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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
Q

ROM

A

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

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26
Q

Which is greater, PROM or AROM?

A

PROM often greater than AROM by 5+ degrees

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27
Q

Signs that suggest problem with joint, related muscle group, or nerve injury

A 
Pain
Limitation of motion
Spastic movt
Joint instability
Deformity
Contractures
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28
Q

Goniometer

A

Used to precisely measure angle for range of motion

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29
Q

Part of neuro exam

A

Muscle strength

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30
Q

Neurovascular assessment

A

Sensory testing from neuro

Blood supply assessed with peripheral vascular exam

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31
Q

Most common complaint

A

Low back pain

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32
Q

Low back pain

A

Most cases are mechanical

Challenge to find pts with more serious disorders

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33
Q

Serious causes of low back pain

A 
Malignancy (MM, mets)
Infection
Inflammatory disease
Leaking aortic aneurysm 
Progressive neurologic deficits
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34
Q

Infection sources of low back pain

A

Discitis
Osteomyelitis
Epidural abscess

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35
Q

Malignancy sources of low back pain

A

Multiple myeloma

Mets

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36
Q

Inflammatory source of low back pain

A

Ankylosing spondylitis

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37
Q

History questions for LBP

A 
Abrupt versus gradual onset
Associated event (lifting, work, travel)
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38
Q

Character of LBP

A

Tearing, burning, steady ache

Tingling or numbness

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39
Q

Location/distribution of LBP

A

Sciatica typically radiates into buttock and down leg

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40
Q

Straight leg raise test

A

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

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41
Q

Lasegue sign

A

Positive when patient is unable to raise leg greater than 30 degrees

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42
Q

Crossover pain in affected leg with straight leg raise test

A

Supportive of tension on nerve roots

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43
Q

Bragard stretch test

A

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

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44
Q

Femoral stretch test

A

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

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45
Q

Common orthopedic shoulder DO

A 
Rotator cuff tendonitis/bursitis/tear
Adhesive capsulitis (frozen shoulder)
Shoulder separation
Shoulder dislocation
Arthritis
Labral tears
Biceps tendonitis
Instability
Fractures
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46
Q

Elbow

A

Inspect in flexed and extended positions
Palpate bony prominences, olecranon bursa, muscles, tendons
Test muscle strength and ROM

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47
Q

Elbow ROM

A

Expect flexion of 160 and extension of 180

Pronation and supination of 90

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48
Q

Common elbow DO

A 
Lateral epicondylitis
Medial epicondylitis
Bursitis (inflammatory, non, septic, olecranon)
Arthritis
Ulnar nerve entrapment
Gouty tophi
Rheumatoid nodules
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49
Q

Lateral/medial epicondylitis aka

A

Tennis elbow - lateral

Golfer’s elbow - medial

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50
Q

Hands and wrist

A 
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
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51
Q

Palpation of hand and wrist

A

Swelling
Bogginess/effusions
Tenderness
Nodules

52
Q

Tests for carpal tunnel

A

Tinel test

Phalen test

53
Q

Rheumatoid arthritis

A

Chronic systemic inflammatory disease affecting mainly the synovial membranes of multiple joints

54
Q

Symptoms of RA

A

Symmetric joint swelling and pain
Fatigue
Malaise
Early morning stiffness

55
Q

PE with RA

A 
Effusion
Redness
Tenderness in affected joints 
Subq nodules
Late stages show characteristic deformities
56
Q

Affected joints of RA

A

MCP
Wrist
Ankles
MTP

57
Q

Swan neck deformitites

A

Hyperextension of PIP joint and flexion of DIP joint

Most commonly seen in RA

58
Q

Boutounniere deformity

A

Flexion of PIP joint and hyperextension of DIP

Common in RA and trauma

59
Q

Heberden’s nodes

A

Hard, contender nodules on DIP joints that occur slowly over time
Common in osteoarthritis

60
Q

Bouchard’s nodes

A

Heberden’s nodes, but in PIP
Hard, contender nodules on PIP that occur slowly over time
Common in osteoarthritis

61
Q

Ganglion cyst

A

Idiopathic, spontaneous protrusion of joint fluid outside of the articular surface
Painless, smooth, fluid filled cyst
Most commonly dorsum of wrist

62
Q

Dupuytren’s contracture

A

Fixed flexion contracture that develops over time due to thickening of the palmar fascia
Rarely painful
Feels thick and tough on exam

63
Q

De Quervain’s Tenosynovitis

A

Inflammation of tendon sheaths of extensor and abductor tendons of the thumb as the cross the styloid process

Perform Finkelstein’s test

64
Q

Finkelstein’s test

A

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
Q

Carpal tunnel syndrome

A

Compression of median nerve by encroachment on the carpal tunnel

66
Q

Causes of carpal tunnel syndrome

A 
Fibrosis of tendon sheaths
Trauma
Arthritis
Repetitive movements
Pregnancy
Past wrist injuries
67
Q

S&S of carpal tunnel syndrome

A 
Numbness and tingling progressing to weakness of first four fingers
Pain in same distribution
Anesthesia
Weakness
Thenar eminence atrophy
68
Q

Tinel sign

A

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
Q

Phalen sign

A

Wrist is held in forced flexion for one minutes

Positive Phalen sign if patient develops paresthesias in nerve distribution

70
Q

Paronychia

Tx

A

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
Q

Hip exam

A 
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
Q

Major landmarks

A

Iliac crest
ASIS
PSIS
Greater trochanter of femur

73
Q

Abnormalities in palpation of hips and pelvis

A

Instability
Tenderness
Crepitus

74
Q

Measuring leg length

A

Measure from ASIS to medial malleolus, crossing knee on medial side

75
Q

Trendelenberg test

A

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
Q

Trendelenberg test with iliac crest drop

A

When iliac crest drops on the side of lifted leg, hip abductors on weight bearing leg are weak

77
Q

Trochanteric bursitis

S&S

A

Inflammation of trochanteric bursa which lies over the greater trochanter

Vague hip pain laterally, worse with walking and activity

78
Q

Exam findings trochanteric bursitis

A

ROM preserved
Pain on direct palpation over bursa
Pain with resisted abduction

79
Q

Osteoarthritis/degenerative joint disease

A

Pain with weight bearing and ambulation
Symptoms progress over time with pain precipitated by less activity as disease worsens
Mostly over 50 yo

80
Q

Exam findings with OA

A

Pain with ambulation, often limping
ROM reduced as dz progresses
Early on internal rotation elicits the most pain

81
Q

Knee exam

A 
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
Q

Major landmarks

A 
Tibila tuberosity
Medial and lateral tibial condyles
Medial and lateral epicondyles
Adductor tubercle
Patella
83
Q

Normal lower leg alignment

A

Angle between femur and tibia is expected to be less than 15 degrees

84
Q

Abnormal leg aligments

A

Valgus
Varus
Recurvatum

85
Q

Valgus

A

Knock knees

86
Q

Varus

A

Bowlegs

87
Q

Recurvatum

A

Excessive hyperextension with weight bearing

88
Q

Palpation of knee

A 
Swelling
Tenderness
Crepitus
Warmth
Nodules
89
Q

ROM of knee

A

Expect 130 flexion and 15 hyperextension

90
Q

Palpating for joint effusion

A

Bulge sign
Ballotment
Balloon sign

91
Q

Causes of joint effusion

A

Inflammation (infection, gout, RA)
Trauma, injury
DJD

92
Q

Technique for smaller effusion

A

Bulge sign

93
Q

Technique for large effusion

A

Ballotment

Balloon sign

94
Q

Bulge sign

A

Knee extended, place left hand above knee and apply pressure on supra patellar pouch, displacing or milking fluid downward

95
Q

Ballotment

A

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
Q

Balloon sign

A

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
Q

Special maneuvers

A 
Abduction Valgus Stress 
Adduction Varus Stress
Anterior drawer 
Lachman
Posterior drawer
McMurray
Apley's
98
Q

Test for MCL

A

Abduction Valgus stress test

99
Q

Test for LCL

A

Adduction varus stress test

100
Q

Test for ACL

A

Anterior drawer test

Lachman test

101
Q

Test for PCL

A

Posterior drawer sign

102
Q

Test for medial and lateral meniscus

A

McMurray test

Apley’s test

103
Q

Valgus test

A

Tests MCL

Push medially on knee

104
Q

Varus test

A

Tests LCL

Pull laterally on knee

105
Q

Anterior drawer

A

Tests ACL

106
Q

Lachman test

A

Tests ACL

Pulls knee out laterally while somewhat flexed

107
Q

Posterior drawer

A

Tests PCL

108
Q

McMurray’s test

A

Tests for tear of medial or lateral meniscus

Feeling of clicking or grinding under fingers

109
Q

Apley’s test

A

Test for meniscal tears
Patient prone, knee flexed, hold foot pressing down and internally/externally rotate (bring)

Click, pops, snaps, indicate meniscal tear

110
Q

Baker’s cyst

Common cause

A

Swelling in popliteal space caused by joint fluid protruding behind the knee
Common cause is DJD

111
Q

Ankle and foot exam

A 
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
Q

Abnormal arches

A

Pes planus - flat foot

Pes cavus - high arch

113
Q

Distal pulses

A

Palpate dorsalis pedis and posterior tibialis

114
Q

Common sports injury

A

Ankle sprain

115
Q

Grades of ankle sprain

A

I - III

Mild, moderate, severe

116
Q

Grade I mild

A

Slight stretching and some damage to ligament

117
Q

Grade II moderate

A

Partial tear with some joint laxity

118
Q

Grade III severe

A

Complete tear with gross instability

119
Q

85% of ankle sprains are…

A

Varus or inversion injuries

Resulting in lateral ligament complex tears

120
Q

Lateral ligament tears

A

Anterior talofibular ligament (ATFL)
Calcaneofibular ligament (CFL)
Poseterior talofibular ligament (PTFL)

121
Q

PE with ankle sprain

A

Ecchymoses
Swelling
Tenderness
Check anterior drawer

122
Q

Plantar fascitits

A

Inflammation of the plantar fascia

Causes pain usually right at medial heel

123
Q

Risk factors for plantar fasciitis

A 
Poor foot mechanics
Tight calf/Achilles
Obesity/weight gain
Improper footwear
Pregnancy
Running
124
Q

Hammer toes

A

Toes crossed

125
Q

Onychomycosis

A

Fungal infection of toenails (or fingernails)

Physical Diagnosis (10 decks)

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