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Physical Assessment 2 > MSK > Flashcards

MSK Flashcards

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1
Q

What are articular structures?

A

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

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2
Q

What are extra-articular structures?

A

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

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3
Q

What are ligaments?

A

Rope-like bundles of collagen fibrils that connect bone to bone.

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4
Q

What are tendons?

A

Collagen fibers connecting muscle to bone.

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5
Q

What is cartilage?

A

Collagen matrix overlying bony surfaces.

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6
Q

What is bursae?

A

Pouches of synovial fluid that cushion the movement of tendons & muscles over bone or other joint surfaces.

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7
Q

Synovial joint?

A

Joint is freely movable.
Bones are covered by articular cartilage & separated by synovial cavity.
Synovial membrane secretes synovial fluid that lubricates joint movement.

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8
Q

Examples of synovial joint?

A

Shoulder & knee.

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9
Q

Cartilaginous joint?

A

Joint is slightly movable.

Bones separated by fibrocartilaginous discs that contain nucleus pulpous that cushions bony movement.

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10
Q

Examples of cartilaginous joint?

A

Vertebral bodies of the spine.

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11
Q

Fibrous joint?

A

Have no appreciable movement.

Bones separated by fibrous tissue or cartilage.

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12
Q

Examples of fibrous joint?

A

Sutures of the skull.

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13
Q

Spheroidal (ball & socket)?

A

Shape: Convex surface in concave activity.
Movement: Wide ranging flexion, extension, abduction, adduction, rotation, and circumduction.
Examples: Shoulder, hip

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14
Q

Hinge?

A

Shape: Flat, Planar.
Movement: Motion in one plane; flexion & extension.
Example: Interphalangeal joints of hand & foot; elbow.

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15
Q

Condylar?

A

Shape: Convex or concave.
Movement: Movement of two articulating surfaces not dissociable.
Examples: Knee; temporo-mandibular joint.

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16
Q

Steps to evaluating joint pain?

A

Articular vs. extra articular
Acute (<6 wks) vs. chronic (>12 wks)
Inflammatory vs. noninflammatory
Localized (monoarticular) vs. diffuse (polyarticular)

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17
Q

What do you ask a patient w’/ joint pain?

A

Fever/chills.

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18
Q

What is monoarticular?

A

Single joint –> injury, monoarticular arthritis, extra articular cause (tendinitis, bursitis)

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19
Q

What is polyarticular?

A

Several joints (>/= 4), Ask about pattern of involvement.

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20
Q

Pt presents w/ migratory pattern from joint to joint?

A

Rheumatic fever, gonococcal arthritis.

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21
Q

Pt presents with pain spreading from one joint to multiple joints or additive/progressive pattern & symmetric?

A

RA

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22
Q

What causes inflammatory joint disorders?

A

Infectious (Neisseria gonorrhea, Mycobacterium tuberculosis).

Crystal induced (gout)
Immune related (lupus, rheumatoid arthritis).

Reactive (reactive arthritis).

Idiopathic

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23
Q

Signs of articular joint pain?

A

Decreased active & passive ROM and morning stiffness.

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24
Q

Signs of extra articular joint pain?

A

Decreased active ROM & nml passive ROM and periarticular tenderness (occurring around the joint).

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25
Myalgias?
"Aches & pains", pain is in the muscle.
26
Arthralgias?
Joint pain w/ no evidence of arthritis.
27
Tenosynovitis?
Inflammation of tendon sheaths.
28
Sprains?
Stretching/tearing of ligaments.
29
Extra articular conditions?
Myalgias, arthralgia, tendonitis, bursitis, tenosynovitis, & sprains.
30
Pt has joint pain and butterfly rash on cheeks?
Lupus
31
Pt has joint pain and scaly plaques on extensor surfaces?
Psoriasis
32
Pt has joint pain and stiffness especially in the morning, better throughout the day w/ movement?
RA
33
Pt has joint pain and bulls eye rash?
Lyme
34
Red Flags for Low Back Pain?
Age <20 yrs or >50 yrs History of cancer Unexplained weight loss, fever, or decline in general health Pain lasting more than 1 mo or not responding to treatment Pain at night or present at rest History of intravenous drug use, addiction, or immunosuppression Presence of active infection or human immunodeficiency virus (HIV) infection Long-term steroid therapy Saddle anesthesia Bladder or bowel incontinence Neurologic symptoms or progressive neurologic deficit Lower extremity weakness
35
Pain when pt touches the opposite scapula also called Apley Scratch Test signifies?
Rotator cuff disorder or adhesive capsulitis.
36
Pain with adduction (crossover test) is positive for what disorder?
AC joint disorder.
37
What is the MCC of shoulder pain?
rotator cuff disorder.
38
Pain provocation tests for Rotator Cuff Disorder?
Pain arc test, neer impingement, & Hawkins impingement sign.
39
Strength Tests for Rotator Cuff Disorder?
External rotation lag test: Supraspinatus & infraspinatus disorders. Internal rotation lag test: Subscapularis disorder Drop-arm test: Supraspinatus rotator cuff tear/bicipital tendinitis
40
Composite Tests for Rotator Cuff Disorder?
External rotation resistance test and Empty can test.
41
What is a positive painful arc test and what does it mean?
Fully abduct the patient’s arm from 0° to 180° and shoulder pain from 60° to 120 and it signifies subacromial impingement/rotator cuff tendinitis disorder.
42
What test signifies infraspinatous disorder?
External Rotation Resistance Test
43
What test signifies a supraspinatous rotator cuff disorder?
Empty Can Test
44
What are the carpal tunnel syndrome special tests?
Tinel Sign: Tap lightly on median nerve & phalen sign: backwards praying for 60 s.
45
What does Finkelstein Test signify?
de Quervain's Disease
46
Tests to check for MCL injury?
Abduction or valgus stress test.
47
Tests to check for LCL injury?
adduction or varus stress test.
48
Tests to check for ACL injury?
Anterior drawer sign, Lachman Test
49
Tests to check for PCL injury?
Posterior Drawer sign.
50
Tests to check for medial and lateral menisci injury?
McMurray Test
51
How to check for minor knee effusion?
Bulge Sign
52
How to check for major knee effusion?
Balloon Sign
53
What does articular disease typically involve?
Swelling & tenderness of joint, crepitus, instability, "locking" or deformity, and limits active and passive ROM due to stiffness or pain.
54
What does extra articular disease typically involve?
"Point or focal tenderness in regions adjacent to articular structures" and limits active ROM . Rarely cause swelling, instability, or joint deformity.
55
Pt has lateral hip pain w/ focal tenderness over great trochanter?
Trochanteric bursitis.
56
Pt w/ severe pain of rapid onset in a red swollen joint or pt w/ inflammation with fever & chills?
Acute septic arthritis and crystalline arthritis.
57
In noninflammatory disorders consider what?
trauma (rotator cuff tear), repetitive use (bursitis, tendinitis), degenerative changes (OA), or fibromyalgia.
58
Pt w/ morning stiffness that gradually improves w/ activity?
Inflammatory disorders like RA and PMR?
59
Pt w/ intermittent stiffness and gelling and crepitus over inflamed joints?
OA
60
Categories of monoarticular arthritis?
Traumatic, crystalline, septic.
61
Categories of oligoarticular arthritis?
Gonorrhea infx, rheumatic fevers, connective tissue disease, and OA.
62
Categories of polyarticular arthritis?
Viral or inflammatory from RA, SLE, or psoriasis.
63
Pt w/ symmetric pain?
RA, SLE, and ankylosing spondylitis.
64
Pt w/ asymmetric pain?
Psoriatic, active, & IBD-associated arthritis.
65
Pt w/ constitutional sxs?
RA, SLE, PMR, and other inflammatory arthritides.
66
What can chemo cause?
Joint pain
67
What condition can infiltrate the synovium?
Leukemia.
68
Pt w/ heliotrope rash on upper eyelid + joint pain?
Dermatomyositis
69
Pt w/ papules, pustules, or vesicles with reddened bases on the distal extremities+ joint pain?
Gonococcal arthritis
70
Pt w/ Painful subcutaneous nodules especially in pretibial area + joint pain?
Sarcoidosis, Behcet disease (erythema nodosum)
71
Pt w/ palpable purpura + joint pain?
Vasculitis
72
Pt w/ hives + joint pain?
Serum sickness or drug reaction.
73
Pt w/ erosions or scaling on the penis and crusted scaling papules on the soles and palms + joint pain?
Reactive (Reiter) arthritis (with urethritis, uveitis).
74
Pt w/ maculopapular rash of rubella + joint pain?
Arthritis of rubella
75
Pt w/ nail fold capillary changes + joint pain?
Dermatomyositis, systemic sclerosis
76
Pt w/ clubbing of fingernails + joint pain?
Hypertrophic osteoarthropathy
77
Pt w/ red, burning, and itchy eyes (conjunctivitis), eye pain and blurred vision (uveitis) + joint pain?
Reactive (Reiter) arthritis, Behçet syndrome,13,14 ankylosing spondylitis
78
Pt w/ scleritis + joint pain?
RA, IBD, vasculitis
79
Pt w/ preceding sore throat + joint pain?
Acute rheumatic fever or gonococcal arthritis
80
Pt w/ oral ulcerations + joint pain?
RA (usually painless); Behçet disease
81
Pt w/ pneumonitis; interstitial lung dz + joint pain?
RA; systemic sclerosis
82
Pt w/ diarrhea, abdominal pain, cramping + joint pain?
IBD, reactive arthritis from Salmonella, Shigella, Yersinia, Campylobacter; scleroderma
83
Pt w/ urethritis + joint pain?
Reactive (Reiter) arthritis, gonococcal arthritis
84
Pt w/ mental status change, facial or other weakness, stiff neck?
Lyme w/ CNS involvement.
85
Pt w/ radicular pain?
Spinal nerve compression and/or irritation, most commonly at C7 or C6 from foraminal impingement from degenerative joint changes (70% to 75%), rather than disc herniation.
86
Pt w/ nonspecific low back pain?
Musculoligamentous injuries and age-related degenerative pro- cesses of the intervertebral discs and facet joints.
87
Pt w/ midline back pain?
Musculoligamentous injury; disc herniation; vertebral collapse; spinal cord metastases; and, rarely, epidural abscess
88
Pt w/ pain off the midline?
Muscle strain, sacroili- itis, trochanteric bursitis, sciatica, and hip arthritis as well as for renal condi- tions like pyelonephritis or stones.
89
Pt w/ radicular gluteal and posterior leg pain in the S1 distribution that increases with cough or Valsalva?
Sciatica.
90
Sciatica is usually due to what?
Disc disorder, usually at L4–L5 or L5-S1.
91
Pt w/ leg pain that resolves w/ rest and/or lumbar forward flexion?
Spinal stenosis.
92
Pt w/ an S2–S4 a midline disc or tumor w/ bowel or bladder dysfunction (usually urinary retention with over- flow incontinence), and saddle anesthesia or perineal numbness?
Cauda equina syndrome.
93
Pt w/ malalignment?
Dupuytren contracture, bow legs or knock knees.
94
Pt w/ crepitus over inflamed tendon sheaths?
tenosynovitis
95
Pt w/ decreased ROM?
arthritis, joints with tissue inflam- mation or surrounding fibrosis, or bony fixation (ankylosis).
96
Pt w/ ACL laxity?
Knee trauma; muscle atrophy
97
Pt w/ subcutaneous nodules and weakness?
RA
98
Pt w/ palpable bogginess or doughiness of synovial membrane usually w/ effusion?
Synovitis
99
Pt w/ tenderness over tendon sheaths?
Tendinitis
100
Pt w/ palpable joint fluid?
Effusion
101
Pt /w increased warmth?
Arthritis, tendinitis, bursitis, and osteomyelitis.
102
Pt w/ redness over a tender joint?
Septic or crystalline arthritis, or possibly RA.
103
Pt w/ diffuse tenderness and warmth over a thickened synovium?
Arthritis or infection.
104
Pt w/ focal tenderness?
Injury or trauma.
105
Pt w/ facial asymmetry and unilateral chronic pain w/ chewing, jaw clenching, or teeth grinding often associated w/ stress & accompanied by headache?
TMJ disorders
106
Pt w/ swelling, tenderness, decreased ROM?
TMJ inflammation or arthritis.
107
Pt w/ palpable crepitus or clicking of jaw?
Poor occlusion, meniscus injury, or synovial swelling from trauma.
108
Pt w/ pain and tenderness of jaw?
TMJ syndrome
109
Pt w/ elevation of one shoulder?
scoliosis
110
Pt w/ flattened rounded lateral aspect of the shoulder?
Anterior dislocation of the shoulder.
111
Pt w/ atrophy of the supraspinatus and infraspinatus with increased prominence of scapular spine can appear within 2 to 3 week?
Rotator cuff tear
112
Pt w/ localized tenderness points to subacromial or subdeltoid bursitis?
Degenerative changes, or calcific deposits in the rotator cuff.
113
Pt w/ swelling of shoulder?
bursal tear
114
Pt w/ tenderness over SITS muscle insertions and inability to abduct arm above shoulder level?
Sprains, tears, and tendon rupture of the rotator cuff, most commonly the supraspinatus
115
Pt w/ shoulder tenderness and effusion?
Glenohumeral joint synovitis.
116
Pt w/ restricted shoulder ROM?
Bursitis, capsulitis, rotator cuff tears or sprains, and tendinitis.
117
An age of ≥60 years and a positive drop-arm test are the findings most likely to identify what?
Degenerative rotator cuff tear.
118
Pt w/ swelling over olecranon process?
olecranon bursitis
119
Pt w/ tenderness distal to epicondyle?
Lateral or medial epicondylitis.
120
Pt w/ olecranon posteriorly placed?
Posterior dislocation of the elbow and supracondylar fracture.
121
Pt w/ tenderness over distal radius after fall?
Colles fracture
122
Pt w/ local swelling of wrist?
ganglion
123
Pt w/ Heberden nodes (DIP joints) and Bouchard nodes (PIP joints)?
OA
124
Pt w/ Thenar atrophy?
Median nerve compression from carpal tunnel.
125
Pt w/ trigger digits?
stenosing tenosynoviti

Physical Assessment 2 (4 decks)

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