Physical exams and pathology Flashcards
What is the anterior drawer test and what does it identify?
Bend the knee at a 90o angle, pull anteriorly
positive test indicates torn ACL
What is the Lachman test and what does it identify?
bend the knee at a 30o angle, pull anteriorly
positive test indicates torn ACL
What is the posterior drawer test and what does it indicate?
Bend the knee at a 90o angle, push posteriorly
positive test indicates torn PCL
What is the passive abduction test (putting a valgus stress on the knee) and what does it indicate?
Knee is extended, lateral (valgus) force
positive test indicates an MCL tear
What is the passive adduction (putting a varus stress on the knee) test and what does it indicate?
Knee is extended, medial (varus) force
positive test indicates an LCL tear
What is the McMurray test and what does it indicate?
During flexion and extension of knee with rotation of tibia/foot:
Pain, “popping” on external rotation indicates medial miniscal tear
Pain, “popping” on internal rotation indicates lateral miniscal tear
What are the muscles of the rotator cuff?
S.I.t.S,
Supraspinatous
Infraspinatous
Teres minor
Subscapularis
Describe general symptoms of osteoarthritic pain (when is it worse/better)? Are systemic symptoms present? Is the joint cool to the touch?
worsening with continued use
improves with rest
no systemic symptoms present
cool to the touch
What joints are typically affected in OA? Is joint involvement symmetrical or unilateral?
affects the DIPs, PIPs, 1st CMC, 1st MTP, hips, knee, cervical and lumbar spine
unilateral monoarticular joint involvement
What are Bouchard and Heberden nodes?
Bouchard - PIP
Heberden - DIP
Is osteoarthritis associated with inflammatory cells?
NO! Although it has -itis in the name, inflammatory cells are not involved in the pathophysiology of the disease
What are the effusion characteristics of OA? Is effusion always present?
Effusion:
clarity: clear
color: straw
WBCs: <2000
PMN %: <25%
Effusion is not always present
What are typical fidings in OA imaging?
Focal joint narrowing (narrowing at one part of the joint)
osteophytes
subchondral cysts
subchondral sclerosis
What joint pathology is this?
osteoarthritis
Describe general symptoms of Rheumatoid arthritic pain (when is it worse/better)? Are systemic symptoms present? Is the joint cool to the touch?
morning stiffness and pain that improves with use
systemic symptoms are usually present (fever, fatigue, weght loss, subcutaneous nodules, uveitis, etc)
Joints are warm to the touch
What joints are typically involved in RA? Is joint involvement symmetrical or unilateral?
PIPs, MCPs, carpals, facets
symmetric polyarticular joint involvement
How does RA affect the hands?
Swan neck deformity
Ulnar deviation of fingers
Subluxation of fingers towards ulna
What are the effusion characteristics of RA? Are inflammatory cells present?
effusion:
Clarity: translucent
Color: yellow
WBC: 2,000-75,000
PMNs: >50%
inflammatory cells are present (pannus formation)
What are typical findings in RA imaging?
Concentric joint narrowing
symmetric marginal erosion of articular cartilage and bone
subluxation or dislocation of joints towards ulna
What are the clinical findings in gout? Is it acute? Does is affect multiple joints at once?
Acute unilateral monarticular arthropathy
tophus formation is common
What joints does gout typically effect?
1st metatarsal-phalangeal joint of the big toe, DIPs, knee, ankle
What are the effusion characteristics of gout? What type of crystals are found in gout?
Effusion:
Clarity: translucent
Color: yellow
WBCs: 2,000-75,000
PMN %: >50%
birefringent crystals under polarized light
What is a boutonniere deformity?
disruption of the rupture of the central slip at the base of the middle phalanx
What is a swan neck deformity?
typically caused by a volar plate injury at the PIP, either caused by RA or trauma
What is a mallet finger?
tear in the terminal slip located in the DIP
What is a trigger finger?
caused by nodule or fusiform swelling of the superficial tendon at the MCP causing flexion at MCP, PIP, and DIP
What is a colles fracture?
fracture of the distal radius and ulna causing a fall of the outstretched arm creating a “dinner fork” appearance
What nerve could be damaged in a colles fracture?
median nerve
What is a scaphoid fracture?
fracture of the scaphoid which typically occurs from falling on an outstretched arm
What physical exam test can be performed to diagnose a scaphoid fracture?
snuffbox pain
What complication can occur in scaphoid fractures?
avascular necrosis
What is carpal tunnel syndrome?
narrowing or inflammation of the carpal tunnel causing compression of the median nerve
What are the symptoms of carpal tunnel?
weakness, numbness, and thenar atrophy of the hand
What is guyon’s syndrome?
Ulnar tunnel syndrome
Compression of the ulnar nerve in guyton’s canal
If there is compression of zone I in guyton’s syndrome, what will the symtpoms be?
If there is compression of zone II in guyton’s syndrome, what will the symtpoms be?
If there is compression of zone III in guyton’s syndrome, what will the symtpoms be?
What causes Erb palsy (waiter’s tip)?
injury to C5-6 roots
deltoid and supraspinatus deficit -> can’t abduct
infraspinatus deficit -> can’t lateral rotate (causes medial rotation)
biceps brachii deficit -> cant flex or supinate (arm extended and pronated)
What causes Klumpke palsy (claw hand)?
damage to C8-T1
intrinsic hand muscle deficit
What causes winged scapula
lesion of long thoracic nerve
