Other Joints Flashcards
Elbow general
Med epi - flexor origin
Lat epi- extensor origin
Olecranon ?bursa
Pain localised or ref from neck
Elbow LOOK
N alignment = CARRYING ANGLE 11-13 valgus
Synovitis blocks full extension ie bursa lat epi to olecranon
Skin
Psoriasis
RA nodules - forearm
Bursitis
Elbow FEEL
Bones
Med and lat epicondyles plus olecranon
? Sponginess/synovitis - either side of fully ext olecranon
? Focal tenderness
Bursa - swelling, tophi, nodules
Forearm nodules
Elbow MOVE
Active
F E Ie touch shoulder and straighten 0-145 functional 30-110
Pronate 90 supinate 85 - elbow at 90
Tests
LAT EPI
Elbow 90 pronate flex wrist, support elbow RESISTED EXTENSION
MED EPI
Elbow 90 supinate RESISTED WRIST FLEXION
Shoulder general
Pain often ref to upper arm - Glenohumeral - ant/lat
To shoulder
C spine
Diaphragm via phrenic nerve
Rotator cuff - degen, calc tendon, rupture
Sub a bursa - calc, polyarth
Capsule - adhesion
Humeral head - tumour, necrosis, trauma
Joints - GH SC ACJ
Shoulder LOOK
FRONT BEHIND INC AXILLAE
Deformity
DISLOCATION - ant obvious ie forward/down. Post= from above
SWELLING
MUSCLE WASTING
Deltoid
Supra or infraspinatus eg chronic tendon tear
SCAP
Elev/depressed
?WINGED ie push hands to wall SERATUS ANTERIOR PARALYSIS
Shoulder FEEL
SC to ACJs - injury/# deformity/local tenderness
Inc acromion and coracoid ie 2cm inf/med
Scap SPINE
Biceps tendon groove ?tendonitis
HYPEREXTENDING arm SUPRASPINATUS tendon ANT out from under ACROMION
Shoulder MOVE
Active
SCREENING HBB/HBN
Flex - pec major, ant deltoid
Ext - lats, teres major, post delt
ABDUCT - first 90 GH PAPLATE SCAP
ie -30 supraspinatus
30-90 deltoid
90 rotation/traps
ADDUCT
EXT ROT
INT ROT - HBB arm by side
Passive mvt
PAINFUL ARC
POWER
Resisted abd - DELTOID ?behind
Resisted abd - HANDS BY SIDES arm on biceps = SUPRASPINATUS
Gerber HBB LIFT OFF = SUBSCAP
EXT ROT intfraspinatus/teres minor = arm neutral/30 - ADDUCT 30 FLEX (limits deltoid contribution)
Or coke can PUSH DOWN
Biceps
PALPATE GROOVE
SUPINATE, FLEX AGAINST RESISTANCE
distal bulge/popeye= ruptu
SPECIAL TESTS
IMPINGEMENT - PAINFUL ARC 60-120
passive abd, int rot to 30-45 THEN CONTINUE ACTIVE ABD +- resistance
NEER test - acromion to greater t
Arm extended, int rot, tether scap, ABDUCT
HAWKINS KENNEDY
arm and shoulder at 90, passive internal rotation ie PRESS DOWN
ROTATOR CUFF
INT ROT - subscap/pec major
Gerber - subscap = lift off back RESISTANCE
ABD supraspinatus = arm by side HAND ON BICEP
painful arc 60 ?tendonitis
EXT ROT intfraspinatus/teres minor = arm neutral/30 - ADDUCT 30 FLEX (limits deltoid contribution)
NO MVT/FIXED INT ROT = ?adhesive
TENDONITIS - pain on forced/resistance
TEAR - reduced power
BICEPS TENDONITIS Palpate long head, groove by humeral head SUPINATE FLEX AGAINST RESISTANCE distal bulge/popeye= rupture
PAINFUL ARC = IMPINGEMENT 120-60
passive full abduction
ACTIVE SLOW ABD
IMPINGEMENT
passive abd, int rot to 30-45 THEN CONTINUE +- resistance
NEER test - acromion to greater t
Arm extended, int rot, tether scap, ABDUCT
HAWKINS KENNEDY
arm and shoulder at 90, passive internal rotation ie PRESS DOWN
Hips general
Pain felt in groin or ref to knee, hips, bum
NOF - shortened, ext rot
Pain usually worse on exertion, night= tumour/necrosis
DDx
Lumbar radiculopathy
Claudication - vasc/neurogenic
Abdo/gynae
Hip LOOK
Gait - symmetry/smoothness ie walk away, turn, walk back
TRENDELLENBERG
Hold I crests, leave ?30sec early fatiguing
FRONT Stance - add deformity flex other knee, abd flex same Shoulders ?// stacking re shoulders Deformity ie hips knees ankles feet MW ie quads
SIDE
stoop, increased lordosis ie FF
Scars/skin
BACK Scoliosis Shoulders/pelvis LL MW ie glutes
Hips FEEL
Lie FLAT
Tender over greater T = trochanteric pain synd or BURSITIS
ASI crest ie enthesitis
Hips MOVE
Supine PASSIVE MVT
Check pelvic position
FLEX one hand under LUMBAR SPINE 120
THOMAS flex both legs up as far as possible. Hand under lumbar spine, hold other leg up, extend far leg. Positive = unable to put straight on bed.
ABD 45
ADD 25 stabilise pelvis op IC
INT EXT ROT
Roll initially
Then leg and hip at 90. N45 ext= medial, int= foot lat
EXTEND PRONE 20
Check pelvis, lift leg
SPECIAL TESTS
APPARENT LEG U to med maleolus TRUE LEG ASIS to med maleolus ? Block test if doubt
TRENDELENBERG
Hold I crests, leave ?30sec early fatiguing
Knee general
Stability = ligaments, muscles
Flex = HAMSTRINGS
Ext = QUADS, tendon, patella tendon
? SLR/extensor lag
ACL prevent ant sublux
PCL prevent post translocation
Lat colat to fib, prevent VARUS
Med colat to tib, prevent VALGUS - distal limb deviates LATERALLY
PAIN general = tibiofemoral Ant = PF Med/lat = collats/menisci ??ref from hip
Swelling
N vol 1-2ml, more = effusion, haemarthrosis ie vasc structure
Locking
LOOSE BODY - osteochondritis dissecans, OA, synovial chondromatosis
TEAR - ie bucket handle, ant beak, post horn at end of flexion
Giving way = ligaments
Knee LOOK
STAND - front side back
Posture ie valgus, Varus
GAIT - stance, swing phases
Skin- scars, sinus, erythema, rash
SQUAT!
COUCH
Quads wasting, knee stability
Sudden ie days if pain/infl
MEASURE QUADS CIRC 20cm ABOVE TIBIAL TUBEROSITY
Leg length
Flexion deformity ie hip/knee/both
Swelling
pre patellar bursa, ie semicircle effusion above knee
Popliteal ie bakers cyst
Knee FEEL
TEMP Compare
EFFUSION
Patellar tap ie mod
Ripple ie small/non tense - empty supra p, med slide up, lat = slide down. LOOK FOR MED BULGE
BONES
SYNOVITIS ie sponginess both sides of quads tendon
FLEX AT 90! Med and lat JOINT LINES, TENDERNESS IE MENISCAL, Colat life fibular art surface Tib tuberosity ?p tendon
