Ortho Flashcards
Nodules
RA - firm, non tender sc EXTENSOR FOREARMS
hands sc, correlate w +ve RF
OA bony nodules
HEBERDENS DIPJ
BOUCHARDS PIPJ
GOUT tophi ie crystal deposits olecranon bursa, ear helix, finger ext, hands, knees, toes
Skin
Psoriasis
SLE
Splinter hs - RA, SLE, vasculitis
Scleroderma
Hands - flexion contract
Ulceration finger pulps - ca deposits/raynauds
Purple blanching telangiectasia
RA - conjunctivitis,mouth ulcers, genital infl
Eyes
Conjunctivitis - RA Dry/sjorgrens Scleritis/epi Iritis Blue sclera
Hypermobility
Beighton
Thumb to forearm Little finger ext beyond 90 Ext elbow 10+ Ext knee 10+ Hands on floor
Gait
Stance and swing phases
Barefoot, straight line, back/side/front
Each level eg foot, ankle, knee, hip, pelvis, trunk, spine
Antalgic
LL= reduced stance phase
Spine= reduced rotary ie slow, short
Hip= reduce compression, lean TOWARDS
Structural
Leg length, - compensate ie scoliosis/flexion/tiptoe
Fusion
Weakness/OA pain +ve trendellenberg, hip falls
Foot drop = peroneal nerve
Hypertonia/spacticity = UMN
NECK General
Movement - mid cervical
Dermatomal if radiculopathy
SC compression UMN - leg weakness, sensation, sphincters
RA ATLANTOAXIAL instab - flexing neck can damage spinal cord
Neck OBSERVE
Neck upper thorax EXPOSED
Posture
Acute lesions- muscle spasm ie loss lordosis/flexion
Same inRA /trauma
Increased in AS
Lat flexion in RA ie atlas errosion
SCM mvt ie torticollis
Neck FEEL
Midline spinous processes - occiput to T1 = most pronounced
Paraspinal muscles
Supra clav - LNs , cervical rib ?tender
Ant neck ie thyroid
?muscle tenderness eg spine traps interscap
Neck MOVE
CARE IN RA
Active Flex forward 80 ie total 130 Ext 50 Lat flex 45 ie 90 Lat rot 80
Try passive if active reduced?? Sudden v gradual resistance
? Pain paraesth over nerve root
Thoracic spine general
Pain
Young - Sheuermans, axial spondy, disc
Old - degen or osteoporotic fracture
All - tumour or infection
Compression gives UMN leg signs ie parapaesis, sensory, sphincter
Osteop - either acute pain or gradual height loss and kyphosis
Thoracic spine examination
Look FRONT SIDE BACK
? Rib hump
Abn curvature
Feel
Midline spinal processes T1-12 increased prominence ie wedge#
Paraspinal muscles - tenderness/tone
Move
Rotational, sitting x arms
Lumbar spine general
Surface anatomy
L4 = dimples SIJs
Cauda equina post L2
Movement - upper segments move first and hips compensate!
Lumbar spine patterns
Radicular
Sciatic L4-S3 = posterior leg
Femoral L1-2 = groin, thigh
Mechanical
Postural - prolonged sit/stand, relieved = rest
Axial spondyloarthropathy
Young, insidious onset, increased by REST, decreased by MOVEMENT
Extra art, FH, small joints
Prolapse
Ie acute if young, worse if coughs/strains
Cauda equina Sensory/motor Perianal Sphincter Saddle anaesthesia
Osteoporotic fractures ie age, sterroids
Worse flexion, improves lying down
Infection ie TB
Severe pain, fever, malaise, wt loss
Mets
Unremitting pain inc sleep
DDD
Chronic intermittent, morning/immobility stiffness
Decreases - gentle activity, worse - intense
Stenosis
Neurogenic claudication
Improves w rest and flexion
Lumbar spine LOOK
Deformity
Lordosis ie hips!
Scoliosis
Soft tissues
Spina bifida - lipoma, hair
Lumbar spine FEEL
Spinal processes ie wedge
Paraspinal ie tone tenderness
Light percussion ie lumbar
