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Physical Diagnosis > PD Musculoskeletal > Flashcards

Flashcards in PD Musculoskeletal Deck (125):
1

Function of MS system

Support and mobility
Protection
Hematopoeisis
Mineral storage

2

MS system

Bony structure with its joints held together by ligaments, attached to muscles by tendons, and cushioned by cartilage

3

Bones covered by...

Articular cartilage

4

What is the most common type of joint?

Diarthroidal (synovial)

5

Synovial membrane

Lines synovial cavity and secretes a small amount of viscous lubricating synovial fluid

6

What is surrounding synovial membrane?

Fibrous joint capsule
Strengthened by ligaments

7

Types of synovial joints

Spheroidal - ball and socket
Hinge
Condylar

8

Ball and socket examples
(spheroidal)

Shoulder
Hip

9

Hinge examples

Interphalangeal joints
Elbow

10

Condylar examples

Knee
TMJ

11

Bursa

Disc shaped, fluid filled synovial sacs that develop at points of friction around joints, between tendons, cartilage, and bone

12

Function of bursa

Decrease friction
Promote ease of motion

13

Examples of bursa

Subacromial
Olecranon
Trochanteric
Pes anserine
Prepatellar

14

Common, concerning symptoms

Low back pain
Neck pain
Muscular pain
Limping
Difficulty with gait
Pain with movement
Injury
Joint pain

15

Examples of joint pain

Monarticular
Polyarticular
Associated with systemic symptoms

16

Historical clues

Functional limitation?
Sx with single joint/region or multiple joints?
Acute or slowly progressive?
Work hx, family hx?
Mechanism of injury?
Prior problems/injuries with the affected area?
Systemic symptoms

17

Examples of systemic symptoms

Fever, chills
Weight loss
GI issues
Skin issues

18

Exam

Inspection
Palpation
Range of motion
Muscle strength
Neuro vascular assessment
Special maneuvers

19

Inspection

Anterior, posterior, and lateral aspects of posture
Symmetry of body parts, alignment of extremities
Lordosis, kyphosis, scoliosis
Skin over joints and muscles
Inspect muscles

20

Inspection of skin over joints

Discoloration - erythema, bruising, pallor
Swelling
Masses

21

Inspection of muscles

Hypertrophy
Atrophy
Fasciculations
Spasms

22

Palpation

Palpate all bones, joints, surrounding muscles

23

With palpation, note any...

Warmth
TEnderness
Swelling
Fluctuation (joint effusion)
Crepitus
Muscle tone (spasticity, flaccid)

24

What areas do we palpate last?

Inflamed joints and tender areas last

25

ROM

Assess active and passive ROM for each major joint and related muscle groups, comparing side to side

Active ROM first, then relax and allow for passive ROM until end of ROM is felt
Do not force if there is pain or spasm

26

Which is greater, PROM or AROM?

PROM often greater than AROM by 5+ degrees

27

Signs that suggest problem with joint, related muscle group, or nerve injury

Pain
Limitation of motion
Spastic movt
Joint instability
Deformity
Contractures

28

Goniometer

Used to precisely measure angle for range of motion

29

Part of neuro exam

Muscle strength

30

Neurovascular assessment

Sensory testing from neuro
Blood supply assessed with peripheral vascular exam

31

Most common complaint

Low back pain

32

Low back pain

Most cases are mechanical
Challenge to find pts with more serious disorders

33

Serious causes of low back pain

Malignancy (MM, mets)
Infection
Inflammatory disease
Leaking aortic aneurysm
Progressive neurologic deficits

34

Infection sources of low back pain

Discitis
Osteomyelitis
Epidural abscess

35

Malignancy sources of low back pain

Multiple myeloma
Mets

36

Inflammatory source of low back pain

Ankylosing spondylitis

37

History questions for LBP

Abrupt versus gradual onset
Associated event (lifting, work, travel)

38

Character of LBP

Tearing, burning, steady ache
Tingling or numbness

39

Location/distribution of LBP

Sciatica typically radiates into buttock and down leg

40

Straight leg raise test

Tests for nerve root irritation or lumbar disk herniation at L4, L5, S1

Have pt lie supine with neck slightly flexed
Ask pt to raise leg
No pain should be felt below knee
Repeat on unaffected leg

41

Lasegue sign

Positive when patient is unable to raise leg greater than 30 degrees

42

Crossover pain in affected leg with straight leg raise test

Supportive of tension on nerve roots

43

Bragard stretch test

Tests for lumbar disk herniation at L4, L5, S1
Have pt lie supine with neck slightly flexed
Hold pts lower leg and raise it slowly with knee extended until pt feels pain
Lower leg slightly and briskly dorsiflex the foot
Pain will be produced if the nerve is inflamed

44

Femoral stretch test

Hip extension test that is used to detect inflammation of nerve root and L1 - sometimes L4 level
Patient lie prone and extend hip
No pain should be felt
Presence of pain on extension is positive sign of nerve root irritation

45

Common orthopedic shoulder DO

Rotator cuff tendonitis/bursitis/tear
Adhesive capsulitis (frozen shoulder)
Shoulder separation
Shoulder dislocation
Arthritis
Labral tears
Biceps tendonitis
Instability
Fractures

46

Elbow

Inspect in flexed and extended positions
Palpate bony prominences, olecranon bursa, muscles, tendons
Test muscle strength and ROM

47

Elbow ROM

Expect flexion of 160 and extension of 180
Pronation and supination of 90

48

Common elbow DO

Lateral epicondylitis
Medial epicondylitis
Bursitis (inflammatory, non, septic, olecranon)
Arthritis
Ulnar nerve entrapment
Gouty tophi
Rheumatoid nodules

49

Lateral/medial epicondylitis aka

Tennis elbow - lateral
Golfer's elbow - medial

50

Hands and wrist

Inspect dorsal and palmar aspects
Look for deformities of digits
Palpate each joint in hand and wrist
Palpate ulnar and radial arteries
ROM
Sensory and muscle strength

51

Palpation of hand and wrist

Swelling
Bogginess/effusions
Tenderness
Nodules

52

Tests for carpal tunnel

Tinel test
Phalen test

53

Rheumatoid arthritis

Chronic systemic inflammatory disease affecting mainly the synovial membranes of multiple joints

54

Symptoms of RA

Symmetric joint swelling and pain
Fatigue
Malaise
Early morning stiffness

55

PE with RA

Effusion
Redness
Tenderness in affected joints
Subq nodules
Late stages show characteristic deformities

56

Affected joints of RA

MCP
Wrist
Ankles
MTP

57

Swan neck deformitites

Hyperextension of PIP joint and flexion of DIP joint
Most commonly seen in RA

58

Boutounniere deformity

Flexion of PIP joint and hyperextension of DIP
Common in RA and trauma

59

Heberden's nodes

Hard, contender nodules on DIP joints that occur slowly over time
Common in osteoarthritis

60

Bouchard's nodes

Heberden's nodes, but in PIP
Hard, contender nodules on PIP that occur slowly over time
Common in osteoarthritis

61

Ganglion cyst

Idiopathic, spontaneous protrusion of joint fluid outside of the articular surface
Painless, smooth, fluid filled cyst
Most commonly dorsum of wrist

62

Dupuytren's contracture

Fixed flexion contracture that develops over time due to thickening of the palmar fascia
Rarely painful
Feels thick and tough on exam

63

De Quervain's Tenosynovitis

Inflammation of tendon sheaths of extensor and abductor tendons of the thumb as the cross the styloid process

Perform Finkelstein's test

64

Finkelstein's test

Have pt put their thumb in the palm, covering it with other 4 digits, make a fist
Gently deviate wrist towards ulna, this stretches the inflamed tendons over the radial styloid, reproducing the patient's pain

65

Carpal tunnel syndrome

Compression of median nerve by encroachment on the carpal tunnel

66

Causes of carpal tunnel syndrome

Fibrosis of tendon sheaths
Trauma
Arthritis
Repetitive movements
Pregnancy
Past wrist injuries

67

S&S of carpal tunnel syndrome

Numbness and tingling progressing to weakness of first four fingers
Pain in same distribution
Anesthesia
Weakness
Thenar eminence atrophy

68

Tinel sign

Strike median nerve where it passes through the carpal tunnel (under flexor retinaculum and velar carpal ligaments)

Tingling sensation radiating from wrist to median nerve distribution is a positive Tinel sign

69

Phalen sign

Wrist is held in forced flexion for one minutes
Positive Phalen sign if patient develops paresthesias in nerve distribution

70

Paronychia
Tx

Painful bacterial (or fungal or viral) infection where skin and nail meet at the side or base of fingernail or toenail

Lancing to drain pus

71

Hip exam

Inspect hips anterioly and posteriorly while patient stands
Locate major landmarks
Asymmetry in height/alignment
Level of gluteal folds
Palpate hips and pelvis with pt supine
ROM
Leg length

72

Major landmarks

Iliac crest
ASIS
PSIS
Greater trochanter of femur

73

Abnormalities in palpation of hips and pelvis

Instability
Tenderness
Crepitus

74

Measuring leg length

Measure from ASIS to medial malleolus, crossing knee on medial side

75

Trendelenberg test

Maneuver to detect weak hip abductor muscles
Pt stands and balance first on one foot, then other
Observe from behind, note asymmetry or change in level of iliac crests

76

Trendelenberg test with iliac crest drop

When iliac crest drops on the side of lifted leg, hip abductors on weight bearing leg are weak

77

Trochanteric bursitis
S&S

Inflammation of trochanteric bursa which lies over the greater trochanter

Vague hip pain laterally, worse with walking and activity

78

Exam findings trochanteric bursitis

ROM preserved
Pain on direct palpation over bursa
Pain with resisted abduction

79

Osteoarthritis/degenerative joint disease

Pain with weight bearing and ambulation
Symptoms progress over time with pain precipitated by less activity as disease worsens
Mostly over 50 yo

80

Exam findings with OA

Pain with ambulation, often limping
ROM reduced as dz progresses
Early on internal rotation elicits the most pain

81

Knee exam

Inspect knees and popliteal spaces, both flexed and extended
Note major landmarks
Observe lower leg alignment
Watch the pt walk
Note scars, signs of swelling, inflammation
Atrophy of muscles
Palpate knee in all areas
ROM
Muscle strength
Special test

82

Major landmarks

Tibila tuberosity
Medial and lateral tibial condyles
Medial and lateral epicondyles
Adductor tubercle
Patella

83

Normal lower leg alignment

Angle between femur and tibia is expected to be less than 15 degrees

84

Abnormal leg aligments

Valgus
Varus
Recurvatum

85

Valgus

Knock knees

86

Varus

Bowlegs

87

Recurvatum

Excessive hyperextension with weight bearing

88

Palpation of knee

Swelling
Tenderness
Crepitus
Warmth
Nodules

89

ROM of knee

Expect 130 flexion and 15 hyperextension

90

Palpating for joint effusion

Bulge sign
Ballotment
Balloon sign

91

Causes of joint effusion

Inflammation (infection, gout, RA)
Trauma, injury
DJD

92

Technique for smaller effusion

Bulge sign

93

Technique for large effusion

Ballotment
Balloon sign

94

Bulge sign

Knee extended, place left hand above knee and apply pressure on supra patellar pouch, displacing or milking fluid downward

95

Ballotment

Place left hand on supra patellar pouch
Gently push down towards patella, forcing any fluid to collect in central part of joint
Gently push down on patella with thumb

Patella will feel like its floating if a sizable effusion

96

Balloon sign

Place thumb and index finger of right hand on each side of patella
With left hand, compress supra patellar pouch against femur

Feel for clid entering spaces next to patella under right thumb and index finger

97

Special maneuvers

Abduction Valgus Stress
Adduction Varus Stress
Anterior drawer
Lachman
Posterior drawer
McMurray
Apley's

98

Test for MCL

Abduction Valgus stress test

99

Test for LCL

Adduction varus stress test

100

Test for ACL

Anterior drawer test
Lachman test

101

Test for PCL

Posterior drawer sign

102

Test for medial and lateral meniscus

McMurray test
Apley's test

103

Valgus test

Tests MCL
Push medially on knee

104

Varus test

Tests LCL
Pull laterally on knee

105

Anterior drawer

Tests ACL

106

Lachman test

Tests ACL
Pulls knee out laterally while somewhat flexed

107

Posterior drawer

Tests PCL

108

McMurray's test

Tests for tear of medial or lateral meniscus
Feeling of clicking or grinding under fingers

109

Apley's test

Test for meniscal tears
Patient prone, knee flexed, hold foot pressing down and internally/externally rotate (bring)

Click, pops, snaps, indicate meniscal tear

110

Baker's cyst
Common cause

Swelling in popliteal space caused by joint fluid protruding behind the knee
Common cause is DJD

111

Ankle and foot exam

Inspect feet and ankles while pt is weight bearing and sitting
Observe contour of feet, alignment with tibia
Position/size
Number of toes
Edema
Ulcers
Observe arch
Palpate all labdmarks
ROM
Muscle strength
Nuerovascular evaluation

112

Abnormal arches

Pes planus - flat foot
Pes cavus - high arch

113

Distal pulses

Palpate dorsalis pedis and posterior tibialis

114

Common sports injury

Ankle sprain

115

Grades of ankle sprain

I - III
Mild, moderate, severe

116

Grade I mild

Slight stretching and some damage to ligament

117

Grade II moderate

Partial tear with some joint laxity

118

Grade III severe

Complete tear with gross instability

119

85% of ankle sprains are...

Varus or inversion injuries
Resulting in lateral ligament complex tears

120

Lateral ligament tears

Anterior talofibular ligament (ATFL)
Calcaneofibular ligament (CFL)
Poseterior talofibular ligament (PTFL)

121

PE with ankle sprain

Ecchymoses
Swelling
Tenderness
Check anterior drawer

122

Plantar fascitits

Inflammation of the plantar fascia
Causes pain usually right at medial heel

123

Risk factors for plantar fasciitis

Poor foot mechanics
Tight calf/Achilles
Obesity/weight gain
Improper footwear
Pregnancy
Running

124

Hammer toes

Toes crossed

125

Onychomycosis

Fungal infection of toenails (or fingernails)