Flashcards in Musculoskeletal Disorders Deck (61)
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