Exam #5: Musculoskeletal Exam Flashcards Preview

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Flashcards in Exam #5: Musculoskeletal Exam Deck (90):
1

What is the purpose of the MSK focused history?

Narrowing of the physical exam

2

What questions should you ask the patient in regards to the MSK?

- Joint & neurological related
- Function/ ADL

3

What is the order for the MSK examination?

1) Inspection
2) ROM
3) Muscle strength eval
4) Reflexes & neuro
5) Special tests
6) Palpation

4

What is the preliminary step to the MSK exam?

Neurological screening exam

5

What are joint locking or crepitus associated with?

Meniscal injury

6

What is giving-way associated with?

Ligamentous or meniscal injury

7

What is weakness associated with?

Neurological
Mylopathy
Tendiopathy
Muscle injury

8

What is clicking, popping, or tearing associated with?

Soft tissue injury
Tear

9

What are tremors, spasms, and weakness associated with?

Neurologic or muscle injury

10

What is one of the most important things to know in regards to patient's with MSK complaints?

How their ADLs are being affected, and how they're changing

11

What are the major red flags that should be asked about in regards to MSK complaints?

Paresthesias
Weakness
Painless weakness
Incontinence
Retention
Weight loss
Night time pain

12

What is tendonitis?

Acute inflammation of a tendon

13

What is tendinosis?

Chronic degeneration of a tendon

14

What is tenosynovitis?

Inflammation of a sheath of a tendon (i.e. DeQuervain's)

15

What is tendinopathy?

Disease of the tendon--a general term when precise etiology is not know

16

What is a tremor?

Involuntary rhythmic muscle movement

17

What is spasticity?

Velocity dependent resistance to muscle stretch

18

What is a strain?

Trauma to a muscle

19

What is Arthritis?

Joint inflammation

20

What does Arthrosis mean?

Joint degeneration

21

What does Arthraliga mean?

Joint pain

22

What does Arthropathy mean?

Disease of a joint

23

What is Bursitis?

Inflammation of the bursa

24

What is the difference between smooth weakness & breakaway?

Breakaway= painful/ MSK weakness

Smooth= neurologic

25

What is a positive babinksi sign? What is this is sign indicative of?

UMN injury in LE

Upward toes

26

What is Hoffman's sign indicative of?

UMN injury in UE

27

Outline the 0-5 grading scale of muscle strength.

0= no movement
1= trace
2= gravity eliminated
3= full ROM against gravity but thats it
4= Full ROM against grav. but weak with DO applied
5= Full

28

How are ligaments generally evaluated?

Elongated by pushing or pulling bone away

29

How are joint surfaces evaluated?

Rub them together

30

How is cartilage evaluated?

Squeeze them between bones

31

In a positive trendelenburg sign, which side is the weakness on?

Side of the leg that is planted

32

What does Genu valgum mean?

knocked knee

33

What does Genu varus mean?

bow legged

34

What does Genu recurvatum?

back knee

35

What are Heberden & Bouchard nodes indicative of? Where are they?

H= DIP
B= PIP

36

What are the common deformities associated with RA?

Swan neck deformity
Ulnar deviation
Boutonniere deformity
MCP swelling

37

What is the classic appearance of ankylosing spondyltis? What is the classic posture?

- Bamboo spine
- Head forward

38

What is Spurling's test for? How is this test performed?

Patient is seated:
1) Extension of c-spine
2) Rotation of head/ neck
+/- sidebending

*Indicates nerve root compression or CERVICAL RADICULOPATHY

39

What is a Bragard's test/ Lasegue's Sign?

Straight Leg Raise= lumbar radiculopathy (L4, L5, S1)

*Confirmation with dorsiflexion SLR= Bragard test/ Lasegue's Sign

40

What is the Apley "Scratch Test" for?

Shoulder ROM

41

What are the tests for shoulder impingement?

Neer's Sign
Hawkin' Sign

42

What tests are used for the Rotator Cuff?

Arm Drop
Empty Can
Lift off Test

43

What tests are used for the biceps tendon?

Speeds Test
Yergason's Test

44

What test is used for shoulder instability?

Apprehension

45

What is Neer's test? How is this test preformed and what is a positive test?

1) Fully internally rotate the shoulder w/ arm extended (thumb down)
2) Bring arm up overhead

*Pain with this test is a sign of IMPINGEMENT

46

What is the Hawkins test? How is this test preformed and what is a positive test?

1) ABduct arm to 90 degrees
2) Flex arm
3) Internally rotate

*Pain is a sign of IMPINGEMENT

47

What is the Arm Drop Test? How is this test preformed and what is a positive test?

1) Lift arm up for patient overhead
2) Ask to lower slowly

*Sudden drop-off of arm is a sign of a ROTATOR CUFF TEAR

48

What is the Empty Can Test? How is this test preformed and what is a positive test?

1) Arm straight & aBducted at 90 degrees
2) thumb down as if "emptying a can"

*Positive test (pain) indicates damage to the SUPRASPINATUS or more generally, the rotator cuff

49

What is the Lift off test? How is this test preformed and what is a positive test?

1) Put dorsum of hand behind back
2) Stabilize elbow
3) Ask patient to push into your hand

*Pain is an indication of SUBSCAPULARIS injury or rotator cuff injury more generally

50

What is Speeds Test? How is this test preformed and what is a positive test?

1) Arm is raised in front & supinated
2) Push the arm down & see if there is pain

*Positive test is pain in biceps region or tendon subluxation felt on exam, which indicate BICEPS TENDIOPATHY OR SUBLUXATION OF BICEPS TENDON

51

What is the Yergason Test? How is this test preformed and what is a positive test?

1) Place thumb in interteburucular groove
2) Flex biceps
3) Ask patient to supinate forearm against resistance

*Positive test is pain in biceps region or tendon subluxation felt on exam, which indicate BICEPS TENDIOPATHY OR SUBLUXATION OF BICEPS TENDON

52

What is the Apprehension test? How is this test preformed and what is a positive test?

1) ABduct arm & felx to 90 degrees
2) Stabilize shoulder
3) Pull up & back, looking for signs of apprehension

*Positive test is if there is obvious "apprehension" or guarding

53

What is lateral epicondylitis?

Tennis elbow

- Caused by overuse of wrist extensors and the supinator muscle

54

What is medial epicondylitis?

Golfer's elbow

55

What is the carrying angle? In which sex is this normally larger?

Valgus angle between the upper arm and forearm with the elbow extended

- Females

>20 degrees is abnormal

56

What is the Varus Test? How is this test preformed and what is a positive test?

1) Stabilize arm (flexed to 20 degrees)
2) Push forearm IN to body

*Positive test indicates damage to RADIAL COLLATERAL LIGAMENT

57

What is the Valgus Test? How is this test preformed and what is a positive test?

1) Stabilize arm (flexed to 20 degrees)
2) Push forearm AWAY from body

*Positive test indicates damage to ULNAR COLLATERAL LIGAMENT

58

What is Tinel Sign's (Cubital Tunnel)? How is this test preformed and what is a positive test?

1) Find medial epicondyle & olecranon
2) Tap on area

*Positive test indicates CUBITAL TUNNEL SYNDROME or ULNAR NEUROPATHY

59

What is Cozen Test? How is this test preformed and what is a positive test?

1) Ask the patient to make a fist (palm down)
2) Grasp lateral epicondyle w/ one hand
3) With other hand ask patient to extend wrist against your resistance

*Positive test is indicative of LATERAL EPICONDYLITIS

60

What is Maudsley's? How is this test preformed and what is a positive test?

This is also known as the "3rd finger Test"
1) Extend arm palm down
2) Ask patient to resist depression of 3rd PIP on extension

*Positive if pain is reproduced over LATERAL EPICONDYLE

61

What is Phalen's Test? How is this test preformed and what is a positive test?

1) Extend the arm
2) Flex the wrist & apply pressure

*Reproduction of symptoms IN LESS THAN 30 SEC= CARPAL TUNNEL SYNDROME

62

What is Tinel's Sign (Carpal Tunnel)? How is this test preformed and what is a positive test?

Tapping over the carpal tunnel

*Reproduction of symptoms= CARPAL TUNNEL SYNDROME

63

What is Finkelstein's Test? How is this test preformed and what is a positive test?

1) Wrap fingers of the thumb
2) Ulnar deviation

*Positive test is reproduction of pain over radial wrist indicative of "DE QUERVAIN'S TENOSYNOVITIS"

64

What is Snuff Box Tenderness? How is this test preformed and what is a positive test?

1) Extend thumb
2) Ulnar deviate
3) Push on snuff box

*Need to R/O SCAPHOID FRACTURE if positive (with imaging)

65

What is Dupuytren's Contracture?

Flexion/ contracture of digits 4 & 5

66

What is Trigger Finger?

Difficulty flexing until sudden snap on finger with full flexion & inability to extend

67

What is Mallet finger?

Trauma causes avulsion of extensor at DIP joint

68

What is APB weakness? How is this test preformed and what is a positive test?

This is a test for strength of the abductor pollicus brevis
- Weak in carpal tunnel syndrome
- Test abduction of pinkey

****If both are positive, likely more proximal (C8/T1) root level injury

69

What is Patrick's FABER test? How is this test preformed and what is a positive test?

1) Flex hip
2) Flex knee
3) External rotation

****SI vs. Hip

70

What is Thomas' Sign? How is this test preformed and what is a positive test?

1) Bring knee to chest (left)
2) Right knee follows

*Indicates Hip flexor tightness or contracture

71

What is Trendelenburg Sign? How is this test preformed and what is a positive test?

Weak or non-functioning gluteus medius (Superior Oblique)

72

What is Ober Test? How is this test preformed and what is a positive test?

1) Lay patient on side, hips "stacked"
2) Extend superior hip
3) Drop leg

*If the leg does not go down, test is positive & indicates a tight IT band--note that patients often complain of LATERAL KNEE PAIN in IT BAND SYNDROME

73

What is Ballottement Test? How is this test preformed and what is a positive test?

1) Compress from thigh down to knee
2) Alt. hand push down on patella

*Positive test is indicative of JOINT EFFUSION--feel like patella is just floating

74

What is the Anterior Drawer Test? How is this test preformed and what is a positive test?

*ACL

75

What is the Posterior Drawer test? How is this test preformed and what is a positive test?

*PCL

76

What is the McMurray Test? How is this test preformed and what is a positive test?

Meniscal test

77

What is Apley's Compresison Test? How is this test preformed and what is a positive test?

1) Patient is prone
2) Compress toward table
3) Turn foot inward

*Positive test indicates MENISCUS INJURY

78

What is Valgus Stress Test? How is this test preformed and what is a positive test?

ABduct the distal leg

*MCL

79

What is Varus Stress Test? How is this test preformed and what is a positive test?

ADduct the distal leg

*LCL injury

80

What is Apley's Distraction Test? How is this test preformed and what is a positive test?

1) Patient is prone
2) Pull leg from table while stabilizing hip
3) Turn foot inward

*Positive test indicates MENISCUS INJURY

81

What is Ankle Anterior Drawer Test? How is this test preformed and what is a positive test?

1) Cup heel
2) Push posterior on tibia

*ATF Ligment Injury

82

What is the Talar Tilt? How is this test preformed and what is a positive test?

1) Cup heel
2) INvert heel

*ATF, CF Ligament Injury

83

What is Squeeze Test? How is this test preformed and what is a positive test?

Squeeze tib & fib together

*Indicates high ankle sprain

84

What is the External Rotation Test? How is this test preformed and what is a positive test?

1) Dorsiflex the foot
2) Externally rotate foot

*Interosseous membrane injury

85

What are the spinal levels associated with the major movements of the upper extremity?

C5= elbow flexion & shoulder aBduction
C6= wrist extension
C7= elbow extension
C8= long finger flexors
T1= small finger abduction/ adduction

86

What are the spinal levels associated with the major movements of the lower extremity?

L2= hip flexion
L3= knee extension
L4= ankle dorsiflexion
L5= long toe extension (EHL)
S1= ankle plantar flexion

87

What spinal levels are associated with the major reflexes typically evaluated?

Biceps brachii= C5
Brachioradialis= C6
Triceps= C7

Patellar= L4
Medial Hamstring= L5
Achilles= S1

88

What is the specific name for the standing flexion/ scoliosis screen?

Adam's Forward Bend

89

What is the femoral nerve stretch test? How is this test performed?

Patient is prone; passively flex the knee & hip

*Positive test has radicular pain to anterior thigh--indicates high lumbar disc hernation (L2, L3, L4)

90

What is the CMC grind test?

Thumb Grind Test
- Push/ twist MCP against trapzeium

*Pain & grinding are indicative of OSTEOARTHRITIS