H&P Midterm MSK UE

Question 1

What are the types of synovial joints?

Answer 1

Spheroidal (ball and socket - convex surface on concave cavity - shoulder/hip)
Hinge (flat planar - motion in one plane - elbow, IP joints )
Condylar (articulating surfaces can be convex or concave - Knee, TMJ)

Question 2

What are synovial joints (structure)

Answer 2

joints that are freely movable
bones that are covered in cartilage and do not touch
synovial fluid lubricates the cavity
joint is surrounded by a fibrous joint capsule

Question 3

What are the types of joints?

Answer 3

Synovial ( freely movable)
Cartilaginous (intervertebral joints, slightly movable)
Fibrous (skull sutures, immovable)

Question 4

What is a bursa?

Answer 4

Sac filled with synovial fluid, providing smooth movement of muscles and tendons over other MSK structures.

Question 5

What are the key factors in obtaining a musculoskeletal history?

Answer 5

Onset/Duration
Progression
Location
Associated symptoms

Question 6

What is included in onset/duration

Answer 6

acute or chronic
activity at time of onset
trauma/mechanism of action
repetitive action

Question 7

What is included in progression

Answer 7

rapid or insidious?
fluctuating or constant symtpoms?

Question 8

What is included in location

Answer 8

localized or diffuse pain?
articular (joint based) or extraarticular (not joint based)?

Question 9

what is an additional consideration when obtaining a MSK HX

Answer 9

hand dominance if applicable.

Question 10

How should you document an HPI for MSK

Answer 10

in progression/chronological order of symptoms.

Question 11

What defines acute and chronic MSK?

Answer 11

Acute is < 6 weeks, chronic is >12 weeks

Question 12

Discriminate between the terms rapid and insidious in terms of progression of symptoms

Answer 12

rapid - progressed over a few hours
insidious - progressed over weeks to months

Question 13

What is myalgia vs arthralgia?

Answer 13

Myalgia is muscle pain
Arthralgia is joint pain

Question 14

What are some associated symptoms with MSK?

Answer 14

Stiffness
Decreased ROM
Cracking/popping (crepitus)
Locking
“Giving out”
Inflammation

Question 15

What are the four parts of a MSK exam

Answer 15

inspection (joint symmetry, alignment, bony deformities, swelling)
palpation (tenderness, muscle atrophy, crepitus)
assessing ROM (active and passive)
Assess strength (joint function/stability)

Question 16

Can you inspect a patient with clothes covering the area of concern

Answer 16

NO!!!!

Question 17

How is muscle strength graded?

Answer 17

0-5.
0 is no contraction.
1 is palpable or visible contraction
2 is active movement but cant resist gravity
3 is active movement against gravity
4 is active movement against resistance
5 is normal strength.

Question 18

What do I palpate for TMJ? what is the Cranial nerve associated?

Answer 18

TMJ
Masseters
Pterygoids
Temporal
CN 5

Question 19

What is pertinent history for TMJ

Answer 19

unilateral chronic pain w/ chewing, clenching or teeth grinding.
associated with stress
may present as a HA
swelling, tenderness, and decreased ROM
pain and tenderness to palpation

Question 20

what signs are indicative of TMJ when palpating or inspecting a patient

Answer 20

inspection - redness/swelling around TMJ
Palpation - tenderness with popping

Note- popping can also be present in healthy people!

Question 21

What is included in the scapulohumeral group and what is this groups main job

Answer 21

rotator cuff muscles + deltoid. job - depress and rotate head of humerus

Question 22

what is in the axioscapular group and what is its major function

Answer 22

pect major
trapezius
rhomboid maj and min
levator scapulae
serratus anterior

pneumonic: PT RLS (pronounced pet reels)

pulls shoulder backward

Question 23

what is the axiohumeral group

Answer 23

pect maj
latissmus dorsi

assists in internal rotation of shoulder

hint: axiohumeral has less letters than axioscapular so you know its the group with less muscles

Question 24

What does a shoulder exam check?

Answer 24

Muscle atrophy
Fasciculations
Height of shoulder, scapula, and clavicle bilaterally.
Symmetry
Swelling
Scars
Skin color change
Swelling of joint capsule anterior
Bony deformities
Bulge in subacromial bursa under deltoid

Question 25

What do you palpate in the shoulder exam

Answer 25

SITS muscles for tenderness all joints (sternoclavicular, acromioclavicular, glenohumeral) acromion and coracoid process. biceps tendon subacromial and subdeltoid bursa (SAABS)

Question 26

What does the apley scratch test check?

Answer 26

Adduction and internal rotation (bottom scratch) Abduction and external rotation (top scratch)

Question 27

What are the nerve impingement tests for the shoulder? what are they suggestive of if they are positive?

Answer 27

Hawkins-kennedy (arm like a hawk will land on it) Neer (near to the ear, arm straight up) Attempts to impinge subacromial structures with humeral head if they produce pain they are positive Indicative of Rotator cuff tear

Question 28

What is the empty can/jobe test?

Answer 28

Pouring out a can vs resistance. Supraspinatus/infraspinatus tear/tendonitis.

Question 29

What is the drop arm test?

Answer 29

Patient lifts arm up and drops it steadily. + is pain between 60-120 deg. suggests subacromial tear or rotator cuff disorder

Question 30

What is the crossover test?

Answer 30

Adduction of arm across chest. + is pain in AC joint, inflammation/arthritis

Question 31

What is the sulcus sign?

Answer 31

Arm at rest on side, pull arm down. + is a depression in front of acromion this suggests inferior glenohumeral instability.

Question 32

What is the apprehension test?

Answer 32

Externally rotate humerus, then push posteriorly + shoulder pops indicative of anterior instability or laxity or recent shoulder dislocation.

Question 33

What do I palpate the elbows for?

Answer 33

Medial/lateral epicondyles, olecranon process, grooves between epicondyles and olecrenon

Question 34

What is the rule of thumb for testing MSK strength actively and passively

Answer 34

active before passive passive only if active is limited assess ROM to its fullest extent.

Question 35

What is tennis elbow and golfer's elbow?

Answer 35

Tennis elbow is lateral epicondylitis, + when pain is from extending wrist (Think tEnnis and Extend) Golfer's elbow is medial epicondylitis, + when pain is from flexing wrist (think golFer and Flex)

Question 36

what are heberdens nodes vs Bouchards nodes

Answer 36

heberdens = swelling at the DIP joint of fingers Bouchards = swelling at PIP joint of fingers

Question 37

What do I palpate the wrist and hand for?

Answer 37

Distal radius/ulna Carpals Metacarpals Anatomic snuffbox Phalanges Thenar/hypothenar eminences

Question 38

Do thumb range of motion rn inlcuding flexion, extension, abduction, adduction and opposition

Answer 38

okayyyyy finnneeee

Question 39

What is finkelstein's test?

Answer 39

Thumb inside of fist pointing forward, then ulnar deviate. + is pain, indicates de quervain's tenosynovitis.

Question 40

What is phalen's test?

Answer 40

reverse Prayer sign + is pain, indicative of carpal tunnel syndrome.

Question 41

What is tinel's test?

Answer 41

Percussing carpal tunnel on wrist + is pain, indicative of carpal tunnel syndrome