Ch. 6 Musculoskeletal System Disorders Flashcards
(133 cards)
1
Q
Name the intrinsic muscles innervated by the MEDIAN nerve
A
Abductor pollicis brevis Opponens pollicis Flexor pollicis brevis: superficial head Lubricals (radial side) (pg. 178 R&SG)
2
Q
Name the intrinsic muscles innervated by the ULNAR nerve
A
Abductor digiti minimi Opponens digiti minimi Flexor digiti minimi Adductor Lumbricals (Ulnar side) Palmar interossei Dorsal interossei (pg. 179 R&SG)
3
Q
Name the extrinsic flexor muscles of the hand innervated by the MEDIAN nerve
A
Flexor digitorum superficialis (FDS) Flexor digitorum profundus (FDP) Flexor pollicis longus (FPL) (pg. 179 R&SG)
4
Q
Name the extrinsic flexor muscles of the hand innervated by the ULNAR nerve
A
Flexor digitorum profundus (FDP) (pg. 179 R&SG)
5
Q
Name the extrinsic extensor muscles of the hand innervated by the RADIAL nerve
A
Extensor digitorum communis (EDC) Extensor digiti minimi (EDM) Extensor indicis proprius (EIP) Extensor policis longus (EPL) Extensor policis brevis (EPB) Abductor pollicis longus (APL) (pg. 180 R&SG)
6
Q
Name wrist flexors innervated by the MEDIAN nerve
A
Flexor carpi radialis (FCR) Palmaris longus (PL) (pg. 180 R&SG)
7
Q
Name wrist flexors innervated by the ULNAR nerve
A
Flexor carpi ulnaris (FCU) (pg. 180 R&SG)
8
Q
Name wrist extensors innervated by the RADIAL nerve
A
Extensor carpi radialis brevis (ECRB) Extensor carpi radialis longus (ECRL) Extensor carpi ulnaris (ECU) (pg. 180 R&SG)
9
Q
Name the volar forearm muscles innervated by the MEDIAN nerve
A
Pronator teres Pronator quadratus (pg. 180 R&SG)
10
Q
Name the dorsal forearm muscles innervated by the RADIAL nerve
A
Supinator (pg. 180 R&SG)
11
Q
Describe the action of the abductor pollicis brevis
A
palmar abduction (pg. 178 R&SG)
12
Q
Describe the action of the abductor opponens policis
A
Opposition (pg. 178 R&SG)
13
Q
Describe the action of the abductor flexor pollicis brevis (superficial head)
A
thumb MCP flexion (deep head innervated by ulnar n.) (pg. 178 R&SG)
14
Q
Describe the action of the lumbricals (radial side)
A
MCP flexion and extension of IP joints (pg. 178 R&SG)
15
Q
Describe the action of the abductor digiti minimi
A
abduction of the fifth digit (pg. 178 R&SG)
16
Q
Describe the action of the opponens digiti minimi
A
opposition of the fifth digit (pg. 179 R&SG)
17
Q
Describe the action of the adductor
A
adducts CMC joint of thumb (pg. 179 R&SG)
18
Q
Describe the action of the lumbricals (ulnar side)
A
MCP flexion and extension of IP joints of digits IV and V. (pg. 179 R&SG)
19
Q
Describe the action of the palmar interossei
A
adduction and assistance with MCP flexion and extension of IP joints of digits II through V. (pg. 179 R&SG)
20
Q
Describe the action of the dorsal interossei
A
abduction and assists with MCP flexion and extension of IP joints of digits II through V. (pg. 179 R&SG)
21
Q
Describe the action of the flexor digitorum superficialis (FDS)
A
flexion of PIP joints (pg. 179 R&SG)
22
Q
Describe the action of the flexor digitorum profundus (FDP)
A
flexion of DIP joints to digits II and III (pg. 179 R&SG)
23
Q
Describe the action of the flexor pollicis longus (FPL)
A
flexion of IP joint of thumb (pg. 179 R&SG)
24
Q
Describe the action of the flexor digitorum profundus (FDP)
A
flexion of DIP joints to digits IV and V. (pg. 179- 180 R&SG)
25
Describe the action of the extensor digitorum communis (EDC)
extension of MCP joints and contributes to extension of the IP joints. (pg. 180 R&SG)
26
Describe the action of the extensor digiti minimi (EDM)
extension of MCP joint at the fifth digit and contributes to extension of the IP joints (pg. 180 R&SG)
27
Describe the action of the extensor indicis proprius (EIP)
extension of MCP joint of the second digit and contributes to extension of the IP joints (pg. 180 R&SG)
28
Describe the action of the extensor pollicis longus (EPL)
extension of IP joint of thumb (pg. 180 R&SG)
29
Describe the action of the extensor pollicis brevis (EPB)
extension of MCP and CMC joints of thumb (pg. 180 R&SG)
30
Describe the action of the abductor pollicis longus (APL)
abduction and extension of CMC joint (pg. 180 R&SG)
31
Describe the action of the flexor carpi radialis (FCR)
flexion of wrist and radial deviation (pg. 180 R&SG)
32
Describe the action of the palmaris longus (PL)
flexion of wrist (pg. 180 R&SG)
33
Describe the action of the flexor carpi ulnaris (FCU)
flexion of wrist and ulnar deviation (pg. 180 R&SG)
34
Describe the action of the extensor carpi radialis brevis (ECRB)
extension of wrist and radial deviation (pg. 180 R&SG)
35
Describe the action of the extensor carpi radialis longus (ECRL)
extension of wrist and radial deviation (pg. 180 R&SG)
36
Describe the action of the extensor carpi ulnaris (ECU)
extension of wrist and ulnar deviation (pg. 180R&SG)
37
Describe the action of the pronator teres
forearm pronation (pg. 180 R&SG)
38
Describe the action of the pronator quadratus
forearm pronation (pg. 180 R&SG)
39
Describe the action of the supinator
forearm supination (pg. 180 R&SG)
40
What nerve innervates the biceps and brachialis?
Musculocutaneous n.
41
What is the action and innervation of the brachioradialis?
Elbow flexion with forearm neutral, innervated by radial n.
42
What is the primary muscle used when flexing elbow while balancing a marble in your palm?
biceps
43
What is the primary muscle being used when flexing at the elbow to admire the rings on your hand?
brachialis
44
Name the muscles and innervation of the muscles used for elbow extension
triceps and anconeus, radial n.
45
Name the rotator cuff muscles
subscapularis, supraspinatus, infraspinatus, teres minor,
46
All rotator cuff muscles are innervated by the suprascapular n. EXCEPT which muscle?
Teres minor is innervated by axillary n.
47
What muscles are involved in shoulder flexion?
Anterior delt and coracobrachialis
48
Name the movement being performed in the picture and the muscles involved
Shoulder ABduction, middle delt and supraspinatus
49
Name the motions performed in this activity pictured
Bonus pat on the back: name the muscles used for those motions
Horizontal ABduction (posterior delt) and Horizontal ADduction (Pectoralis major)
50
Name the injury pictured here and the nerve involved
Wrist drop- radial nerve injury
51
Name the muscles involved in shoulder extension
Latissimus dorsi, teres major, posterior delt
52
Name 3 of the initial OT interventions for a new client with a recent diagnosis of Dupuytren's contracture
1- wound care (dressing changes)
2- edema control (elevation above heart)
3- AROM/PROM
53
True or False, in a client with Duputren's contracture, you want to work on resistive strengthening as soon as swelling is reduced to prevent further weakness.
FALSE. Dupuytren's is a diseas of the fascia of palm and digits which becomes thick and causes deformity from contractures.
You would work on extension with hand based splint (dorsal or volar) and AROM/PROM THEN progress to strengthening when woulds are healed.
54
In treating a client with Dupuytren's, what types of functional activities should you focus your interventions?
flexion and extension aka grasp and release activities
55
Describe the treatment for a client with Skier's thumb
Conservative management:
* thumb splint for 4-6 weeks
* AROM and pinch strengthening at 6 weeks
* Focus on ADLs requiring opposition and pinch strength
Post-operative management:
* thumb splint for 6 weeks followed by AROM
* PROM at 8 weeks
* Strengthening at 10 weeks
56
Describe the OT management of a client with Complex Regional Pain Syndrome (CRPS)
* modalities to decrease pain
* edema management (elevation, manual edema mobilization, compression glove)
* AROM to involved joints
* ADLs to encourage pain-free active use
* stress loading (weight bearing and joint distraction activities such as scrubbing and carrying)
* splinting to prevent contractures but enable participation
\*\*Avoid/Caution with PROM, passive stretching, joint mobilization, dynamic splinting, and casting
57
What is the difference between a Colles' fracture and a Smith's fracture
Colles' fracture has dorsal displacement of the distal radius.
Smith's fracture has volar displacement of the distal radius.
58
Where is the most common carpal fracture?
scaphoid
\* caution- proximal scaphoid has poor blood supply and may become necrotic
59
What type of splint will you use with a boxer's fracture?
- Ulnar gutter splint
- Boxer's fracture is a fracture of the 5th metacarpal
60
True or false, fracture at the head of the ulna will limit rotation of the forearm.
FALSE- fracture of the RADIAL HEAD will impact rotation of the forearm
\*\*recall the head of the ulna is distal while the radial head is proximal
61
You have a client with a humeral shaft fracture. What secondary injury will you be screening for?
Injury to the radial nerve as noted by wrist drop
62
True or False, when evaluating a client with a UE fracture, you will not assess PROM.
TRUE, you do not assess PROM or strength until ordered by a physician.
\*\* one exception is humerous fractures that often begin with PROM or AAROM.
63
Describe conservative treatment for De Quervain's
* thumb spica splint with IP free
* activity modification
* ice massage over radial wrist
* gentle AROM of wrist and thumb to prevent stiffness
64
Describe OT treatment for a client with De Quervain's who is post-operative
* thumb spica and gentle AROM 0-2 weeks
* strengthening, ADLs and role activities 2-6 weeks
* unrestricted after 6 weeks
65
Name the injury caused from overuse of wrist flexors
Medial Epicondylitis also known as Golfer's elbow
66
What muscle is most commonly involved in lateral epicondylitis or Tennis elbow?
extensor carpi radial brevis
67
Describe treatment for lateral or medial epicondylitis
* elbow strap; wrist splint
* ice and deep friction massage
* stretching
* activity/work modification
* as pain decreases, strengthening can begin with isometric exercises and then progress to isotonic and eccentric
68
True or False, you would avoid having a client with grasp and release items into a basket
TRUE
avoid repetitive gripping activities or using any tools with handles too far apart
69
Describe treatment for a client with trigger finger, or tenosynovitis of the finger
* hand or finger based trigger finger splint (MCP extended and IP free)
* scar massage
* edema control
* tendon gliding
* activity/work modification to avoid repetitive gripping or using handles too far apart
70
The Kleinert protocol for mobilization of flexor tendon repairs uses passive flexion using rubber band traction and active extension to the hood of the splint.
Describe the Kleinart protocol timeline.
* 0-4 weeks (early phase): dorsal block splint with wrist positioned in 20-30 degrees of flexion, MCP joints at 50-60 degrees of flexion and IP joints extended.
* Passive flexion and active extension within limits of splint.
* 4-7 weeks (intermediate): cont' w/ dorsal block splint but adjust the wrist to neutral.
* Place/hold exercises and differential flexor tendon gliding exercises.
* Scar management
* 6-8 weeks: AROM.
* differential tendon gliding
* light purposeful activity
* d/c splint
* 8-12 weeks:
* strengthening
* work and leisure activities
71
The Duran protocol for early mobilization of flexor tendon repairs focuses on flexion and extension of digit.
Describe the protocol timeline.
* 0-4.5 weeks: dorsal blocking splint- w/in splint passive flexion of PIP joint, DIP joint, and DPC. Ten reps hourly.
* 4.5 weeks to 6 weeks: active flexion and extension within limits of splint
* 6-8 weeks: tendon gliding and differential tendon gliding, scar management, and light purposeful and occupation-based activities.
* 8-12 weeks: strengthening and work activities
72
What is the extensor tendon early mobilization recommendation for Zones I and II
0-6 weeks: DIP extension splint
| (Mallet finger deformity)
73
What is the extensor tendon early mobilization recommendation for Zones III and IV.
0-4 weeks: PIP extension splint (DIP free) with AROM of DIP while in splint.
4-6 weeks: begin AROM of DIP and flexion of digits to DPC
(Boutonniere deformity)
74
What is the extensor tendon early mobilization recommendation for Zones V, VI, and VII.
* 0-2 weeks: volar wrist splint with wrist in 20-30 degrees of extension, MCPs in 0-10 degrees of flexion, and IP joints in full extension.
* 2-3 weeks: shorten splint to allow flexion and extension of IP joints
* 4 weeks: remove splint to begin MCP active flexion and extension
* 5 weeks: begin wrist AROM. Wear splint inbetween exercise sessions
* 6 weeks: d/c splint
75
What injury presents with muscle atrophy of the thenar eminance in it's advanced stage?
Carpal Tunnel Syndrome
76
What injury presents with symptoms of:
* numbness and tingling of the thumb, index, middle, and radial half of the ring fingers.
* Parasthesias usually occur at night
* c/o dropping things
Carpal Tunnel Syndrome (CTS)
Median nerve compression
77
What tests would you use to confirm CTS?
* Positive Tinel's sign at wrist
* Positive Phalen's sign
78
Describe conservative treatment for CTS
* Wrist splint in neutral worn nights and during day if performing repetitive activities
* Median nerve gliding exercises and differential tendon gliding exercises
* activity modification to avoid extreme positions of wrist flexion, wrist flexion with repetitive finger flexion and wrist flexion with static grip
* ergonomics for work station
79
Describe post-op treatment for Carpal Tunnel Release (CTR)
* Edema control: elevation, retrograde massage, compression glove, and/or contrast bath
* AROM
* Nerve and tendon gliding exercises
* sensory re-education
* strenthening of thenar muscles (usually 6 weeks post op)
* Work/activity mdoification
80
What nerve is involved in Pronator teres syndrome?
Median n.
The median nerve becomes compressed between the two heads of the pronator teres.
81
How can you differentiate between CTS and Pronator teres syndrome?
* Positive Tinel's sign at forearm
* aching pain in proximal forearm
* no night symptoms
82
Describe conservative management of pronator teres syndrome
* elbow splint at 90 degrees with forearm in neutral
* avoid activities that include repetitive forearm pronation and supination
83
Describe post op treatment for pronator teres syndrome
* AROM
* nerve gliding
* strengthening (2 weeks post op)
* sensory re-education
* work/activity modification
84
What causes Guyon's canal?
Ulnar nerve compession at the wrist.
can be caused by repetition, ganglion, pressure, or fascia thickening,
85
Describe symptoms of Guyon's canal
* Numbness and tingling in the ulnar nerve distrubution of the hand
* motor weakness of the ulnar nerve innervated musculature with atrophy in advanced stages.
* postive tinel's sign at Guyon's canal
86
Descrive conservative treatment of Guyon's canal
* Wrist splint in neutral
* work/activity modification
87
Describe post-op treatment (decompression) of Guyon's canal
* Edema control
* AROM
* Nerve gliding
* Strengthening (2-4 weeks) focusing on power grip
* Sensory re-education
88
A client complains of numbness and tingling along medial aspect of forearm and hand, pain at elbow especially with extreme flexion, weakness of power grip, and positive Tinel's at elbow. What do you suspect?
Symptoms indicate ulnar n. compression at the elbow
Cubital Tunnel Syndrome
89
90
What muscles are affected in advanced cubital tunnel syndrome?
Atrophy of:
* FCU
* FDP to digits IV and V
* Ulnar n. innervated intrinsic hand muscles
91
Describe conservative treatment of Cubital tunnel syndrome
* Elbow splint at 30 degrees of flexion to prevent positions of extreme flexion (especiallly at night)
* elbow pad to decreased compression when leaning on elbows
* activity/work modification
92
Describe treatment after surgical decompression or transposition for cubital tunnel syndrome
* Edema control
* scar management
* AROM and nerve gliding (2 weeks post op)
* Strengthening (4 weeks post op)
* MCP flexion anticlaw splint if clawing noted
93
What nerve injury might you be concerned for in a client with a humeral shaft fracture?
radial nerve compression
aka Radial nerve palsy (or Saturday night palsy)
94
What are symptoms of radial nerve palsy
* weakness or paralysis of extensors to the wrist, MCPs, and thumb; wrist drop
95
Describe conservative treatment for Radial nerve palsy
* Dynamic wrist and MCP extension splint
* work/activity modification
* strengthening wrist and finger extensions when motor function returns
96
Describe post op (decompression) treatment for radial nerve palsy
* AROM
* Strengthening (6-8 weeks)
* ADLs and meaningful role activities
* Avoid the combined positioning below as this can place tension on the nerve:
* forearm pronation
* elbow extension
* wrist flexion
97
Describe area of sensory loss in median nerve laceration
* Central palm (thumb to raadial half of ring finger)
* Palmar surface of thumb, index, middle, and radial half of ring fingers
* Dorsal surface of index, middle and radial half of ring fingers (middle and distal phalanges)
98
Describe the deformities you would observe if median nerve laceration occured
* Ape hand- flattening of the thenar eminence
* Clawing of index and middle fingers of a LOW lesion
* Bendiction sign for a HIGH lesion
99
Describe motor loss for a low lesion of the median n.
* lumbricals I and II (MCP flexion of digits II and III)
* opponens pollicis (opposition)
* Abductor pollicis brevis (abduction)
* Flexor pollicis brevis (flexion of thumb of MCP)
100
Describe motor loss associated with a high lesion at/or proximal to the elbow of the median n.
* Lumbricals I and II (MCP flexion of digits II and III)
* Opponens pollicis (opposition)
* Abductor pollicis brevis (abduction)
* Flexor pollicis brevis (flexion of thumb of MCP)
* FDP to index and middle fingers and FPL (flexion of tip of index, middle fingers, and thumb)
* FCR (inability to flex to radial aspect of wrist)
101
What nerve is affected in a client who is unable to perform thumb opposition and has a weak pinch?
Median n.
102
Describe interventiond for Median n. lesion
* Dorsal protection splint with wrist positioned in 30 degree flexion if a low lesion.
* consider c-bar to prevent thumb adduction contracture
* A/PROM of digits with wrist in flexed position at 2 weeks post op
* scar management
* AROM of wrist at 4 weeks post op, including elbow if high lesion
* begin strengthening at 9 weeks
103
Describe sensory area affected by ulnar nerve laceration
* ulnar aspects of palmaar and dorsal surfaces
* ulnar half of ring and little fingers on palmar and dorsal surfaces
104
Describe motor loss from ulnar nerve low lesion at the wrist
* palmar and dorsal interossei (adduction and abduction of MCP joints
* lumbricals III and IV (MCP flexion of digits 4 and 5)
* FPB and adductor pollicis (flexion and adduction of thumb)
* ADM, ODM, and FDM (abduction, opposition, and flexion of fifth digit
105
Describe motor loss associated with ulnar n. high lesion at wrist or above
* palmar and dorsal interossei (adduction and abduction of MCP joints
* lumbricals III and IV (MCP flexion of digits 4 and 5)
* FPB and adductor pollicis (flexion and adduction of thumb)
* ADM, ODM, and FDM (abduction, opposition, and flexion of fifth digit
* FCU (flexion toward ulnar wrist)
* FDP IV and V (flexion of DIPs of ring and little fingers
106
Describe the deformities observed in a client with an ulnar n. lesion
* Claw hand
* Flattened metacarpal arch
* Positive froment's sign (assessment of thumb adductor while laterally pinching paper)
107
Describe intervention for ulnar n. lesion
(same as median n. except for splint type)
* Dorsal protection splint with wrist positioned in 30 degree flexion if a low lesion.
* consider MCP flexion block splint
* A/PROM of digits with wrist in flexed position at 2 weeks post op
* scar management
* AROM of wrist at 4 weeks post op, including elbow if high lesion
* begin strengthening at 9 weeks
108
Describe sensory loss of radial n. lesion at the level of the humerus
* medial aspect of dorsal forearm
* Radial aspect of dorsal palm, thumb, index, middle, and radial half of ring phalanges
109
Describe the motor loss associated with a low radial n. lesion at the level of the forearm
* Loss of wrist extension due to absent or impaired innervation to ECU
* EDC, EI, EDM (MCP extension)
* EPB, EPL, APL (thumb extension)
110
Describe the motor loss associated with a high radial n. lesion at the level of the humerus
* Loss of wrist extension due to absent or impaired innervation to ECU
* EDC, EI, EDM (MCP extension)
* EPB, EPL, APL (thumb extension)
* ECRB, ECRL, and Brachioradialis
* loss of triceps (elbow extension) if lesion at level of axilla
111
Describe function loss and deformity observed in clients with radial n. lesion
* inability to extend digits to release objects
* difficulty manipulating objects
* Wrist drop observed
112
Describe intervention for radial n. injury
* dynamic extension splint
* ROM
* sensory re-education if needed
* home program
* activity modification
* neuromuscular electrical stimulation (NMES) to aide in muscle re-education
113
What is a hypertrophic scar?
* Scarring most common with deep second and third degree burns
* appears 6-8 weeks after wound closure
* 1-2 years to mature
114
How should you treat a hypertrophic scar?
* compression garments should be worn 24 hours/day once wounds are healed for 1-2 years until scar is matured.
* ROM
* Skin care
* ADLs, role activities
* pt and family education
115
Name 3 pain scales used to functionally assess pain
McGill Pain questionnaire
Pain Disability Index
Functional Interference Estimate
116
Describe position of splint for burn to the hand
* wrist in 20-30 degrees extension
* MCP joints in 70 degrees flexion
* IP joints in full extension
* thumb abducted and extended
117
Describe a palmar extension splint used for burns to the volar surface of the hand (causing flexion contractures)
* wrist in 0-30 degrees extension
* MCP joints in neutral to slight extension and abducted (monitor collateral ligaments)
* IP joints in full extension
* Thumb abducted and extended
118
What type of splint will you used for a client with burns to webspace?
C-splint
119
Describe the "Rule of nines"
* 9% of each arm
* 9% for the head
* 18% for each leg
* 36% for the torso
* 1% for private areas
120
In a client with burns, when should you assess ROM, Sensation, and Strength?
* ROM: 72 hours post operative
* Sensation: when wounds are healed
* Strength: when wounds are healed
121
Describe post op treatment for a full thickness burn
* 72 hours: dressing changes, splint at all times
* 5-7 days: begin AROM, light ADLs, sterile whirlpool
* over 7 days: PROM as tolerated, ADLS
* When wounds are healed used massage
* order compression garments
* provide Otoform/elastomer inserts
* strengthening
122
Describe burn interventions for superficial partial-thickness and deep partial-thickness burns
* wound care and debridement
* sterile whirlpool
* dressing changes
* gentle AROM and PROM to pt tolerance
* edema control
* splinting if necessary
* ADLs and meaningful role activities
* strengthening when wounds are healed
123
Describe conservative management of rotator cuff tendonitis
* activity modification: avoid above shoulder level activities until pain subsides
* educate in sleeping posture: avoid sleeping with arm overhead or combined adduction and internal rotation
* decrease pain: positioning, modalities, and rest
* restore pain free ROM
* strengthening below shoulder level
* occuaption and role specific training
124
Describe treatment for a post op client treated for rotator cuff tear
* Begin with PROM (able to initiate 0-6 weeks post-op)
* progress to AAROM/AROM (6-8 weeks)
* sling or abduction orthosis worn between exercises
* strengthening 8-10 weeks
* begin with isometrics progress to isotonic
* activity modification, light ADLs progressing to leisure and work activities 8-12 weeks post op
125
What shoulder disorder is linked to diabetes and Parkinson's disease?
Adhesive capsulitis aka frozen shoulder
inflammation and immobility resulting in restricted PROM of shoulder.
Most limited in external rotation, then abduction, internal rotation, and flexion.
126
Describe treatment for a pt with adhesive capsulitis
Conservative management:
* Encourage frequent and active use through ADL and role activities
* PROM
* Modalities for pain
With surgical interventions PROM can begin immediately after surgery.
127
Describe treatment for shoulder dislocations
* Regain ROM- avoid combined abduction and external rotation w/ anterior dislocation (most common)
* Strengthen rotator cuff
* pain free ADLs and activities
128
What three deformities are common in RA?
* Ulnar deviation and subluxation of the wrists and MCP joints
* Boutonniere deformity
* Swan neck deformity
129
What deformity appears with flexion of PIP joint and hyperextension of DIP joint?
Boutonniere Deformity
130
What deformity has hyperextension of the PIP joint and flexion of the DIP joint
Swan Neck
131
True or False
Osteoarthritis is a systemic and symmetrical?
FALSE
Osteoarthris is wear and tear- affects LARGE weightbearing joints (hyaline cartilage)
RA is systemic and symmetric and affects small joints of the hands (starts with synovial lining)
132
What are the names of the bone spurs that occur at the DIP?
Heberden's nodes at the DIP joints
133
What are the names of the bone spurs that occur at the PIP?
Bouchard's nodes at the PIP
