Approach To Pt With Joint Pain

Question 1

History of pain

Answer 1

OLDCAAARTS
Point to the pain
Anything that might have occurred to cause the pain

Question 2

Mechanism of injury

Answer 2

Direction of force
What did joint do
What did it feel like at the time
Any sounds or sensations

Question 3

Sprain

Answer 3

Ligaments stretch causing tearing
Tearing causes bruising
Greater the tearing of the ligament, the greater the blood loss and subsequent bruising
May fee or hear a “pop”

Question 4

Strain

Answer 4

Muscle is stretched

“Grabbing sensation”

Question 5

Assessing strain or sprain

Answer 5

Any immediate swelling or bruising?
Could you still use the joint (walking/standing)?
How does it feel now?

Question 6

Symptoms

Answer 6

What the patient feels
Pain
Stiffness

Question 7

Signs

Answer 7

What can be observed, measured, and described
Warmth
Redness
Swelling
Pain

Question 8

Injury

Answer 8

Definitive onset
General mono-articular
Generally unilateral

Question 9

Non-injury

Answer 9

Insidious or gradual
Associated with constitutional symptoms
Mono-articular or polyarticular
Unilateral or bilateral
Single or multiple joints
Migratory
Change with activity
Extra-articular signs: not on joint, but around joint

Question 10

Mono articular

Answer 10

1 joint

Question 11

Poly articular

Answer 11

Multiple joints

Question 12

Migratory

Answer 12

Moves from one joint to another

Question 13

Extra-articular

Answer 13

Bones, muscles, tendons, bursa, skin

Question 14

Myalgia

Answer 14

Muscle pain

Question 15

Arthralgia

Answer 15

Joint pain

Question 16

Effusion

Answer 16

Fluid escaped from blood vessels or lymphatics into the tissues or a cavity

Question 17

Tendinitis

Answer 17

Inflammation of the tendon

Question 18

Bursitis

Answer 18

Inflammation of the bursa

Question 19

Tenosynovitis

Answer 19

Inflammation of the tendon sheath

Question 20

Genu varus

Answer 20

Bowed legs

Question 21

Genu valgus

Answer 21

Knock kneed

Question 22

Subluxation

Answer 22

Residual contact between two articular surfaces

Question 23

Dislocation

Answer 23

Complete lack of contact between two articular surfaces

Question 24

Sensitivity

Answer 24

The proportion of patient with the diagnosis that also have the physical sign (true positive)
Rules things out
SnOUT: a sensitive test it’s a negative result rules a disease OUT

Question 25

Specificity

Answer 25

The portion of the patient without the diagnosis who lacks the physical sign (true negative) Rules things in SpIN: a specific test with a positive result rules IN a disease

Question 26

Likelihood ratio (LR)

Answer 26

Values between 0 and infinity LR>1 increase the probability of a disease The greater the value of the LR, the more likely the diagnosis or disease LR<1 decrease the probability of disease The closer to 0, the probability of the disease or diagnosis decreases LR=1 do not change the probability of the disease

Question 27

What should you always do when assessing a joint

Answer 27

``` Do it BILATERALLY Observe Palpation Range of motion Neuro Vascular Diagnostic testing ```

Question 28

Muscle strength testing

Answer 28

0-no visible or palpable contraction 1-visible or palpable contraction with no motion 2-full ROM with no gravity 3-full ROM against gravity 4-full ROM against gravity, with moderate resistance 5-muscle contracts normally against full resistance

Question 29

Reflexes

Answer 29

4+-very brisk, hyperactive it’s clonus 9rhythmic oscillations between flexion and extension) 3+-brisker than average, possibly but not necessarily indicative of disease 2+-average; normal 1+-somewhat diminished; low normal 0-no response

Question 30

Triceps reflex

Answer 30

C7

Question 31

Biceps reflex

Answer 31

C5,6

Question 32

Brachioradialis reflex

Answer 32

C5,6

Question 33

Patellar reflex

Answer 33

L2-L4

Question 34

Achilles reflex

Answer 34

S1

Question 35

Capillary refill

Answer 35

Compress digit between index and thumb to cause blanching; release pressure and note time to regain color Normal time-2 sec or less Tests digital perfusion (e.g. arterial occlusion, hypovolemic shock, hypothermia)

Question 36

Pulses

Answer 36

0/4 absent 1/4-palpable, but thready and weak; easily obliterated 2/4 normal, easily identified; not easily obliterated 3/4 increased pulse; moderate pressure for obliteration 4/4 full, bounding, cannot obliterate

Question 37

Edema

Answer 37

Pressing firmly for 5 seconds over the dorsum of foot, anterior tibia, or behind medial malleolus 0-absent 1+: barely detectable, slight pitting (2mm); disappears rapidly 2+ slight indentation (4 mm); 10-15 seconds 3+ deeper indentation (6 mm); over 1 minute 4+ very marked indentation (8 mm); 2-5 minutes

Question 38

C2 Dermatomes

Answer 38

Ears

Question 39

C3 dermatome

Answer 39

Front of neck

Question 40

C4 dermatome

Answer 40

Across clavicles and over shoulders

Question 41

C5 dermatome

Answer 41

Superior lateral arm

Question 42

C6 dermatome

Answer 42

Lateral arm-forearm and thumb

Question 43

C7 dermatome

Answer 43

Middle 1 finger plus lateral half of first finger and medial half of 3rd finger

Question 44

C8 dermatome

Answer 44

Pinky finger

Question 45

T4 dermatome

Answer 45

Nipples

Question 46

T10 dermatome

Answer 46

Umbilicus

Question 47

L1 dermatome

Answer 47

Inguinal region

Question 48

L2 dermatome

Answer 48

Very top of thigh by femoral triangle

Question 49

L3 dermatome

Answer 49

From lateral superior thigh crossing diagonally to medial inside of knee

Question 50

L4 dermatome

Answer 50

Lateral middle thigh crossing over knee and down to medial leg

Question 51

L5 dermatome

Answer 51

Lateral superior leg crossing over to big toe | Anterior ankle and foot

Question 52

S1 dermatome

Answer 52

Lateral thigh and leg and little toe (posterior side)

Question 53

S2 dermatome

Answer 53

Posterior side | Medial thigh and leg

Question 54

T1 dermatome

Answer 54

Posterior medial side of arm and forearm