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Physical Diagnosis > PD Musculoskeletal > Flashcards

PD Musculoskeletal Flashcards

1
Q

Function of MS system

A

Support and mobility
Protection
Hematopoeisis
Mineral storage

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2
Q

MS system

A

Bony structure with its joints held together by ligaments, attached to muscles by tendons, and cushioned by cartilage

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3
Q

Bones covered by…

A

Articular cartilage

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4
Q

What is the most common type of joint?

A

Diarthroidal (synovial)

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5
Q

Synovial membrane

A

Lines synovial cavity and secretes a small amount of viscous lubricating synovial fluid

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6
Q

What is surrounding synovial membrane?

A

Fibrous joint capsule

Strengthened by ligaments

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7
Q

Types of synovial joints

A

Spheroidal - ball and socket
Hinge
Condylar

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8
Q

Ball and socket examples

spheroidal

A

Shoulder

Hip

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9
Q

Hinge examples

A

Interphalangeal joints

Elbow

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10
Q

Condylar examples

A

Knee

TMJ

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11
Q

Bursa

A

Disc shaped, fluid filled synovial sacs that develop at points of friction around joints, between tendons, cartilage, and bone

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12
Q

Function of bursa

A

Decrease friction

Promote ease of motion

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13
Q

Examples of bursa

A 
Subacromial
Olecranon
Trochanteric
Pes anserine
Prepatellar
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14
Q

Common, concerning symptoms

A 
Low back pain
Neck pain
Muscular pain
Limping 
Difficulty with gait
Pain with movement
Injury 
Joint pain
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15
Q

Examples of joint pain

A

Monarticular
Polyarticular
Associated with systemic symptoms

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16
Q

Historical clues

A

Functional limitation?
Sx with single joint/region or multiple joints?
Acute or slowly progressive?
Work hx, family hx?
Mechanism of injury?
Prior problems/injuries with the affected area?
Systemic symptoms

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17
Q

Examples of systemic symptoms

A

Fever, chills
Weight loss
GI issues
Skin issues

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18
Q

Exam

A 
Inspection
Palpation
Range of motion
Muscle strength
Neuro vascular assessment
Special maneuvers
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19
Q

Inspection

A

Anterior, posterior, and lateral aspects of posture
Symmetry of body parts, alignment of extremities
Lordosis, kyphosis, scoliosis
Skin over joints and muscles
Inspect muscles

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20
Q

Inspection of skin over joints

A

Discoloration - erythema, bruising, pallor
Swelling
Masses

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21
Q

Inspection of muscles

A

Hypertrophy
Atrophy
Fasciculations
Spasms

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22
Q

Palpation

A

Palpate all bones, joints, surrounding muscles

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23
Q

With palpation, note any…

A 
Warmth
TEnderness
Swelling
Fluctuation (joint effusion)
Crepitus
Muscle tone (spasticity, flaccid)
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24
Q

What areas do we palpate last?

A

Inflamed joints and tender areas last

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25
ROM
Assess active and passive ROM for each major joint and related muscle groups, comparing side to side Active ROM first, then relax and allow for passive ROM until end of ROM is felt Do not force if there is pain or spasm
26
Which is greater, PROM or AROM?
PROM often greater than AROM by 5+ degrees
27
Signs that suggest problem with joint, related muscle group, or nerve injury
``` Pain Limitation of motion Spastic movt Joint instability Deformity Contractures ```
28
Goniometer
Used to precisely measure angle for range of motion
29
Part of neuro exam
Muscle strength
30
Neurovascular assessment
Sensory testing from neuro | Blood supply assessed with peripheral vascular exam
31
Most common complaint
Low back pain
32
Low back pain
Most cases are mechanical | Challenge to find pts with more serious disorders
33
Serious causes of low back pain
``` Malignancy (MM, mets) Infection Inflammatory disease Leaking aortic aneurysm Progressive neurologic deficits ```
34
Infection sources of low back pain
Discitis Osteomyelitis Epidural abscess
35
Malignancy sources of low back pain
Multiple myeloma | Mets
36
Inflammatory source of low back pain
Ankylosing spondylitis
37
History questions for LBP
``` Abrupt versus gradual onset Associated event (lifting, work, travel) ```
38
Character of LBP
Tearing, burning, steady ache | Tingling or numbness
39
Location/distribution of LBP
Sciatica typically radiates into buttock and down leg
40
Straight leg raise test
Tests for nerve root irritation or lumbar disk herniation at L4, L5, S1 Have pt lie supine with neck slightly flexed Ask pt to raise leg No pain should be felt below knee Repeat on unaffected leg
41
Lasegue sign
Positive when patient is unable to raise leg greater than 30 degrees
42
Crossover pain in affected leg with straight leg raise test
Supportive of tension on nerve roots
43
Bragard stretch test
Tests for lumbar disk herniation at L4, L5, S1 Have pt lie supine with neck slightly flexed Hold pts lower leg and raise it slowly with knee extended until pt feels pain Lower leg slightly and briskly dorsiflex the foot Pain will be produced if the nerve is inflamed
44
Femoral stretch test
Hip extension test that is used to detect inflammation of nerve root and L1 - sometimes L4 level Patient lie prone and extend hip No pain should be felt Presence of pain on extension is positive sign of nerve root irritation
45
Common orthopedic shoulder DO
``` Rotator cuff tendonitis/bursitis/tear Adhesive capsulitis (frozen shoulder) Shoulder separation Shoulder dislocation Arthritis Labral tears Biceps tendonitis Instability Fractures ```
46
Elbow
Inspect in flexed and extended positions Palpate bony prominences, olecranon bursa, muscles, tendons Test muscle strength and ROM
47
Elbow ROM
Expect flexion of 160 and extension of 180 | Pronation and supination of 90
48
Common elbow DO
``` Lateral epicondylitis Medial epicondylitis Bursitis (inflammatory, non, septic, olecranon) Arthritis Ulnar nerve entrapment Gouty tophi Rheumatoid nodules ```
49
Lateral/medial epicondylitis aka
Tennis elbow - lateral | Golfer's elbow - medial
50
Hands and wrist
``` Inspect dorsal and palmar aspects Look for deformities of digits Palpate each joint in hand and wrist Palpate ulnar and radial arteries ROM Sensory and muscle strength ```
51
Palpation of hand and wrist
Swelling Bogginess/effusions Tenderness Nodules
52
Tests for carpal tunnel
Tinel test | Phalen test
53
Rheumatoid arthritis
Chronic systemic inflammatory disease affecting mainly the synovial membranes of multiple joints
54
Symptoms of RA
Symmetric joint swelling and pain Fatigue Malaise Early morning stiffness
55
PE with RA
``` Effusion Redness Tenderness in affected joints Subq nodules Late stages show characteristic deformities ```
56
Affected joints of RA
MCP Wrist Ankles MTP
57
Swan neck deformitites
Hyperextension of PIP joint and flexion of DIP joint | Most commonly seen in RA
58
Boutounniere deformity
Flexion of PIP joint and hyperextension of DIP | Common in RA and trauma
59
Heberden's nodes
Hard, contender nodules on DIP joints that occur slowly over time Common in osteoarthritis
60
Bouchard's nodes
Heberden's nodes, but in PIP Hard, contender nodules on PIP that occur slowly over time Common in osteoarthritis
61
Ganglion cyst
Idiopathic, spontaneous protrusion of joint fluid outside of the articular surface Painless, smooth, fluid filled cyst Most commonly dorsum of wrist
62
Dupuytren's contracture
Fixed flexion contracture that develops over time due to thickening of the palmar fascia Rarely painful Feels thick and tough on exam
63
De Quervain's Tenosynovitis
Inflammation of tendon sheaths of extensor and abductor tendons of the thumb as the cross the styloid process Perform Finkelstein's test
64
Finkelstein's test
Have pt put their thumb in the palm, covering it with other 4 digits, make a fist Gently deviate wrist towards ulna, this stretches the inflamed tendons over the radial styloid, reproducing the patient's pain
65
Carpal tunnel syndrome
Compression of median nerve by encroachment on the carpal tunnel
66
Causes of carpal tunnel syndrome
``` Fibrosis of tendon sheaths Trauma Arthritis Repetitive movements Pregnancy Past wrist injuries ```
67
S&S of carpal tunnel syndrome
``` Numbness and tingling progressing to weakness of first four fingers Pain in same distribution Anesthesia Weakness Thenar eminence atrophy ```
68
Tinel sign
Strike median nerve where it passes through the carpal tunnel (under flexor retinaculum and velar carpal ligaments) Tingling sensation radiating from wrist to median nerve distribution is a positive Tinel sign
69
Phalen sign
Wrist is held in forced flexion for one minutes | Positive Phalen sign if patient develops paresthesias in nerve distribution
70
Paronychia | Tx
Painful bacterial (or fungal or viral) infection where skin and nail meet at the side or base of fingernail or toenail Lancing to drain pus
71
Hip exam
``` Inspect hips anterioly and posteriorly while patient stands Locate major landmarks Asymmetry in height/alignment Level of gluteal folds Palpate hips and pelvis with pt supine ROM Leg length ```
72
Major landmarks
Iliac crest ASIS PSIS Greater trochanter of femur
73
Abnormalities in palpation of hips and pelvis
Instability Tenderness Crepitus
74
Measuring leg length
Measure from ASIS to medial malleolus, crossing knee on medial side
75
Trendelenberg test
Maneuver to detect weak hip abductor muscles Pt stands and balance first on one foot, then other Observe from behind, note asymmetry or change in level of iliac crests
76
Trendelenberg test with iliac crest drop
When iliac crest drops on the side of lifted leg, hip abductors on weight bearing leg are weak
77
Trochanteric bursitis | S&S
Inflammation of trochanteric bursa which lies over the greater trochanter Vague hip pain laterally, worse with walking and activity
78
Exam findings trochanteric bursitis
ROM preserved Pain on direct palpation over bursa Pain with resisted abduction
79
Osteoarthritis/degenerative joint disease
Pain with weight bearing and ambulation Symptoms progress over time with pain precipitated by less activity as disease worsens Mostly over 50 yo
80
Exam findings with OA
Pain with ambulation, often limping ROM reduced as dz progresses Early on internal rotation elicits the most pain
81
Knee exam
``` Inspect knees and popliteal spaces, both flexed and extended Note major landmarks Observe lower leg alignment Watch the pt walk Note scars, signs of swelling, inflammation Atrophy of muscles Palpate knee in all areas ROM Muscle strength Special test ```
82
Major landmarks
``` Tibila tuberosity Medial and lateral tibial condyles Medial and lateral epicondyles Adductor tubercle Patella ```
83
Normal lower leg alignment
Angle between femur and tibia is expected to be less than 15 degrees
84
Abnormal leg aligments
Valgus Varus Recurvatum
85
Valgus
Knock knees
86
Varus
Bowlegs
87
Recurvatum
Excessive hyperextension with weight bearing
88
Palpation of knee
``` Swelling Tenderness Crepitus Warmth Nodules ```
89
ROM of knee
Expect 130 flexion and 15 hyperextension
90
Palpating for joint effusion
Bulge sign Ballotment Balloon sign
91
Causes of joint effusion
Inflammation (infection, gout, RA) Trauma, injury DJD
92
Technique for smaller effusion
Bulge sign
93
Technique for large effusion
Ballotment | Balloon sign
94
Bulge sign
Knee extended, place left hand above knee and apply pressure on supra patellar pouch, displacing or milking fluid downward
95
Ballotment
Place left hand on supra patellar pouch Gently push down towards patella, forcing any fluid to collect in central part of joint Gently push down on patella with thumb Patella will feel like its floating if a sizable effusion
96
Balloon sign
Place thumb and index finger of right hand on each side of patella With left hand, compress supra patellar pouch against femur Feel for clid entering spaces next to patella under right thumb and index finger
97
Special maneuvers
``` Abduction Valgus Stress Adduction Varus Stress Anterior drawer Lachman Posterior drawer McMurray Apley's ```
98
Test for MCL
Abduction Valgus stress test
99
Test for LCL
Adduction varus stress test
100
Test for ACL
Anterior drawer test | Lachman test
101
Test for PCL
Posterior drawer sign
102
Test for medial and lateral meniscus
McMurray test | Apley's test
103
Valgus test
Tests MCL | Push medially on knee
104
Varus test
Tests LCL | Pull laterally on knee
105
Anterior drawer
Tests ACL
106
Lachman test
Tests ACL | Pulls knee out laterally while somewhat flexed
107
Posterior drawer
Tests PCL
108
McMurray's test
Tests for tear of medial or lateral meniscus | Feeling of clicking or grinding under fingers
109
Apley's test
Test for meniscal tears Patient prone, knee flexed, hold foot pressing down and internally/externally rotate (bring) Click, pops, snaps, indicate meniscal tear
110
Baker's cyst | Common cause
Swelling in popliteal space caused by joint fluid protruding behind the knee Common cause is DJD
111
Ankle and foot exam
``` Inspect feet and ankles while pt is weight bearing and sitting Observe contour of feet, alignment with tibia Position/size Number of toes Edema Ulcers Observe arch Palpate all labdmarks ROM Muscle strength Nuerovascular evaluation ```
112
Abnormal arches
Pes planus - flat foot | Pes cavus - high arch
113
Distal pulses
Palpate dorsalis pedis and posterior tibialis
114
Common sports injury
Ankle sprain
115
Grades of ankle sprain
I - III | Mild, moderate, severe
116
Grade I mild
Slight stretching and some damage to ligament
117
Grade II moderate
Partial tear with some joint laxity
118
Grade III severe
Complete tear with gross instability
119
85% of ankle sprains are...
Varus or inversion injuries | Resulting in lateral ligament complex tears
120
Lateral ligament tears
Anterior talofibular ligament (ATFL) Calcaneofibular ligament (CFL) Poseterior talofibular ligament (PTFL)
121
PE with ankle sprain
Ecchymoses Swelling Tenderness Check anterior drawer
122
Plantar fascitits
Inflammation of the plantar fascia | Causes pain usually right at medial heel
123
Risk factors for plantar fasciitis
``` Poor foot mechanics Tight calf/Achilles Obesity/weight gain Improper footwear Pregnancy Running ```
124
Hammer toes
Toes crossed
125
Onychomycosis
Fungal infection of toenails (or fingernails)

Physical Diagnosis (10 decks)

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