Summer Semester Final Flashcards
3 types of joints
- Cartilaginous (min movment - syphysis pubis)
- Fibrous ( immovable - skull sutures)
- Synovial (freely movable - hip/shoulder)
Busiest joint in the body?
Temporomandibular joint
An exaggerated thoracic kyphosis is…
hunchback –> gibbous
Exaggerated thoracic kyphosis in post menopausal women
Dowager’s hump…caused from osteoporotic wedge fx
If a patient comes in complaining of shoulder pain and during the physical exam you take them through ROM and provacative maneurvers w/o any pain then what is the most likely etiology of pain?
Neck pain
A patient bends forward to touch their toes and their lordosis does not flatten. What may this mean?
Paravertebral muscle spasm
A pt w/ suspected cervical radiculopathy may have neurologic deficits in _____
A pt w/ suspected cervical myelopathy may have….
Cervical radiculopathy –> neurologic defects in UE
Cervical myelopathy –> upper and lower extremity deficits
If a patient comes in with neck pain and when asked to swallow they report difficulty swallowing then they likely have…
Anterior cervical disk herniation
Bony osteophytes
Distinguish Adson’s test with Wright’s Test
Adson’s: pt turns head TOWARD arm being tested
Wright’s: pt turns head AWAY from arm being tested
Both test for Thoracic Outlet Syndrome (subclavian artery)
The iliac crests sit at which spinal level?
L4-L5
Describe the straight leg test
We lift pt’s leg and note pain. If pt has pain then we lower until they feel no more pain. Then we dorsiflex foot. If pain still occurs this is a positive sign and most likely herniated nucleus pulposus of a disc that is stretching the sciatic nerve
If no pain with dorsiflexion –> hamstring tightness
Describe the crossed straight leg raise test
Straight leg test on unaffected side and if pain occurs (on involved side) then it is even more suggestive that pt has a herniated disc
–> Add on test to straight leg test
What does the Hoover Test look for?
Malingers that say they are weak in a leg/can’t move it at all.
What is the normal “carrying angle” of elbow in females and males?
An inc. angle of ____ may indicate a hx of ____.
A dec. angle of ___ may indicate a hx of ____.
Females: 10 degrees
Males: 5 degrees
Angle > 15 –> hx of lateral epicondylar fx and epiphyseal damage as a child
Angle < 5 –> called a gunstock deformity and may indicate supracondylar fx as a child w epiphyseal injury
Where will a patient feel numbness/tingling with ulnar nerve compression?
Pinky finger and ring finger (maybe half of ring finger…most can’t distinguish)
Which is more common? Tennis elbow or golfer’s elbow?
Tennis elbow (latera epicondylitis)
Where do you palpate the brachioradialis muscle/how do you make it more prominant? (remember to use anatomical position)
Have pt place hand under table and pull up
Brachioradialis is anterolateral
Going from medial to lateral: median nerve, brachial artery, biceps tendon
Median nerve –> Brachial artery –> Biceps tendon
4 movements at the elbow and the degrees of movement associated
- Flexion - 135
- Extension - 0
- Pronation - 90
- Supination - 90
Tinel’s Sign (elbow) tests for _________.
Ulnar Nerve Compression
–> Tap on ulnar groove –> (+) is tingling in pinky/ring finger
Thickened palmar fascia over the palmar aspect of the hand causes flexion in 3-5th fingers is called….
Dupuytren’s contractures
Joints involved in RA vs. OA
RA: PIP, MCP, wrist joints (ulnar deviation)
OA: DIP, PIP
What is a Mallet finger?
WHAT YOU HAVE
After avulsion fx of distal phalanx - result of bony build up –> can’t flex finger
Swan neck and boutonniere deformities are associated with ____.
RA
Small closed space infection at the distal pulp of finger
Felon
Fingernail abscess usually infected with S. aureus
Paronychia
Atrophy of the thenar eminence would suggest…
Carpal Tunnel Syndrome (compression of median nerve)
Hypothenar atrophy indicates..
Ulnar nerve injury
Most commonly fxed carpal bone
Navicular
A pt presents w/ tenderness over the snuffbox. what does this indicate?
Navicular fx
What does the Finkelstein maneuver test for?
DeQuervian’s dz
Wrist Flexion/Extension (degrees)
Wrist ulnar/radial deviation (degrees)
Flexion - 80
Extension - 70
Ulnar deviation - 30
Radial deviation - 20
Where is a good place to check for pure radial nerve sensation?
Dorsal web space between the thumb and index finger
Phalen’s Test
Test for Carpal tunnel syndrome
Pt holds wrists together in flexed position for 1 minute…if tingling sensation it is positive
Allen’s test
Tests competency of radial and ulnar arteries…the pumping the hand and releasing one artery to look for collateral blood flow
Genu valgus
Knock-knee
Genu varus
Bow-legged
Genu recurvatum
Hyperextended knees
What can joint line tenderness be a sign of?
OA
Meniscal tears/cysts
Synovitis
A lump on the tibial tubercle (anteriorly) is consistent with….
Osgood Schlatter Disease
Is a Baker’s cyst usually medial or lateral?
Medial
Special tests for possible ACL tear
Lachman - knee flexed 30 degrees, draw tibia toward you and look for laxity (knee is supported by hand)
Anterior Draw Test - sitting on feet and using two hands
Which is more sensitive for an ACL tear? Lachman’s or Anterior Draw Test?
Lachman’s Test
Special tests if MCL tear was suspected
Flex knees to 30 degrees, support femur w/ hand and apply valgus stress
Normal laxity of MCL:
Grade 2 tear laxity of MCL:
Grade 3 tear laxity of MCL:
Normal: 0-5mm
Grade 2: 5-10mm
Grade 3: >10mm
The knee can flex how many degrees? (do this via squatting
130 degrees
McMurrays test
Assess for torn meniscus
Rotate knee first internally then externally
(+) is pain and joint line tenderness, further confirmation by audible click
Apley Grind Test
Same as McMurray’s except pt is laying prone instead of supine
Squeeze Test
Tests extensor dysfunction
Squeeze quad at it’s attachment to patella and then have pt gently tighten quad muscle
Pain is a positive response
If a pt is noticed to have wear/tear on the medial side of their shoe what kind of foot anatomy do they have?
Flat feet
Bunionette
Small bunion on lateral side of foot
aka Tailor’s Bunion
Pump bump’s medical name is….
Haglunds deformity
3 lateral ligaments of the ankle
- Anterior talofibular ligament
- Calcaneofibular ligament
- Posterior talofibular ligament
Which of the lateral ligaments of the ankle is most often injured?
Anterior talofibular ligament
- -> calcaneofibular injured in more severe sprains
- -> posterior talofibular injured in the MOST SEVERE sprains
Primary foot everter muscles
Peroneus longus and brevis
Where does Morton’s neuroma most often appear?
Between 3rd and 4th MT head
Ankle: dorsiflex/plantar flex/invert/evert and degrees associated
Dorsiflex: 20
Plantar flex: 50
Invert: 5
Evert: 5
Where would you measure when wanting to measure leg length?
From superior iliac spine –> medial malleolus
run tape measure across medial side of knee
If you suspect trochanteric bursitis after palpation then what other test can you do?
Move leg into abduction and external rotation (knee flexed) and this should produce pain
Rectus femoris ____ the leg and gluteus medius _____ the leg.
flexes
abducts
Hip ROM:
- Abduction
- Adduction
- Flexion
- Extension
- Internal Rotation
- External Rotation
Abduction - 45 Adduction - 20 Flexion - 135 Extension - 30 IR - 35 ER - 45
Thomas Test
Determines presence of a flexion contracture of hip
Pt lies supine, we place hand in lordotic curve and have pt hold one leg flexed toward their chest
THE HIP BEING TESTED IS THE CONTRALATERAL HIP
Normal: lordotic curve flattens and contralateral leg remains on table
ABnormal: Contralateral leg comes off the table
Condyloid joint
Permits movement in two axes, ex: wrist
Saddle Joint
Biaxial joint; ex: carpometacarpal joint of thumb
Pivot joint
Rotation in one axis (longitudinal); ex: proximal radioulnar joint
____ weakness is usually myopathy; ____ weakness is usually a _____.
Proximal
Distal
Do pts w/ polymyalgia usually have proximal muscle weakness or distal?
Promixal muscle weakness
Symptoms of myasthenia gravis
Generalized weakness
Diplopia
Difficulty swallowing
A persistence of the concavity of the spine may indicate ________.
Ankylosing Spondylitis
What other etiologies should you keep in mind when a patient presents w/ shoulder pain?
It could possibly referred from either chest or abdomen
A pt comes in w/ sudden onset of shoulder pain and says he was in a car accident and hit his shoulder against the window about 7 hours ago. What do you suspect?
Rotator cuff tear or rupture
Hallmark of bicipital tendinitis
Reproduction of anterior shoulder pain during resistance to forearm supination
What range of motion is first lost w/ degenerative disease of the hip?
External rotation
Trendelenburg Test
Normal: pt puts weight on one foot (standing) and contralateral hip goes up
ABnormal: pt puts weight on one foot (standing) and contralateral hip goes down
Tuberous sclerosis classic triad
- Mental retardation
- Seizures
- Adenoma sebaceum - occurs near nasolabial folds and over cheaks
Kaposi’s Sarcoma frequently seen on the feet.
Can occur anywhere really. Bx to confirm dx
Bullosis diabeticorum
Noninflammatory, blistering condition that usually occurs in pts w/ long-standing diabetes
Tense bullae develop on normal-appearing skin in acral areas
Cutaneous larva migrans
Hookworms that invade bottom of feet and leave trails of their burrows. Parasite is unable to invade the dermis
Sesamoiditis
Pain in ball of foot, usually effects young active people (ballerinas, catchers, joggers)
Patient’s who cannot accomplish the finger-to-nose test (overshoot) may have _____.
Cerebellar disease
Diadochokinesia
Rapid alternating movements
Pt walks with a weak/spastic leg and arm is flexed at elbow. Gait?
Hemiplegia gait
–> probably from stroke
Pt walks w/ head bowed, back bent over and shuffles with short, hurried steps. Gait?
Parkinsonian Gait
–> Parkinson’s Disease
Pt walks with feet very far apart and moves clumsily
Cerebellar Ataxia
Pt is walking with high steps and slaps feet down forcefully
Sensory ataxia
Pt is walking with high steps
Foot Drop
