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Flashcards in Musculoskeletal Deck (264)
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knock-kneed (2-5 degrees at baseline in normal knees)





Patella baja

Abnormally low-lying patella


Patella alta

Abnormally high patella


Infrapatellar bursitis

"Roofer's knees"
- Seen in someone on knees repeatedly
- Often bilateral (vs suprapatellar)


Knee movement: extension

Quadriceps muscle
L4 (Femoral nerve)
To -5 degrees


Knee movement: flexion

Four flexors, including hamstrings
Sciatic nerve L5-S1
To 130 degrees


Baker's cyst

Extra-articular swelling mass with transillumination


Popliteal artery aneurysm

Pulsatile mass, nontransilluminable on auscultation
- Bruit


5 Features of ACL tear and assessment

1. Acute pain
2. Severe swelling
3. Audible pop
4. Inability to walk
5. Clenched fist upon manipulation of knee

* Severe tear may show anterior sag of tibia

Assess for:
- Effusion
- Foot pulses
- Great toe extension= Deep peroneal nerve
- Great toe flexion= Tibial nerve
- Sensation on top of foot= deep peroneal
- Sensation on bottom of foot= tibial nerve


Lachman's maneuver

To assess for ACL tear
- 80-85% sensitive

Knee stabilized at 25 degrees flexion
Tibia subluxed > 5 mm anteriorly on femur


Anterior drawer maneuver

To assess for ACL tear
- 40% sensitive

Knee stabilized at 90 degrees
Knee subluxed > 5mm anteriorly on femur


Passive crank maneuver

Stabilize humerus, upper extremity in "handshake"
- Palpate head of humerus
- Note pain or limitation of movement
1. Passively internally rotate to 30 degrees
2. "" external
3. "" abduct humerus


Auenbrugger's maneuver

Auscultatory percurssion
- Stethoscope over AC joint, tap on olecranon
- Diminished sound= discontinuous structures (fractured humerus or scapula)


Abduction of humerus

170 degrees
- Baseline to 100 degrees intrinsic
- 100 to 170 degrees extrinsic


Apley scratch test

Infraspinatus: brush hair
Subscapularis: unhook bra


Yergason's maneuver

Patient in neutral handshake position
- Examiner inspects anterior shoulder
- Patient supinates forearm, flex elbow against resistance
- Pain at bicipetal groove= bicipetal tendonitis


Elbow passive ROM

Passively flex to 130


Elbow active ROM

Active flexion= biceps brachiii C5 musculocutaneous
Active extension= trceps C7and radial nerve
Active pronation: pronator teres
Active supination: musculocutaneous


Medial epicondylitis

Pain with active flexion, pronation


Pronator syndrome

Pain, tingling on palm of forearm to digits 1, 2, 3
Postive Tinel's test
- Entrapment of proximal medial and branch of anterior interosseous nerve


Cubital tunnel syndrome

Pain and tingling of ulnar forearm, hand
- Positive Tinel's test

- Weakness to finger 2-5 abduction/adduciton
- Weakness in flexion of digits 4, 5 when making a fist
- Atrophy of intraosseous muscles


Olecranon bursitis

Serous= cool, non-erythematous, fluctuant mass
- Transilluminable
- "Student's elbow

Infected olecranon bursitis
- Fluctant warm, red, tender, non-transilluminable mass

Tophi= 1+ firm, nontender, gritty nodules
- Yellow-colored papules

Rheumatoid nodules
- Subcutaneous, firm nodules
- Aponeurosis of triceps muscle`


Radial tunnel syndrome

Pain and tingling of dorsal side of forearm--> digits 1, 2, 3 + anatomic snuffbox
- Positive Tinel's over radial tunnel
- No motor deficits

Vs Radial head fracture=
- pain in lateral elbow to snuffbox with a "Squeeze sign" (pain on lateral, antecubital elbow)
- decrease in passive/active supination and pronation



Incorporates Inflammatory states:
- Autoimmune (RA, SLE, Vasculitides)
- Autoinflammatory (Gout, Juvenile RA, TRAPS, FMF)
Non-inflammatory musculoskeletal states:
- Degenerative disease (osteoarthritis)


Autoimmune disease

Inflammatory state
= Immune system response against "self" antigens
- Characterized by B and T lymphocyte activation and autoantibody production
- Selection in Thymus destroys "self" reactive T-cells (needs low affinity for thymus cells to survive)

Innate system:
1. Antigen-presenting cells:

2. Phagocytes, NK-cells, dendritic cells, epithelial surfaces, non-antibody molecules (activated cells)

3. B cells (adaptive) and T cells (adaptive)


Antigen-presenting cells

- Express Toll-like receptors (TLR) in their surface
- Internalizes and presents antigens
- Secrete co-stimulatory molecules (CD80, CD86)
- Secrete cytokines: regulate process


B cells

- B cells also recognize antigens via surface receptors
- Antigens are internalized and processed into peptide fragments
- Fragments bind to MHC molecules (B cells are also APC) and are
- Recognized by T cells
- T cells become activated


T cells

- T cells mature in the thymus
- T cell activation requires recognition of MHC+peptide (signal 1) and
- Co-stimulation (signal 2). Ex CD28 (APC) by CD80/86 (T cells) or CD40 (APC) by CD40L (T cells)
- In the absence of signal 2, T cells undergo apoptotic death

T-cell types and stimulating interleukins:
1. APC presents native T cell with:
Th-1: IL-12, IL-18
Th-2: IL-4
Th-17: IL-6, TGF-beta
Treg: Il-2, TGH beta
2. Nucelated cell presents native T-cell:
Forms Cytotoxic T-cell

T-cell goes to Thymus:
- Positive selection= low affinity for "self"
- Negative selection= high affinity for "self"--> destroyed in Thymus


Autoreactive T cells in periphery

May escape negative selection
Inactivated in periphery by:
- Immune ignorance (hidden in body in eye, brain, testes--> won't react)
- Anergy
- Suppression by regulatory T cells