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MSK > MSK Exam 1 > Flashcards

MSK Exam 1 Flashcards

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1
Q

The patient enters the rooom for the first time. What should the initial eval go like?

A

We should have some hypotheses about what is going on
Ask open-ended questions.
summarize what is going on at the end.

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2
Q

What are we concerned about in terms of social habits?

A

smoking
drinking
activity levels

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3
Q

constant and severe pain at night: cause?

A

possible neoplasm

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4
Q

unexplained weight loss: cause?

A

neoplasm

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5
Q

loss of appetite: cause?

A

neoplasm

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6
Q

unusual fatigue: cause?

A

neoplasm or thyroid dysfunction

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7
Q

blurred or loss of vision: cause?

A

neoplasm or neurological issue

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8
Q

frequent or severe headaches: cause?

A

neoplasm or neurological dysfunction

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9
Q

persistent nerve root pain: cause?

A

neoplasm or neurological dysfunction

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10
Q

radicular pain with coughing: cause?

A

neoplasm or neurological dysfunction

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11
Q

increased arm pain with increased cardio demand: cause?

A

cardiovascular condition

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12
Q

paralysis: cause?

A

neoplasm or neurological problem

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13
Q

trunk and limb parasthesia: cause?

A

neoplasm or neurological dysfunction

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14
Q

bilateral nerve root signs and symptoms: cause?

A

neoplasm or neurological dysfunction

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15
Q

difficulty with balance/ coordination: cause?

A

neoplasm or neurological dysfunction

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16
Q

fever or night sweats: cause?

A

systemic infection or disease

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17
Q

frequent nausea and vomiting: cause?

A

common in many disease, particularly GI system

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18
Q

dizziness: cause?

A

upper cervical impairment
CNS involvement
cardiovascular dysfunction

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19
Q

shortness of breath: cause?

A

cardiovascular dysfunction
pulmonary dysfunction or asthma

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20
Q

shortness of breath: cause?

A

cardiovascular dysfunction
pulmonary dysfunction or asthma

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21
Q

quadrilateral parasthesia

A

spinal cord compression

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22
Q

What are the general outcome measures?

A

Numerical Pain Rating Scale (0 - 10)
Patient Specific Functional Scale (0 - 10) 5 functional tasks
Global Rating of Change (11 - point scale)

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23
Q

What are the general upper extremity outcome measures?

A

Disabilities of the Arm, Shoulder and Hand (30 items, 0 - 100, high score greater disability)
Quick Dash (11 items, 0 - 100, high score, greater disability)
Shoulder Pain and Disability Index - SPADI (13 items, 0 - 10 scale, 0 - 100 score range, high score greater disability)
Penn Shoulder Score (PSS - scores range 0 - 100, low pain, high satisfaction, and high functions)

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24
Q

What are the Components of Evaluation?

A

Review Pt chart
Pt history
Systems Review
Observations/ Postural Assessment
Upper Quarter Screen
MMT
ROM
Joint Mobility
Palpation
Special Tests

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25
What should be done after every patient history to ensure they are safe to exercise?
cardiovascular cognition neurological musculoskeletal integument
26
What are we looking to do what during a screening examination?
Change their symptoms/their pain reproduce/reduce their symptoms
27
What are the components of an upper quarter screen?
AROM with and without overpressure symmetry quality of movement willingness to move pain end feel scapulohumeral rhythm with arm elevation
28
What are the components of a neurological exam during the upper quarter screen?
dermatomes myotomes reflexes pathological reflexes
29
What are muscles prone to tightness?
Upper trapezius Levator scapulae Pectoralis major and minor upper cervical extensors SCM Teres major subscapularis
30
What are muscles prone to inactivity or lengthening?
lower and middle trapezius rhomboids serratus anterior deep neck flexors supraspinatus infraspinatus teres minor
31
What can cause rotator cuff pathologies?
compression tensile load traumatic tear degenerative tear
32
tendonitis vs tendinosis:
tendonitis: inflammatory state of the tendon tendinosis: intratendon degeneration often due to repeated microtrauma
33
what contributes to tendonitis/ tendinosis?
tissue abnormalities anatomic abnormality of acromion bursitis calcific bone spur tendon thickening OTHER: altered scapulothoracic kinematic + posture
34
What are symptoms of tendinitis/tendinosis?
dull ache of the lateral upper/ lower arm reaching away from the body - painful over shoulder level activities - painful
35
What is subacromial impingement?
excessive superior translation of the humeral head with elevation.
36
What is the difference between subacromial (outlet) impingment and posterior internal (non - outlet) impingement?
with subacromial impingement,there is an abrasion of the soft tissue structures between the humeral head and the shoulder roof. With posterior internal, the subacromial space appears to be expected and there is an impingement of the rotator cuff muscles against the posterior superior glenoid labrum and humeral head.
37
What contributes to subacromial impingement?
the shape of the acromion calcific bone spur tendon thickening
38
what are common soft tissues that can be involved with subacromial impingement?
supraspinatus primarily long head of biceps subacromial bursa
39
What special tests can detect shoulder impingement?
Hawkins - Kennedy Test Neers Test Empty Can Painful Arc Cross Body Adduction Test Scapular Assistance Test Scapular Repositioning Test
40
Degenerative RCT can occur secondary to:
sarcopenia postural changes balance changes
41
During a physical examination with rotator cuff tears, what will we find?
We will find similar findings to rotator cuff tendonitis/tendinopathy. Weakness compensation with scapular when attempting UE elevation Pain w trying to sleep common pain in lateral upper arm
42
special tests for a rotator cuff pathology include:
drop arm tests external rotation lag sign infraspinatus muscle test hornblower sign internal rotation lag sign belly press lift off empty can
43
Snapping Scapula is associated with:
pain at the superomedial angle of the scapula painful scapulothoracic motions crepitus with motion of the scapula
44
what are causes of snapping scapula?
inflammation of the bursa between scapula and thorax prominence of the superomedial angle of the scapula muscle imbalance of the scapular rotators LESS COMMON CAUSES: - rib fracture - benign excess growth of bone growth on the scapula - Sprengel's deformity
45
When do we typically see scapular dyskinesia patients?
After it has impacted function or has led to a different injury like shoulder impingement or rotator cuff tendonitis.
46
What motions are diminished with scapular dyskinesia?
posterior tilting upward rotation clavicle retraction
47
What motion is excessive with scapular dyskinesia?
clavicular rotation
48
When is winging or dysrhythmia observed with scapular dyskinesia?
best observed when pt lifts 3 - 5# weight overhead for 5 repetitions.
49
What tight muscles contribute to scapular dyskinesia?
pectoralis minor posterior shoulder capsule levator scapulae, latissimus dorsi, GH external rotators
50
What is the symptoms of posterior instability?
symptoms of instability w shoulder in flexed/ abduction (pushing the door open) pain guarding
51
If someone has posterior instability, what will you see in the physical examination?
observable prominence posterior shoulder if currently dislocated limited/ painful shoulder AROM (IR, elevation) hypermobile posterior capsule, pain, apprehensive
52
What is the special test for posterior instability?
The jerk test
53
What are the symptoms of inferior instability?
pain guarding carrying items with weight to them
54
What should I find in the physical examination of someone with inferior instability?
shoulder locked in abducted position if currently dislocated sulcus if currently dislocated hypermobile inferior, pain, apprehension
55
what is the special test for inferior instability?
Sulcus sign
56
What is the most common direction of shoulder instability?
anterior instability
57
What is the common MOI of anterior instability?
abduction, ER, extension
58
What should you see in the physical examination of someone with anterior instability?
Observed self - immobilization by the patient (slightly abducted/ externally rotated spasm/ guarding possible hypomobility of posterior GH joint
59
What are special tests for anterior instability?
anterior apprehension test relocation test
60
What are complications of an anterior dislocation?
Hills - Sachs Lesion Axillary nerve injury Bankart Lesion SLAP tear
61
What is a Bankart lesion?
tear of anterior inferior labrum
62
How will a bankart lesion present?
Clicking/clunking/popping/locking deep shoulder pain hx of trauma recurrent subluxations
63
What is the special tests for a bankart lesion?
anterior apprehension and relocation test
64
Benign hypermobility syndrome is represented by:
4 or greater than 5 on the Beighton scale
65
What is AMBRI vs TUBS?
AMBRI: atraumatic multidirectional bilateral for rehabilitation and possibly inferior capsular shift energy TUBS: Traumatic Unilateral Bankart needing/ responding to Surgery
66
Who is likely to suffer from microtrauma to the labrum?
overhead athletes
67
Why are labral tears difficult to diagnose?
They often present similarly to rotator cuff pathology or instability.
68
How will a labral tear present?
pain in anteriolateral arm aggravation w overhead IR ROM limitation due to pain locking/ clicking/ popping tenderness of anterior shoulder
69
What are the special tests for labral tears?
O'Brien's Test Yergason Test Speed Test Compression - Rotation (Grind) Test Biceps Load II Test
70
How will a sternoclavicular joint injury look?
Deformity Local tenderness pain with shoulder motion primarily at end range

MSK (1 decks)

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