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PCM Spring 2015 Exam 1 > MSK Exam - Pitcher > Flashcards

MSK Exam - Pitcher Flashcards

1
Q

3 bones of shoulder

A

clavicle
scapula
proximal humerus

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2
Q

rotator cuff

A

supraspinatus
infraspinatus
subscapularis
teres minor

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3
Q

articular surfaces of shoulder

A

glenohumeral
sternoclavicular
acromioclavicular
scapulothoracic

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4
Q

teres minor action

A

external rotation

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5
Q

injury to shoulder

A

intrinsic - problem in shoulder

extrinsic - referred to shoulder

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6
Q

intrinsic injury to shoulder

A

ligaments, muscle or tendon, bones

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7
Q

muscle

A

strain

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8
Q

ligament

A

sprain

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9
Q

extrinsic injury to shoulder

A

neuro - nerve compression, brachial plexion lesion, herpes zoster

abdomen - hepatobiliary, diaphragm irritation, ruptured ectopic pregnancy

cardio - MI, axillary vein thrombosis, thoracic outlet syndrome

thorax - pneumonia, lung tumor, PE

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10
Q

reproduction of pain

A

should not happen with extrinsic shoulder pain

also - pain is more poorly localized if extrinsic

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11
Q

tendinopathy

A

long standing tendinitis

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12
Q

frozen shoulder

A

adhesive capsulitis

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13
Q

pain with specific movement, stiff, weak, instability

A

intrinsic shoulder issue

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14
Q

intrinsic issue

A

can reproduce pain usually on exam

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15
Q

always test with shoulder

A

strength

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16
Q

patient abduct against resitance

A

supraspinatus test

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17
Q

empty can test

A

exam for supraspinatus

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18
Q

patient rotate forearm medially against resistance

A

subscapularis

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19
Q

lift off test

A

for subscapularis

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20
Q

patient rotates forearm laterally against resistance

A

infraspinatus

teres minor

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21
Q

most common rotator cuff issue

A

with supraspinatus

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22
Q

supraspinatus

A

superior aspect of scapula to greater tubercle of humerus

susceptible to repetitive motion - baseball, house painter

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23
Q

UPS

A

pinched supraspinatus in abduction

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24
Q

protection of supraspinatus

A

subacromial bursa

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25
Q

weakness of rotator cuff

A

allows upward movement of humeral head
-irritates supraspinatus tendon - and impingement can occur

acute tear - forceful injury mechanism

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26
Q

positive drop arm test

A

inability to hold arm 90 degree abduction when arm released

complete supraspinatus tear

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27
Q

night pain, gradual onset, pain in shoulder while abductiong arm

A

impingement of supraspinatus

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28
Q

hawkins test

A

shoulder impingement test

flex arm and elbow
internally rotate

looks at supraspinatus tendon

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29
Q

drop arm test

A

supraspinatus

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30
Q

AC separation

A

almost always traumatic problem

strain, partial tear, complete tear

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31
Q

visualized on inspection for AC separation

A

grade 3

there are 5 grades of separation

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32
Q

surgery for AC separation

A

usually type 4-6

conservative therapy - PT

33
Q

arthritis

A

loss of joint space**

34
Q

loss of passive and active ROM of shoulder

A

arthritis**

35
Q

adhesive capsulitis

A

inflammation in capsule - frozen shoulder

hard to tell from arthritis

MRI useful**

36
Q

bursitis

A

repetitive motion

option to inject - steroid

37
Q

when to avoid epinephrine/lidocaine

A

small capillaries

38
Q

lidocaine vs. marcaine

A

lido - short term

marc - long term

39
Q

strength and pain recover after numbing meds

A

bursitis

40
Q

therapeutic challenge

A

lidocaine to bursa to diagnose it

ROM and strength recover with bursitis after injection

41
Q

rotator cuff tear

A

persistant weakness despite injection

42
Q

rotator cuff tendinopathy

A

normal strength in association with pain relief

43
Q

frozen shoulder

A

persistent loss of ROM

44
Q

lidocaine injection test

A

subacromial bursa

when physical exam cannot exclude cuff tear, frozen shoulder, or AC joint involvement

45
Q

SLAP lesion

A

superior labrum tear anterior to posterior

biceps tendon anchors to labrum

46
Q

fall and grab something and flex bicep against lots of resistance

A

SLAP lesion

47
Q

O’briens test

A

test for slap lesion labrum tear

48
Q

work up for trauma to shoulder

A

Xray

US helpful for experienced hands

MRI

arthrography - contrast injection into joint with serial x-rays of fluoroscopy largely replaced by MRI

49
Q

shoulder pain algorithm

A

traumatic vs. non-traumatic

intrinsic vs. extrinsic

50
Q

no difference active vs. passive

A

bursitis

51
Q

lateral pain

A

rarely hip

more bursa issues

with paresthesia - meralgia paresthetica**

52
Q

true hip pain

A

groin - anterior

osteonecrosis, sepsis, fx, synovitis of hip joint

53
Q

neither direct pressure or ROM reproduces hip pain

A

think hernia, lower abdominal pathology, referred pain from lumbar area

54
Q

lower anterior thigh pain

A

referred true hip issue
upper femur
femoral neck
lumbar radiculopathy

55
Q

true hip joint pain

A

often arthritis

56
Q

trochanteric bursitis

A

lateral bursa

abnormal movement of glut medius and tensor fascia lata over greater trochanter

investigate - posteior superior to point of trochanter

chronic - fibrosis

57
Q

leg length discrepancy

A

trochanteric bursitis

58
Q

activity pain at night

A

osteoarthritis

located in groin**

59
Q

restricted abduction, morning stiffness, internal rotation limitation and pain, limited flexion

A

osteoarthritis of hip

60
Q

key feature for osteoarthritis

A

restricted abduction

61
Q

key physical exam for hip

A

internal/external rotation movements

62
Q

lateral femoral cutaneous nerve impingement

A

meralgia paresthetica

as couses under inguinal ligament

63
Q

burning/paresthsia upper lateral thigh, weakness or DTR changes

A

meralgia paresthetica

aka beer gut nerve or truckers nerve pinch

64
Q

anterior and lateral thigh to the knee

A

meralgia paresthetica

not below knee

65
Q

osteonecrosis

A

aka aspectic necrosis, avascular necrosis, osteochondritis dissecans

decreased vascular supply to femoral head

joint destroyed within 3-5 years

66
Q

dislocated hip

A

look for osteonecrosis

67
Q

steroids and excessive alcohol

A

osteonecrosis

68
Q

severe pain with light weight bearing

A

occult fracture

intolerable hip rotation ROM

MRI needed, Xray not sensitive enough **

69
Q

groin and back pain, sx beyond knee, paresthesia

A

referred pain

-lumbar and SI joint

70
Q

bone scan

A

Tc-99, sensitive, but not specific about 40%

for occult fracture

lots of false positives

71
Q

duck walk quick screen

A

good screening for hip issues

better for kids

72
Q

significant pain at ROM end point of hip

A

osteonecrosis
occult fx
acute synovitis
mets

73
Q

fabere test

A

flex, abduct, external rotation
extend to figure 4

gently push knee

74
Q

positive fabere test

A

hips, psoas, SI problem

75
Q

tibial tuberosity avulsion

A

osgood schlatter

osteochondritis of tibial tubercle

apophysitis of tibial tubercle at insertion of patellar tendon

76
Q

young person doing sports with knee pain, tender area that is palpable

A

osgood schlatter

tx - pain control, continue activity, leg strengthening through PS

77
Q

osteoporotic fractures

A

older, female, fair, thin, smoker, minor trauma

78
Q

strain vs. sprain

A

muscle - strain

ligament - sprain

79
Q

3 major signs MRI needed for impingement

A

pain, weak, atrophy

PCM Spring 2015 Exam 1 (6 decks)

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