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PCMI > 1.4. Joint Exam > Flashcards

1.4. Joint Exam Flashcards

(44 cards)

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1
Q

What is a strain vs sprain?

A

Strain: muscular injury
Sprain: ligamentous injury

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2
Q

What is a dislocation?

A

Complete lack of contact between 2 articular surfaces

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3
Q

What is a subluxation?

A

partial dislocation: residual contact between 2 articular surfaces

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4
Q

What is a valgus deformity?

A

distal part of limb directed away from midline (knock knee)

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5
Q

What is a varus deformity?

A

distal part of limb directed toward midline (bowleg)

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6
Q

What is the exam approach for a joint?

A
  • Inspect
  • Palpation
  • ROM (active and passive)
  • Speciality testing
  • compare both extremities
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7
Q

What is the exam approach for an extremity?

A

-Inspect
-Palpation
-ROM (active and passive)
-Speciality testing
PLUS (compared to joint)
-Reflexes
-Neurovascular status: Neuro (motor/sensory) and Vascular (pulses/cap refill, always check distal to injury)
*compare both extremities

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8
Q

What is an intra-articular structure?

A

Within joint capsule

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9
Q

What is an extra-articular structure?

A

outside joint capsule

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10
Q

Effusion

A

Fluid in joint

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11
Q

What things should you consider specifically for your HPI in regard to joint complaint?

A
  • Traumatic or atraumatic
  • Mechanism
  • Can they bear weight or use extremity?
  • Last food intake (possible surgery)
  • Location: mono or polyarticular
  • Duration: acute or chronic problem
  • Onset: sudden or gradual
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12
Q

What types of medications should you specifically ask in regards to joint complaint?

A

-NSAIDS, Tylenol, narcotics, steroids

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13
Q

What medication allergies are complaint specific to joint complaints?

A

Narcotics and NSAIDs

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14
Q

What social history is pertinent to joint complaints?

A

IV drugs: what? how? how often? how recent?

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15
Q

What family history is pertinent to joint complaints?

A
  • Neck and back problem

- Systemic diseases that could manifest as MSK issues (ex: RA)

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16
Q

What part of the joint exam is most sensitive indicator of joint disease?

A

Range of motion, specifically active

-Don’t force ROM if hurts patient

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17
Q

What do you want to pay attention to in palpation of joint CC exam?

A

General tenderness vs point tenderness

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18
Q

What 6 speciality tests can be done for joint complaint of shoulder?

Study These Flashcards
A
  1. Painful ARC: pain w/ abduction 60-120
  2. Cross arm
  3. Neer impingement
  4. Hawkins
  5. Empty can
  6. Drop-arm
19
Q

What 5-8 speciality tests can be done for joint complaint of Elbow?

Study These Flashcards
A
  1. Valgus stress test
  2. Varus stress test
  3. Tinel test
  4. Medial epicondyle test (golfer)
  5. Lateral epicondyle test (Tennis elbow)
  6. Palpate over radial head - annular tear
  7. palpate over medial epicondyle: little league elbow
  8. Palpate over posterior elbow - olecranon bursitis
20
Q

What speciality test can be done for joint complaint of Wrist/hand?

Study These Flashcards
A
  1. Tinel test
  2. Phalen’s test
  3. Flinkelstein test
21
Q

What 9 speciality tests can be done for joint complaint of knee?

Study These Flashcards
A
  1. Valgus: MCL disruption
  2. Varus: LCL disruption
  3. Anterior drawer: ACL insuffiency (pull tibia anteriorly)
  4. Lachman’s Test: ACL
  5. Posterior drawer test: PCL
  6. McMurry’s Test: medial and lateral meniscus
  7. Apley’s Grind/Compression Test: meniscus, collateral l injury or both
  8. Apley’s Grind/Distraction Test:
  9. Patella-Femoral Grinding Test: roughness of articulating surfaces
22
Q

What 8 speciality tests can be done for joint complaint of hip?

Study These Flashcards
A
  1. Labral loading
  2. Labral distraction
  3. Scour: flex and externally rotate
  4. Apprehension/Faber 1: labral pathology
  5. Patrick’s Faber 2: gluteus medius pathology
  6. Patrick’s Faber 3: iliopsoas pathology
  7. Jump sign: pressure to greater trochanter = trochanteric bursitis
  8. Thomas test: hip flexor contraction
23
Q

What 6 speciality tests can be done for joint complaint of ankle/foot?

Study These Flashcards
A
  1. Anterior Drawer
  2. Talar Tilt
  3. Eversion Test
  4. Squeeze test
  5. Thompson test
  6. Homan’s sign
24
Q

What are reflexes scored out of?

Study These Flashcards
A

0-4, normal is 2

25
What is neuro muscular strength recorded out of?
0-5, 5/5 is normal | *Always assess and document motor and sensory function distal to soft tissue injury of fracture
26
What scale are pulses recorded out of?
0-4 | -Always check pulse and cap refill distal to injury
27
What are top causes of life threatening joint pain presentations?
- Septic arthritis | - Referred pain: STEMI, intraperitoneal hemorrhage, lung pathology
28
What should you consider for a traumatic joint injury in regards to extra-articular boney processes?
Bone: fracture or dislocation
29
What should you consider for a traumatic joint injury in regards to extra-articular soft tissue processes?
- Myofascial - Ligaments - Tendon - Bursae
30
What should you consider for a traumatic joint injury in regards to intra-articular processes?
Cartilage: joint capsule and bone
31
What should you consider for a Atraumatic joint injury in regards to Intrinsic (intra and extra-articular) processes?
- Overuse injuries, joint instability - Tendinitis, tendinopathy, impingement - Bursitis, synovitis - Capsulitis, osteoarthritis - Septic arthritis, gout, systemic disease
32
What is a Colle's fracture?
- Traumatic injury from FOOSH - Distal radius fracture - Often referred to as "distal fork" deformity - Treatment: reduction, sling, rest, ortho followup
33
Arthrocentesis
Synovial fluid from joint aspiration
34
What patient population is septic arthritis more frequent in?
- >80 years old, DM - RA - Prosthetic joint - Recent joint surgery - Skin infection - IV DRUG ABUSE, alcoholism - Prior intraairticular corticosteroid injection
35
What physical findings of the joint would be concerning for septic arthritis?
- Knee involved more than 50% - Joint is erythematous, swollen, warm, painful - Limited active and passive ROM
36
How would you diagnose septic arthritis?
- Plain x-ray: normal or show effusion | - Lab: elevated CBC, ESR, CRP; synovial fluid show WBC and bacteria after ASPIRATING SYNOVIAL FLUID FROM JOINT
37
How would you treat septic arthritis?
- Antibiotics, broad spect after aspiration | - Surgical washout of joint
38
Describe acute arterial occlusion of LLE in relation to joint complaint?
- Acascular emegency - US and arteriogram imaging - Heparin, vascular surgery, OR stat
39
What PSH is joint pertinent?
prior orthopedic surgery or procedures
40
What PMH is joint pertinent?
- prior symptoms or injury to same location | - systemic illness (like RA)
41
What are the 6 pertinent boney prominences of the wrist and hand?
1. anatomical snuff box 2. carpal bones 3. MCP 4. DIP and PIP 5. Distal ulna 6. Distal radius
42
What are the 4 pertinent boney prominences of the hip?
1. iliac crest 2. ASIS 3. Greater trochanter 4. pubic tubercle
43
What are the pertinent boney(3) and ligamentous (2) prominences of the knee?
1. Patella 2. fibular head 3. tibial head 4. quadriceps femoris tendon 5. patellar ligament
44
What are the 5 pertinent prominences of the ankle?
1. ankle joint 2. medial and lateral malleolus 3. achilles tendon 4. heel 5. metatarsal joint

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