to see if there is any impinging on a nerve
Bragard’s test
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
Gibbus
Sharp, angular deformity associated with collapsed vertebra due to atherosclerosis
Goniometer
Apparatus to measure joint movements and angles
Spurling’s test and distraction maneuver
Tests for nerve root compression – positive Spurling’s is pain past mid-humerus
Apley Scratch Test
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
Neer’s test
Internally rotate shoulder, fully extend arm, assess for pain
Hawkins test
Abduct shoulder, flex arm, internally rotate forcibly
Lift off test
Wing scapula, stabilize elbow, have patient push hand against you to test subscapularis
Arm drop test
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)
Apprehension test
Abduct shoulder, flex elbow, apply external rotation to test for shoulder dislocations
Yergason’s test
Palpate interturbicular groove, have pt supinate against resistance
Speed’s test
Arm is supinated, shoulder is flexed, have patient press arm down against resistance to test for biceps tendinitis
Empty can test
Abduct shoulder, palm facing back, have patient push arm down against resistance
How is the patient situated during elbow MSK exam?
Elbows held in close to body
What valgus angle would be abnormal?
Greater than 20 degrees
Varus and valgus tests
Flex arm about 20-30 degrees, apply varus or valgus force
Assessing RCL and UCL, respectively
Tinel sign
Tapping between medial epicondyle and olecranon causes symptoms
Lateral epicondylitis
“Tennis elbow”
Inflammation at the origin of the wrist extensors and supinator muscle
Repetitive wrist extension and supination
Cozen’s test
Pronation of pt forearm, wrist extension, radial deviation, assess resistance
Maudsley’s test
Have pt resist pushing their 3rd finger down, assessing for pain
Phalen’s test
Flex the pt’s wrist, positive if pt gets symptoms in
Tinel’s sign for CTS
Tapping at base of thumb, assessing for pain
de Quervain’s tenosynovitis
Swelling or stenosis of the sheath around the APL and EPB
Finkelstein’s test
- -Thumb flexed and fingers fisted around it
- -Ulnar deviation
- -Positive if pain produced over radial wrist
Assess for scaphoid fracture
Assess tenderness in the snuff box
Thumb grind test
(1st CMC) Carpo-metacarpal joint and joint and metacarpo-phalangeal joint for OA
Causes of osteoarthritis in the hand
- -Cartilage degeneration, trauma
- -Progressive destruction of PIP and DIP, especially DIP and CMC of thumb
Heberden’s nodes
DIP bony nodules
Bouchard’s nodes
PIP abnormal enlargements, synovitis
RA inspection
Look for swan neck deformity, Boutonniere deformity, Ulnar deviation, MCP swelling/thickening
Dupuytren’s contracture
Painless, flexion contractures of ring finger and pinky
Mallet finger
“Baseball finger,” forced DIP flexion of finger
Thumb grind test
- -Pushing/twisting thumb metacarpal against the trapezium
- -Positive with pain/grinding
Thomas’ sign
Hyperflex one leg, and positive if the other leg lifts up (tightness of hip flexors on the other side)
Ober test
Pt lays on their side, extend hip and leg pt’s leg fall, positive if the leg stays up (IT band tightness)
Ballottement
Compress thigh down towards knee, then tap patella to see if it’s floating in excess fluid
Apley’s compression
Pt is prone, knee is flexed, push on heel and twisting to test menisci
Apley’s distraction
Pt prone, flex knee, pull ankle up and rotate, to assess collateral ligaments
McMurray’s test
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
Anterior drawer test (ankle)
Support calcaneus and apply posterior pressure to assess ATFL
Talar tilt
Support calcaneus, slight plantar flexion, invert and evert the foot to assess for AFTL and CFL
Squeeze test
Squeeze at the distal part of the knee joint, looking for fractures
External rotation stress
Fully dorsiflex, rotate the ankle
