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Medicine II: Orthopedics > General Principles of Physical & Radiological Evaluation > Flashcards

Flashcards in General Principles of Physical & Radiological Evaluation Deck (51)
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1

Components of Musculoskeletal Exam

1) GENERAL SURVEY:
2) INSPECTION/OBSERVATION:
3) PALPATION:
4) RANGE OF MOTION:
5) NEUROLOGIC & VASULAR TESTING
6) SPECIAL TESTS

2

GENERAL SURVEY:

record the pt’s general appearance, body proportions and ease of movement (preferably even before they enter the exam room, to get a more candid picture)

3

INSPECTION/OBSERVATION:

Look for symmetry, joint deformities or malalignment of bones, muscle atrophy and fasciculations, pigmentation/skin texture changes, bruising, scars, and swelling.

4

PALPATION:

be systematic, know anatomy (know what palpating), have pt point w/ one finger to area of pain. Palpate the bony landmarks and joint spaces when accessible, as well as the surrounding soft tissue structures. Palpate for crepitus, masses, swelling, warmth and tenderness. *Always palpate joint above and below*

5

RANGE OF MOTION:

Bilateral comparison is essential!! Assess for ROM limitation and joint instability. (This requires that you know the normal ranges of motion for each joint!) Ask the patient to actively move the joint; if pt cannot, then test passive ROM. Either way, don’t neglect to compare one side to the other.

6

NEUROLOGIC & VASULAR TESTING:

(Motor and neuro exam); includes MSE, CN exam, dermatomal sensation tests, vibratory sensation, joint position sense, discriminative sensation, muscle tone, muscle strength, DTRs, Ankle clonus, Plantar response (Babinski) and the coordinaton tests (Gait, heel-to-toe walk, station, Romberg, point to point movements, Rapid alternating movements, and pronator drift) and peripheral pulses.

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L5 innervation

top of foot

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S1 innervation

lateral mallelous

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Upper limb nerves:

Axillary, Musculocutaneous, Radial, Median, and Ulnar

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Lower limb nerves:

Femoral – Obturator, Sciatic - Fibular (peroneal) or Tibial

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L4 innervation

med malleolus

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C6 innervation

thumb

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C7 innervation

middle finger

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C8 innervation

little finger

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Muscle grading: 5

5 = Normal- Complete ROM against gravity w/ full resistance

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Muscle grading: 4

4 = Decreased- Good- Complete ROM against gravity w/ some resistance

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Muscle grading: 3

3 = Fair- Complete range of motion against gravity (no weight)

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Muscle grading: 2

2 = Poor- Complete ROM with gravity eliminated

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Muscle grading: 1

1 = Twitch/Trace- Muscle contraction but no or very limited joint motion

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Muscle grading: 0

0 = Zero- No evidence of muscle function

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Articular structures:

Joint capsule, articular cartilage, synovium, synovial fluid, intra-articular ligaments and juxta-articular bone

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Articular disease:

Involves swelling and tenderness of the entire joint. Joint “locking” and deformity may be present. Both active AND passive ROM are limited

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Extra-articular structures:

Periarticular ligaments, tendons, bursae, muscle, fascia, bone nerve and overlying skin.

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Extra-articular disease:

Typically involves selected region(s) of the joint and certain types of movement. There is classically a loss of active but NOT passive ROM. Compared to intra-articular dz, the pain and swelling of extra-articular dz is more focal. Examples- bursitis, tendonitis, tenosynovitis, (ligament) sprains.

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“Gelling”:

Stiffness and limited motion after inactivity.

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Dermatome:

An area of skin supplied by a single nerve root.

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Myotomes:

Groups of muscles supplied by a single nerve root.

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Monoarticular pain:

the pain is localized and involves only one joint. Potential causes include: trauma, monoarticular arthritis, tendinitis or bursitis

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Polyarticular pain:

the pain involves many joints, and should be further described regarding the joints’ pattern of involvement. For example, a migratory spread is seen in rheumatic fever and gonococcal arthritis; but rheumatoid arthritis has a progressively additive and symmetric joint involvement.

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Sprain:

stretching or tearing of a ligament