Pitcher_MSK Flashcards
supraspinatus tests
1) empty can
2) with shoulder adducted and elbow at 90, patient tries to abduct against resistance
Subscap tests
1) Lift off
2) with shoulder adducted and arm at 90 the patient tries to IR shoulder (move forearm medially against resistance)
Infraspinatus and teres minor test
Patient tries to ER against resistance
What protects the supraspinatus
subacromial bursa
mechanism of injury to supra
weakness of the other mm causes an elevation of the humerus in the glenoid, which irritates the tendon
predisposes to impingement under the acromion
signs of complete supraspinatus tear
shoulder shrugs upward during abduction d/t efforts of the deltoid
+drop arm test
AC separation
Fall on tip of shoulder typical; involve both AC and coracoclavicular ligaments. 5 grades of separations.
Tenderness over AC joint above type 3
shoulder arthritis
loss of both active and passive ROM
tender, crepitis
loss of joint space and loss of cartilage on XRAY
Adhesivve capsulitis
longstanding loss of ROM loss of both active and passive ROM tender MORE crepitus and stiffness DM is risk ***** night pain MRI is best
Bursitis
trauma or repetitive motion
often presents first
differ from tendinitis w/ active and passive ROM
can inject !!! (use lido- help for dx)
Strength will return!! IF it does not return, then it is likely tendinitis
SLAP lesion
superior labrum tear from anterior to posterior
from repetitive motion (i.e. throwing) or acute damage from falling and trying to gram something
Lidocaine injection test-shouilder
1) RC tear will have persistent weakness
2) tendonopathy will have normal strength
3) Frozen shoulder will have persistent loss of ROM
inflammation of LH biceps-test
adduct shoulder, flext arms to 90
Pronate
have patient supinate against resistance
or Speed’s test
Speed’s test
flex arm to 90, parallel to flore while palm is supinated
ask patient to resist your effort to push arm back into extension
indicates bicep tendonitis
Obrein’s test
flex arm to 90 and adduct across chest while IR the shoulder (point thumbs down)
then push down
pain= SLAP
Cross-over test
adduct arm over chest
Pain= AC dysfunction
lateral hip pain
Bursitis or meralgia paresthetica
Posterior
SI, lumbar, unusual true hip joint
anterior hip pain/ groin
ostenecrosis, sepsis, fx, synovitis
lower anterior thigh pain
ref true hip, upper femur, femoral neck lumbar radiculopathy
Trochanteric bursitis
abnormal movement of gluteus medius and TFL over greater trochanter.
need to ask them about their gate, lumbar mm tightness, LLD, knee pain, varus/valgus
bursa may fibrose
Osteoarthritis
activity pain, occur at night only when advanced
occurs d/t low grade inflammation
painful in the morning, better later in day
restricted abduction
IR is very painful
insidious onset .
Meralgia Paresthetica
LFC is sensory above the knee
Paresthesia ONLY
Osteonecrosis
anything that causes decreased circulation into fovea
Groin pain, weight bearing and motion induced pain
**Steroid use and exs ETOH use
True groin pain
Referred pain to hip
from lunbar or SI when there is also LBP sx extend beyone knee parenthesis present unremarkable exam of hip
Occult fx of hip
seen in older patients or acutely d/t sheer forces
severe pain to light weight bearing
need MRI**
Fabere
flex, abduct, externally rotates, extends the leg in a figure 4, then gently push knee to table. If painful, indicates hip, psoas or SI problem.
Osgood Schlatter
tibial tuberosity avulsion
osteochondritis of tibial tuberosity
young, active pain, focal tenderness clinical dx pain control, CONTINUED ACTIVITY, PT knee knob may be permanent but not painful increases risk for future avulsion fx
lumbar radiculopathy
shooting pain down below the foot
use straight leg raise
Strain
A sprain is a stretch and/or tear of a ligament, Ligaments stabilize and support the body’s joints.
Sprain
A strain is an injury of a muscle and/or tendon. Tendons are fibrous cords of tissue that attach muscles to bone.
