Approach To Joint Exam

Question 1

What are intra-articular structures?

Answer 1

Within the joint capsules

Question 2

What are extra articular structures?

Answer 2

Outside the joint capsule

Question 3

What is a dislocation?

Answer 3

Complete lack of contact between 2 articular surfaces

Question 4

What is subluxation?

Answer 4

Residual contact between 2 articular surfaces

Not completely separated - shifted

Question 5

What is valgus deformity?

Answer 5

Distal part of limb directed away from midline

Genu valgus = knock knees (knees touching)

Question 6

What is a varus deformity?

Answer 6

Distal part of limb directed toward midline

Genu varus = bow legs

Question 7

What is mono articular?

Answer 7

One joint

Question 8

What is poly articular?

Answer 8

Multiple joints

Question 9

What is migratory?

Answer 9

Moves from one joint to another

Question 10

What are extra articular structures?

Answer 10

Bones, muscles, tendons, bursa and skin

Question 11

What is myalgia?

Answer 11

Muscle pain

Question 12

What is arthralgia?

Answer 12

Joint pain

Question 13

What is tensoynovitis?

Answer 13

Inflammation of the tendon sheath

Question 14

What is a sprain?

Answer 14

Ligament injury

Question 15

What is a strain?

Answer 15

Muscular injury

Question 16

What is effusion?

Answer 16

Fluid in the joint

Question 17

What are important components of a history and physical regarding joints?

Answer 17

Location (mono or poly; entire joint or just one spot)
Duration (acute or chronic) 
General ROS (discriminators and life threats like fever, chills, CP, SOB)
Complaint specific ROS

Question 18

What is an important aspect to obtain during an HPI for joint complaints?

Answer 18

Traumatic or atraumatic

Question 19

What is important information to know regarding medications the pt with joint complaint may be taking?

Answer 19

Blood thinners

Effects surgery and body’s response

Question 20

What are important aspects during a joint exam?

Answer 20

Inspection, palpation, range of motion and specialty testing

Question 21

What must you always do during a joint exam?

Answer 21

Always compare to the opposite extremity

Question 22

Describe inspection of the joint

Answer 22

Look at the joint what do you see?

Question 23

Describe what to look for upon palpation of the joint

Answer 23

Temperature difference? Tenderness (general tenderness or point tenderness?)

Question 24

Describe evaluation ROM during a joint exam

Answer 24

Active ROM first then try passive
Restricted ROM is the most sensitive indicator of joint disease
Never force ROM if it hurts the pt

Question 25

What should always be evaluated during an extremity exam?

Answer 25

Always check neurovascular status distal to the injury

Question 26

Which components are involved during an extremity exam?

Answer 26

``` Inspection, palpation, ROM, specialty testing Neurovascular status (neuro/reflexes and vascular/pulses) ```

Question 27

Specialty tests

Answer 27

There are a ton of them | Some are helpful others are not

Question 28

Reflexes

Answer 28

Always check the reflexes in affected extremity and compare to the opposite extremity Recorded as 0-4 out of 4

Question 29

What should you always assess for muscle strength?

Answer 29

Always assess and document motor and sensory function to soft tissue injury of fracture Compare with opposite extremity

Question 30

Scale for grading pulses

Answer 30

``` 0 = absent, unable to palpate 1+ = diminished, weaker than expected 2+ = brisk, expected, normal* 3+ = bounding ```

Question 31

What do you always check for when evaluation vasculature?

Answer 31

Always check pulses and/or capillary refill distal to the site of injury

Question 32

What are some pearls for the joint exam?

Answer 32

Do not ever force a range of motion exam or specialty test that greatly increases the pts pain Always compare the joint/extremity with the pathology to the opposite “normal” extremity

Question 33

What is the process for developing and working through a DDx?

Answer 33

``` Develop broad DDx* Narrow DDx* Develop working DDx* Pursued DDx Assessment and plan ```

Question 34

What is the VINDICATE pneumonic for a systemic approach when developing a broad DDx?

Answer 34

``` Vascular Inflammatory Neoplastic Degenerative/deficiency Idiopathic/intoxication Congenital Autoimmune/allergic Traumatic Endocrine ```

Question 35

What are examples of traumatic joint pain?

Answer 35

Extra-articular (bone vs soft tissue) or intra-articular

Question 36

What are examples of ataumatic joint pain?

Answer 36

Extrinsic/referred pain | Intrinsic (the joint in general) - intra or extra articular

Question 37

What is the top causes of life threatening joint pain?

Answer 37

``` Referred pain (ex. MI)* Septic arthritis ```

Question 38

What is FOOSH?

Answer 38

Fall on out stretched hand

Question 39

What is a Colle’s fracture?

Answer 39

Distal radius fracture | Usually results from a FOOSH