adult MSK Flashcards
(69 cards)
1
Q
shoulder bones
A
- clavicle
- scapula
- proximal humerus
2
Q
shoulder articulation
A
- glenohumeral
- sternoclavicular
- acromioclavicular
- scapulothoracic
3
Q
shoulder mm
A
deltoid rotator cuff: 1. supraspinatus: abduction to 90 degrees 2. infraspinatus: ext rotation 3. subscapularis: int rotation 4. teres minor: ext rotation
4
Q
cause of extrinsic shoulder pain
symptoms of extrinsic shoulder pain
A
- cause - referred pain
2. symptoms - poorly localized, no or minimal reproduction of pain
5
Q
work up for shoulder problem
A
- X-ray
- US
- MRI
6
Q
empty can test which mm?
A
supraspinatus
7
Q
lift off test which mm?
A
subscapularis
8
Q
complete tear of supraspinatus symptom
A
can’t keep arm up at 90 degree
9
Q
rotator cuff tear
A
- chronic use problems - tendonopathy, tendonitis, bursitis
- injury to mm
- disuse atrophy
10
Q
shoulder impingement symptoms
A
- night pain
2. localized pain, crepitus, or sudden pain while abducting the arm
11
Q
shoulder impingement causes
A
- superior and posterior mm atrophy
2. bone spurs
12
Q
shoulder impingement involve which mm?
A
supraspinatus
13
Q
shoulder impingement exams
A
hawkins and near impingement signs
14
Q
shoulder impingement definition
A
weakness of the rotator cuff -> superior sublaxation of the humeral head when the shoulder is abducted beyond 90 degrees
15
Q
shoulder impingement tx
A
surgery
16
Q
AC separation
cause?
diagnose with?
tx?
A
- injury associated problems
- dx by inspection
- tx: surgery, or can allow it to heal by itself (but can decrease function of shoulder)
17
Q
shoulder arthritis hx
A
- significant shoulder use
2. other joints have arthritis
18
Q
shoulder arthritis symptoms
A
- generalized tenderness
- decreased shoulder ROM
- disuse atrophy
- active or passive crepitus
- can be u/l
19
Q
shoulder arthritis x-ray
A
- substantial lost of joint space
- a lot of sclerosis
- cartilage degen
- bone spur
20
Q
shoulder arthritis tx
A
- non-narcotic meds for pain
2. therapy - hot or cold motion
21
Q
adhesive capsulitis symptoms
A
- worst pain at night
- loss of active and passive ROM
- hear and feel active and passive crepitus
22
Q
adhesive capsulitis risk factor
A
diabetes mellitus
23
Q
adhesive capsulitis exams
A
MRI
24
Q
adhesive capsulitis tx
A
- increase ROM with therapy or surgery if therapy doesn’t work
- pain med
25
bursitis onset
young
26
bursitis history
1. trauma
2. repeated trauma
3. repetitive motion
27
bursitis physical finding
1. active and passive ROM tenderness with abduction (tendonitis only have active ROM tenderness)
2. no atrophy
28
bursitis diagnose with
| how to differentiate it between bursitis, tear, frozen shoulder, and arthritis
lidocaine injection challenge - traumatic reduction in pain and improvement in shoulder function after injection
(tear - reduction in pain after injection but still have weakness)
(frozen shoulder and arthritis - does not have significant pain and shoulder function improvement)
29
bursitis tx
1. find underlying cause of inflamm
2. restrengthen mm around rotator cuff with therapy
3. lidocaine injection
30
SLAP lesion definition
tear located superior labrum, extends anterior to posterior
31
SLAP history
1. athletes who throws a lot
2. works overhead
3. falling and grabbing something to break fall
32
SLAP physical exam findings
1. reproduce pain with click (abduction and external rotation and resist motion by coming back to normal position)
2. no atrophy
3. no reproduce pain with palpation
33
SLAP exams
MRI
34
SLAP tx
1. allow it to sclerosis itself to heal (takes a long time to heal due to low vascular supply)
2. surgery if severe
35
lateral hip tenderness with palpation dx
bursitis
36
trochanteric bursitis physical exam
1. gait
| 2. reproduce pain
37
trochanteric bursitis diagnose with and treatment
lidocaine injection
38
laterla hip pain with paresthesia dx
meralgia paresthetica
39
meralgia paresthetica pathogenesis
irritation of lateral femoral cutaneous nerve as it goes over inguinal area
40
meral paresthetica physical exam findings
1. sensory problems
2. not map to one dermatome
3. anterior-lateral around thigh and don't go below the knee
41
meral paresthetica caused by
1. mechanical irritation
| 2. compression due to overweight person with abdominal fat
42
posterior hip pain dx
SI, lumbar, unusual true hip joint problem
43
osteoarthritis of hip joint history findings
1. sport injury
2. inisidious onset
3. gelling pain (pain when first get up in the morning or after not moving for a period of time, pain improves as day goes on and move around)
44
osteoarthritis of hip joint physical exam findings
1. nonspecific pain
2. restricted abduction
3. referred pain
45
anterior/groin pain dx
true hip pain
1. osteonecrosis
2. sepsis
3. fracture
4. synovitis
46
osteonecrosis definition
compromise vascular supply to femoral head -> collapse of femoral head
47
osteoncrosis history finding
1. worst with weightbearing and motion
| 2. pain at rest and night
48
hip fracture history finding
1. worst with weightbearing
| 2. pain with rotation
49
hip fracture diagnose with
1. X-ray (can't see occult fracture until it heals)
2. MRI - if fracture near soft tissue
3. CT with bone windows for long bone
50
hip fracture tx
1. non-weightbearing
| 2. pain control
51
hip fracture onset
sudden onset in elderly
52
low anterior thigh pain dx
referred hip pain from
1. true hip pain
2. upper femur
3. femoral neck
4. lumbar radiculopathy
53
referred hip pain symptoms
direct pressure and ROM do not reproduce pain
54
other types of arthritis
1. Reactive: aseptic arising 1-6 weeks after extra- articular infection, most common from GI or GU infection.
2. Septic: site of infection, warm, swollen, red, usually localized
3. Psoriatic: more than one site, non-rheumatic and associated with rash
4. Rheumatic: specific criteria for diagnosis, + RF or anti-CCP
55
osteonecrosis risk factor
1. excessive alcohol use
| 2. frequent steroid use
56
hip special exams and what it tests
Faber - hip joint, SI, psoas
57
significant pain at hip ROM end point is a strong indicator for
1. osteonecrosis
2. occult fracture
3. acute synovitis
4. metastasis
58
Osgood-Schlatter definition
apophysitis of tibial tubercle at insertion of patellar tendon
59
Osgood-Schlatter demographic
active kids (14-15y/o)
60
Osgood-Schlatter physical exam findings
1. pain
| 2. knot at tibial plateau
61
Osgood-Schlatter diagnose with
clinical findings
62
Osgood-Schlatter tx
1. non-weightbearing
2. casting
3. follow-up to see how it is healing
4. continue activity to help healing
5. pain med
63
Osgood-Schlatter other ddx
1. stress fracture
2. evulsion of quad tendon
3. tumor
64
plantar fasciitis caused by
abnormal gait -> over pronate foot -> stress on plantar fascia --> pain at anterior calcaneus
65
plantar fasciitis symptoms
1. foot hurts at heel when get up and step on it in the morning
2. gets better with massage and as the day goes on
66
plantar fascitis treatment
1. find underlying cause
2. counerstrain
3. NSAIDs
4. taping support
5. massage arch or heel
6. orthotics
7. hip motion that might be affecting gait
67
plantar fasciitis physical exam findngs
reproduce pain with palpation
68
plantar fasciitis associated with
tarsal syndrome (due to plantar fasciitis affecting tibial nerve)
69
plantar fasciitis radiograph finding
bone spurs but often not the cause of pain
