Flashcards in Musculoskeletal Disorders Deck (61):
What are some sources of referred shoulder pain?
cervical spine, gallbladder, spleen, heart
What is "casualty or culprit"?
Implies that the site of pain may not be the source of the problem
What is Spurling's position?
extension and rotation of the neck to the side of pain - indicates pathology of the cervical spine that may cause shoulder pain
What is the most common neuropathy associated with shoulder pain?
compression of the suprascapular nerve
What are the essential elements of the examination for shoulder pain?
inspection, palpation, tests of motion and strength
What is the "Popeye deformity"?
deformity of the upper arm indicating rupture of the long head biceps tendon
What is the most common cause of shoulder pain?
rotator cuff injury
What is Jobe's test (empty can test)?
Straight arm at 90 degrees abduction and 30 degrees forward flexion with arm internally rotate completely (thumb pointing down) - clinician adducts arm: pain w/o weakness = tendinopathy; pain w/weakness = tendon tear
What is Apley scratch test?
used to assess shoulder ROM - patient reaches across chest (assess adduction), behind head (external rotation and abduction), and behind back (internal rotation and adduction)
What is the push off (Gerber's) test?
patient places one hand behind back and pushes posteriorly against resistance - assesses subscapularis muscle
What is the Neer test?
passive painful arc maneuver - passively flexing the glenohumeral joint while preventing shoulder shrugging (used to assess shoulder impingement)
What is the drop arm test?
patient is unable to lower arm from a fully abducted position with a smooth coordinated motion (assesses rotator cuff tear)
Which tests should be used together to assess rotator cuff tear?
active painful arc test (pain with active abduction beyond 90 degrees), drop arm test, weak in external rotation
What is the Hawkins Kennedy test?
used to assess shoulder impingement - clinician stabilizes shoulder with one hand with elbow flexed at 90 degrees and internally rotates the shoulder using other hand - pain with internal rotation = positive test
What is tendinopathy?
clinical syndrome characterized by tendon thickening and chronic localized tendon pain - due to acute trauma or overuse - failed healing response within the tendon tissue
What is "tissue creep"?
sustained or repetitive loading of extracellular matrix in tendons displaces water ("wringing out" the tendon) and reduces capacity to absorb force - load that is initially manageable produces tendon damage
What are treatments for tendinopathy?
limit the volume and intensity of loads placed on the tendon; ergonomics; slow, controlled, progressive heavy load exercises; sustained stretching; NSAIDs; glucocorticoids (acute tendinopathy)
What is impingement syndrome?
symptoms and signs that result from compression of the rotator cuff tendons and the subacromial bursa between the greater tubercle of the humeral head and the lateral edge of the acromion process
What is frozen shoulder?
adhesive capsulitis - stiffened glenohumeral joint that has lost significant range of motion (abduction and rotation) - lidocaine injection does not improve ROM
What is the lidocaine injection test?
used to confirm rotator cuff tendinopathy (normal strength with pain relief versus persistent weakness despite pain relief with rotator cuff tear)
What are the primary imaging modalities for shoulder injuries?
plain film radiography (first modality), MRI soft tissue injuries), bone scan (infections), arthrography (rotator cuff tears)
What is the Tinel test?
light percussion over the median nerve to detect nerve inflammation (carpal tunnel syndrome) - sensation of tingling or pins and needles
What is the Phalen maneuver?
full flexion of the wrist for 60 seconds causes paresthesias in the distribution of the median nerve (backs of hands placed together with wrists flexed)
What is the Finkelstein test?
patient forms fist around thumb - clinician stabilizes forearm and holds patient's fist with other hand then moves wrist into ulnar deviation (rotates fist up and out) - used to diagnose de Quervain's tenosynovitis
What is the Thomas test?
patient brings one leg to chest and leaves other relaxed and flexed - + findings: (1) lack of hip extension with knee flexion > 45 degrees = iliopsoas tightness, (2) full hip extension with knee flexion < 45 degrees = rectus femoris tightness, (3) lack of hip extension with knee flexion < 45 degrees = both
What is the Trendelburg test?
shows whether hip remains straight when lifting healthy leg - if pelvis and hip drop when lifting healthy leg, may indicate gluteus medius injury
What is Ober's test?
test of contracted/inflamed tensor fasciae latae or iliotibial band - patient lies on unaffected side with knee flexed 90 degrees and slightly extended, leg allowed to drop (+ if leg does not fall to parallel)
What is Ely's test?
patient lies prone - able to fully flex knee without creating hip flexion (rectus femoris tightness if hip flexes with knee flexion)
What is Patrick's (FABER) test?
patient flexes, abducts, and externally rotates leg (creates figure 4 with leg) - examiner pushes down on hip and knee - pain with maneuver indicates problem with iliosacral joint
What are the three radiographic views of the hip?
low anteroposterior (demonstrates joint space narrowing), anteroposterior, and frog-lateral (femoral head collapse)
What is the painful arc test?
active ROM test - patient experiences pain with lifting arm to side and above head - indicates rotator cuff injury
What is the belly test?
patient presses hand into stomach and rotates elbows forward - indicates tear in subscapularis if patient cannot press belly while rotating shoulder
What is the sulcus sign?
maneuver used to assess glenohumoral instability - patient sits with arm hanging naturally at side - clinician grasps humerus by elbow and palpates acromioclavicular joint while applying traction to humerus - positive when the humeral head is readily displaced by >= 2 cm inferiorly (creates a sulcus)
What is the apprehension test?
used to assess anterior shoulder instability - patient prone with arm in throwing position - examiner braces shoulder and pushes hand back - positive if there is a sensation of impending dislocation
What is the glenohumeral joint?
the shoulder joint - the principal articulation in the shoulder
What are the components of the shoulder girdle?
3 bones (clavicle, scapula, proximal humerus) and 4 articular surfaces (sternoclavicular, acromioclavicular, glenohumeral, scapulothoracic)
What is the rotator cuff?
the primary dynamic stablizer in the shoulder - comprised of 4 muscles: supraspinatus, infraspinatus, subscapularis, teres minor
What are SLAP lesions?
superior labral tears oriented anterior to posterior
What is the labrum?
piece of fibrocartilage attached to the rim of the shoulder socket that helps keep the ball of the joint in place
What distinguishes referred pain from intrinsic shoulder pain?
shoulder movement is normal with referred pain
What imaging studies are appropriate with shoulder injury?
x-rays for loss of ROM accompanied by severe pain and trauma; MRI for suspected impingement and rotator cuff injury
What imaging tests are recommended for acute (< 4 weeks duration) back pain?
no laboratory or imaging tests are necessary - most adults will have incidental abnormal findings and pain will typically resolve within seven weeks
What are Waddell's signs?
inappropriate physical signs associated with back pain of psychological origin (e.g., straight leg raise tenderness that improves with distraction)
When should imaging tests be used with low back pain?
severe or progressive neurological deficits, serious underlying conditions are suspected, pain that worsens despite treatment, trauma
What are appropriate treatments for acute low back pain?
NSAIDs/acetaminophen, opioids/tramadol (< 2 weeks), exercise, spinal manipulation (limited evidence of benefit), acupuncture (better for chronic back pain), heat (provides temporary relief)
What types of imaging/diagnostic tests are recommended with knee pain?
radiological (if trauma suggestive of fracture), MRI (for soft tissues), aspiration (for effusions)
What is the hallmark for structural joint problems in the hip?
pain with or after use and improvement with rest
What type of pain suggests involvement of the hip joint?
anterior hip or groin pain
What are the signs and symptoms of hip osteoarthritis?
hip pain exacerbated by activity/relieved with rest, internal rotation < 15 degrees, pain on internal rotation, morning stiffness (< 30-60 minutes), flexion < 115 degrees
What is antalgic gait?
patient spends shorter time weight bearing on the affected side when hip pain is present
What is a Trendelenburg gait?
patient shifts the torso over the affected hip, reducing the load on the hip and decreasing pain
What does the straight leg test show?
irritation of nerve roots (radiculopathy) - positive test elicits pain in the leg, buttock, or back at <= 60 degrees of leg elevation
What are the imaging studies used for hip pain?
plain film radiography (initial evaluation of any hip pain), CT (trauma, preoperative planning), MRI (inflammation, bone marrow, joint spaces, soft tissues, fractures not demonstrated on radiography), MR arthrography (acetabular labrum, articular cartilage, ligamentum teres)
What is a PASTA lesion?
partial articular supraspinatus tendon avulsion of the shoulder
What is Yergason test?
tests transferus humoral ligament, which holds the bicep in place (test of bicipital tendinitis) - patient's arm is bent 90 degrees and pronated/adducted at side - rotates and suppinates arm against resistance (+ with snapping or clicking) - indicates biceps tendon or labral pathology
What is Speeds test?
tests transferus humoral ligament, which holds the bicep in place (test of bicipital tendinitis) - patient forward flexes arm (arm straight out front) with palm suppinated against resistance (+ with pain) - indicates biceps tendon or labral pathology
What is epicondylitis?
degenerative process at the tendon-bone interface (tennis or golfer's elbow) - pain with elbow/wrist motion, gripping, palpation
What is cubital tunnel syndrome?
nerve compression of the ulnar nerve at the ulnar groove of the elbow - numbness in fingers 4 and 5
What is DeQuervain's syndrome?
painful condition affecting the radial nerve (thumb side of wrist) - pain with grasping or turning wrist
What is Finkelstein's test?
test for DeQuervain's syndrome - patient makes fist with thumb in palm and flexes wrist (+ with pain and crepitus)