Rheuma Flashcards
(343 cards)
1
Q
Articular Structures
A
Joint capsule and articular cartilage
Synovium and synovial fluid
Intra-articular ligaments
Juxta-articular bone
2
Q
Extra Articular Structures
A
Periarticular ligaments Tendons Bursae Muscle Fascia Bone Nerve Overlying skin
3
Q
Are ropelike bundles of collagen fibrils that connect bone to bone
A
Ligaments
4
Q
→ Are collagen fibers connecting muscle to bone
→ Another type of collagen matrix forms the cartilage that overlies bony surfaces
A
Tendons
5
Q
Are pouches of synovial fluid that cushion the movement of tendons and muscle over bone or other joint structures
A
Bursae
6
Q
Inflammation of a joint
A
Arthritis
7
Q
Arthritis
Symptoms:
A
→ Pain
→ Swelling
→ Warmth
→ Erythema
→ Decrease range of motion of loss of function
If it doesn’t involve the joints, it is not arthritis!
8
Q
Monoarticular
A
1 joint
9
Q
Monoarticular examples
A
→ Septic arthritis
→ Gouty arthritis
10
Q
Oligoarticular
A
2-4 joints
11
Q
Oligoarticular examples
A
→ Reactive arthritis
→ Psoriatic arthritis
12
Q
Polyarticular
A
more than 4 joints
13
Q
Polyarticular examples
A
→ Rheumatoid arthritis
→ Systemic lupus erythematosus
14
Q
Symmetric
A
affecting joints both sides of the body
15
Q
Symmetric examples
A
→ Rheumatoid arthritis
16
Q
Migratory examples
A
→ Rhuematoid fever (especially in younger individuals)
→ Gonococcal arthritis (sexually active patients)
17
Q
Additive examples
A
→ Rheumatoid arthritis
18
Q
Joint pain in the right wrist, will resolve before it will migrate to another joint
A
Migratory
19
Q
Joint pain in the wrist, is not yet resolve, yet another pain in other joints
A
Additive
20
Q
Acute
A
less than 6 weeks
21
Q
Acute examples
A
→ Septic arthritis
→ Acute gout
22
Q
Chronic
A
more than 6 weeks
23
Q
Chronic examples
A
→ Rheumatoid arthritis
→ Osteoarthritis
24
Q
Worsen with activity
A
Osteoarthritis
25
Worsen by rest
o Inflammatory arthritis
o Rheumatoid arthritis
o Spondyloarthropathies
26
Inflammatory symptoms
```
Tenderness
Warmth
Redness
Swelling
Stiffness
Fever or chills
```
27
Systemic features
```
Fever
Chills
In patient with malignancy
→ Anorexia
→ Weight loss
Weakness
```
28
Fever
| In cases of infections
o Rheumatic fever
o Gonococcal infection
o Gonococcal arthritis
o Active arthritis
29
Weakness example
→ Polymyositis
30
Butterfly rash on cheeks
SLE
31
Scaly rash and pitted nails
psoriasis
32
Papules, pustules, or vesicles on reddened bases, located on the distal extremities
→ Reactive arthritis
33
Only involving your sole and palm
keratoderma blendoragica
34
Red, burning and itchy eyes conjunctivitis / anterior uveitis
Spondyloarthropathy
35
Preceding sore throat
Rheumatic fever
36
Symptoms of urethritis
→ Oligoarthritis
o Acute (less than 6 weeks)
→ Reactive arthritis
→ Reiter’s syndrome
37
Mental status change, facial or other weakness, stiff neck
→ Lupus erythematsus
→ Polymyositis
→ Dermatomyositis
38
Manifestations of Articular
Deep or diffuse pain
Pain or limited range of motion on active or passive movement
Swelling (Caused by synovial proliferation, effusion, bony enlargement)
Crepitation – abnormal creaking or popping sound when moving a joint
Instability
“Locking” – unable to fully flex or extend a joint
Deformity
39
Manifestations of Non-articular
Painful on active but not passive ROM*
Point or focal tenderness in regions adjacent to articular structures
Seldom demonstrate swelling, crepitus, instability, deformity
40
Inflammatory Disorders
Infectious (N. gonorrhea or M. tuberculosis)
Crystal induced (gout, pseudogout)
Immune related (Rheumatoid arthritis (RA), Systemic lupus erythematosus (SLE), reactive arthritis , rheumatic fever)
Idiopathic
41
Non-inflammatory Disorders
Trauma (Rotator cuff tear)
Repetitive use (bursitis, tendinitis )
Degeneration or ineffective repair (OA)
Neoplasm (Pigmented villonodular synovitis)
Pain amplification
42
Inflammatory Symptoms
Cardinal signs of inflammation (erythema, warmth pain & swelling
Systemic symptoms (fatigue , fever, rash, weight loss)
Laboratory evidence of inflammation (ESR, CRP, thrombocytosis, anemia of chronic disease or hypoalbuminemia)
Morning stiffness (hours)
43
Non-inflammatory Symptoms
Pain without swelling or warmth
Absence of systemic features
Daytime gel phenomena
Normal (for age) or Negative laboratory investigations
44
→ Young -
SLE, reactive arthritis
45
→ Middle age -
RA, fibromyalgia
46
→ Elderly –
Osteoarthritis (OA), polymyalgia rheumatica
47
→ Men ‐
Gout, spondyloarthritis, ankylosing spondylitis
48
→ Women ‐
RA, SLE, fibromyalgia
49
→ Whites -
polymyalgia rheumatica, giant cell arteritis, granulomatosis w/ polyangiitis
50
→ African American-‐
SLE
51
Familial aggregation
→ Ankylosing spondylitis, gout, Heberden’s node of OA (Bony enlargement of distal phalangeal joint)
52
→ Abrupt –
septic arthritis, gout
53
→ Indolent presentations -
OA, RA, Fibromyalgia
54
→ Chronic ‐
OA
55
→ Intermittent -
crystal or lyme arthritis
56
→ Migratory –
rheumatic fever, gonococcal, viral arthritis
57
→ Additive –
Rheumatoid arthritis, Psoriatic arthritis(PsA)
58
→ Acute –
infectious , crystal induced or reactive
59
→ Chronic –
noninflammatory (OA) or immunologic arthritides (RA), nonarticular disorders (Fibromyalgia)
60
Monoarticular -
Infectious arthritis
61
Oligoarticular/pauciarticular -
Crystal arthritis
62
- symmetric and polyarticular
→ Rheumatoid arthritis
63
- asymmetric and oligoarthritis
→ Spondyloarthritis, gout, reactive arthritis
64
- either symmetric or asymmetric and oligo- or polyarticular
→ OA & PsA
65
Upper extremities
→ frequently involved in RA (MCP, PIP, wrist joints), OA (can also manifest in Heberden and Buchard’s node)
66
Lower extremities
→ characteristic of reactive arthritis and gout at their onset
67
Axial skeleton
→ common in OA & AS
| → infrequent in RA, EXCEPT the cervical spine C1 and C2
68
Trauma
→ Osteonecrosis
| → Meniscal tear
69
Drug administration
| → Anti -TB, diuretics, aspirin – can trigger?
gouty arthritis
70
Drug administration
| → Hydrosteroids – can manifest as?
Polymyositis
71
Antecedent or Intercurrent infection
| →(sore throat prior)
Rheumatic fever
72
Antecedent or Intercurrent infection
| → (GI & GU)
reactive arthritis
73
Antecedent or Intercurrent infection
| → hepatitis
(certain vasculitis)
74
Musculoskeletal Consequences:
| Diabetes mellitus –
Carpal-tunnel syndrome
75
Musculoskeletal Consequences:
| Renal Insufficiency –
Gout
76
Musculoskeletal Consequences:
| Depression or insomnia –
fibromyalgia
77
Musculoskeletal Consequences:
| Myeloma –
Low back pain (usually in elderlies)
78
Musculoskeletal Consequences:
| Cancer –
myositis
79
Musculoskeletal Consequences:
| Osteoporosis –
Fracture
80
Musculoskeletal Consequences:
| → Glucocorticoids –
osteonecrosis, septic athritis
81
→ Diuretics or chemotherapy -
Gout
82
Fever –
SLE, infections
83
Rash –
SLE, Psoriatic arthritis or reactive arthritis
84
Myalgia –
fibromyalgia, statin or drug induced myopathy
85
Weakness –
polymyositis, neuropathy
86
Rheumatologic Conditions Associated with Involvement of other organ systems:
Eyes-
Bechet’s. Disease, carcoidosis (granuloma formation) , spondyloarthritis (anterior uveitis)
87
Rheumatologic Conditions Associated with Involvement of other organ systems:
Gastrointestinal tract –
scleroderma, inflammatory bowel disease
88
Rheumatologic Conditions Associated with Involvement of other organ systems:
Genitourinary tract –
reactive arthritis, gonococcemia
89
Rheumatologic Conditions Associated with Involvement of other organ systems:
Nervous System –
Lyme disease, vasculitis
90
Gouty Arthritis
→ acute, monoarticular, inflammatory
91
Septic Arthritis
→ acute,monoarticular,inflammatory
92
Osteoarthritis
→ chronic, monoarticular or oligoarticular, non-inflammatory
93
Reactive Arthritis
→ acute,chronic, oligoarticular, inflammatory
94
Psoriatic Arthritis
→ chronic, oligoarticular, inflammatory
95
Rheumatoid Arthritis
→ chronic, polyarticular, inflammatory, symmetric
96
SLE
→ chronic, polyarticular, inflammatory, asymmetric
97
TB Arthritis
→ chronic, monoarticular, inflammatory
98
Rheumatoid Arthritis -
Female, middle age, symmetric and smaller joints involved
99
Rheumatic Fever -
Migratory arthritis with history of sore throat
100
Pain and tenderness on palpation of TMJ
TMJ syndrome
101
Pain with chewing
in trigeminal neuralgia, temporal arteritis
102
Dislocation of the TMJ may be seen in
trauma
103
→ Swelling of the TMJ may appear as?
→ Swelling may appear as a rounded bulge approximately 1⁄2 cm anterior to the external auditory meatus.
104
How to locate and palpate the TMJ?
To locate and palpate the joint, place the tips of your index fingers just in front of the tragus of each ear and ask the patient to open his or her mouth.
105
→ externally at the angle of the mandible
Masseters
106
→ externally during clenching and relaxation of the jaw
Temporal muscles
107
→ internally between the tonsillar pillars at the mandible
Pterygoid muscle
108
Range of Motion: TMJ
glide (upper) and hinge motion (lower)
109
Chewing primarily _____ movement?
Chewing primarily gliding movement in the upper compartment
110
Normally as the mouth is opened wide, _____ fingers can be inserted between incisors.
three
111
– fine tremors of the muscles
→ Fasciculations
112
May cause elevation of one shoulder. With anterior dislocation of the shoulder, the rounded lateral aspect of the shoulder appears flattened.
o Scoliosis
113
Within 2-3 weeks of rotator cuff tear
o Atrophy of supraspinatus and infraspinatus over posterior scapula with increased prominence of the scapular spine within 2-3 weeks of rotator cuff tear.
114
the summit of the shoulder
acromion
115
→ Its upper surface is rough and slightly convex.
acromion
116
coracoid process is part of the?
scapula
117
where the SITS muscles are inserted.
greater tubercle
118
Palpate the biceps tendon in the?
intertubercular bicipital groove
119
– directly under the acromion
→ Supraspinatus
120
– posterior to supraspinatus
→ Infraspinatus
121
– posterior and inferior to the supraspinatus
→ Teres Minor
122
– inserts anteriorly and is not palpable
→ Subscapularis
123
The six motions of the shoulder girdle:
```
→ Flexion
→ Extension
→ Abduction
→ Adduction
→ Internal Rotation
→ External Rotation
```
124
―Raise your arms in front of you and overhead
Flexion
125
Raise your arms behind you
Extension
126
Raise your arms out to the side and overhead
Abduction
127
Glenohumeral motion
-patient should raise the arms to shoulder level at 90 degrees, with palms facing down
128
Scapulothoracic motion
-patient should turn the palms up and raise the arms an additional 60 degrees.
129
Cross your arm in front of your body
Adduction
130
Place one hand behind your back and touch your shoulder blade
Internal rotation
Identify the highest midline spinous process the patient is able to reach.
131
Raise your arm to shoulder level; bend your elbow and rotate your forearm toward the ceiling
External rotation
132
Place one hand behind your neck or head as if you are brushing your hair
External rotation
133
Affecting Movement:
| Flexion
```
Anterior deltoid
Pectoralis major (clavicular head), Coracobrachialis
Biceps brachii
```
134
Affecting Movement:
| Extension
```
Latissimus dorsi
Teres major
Posterior deltoid
Triceps brachii (long head)
```
135
Affecting Movement:
| Abduction
```
Supraspinatus
Middle deltoid
Serratus anterior (via upward rotation of the scapula)
```
136
Affecting Movement:
| Adduction
- Pectoralis major
- Coracobrachialis
- Latissimus dorsi
- Teres major
- Subscapularis
137
Affecting Movement:
| Internal rotation
- Subscapularis
- Anterior deltoid
- Pectoralis major
- Teres major
- Latissimus dorsi
138
Affecting Movement:
| External rotation
Infraspinatus, teres minor, posterior deltoid
139
Are the most common cause of shoulder pain in primary care
Rotator Cuff Disorders
140
Compression of the rotator cuff muscles and tendons between the ______ and the _______ causes “impingement signs‖ or pain during shoulder movement
Compression of the rotator cuff muscles and tendons between the head of the humerus and the acromion causes “impingement signs‖ or pain during shoulder movement
141
Five maneuvers that have the best Likelihood Ratios (LR) and the narrowest confidence intervals are currently recommended:
1 Pain Provocation Test
3 Strength Tests
1 Composite Test
142
In ______ tests, the patient experiences either pain or weakness during the maneuver.
composite tests
143
Cross-over test
| -Palpate and compare both joints for swelling or tenderness. Adduct the patient’s arm across the chest
Acromioclavicular Joint
144
Localized tenderness or pain with adduction suggests:
-inflammation or arthritis of the acromioclavicular joint
145
Apley scratch test
| -Ask the patient to touch the opposite scapula using the two motion
Overall Shoulder Rotation
146
Difficulty with Apley scratch test suggests
- rotator cuff disorder
| - adhesive capsulitis.
147
Test Neer’s impingement
-Press on the scapula to prevent scapular motion with one hand, and raise the patient’s arm with the other. This compresses the greater tuberosity of the humerus against the acromion.
Rotator Cuff
148
Test Neer’s impingement
Pain during this maneuver is a positive test, indicating
-inflammation or rotator cuff tear.
149
Hawkin’s impingement
-Flex the patient’s shoulder and elbow to 90 degrees with the palm facing down. Then, with one hand on the forearm and one on the arm, rotate the arm internally. This compresses the greater tuberosity against the coracoacromial ligament.
150
Hawkin’s impingement
Pain during this maneuver is a positive test, indicating
-inflammation or rotator cuff tear.
151
-(sometimes called the
| “empty can test”). -
Test supraspinatus strength
152
Test supraspinatus strength
Elevate the arms to 90 degrees and internally rotate the arms with the thumbs pointing down, as if emptying a can. Ask the patient to resist as you place downward pressure on the arms.
153
Test supraspinatus strength
Weakness during this maneuver is a positive test, indicating
-rotator cuff tear.
154
Test infraspinatus strength
-Ask the patient to place arms at the side and flex the elbows to 90 degrees with the thumbs turned up. Provide resistance as the patient presses the forearms outward.
155
Test infraspinatus strength
Weakness during this maneuver is a positive test, indicating
- rotator cuff tear
| - bicipital tendinitis.
156
Test forearm supination
-Flex the patient’s forearm to 90 degrees at the elbow and pronate the patient’s wrist. Provide resistance when the patient supinates the forearm.
157
Test forearm supination
Pain during this maneuver is a positive test, indicating
-inflammation of the long head of the biceps tendon -possible rotator cuff tear.
158
Test the “drop-arm” sign
-Ask the patient to fully abduct the arm to shoulder level (or up to 90 degrees) and lower it slowly. Note that abduction above shoulder level, from 90 degrees to 120 degrees, reflects action of the deltoid muscle.
159
If the patient cannot hold the arm fully abducted at shoulder level or cannot control lowering the arm, the test is positive, indicative
-rotator cuff tear
160
Swelling over the olecranon process in
olecranon bursitis;
161
inflammation or synovial fluid in
arthritis.
162
medial epicondylitis
(pitcher’s or golfer’s elbow)
163
The olecranon is displaced posteriorly in?
posterior dislocation of the elbow and supracondylar fracture.
164
The _____ is most accessible to examination between the olecranon and the epicondyles
synovium
165
Can you palpate the synovium & bursae?
Normally neither synovium nor bursae is palpable
166
The sensitive ______ nerve can be palpated posteriorly between the olecranon process and the medial epicondyle
ulnar nerve
167
The four motions of the elbow joint:
→ Flexion
→ Extension
→ Supination
→ Pronation
168
Tenderness distal to the epicondyle
lateral epicondylitis
169
(tennis elbow)
lateral epicondylitis
170
Usually in Rheumatoid arthritis, the alignment of your DIP’s and PIP’s are not parallel, it is called?
subluxation
171
Diffuse swelling of the hand in?
arthritis or infection;
172
local swelling of the hand in?
cystic ganglion
173
In osteoarthritis, ______ at the DIP joints,
Heberden’s nodes
174
In osteoarthritis, _______ at the PIP joints.
Bouchard’s nodes
175
In _______, symmetric deformity in the PIP, MCP, and wrist joints, with ulnar deviation
rheumatoid arthritis
176
_______ atrophy in median nerve compression from carpal tunnel syndrome;
Thenar
177
________ atrophy in ulnar nerve compression.
hypothenar
178
Flexion contracture in the ring, 5th, and 3rd fingers, aka _____ , arise from thickening of the palmar fascia
Dupuytren’s contracture
179
Bogginess is seen in
synovial inflammation,
180
usually in Tb arthritis,
softer
181
anatomical snuffbox, a hollowed depression just distal to the radial styloid process formed by the?
abductor and extensor muscles of the thumb.
182
“With palms down,
point your fingers
toward the floor.”
Wrist Flexion
183
“With palms down,
point your fingers
towards the
ceiling.”
Wrist Extension
184
“With palms down,
bring your fingers
toward the
midline.”
Wrist Adduction
(radial
deviation)
185
“With your palms
down, bring your
fingers away from
the midline.”
Wrist Abduction
(ulnar
deviation)
186
PRIMARY MUSCLES
AFFECTING MOVEMENT:
Wrist Flexion
Flexor carpi radialis,
| flexor carpi ulnaris
187
PRIMARY MUSCLES
AFFECTING MOVEMENT:
Wrist Extension
Extensor carpi ulnaris,
extensor carpi radialis
longus, extensor carpi
radialis brevis
188
```
PRIMARY MUSCLES
AFFECTING MOVEMENT:
Wrist Adduction
(radial
deviation)
```
Flexor carpi ulnaris
189
```
PRIMARY MUSCLES
AFFECTING MOVEMENT:
Wrist Abduction
(ulnar
deviation)
```
Flexor carpi radialis
190
Carpal Tunnel Syndrome
You can test sensation as follows:
o median nerve
→ Pulp of the index finger
191
Carpal Tunnel Syndrome
You can test sensation as follows:
o ulnar nerve
→ Pulp of the 5th finger
192
Carpal Tunnel Syndrome
You can test sensation as follows:
o radial nerve
→ Dorsal web space of the thumb and index finger
193
Test _______ by
asking the patient to grasp
your second and third fingers.
hand grip strength
194
This tests function of wrist
joints, the finger flexors, and
the intrinsic muscles and
joints of the hand.
hand grip strength
195
Finkelstein’s test
```
Test the thumb function if there
is wrist pain by asking the
patient to grasp the thumb
against the palm and then
move the wrist toward the
midline in ulnar deviation
```
196
Pain during Finkelstein’s test identifies?
de Quervain’s tenosynovitis
197
Mechanism of de Quervain’s tenosynovitis
from inflammation
of the abductor pollicis longus and extensor
pollicis brevis tendons and tendon sheaths.
198
CARPAL TUNNEL THUMB
| ABDUCTION
Test thumb abduction by asking the patient to raise the thumb straight up
as you apply downward resistance
199
Weakness on the thumb abduction is a?
positive test--
the abductor pollicis longus is innervated only by the median nerve.
200
TINEL’S SIGN
Test for median nerve compression by tapping lightly over the course of the median nerve in the carpal tunnel as
shown.
201
Positive TINEL’S SIGN
Aching and numbness in the median
| nerve distribution is a positive test.
202
PHALEN’S SIGN
Test for median nerve compression by
asking the patient to hold the wrists
in flexion for 60 seconds. Alternatively, ask
the patient to press the backs of both hands together to form right angles. These maneuvers compress the median nerve.
203
Reverse prayer sign
Phalen’s test
204
Positive Phalen’s test
Numbness and tingling in the median nerve distribution within 60 seconds is a
positive test.
205
Range of Motion:
| Fingers
Assess flexion, extension, abduction, and
| adduction of the fingers.
206
Range of Motion:
| Thumb
At the thumb, assess flexion, extension
| abduction, adduction, and opposition
207
Concave Curves
→ Cervical (C1-C7)
| → Lumbar(L1-L5)
208
Convex Curves
→ Thoracic (T1-T12)
| → Sacrococcygeal
209
Cervical –
7
210
Thoracic-
12
211
Lumbar-
5
212
Coccyx-
4
213
– lateral deviation and rotation of the
head, from contraction of the sternocleidomastoid
muscle (SCM)
Torticollis
214
–―hunchback, accentuated flexion of
| thoracic spine
Kyphosis
215
Fractures in osteoporosis involves?
lower thoracic
216
– short-segment structural thoracolumbar
| kyphosis resulting in sharp angulation (suggestive of Tb of the Spine)
Gibbus
217
Lost of Lumbar lordisis-
in patients with ankylosing spondylitis
218
– abnormal lateral curvature of the spine,
| which also includes an abnormal rotation of one vertebra upon the other
Scoliosis
219
– most mobile portion of the spine
Neck
220
→ Atlas (C1) –
flexion and extension
221
→ Axis (C1 & C2) –
rotation
222
→ C2 – C7 –
lateral bending
223
Touch the chin to the chest
Neck Flexion
224
Look up at the ceiling
Neck Extension
225
turn the head to each side, looking
| directly over the shoulder
Neck Rotation
226
Tilt the head, touching each ear to the corresponding shoulder
Lateral bending of the Neck
227
Bend forward and try to touch your toes
Flexion of lumbar
228
Bend back as far as possible
Extension
229
rotate from side to side
Rotation
230
bend to the side from the waist
Lateral bending
231
→ Ankylos:
―bent or ―crooked
232
→ Spondylos:
―vertebral disk
233
→ -itis:
―inflammation
234
(dimples of Venus)
2 midline marks 10 cm apart starting at the posterior superior iliac spine
→ Less than 5 cm difference suggests pathology
235
This is suggestive a back pain which is nervous in origin
To differentiate if the back pain is muscular or nervous in origin
Raise the leg of the patient up to the level where the pain is felt
There should be increase pain on dorsiflexion on patient’s foot
236
Mechanical back pain
Back pain caused by placing abnormal stress and strain on the muscles of the vertebral column
Results from bad habits, such as poor posture, poorly designed seating
and incorrect bending and lifting
237
Radicular Back pain
Radiates into the lower extremities directly along the course of a spinal nerve root
Caused by compression, inflammation and/or injury to a spinal nerve root arising from common conditions including herniated disc, foraminal stenosis and peridural fibrosis.
238
HIP JOINT
| Muscle Groups
Flexor group – anterior, flexes the thigh
Extensor group – posterior, extends the thigh
Adductor group – medial, swings the thigh toward the body
Abductor group – lateral, moves thigh away from the body
239
Stance
foot on the ground and bears weight
| 60% of the walking cycle
240
Swing
foot moves forward and does not bear
| weight (40%)
241
Measuring the Length of Legs
patient in supine position
| measure the distance between the ASIS and the medial malleolus. (the tape should cross the knee on its medial side)
242
Trendelenburg Test
When the gluteus medius is weak, the
pelvis drops on the non-weight-bearing
side when the patient stands on the affected hip
243
Anterior surface landmarks of the hip:
```
→ iliac crest at the level of L4
→ iliac tubercle
→ anterior superior iliac spine (ASIS)
→ greater trochanter
→ pubic symphysis
```
244
Posterior surface landmarks of the hip:
→ posterior superior iliac spine (PSIS)
→ greater trochanter
→ ischial tuberosity
→ sacroiliac joint
245
Flexion of the hip
With the patient supine, place your hand under the patient’s lumbar spine. Ask the patient to bend each knee in turn up
to the chest and pull it firmly against the
abdomen
246
Hip flexion and
| flattening found in?
lumbar lordosis
247
Hip Extension
→ With the patient lying face down, extend the thigh toward you in a posterior direction
248
Hip Abduction
→ Stabilize the pelvis by pressing down on the opposite anterior superior iliac spine with one hand. With the other hand, grasp the ankle and abduct the extended leg until you feel the iliac spine move.
249
Hip Adduction
→ With the patient supine, stabilize the pelvis, hold one ankle, and move the leg medially across the body and over the opposite extremity.
250
Hip External and internal rotation.
→ Flex the leg to 90° at hip and knee, stabilize the thigh with one hand, grasp the ankle with the other, and swing the lower leg— medially for external rotation at the hip and laterally for internal rotation.
251
Stumbling or pushing the knee into extension with the hand during heel strike suggests?
quadriceps weakness
252
( genu varum)
→ Bowlegs (affected is in the
medial comapartment)
→ Varum- R—Room
253
(genu valgum)
knock-knees (affected is in the lateral
compartment)
→ Valgus- L- Locked kness ( in OA)
254
Look for loss of the normal hollows around the patella, a sign of swelling in the knee joint and suprapatellar pouch
Atrophy of the quadriceps muscles
255
Swelling over the patella suggests?
prepatellar bursitis
256
Swelling over the tibial tubercle
| suggests?
infrapatellar or, if more medial,
| anserine bursitis.
257
Bulge sign (for minor effusions)
With the knee extended, place the left hand above the knee and apply pressure on the suprapatellar pouch, displacing or ―milking‖ fluid downward.
Stroke downward on the medial aspect of the knee and apply pressure to force fluid into the lateral area
Tap the knee jjust behind the lateral margin of the patella with the right hand.
258
positive bulge sign
A fluid wave or bulge on the medial side
| between the patella and the femur is a positive bulge sign consistent with an effusion
259
Balloon sign (for major effusions)
Place the thumb and index finger of your right hand on each side of the patella
with the left hand, compress the suprapatellar pouch against the femut
feel for fluid entering (or ballooning into) the spaces next to the patella under your right thumb and index finger
260
positive balloon sign
When the knee joint has a large effusion,
suprapatellar compression ejects fluid to the spaces adjacent the patella. A palpable fluid wave is a positive balloon sign.
A returning fluid wave into the suprapatellar pouch confirms an effusion
261
Ballotting the patella
To assess large effusions, you can also
compress the suprapatellar pouch and ―ballotte or push the patella sharply against the femur
Watch for fluid returning to the suprapatellar pouch, it confirms a large effusion
palpable fluid returning into the pouch further confirms the presence of a large effusion.
a patellar click with compression may also occur but yields more false positives
262
Maneuver: McMurray Test
Structure: ?
Med. Lemniscus and Lat.
| Meniscus
263
Maneuver: Abduction/Valgus Stress Test
Structure: ?
Med. Collateral Ligament
264
Maneuver: Adduction/Varus Stress Test
Structure: ?
Lat. Collateral Ligament
265
Maneuver: Anterior Drawer Sign
Structure: ?
Ant. Cruciate Ligament
266
Maneuver: Lachman Test
Structure: ?
Ant. Cruciate Ligament
267
Maneuver: Posterior Drawer Sign
Structure: ?
Post. Cruciate Ligament
268
McMurray Test
A click or pop along the medial joint with valgus stress, external rotation, and leg extension suggests a probable tear of the post. portion of the med. Meniscus. The tear may displace meniscal tissue, causing ―locking‖ on full knee extension
269
Abduction/Valgus Stress Test
pain or gap in the medial joint line points to ligamentous laxity and partial tear of the lateral collateral ligament
most injuries are on the medial side
270
Adduction/Varus Stress Test
pain or gap in the lateral joint line points to ligamentous laxity and partial tear of the lateral collateral ligament
271
Anterior Drawer Sign
a few degrees of forward movement are normal if equally present on the opposite side. A forward jerk showing the contours of the upper tibia is a positive anterior drawer sign making an ACL tear 11.5 times more likely.
272
Lachman Test
Significant forward excursion indicates an ACL tear
273
Posterior drawer sign
isolated PCL tears are rare
274
focal heel pain on plantar fascia suggest?
focal heel pain on plantar fascia suggest
| plantar fasciitis, seen in prolonged standing or heel-strike exercise
275
Tenderness on compression of metatarsals
| is an early sign of?
RA
276
Acute inflammation of the 1st MTP joint
(PUDAGRA) in gout
277
Maneuver: Dorsiflex and plantarflex the
foot at the ankle
Structure: ?
Ankle (tibiotalar) joint
278
Maneuver: Stabilize the ankle with one hand, grasp the heel with the other, and invert and evert the foot
Structure: ?
Subtalar (talocalcaneal) joint
279
Maneuver: Stabilize the heel and invert and evert the forefoot
Structure: ?
Transverse tarsal joint
280
Maneuver: Flex the toes in relation to the
feet
Structure: ?
Metatarsophalangeal joints
281
Indicative of a problem that requires more
extensive examination, precaution and
consideration
Yellow Flag Sign and Symptoms
282
Indicative of more serious problem that
should be referred to appropriate medical
specialist
Red Flag Signs and Symptoms
283
RED FLAGS:
| CANCER
Persistent pain at night, constant pain anywhere in the body, unexplained weight loss, loss of appetite, unusual lumps or
growths, unwarranted fatigue
284
RED FLAGS:
| CVS
Shortness of breath, dizziness, pain or feeling of heaviness in the chest, pulsating pain anywhere in the body, constant and severe pain in the lower leg (calf) or arm,
discolored or painful feet, swelling (no history of injury)
285
RED FLAGS:
| GI/GU
Frequent or severe abdominal pain, frequent heartburn or indigestion, frequent nausea or vomiting, change in or problems
with bowel and/or bladder function, unusual menstrual irregularities
286
RED FLAGS:
| NEUROLOGICAL
Changes in hearing, frequent or severe headaches with no history of injury, problems with swallowing or changes in speech, changes in vision (e.g. blurriness or loss of sight), problems with balance,
coordination, or falling, faint spells (drop attacks), sudden weakness
287
RED FLAGS:
| MISCELLANEOUS
Fever or night sweats, recent severe emotional disturbances, swelling or redness in any joint with no history or injury, Pregnancy
288
YELLOW FLAGS:
Abnormal signs and symptoms (unusual patterns of complaint
Fainting
Bilateral symptoms
Drop attacks
Symptoms peripheralizing
Vertigo
Neurological symptoms (nerve root or peripheral nerve)
Autonomic nervous system symptoms Multiple nerve root involvement Progressive weakness
Abnormal sensation patterns (do not follow dermatome or peripheral nerve patterns)
Progressive gait disturbances
Saddle anesthesia
Multiple inflamed joints
Upper Motor neuron symptoms (spinal cord) signs
Psychosocial stresses
Circulatory or skin changes
289
Initial GAIT assessment:
| What signs are easily noticed?
→ Trendelenburg sign and Drop foot are easily noticed
290
Test the _____ side first
Test the normal or uninvolved side first
→ To establish a baseline for normal movement of the joint being tested
→ To show the patient what to expect, thereby increasing patient confidence and less apprehension when testing the injured side.
291
Have patient do _____ movements first,
Have patient do active movements first,followed by the passive movements done by the examiner.
292
you let the patient move the limbs first
Active movements:
293
If active movement is limited, you can push the joint or limb passively which is usually done by the examiner
passive movements
294
Any painful movements are done?
last
295
How is Resisted isometric movements done?
are done with joint in a neutral or resting position
| position the limb first, you can have the patient resist your movement or you resist the patient’s movement
296
When testing myotomes (group of muscles supplied by a single nerve root), each contraction is held at least _____ , for Myotomal weakness takes time to develop
5 seconds
297
away from the midline
Abduction-
298
toward the midline
Adduction-
299
movement of bending from the starting position
Flexion-
300
movement form bending to the starting postion
Extension-
301
rotating the forearm to face the palm upward
Supination-
302
rotating the forearm to face the arm downward
Pronation-
303
turning inward toward the axis of the body
Internal Rotation-
| medial rotation
304
turning outward away from the axis of the body
External Rotation-
| lateral rotation
305
turning the hindfoot inward
Inversion-
306
turning the hindfoot outward
Eversion-
307
pointing the toes away from the body (toward the floor)
Plantar flexion-
308
pointing the toes toward the body (toward the ceiling)
Dorsiflexion-
309
Isolate individual muscles with similar functions instead of testing the entire muscle group (to know which muscle is affected)
Isolation
310
Be aware of basic substitution patterns (e.g. elbow flexion) Ex: when there is weakness of biceps/biceps brachii and when you do elbow flexion, there are some muscles that substitute for the main function of your biceps brachii like your brachioradialis. Know the position of the forearm so that you will know what muscle is functioning
Substitution Patterns
311
→ Occur when determining patient’s muscle strength while under the influence of sedatives, significant pain, positioning, language, or cultural barriers, spasticity and hypertonicity
Suboptimal testing conditions
312
→ Occurs when the examiner applies increased force when the patient is unable to achieve the full available ROM yet (especially if the examiner is not strong enough, if males ang gina grade nyo, you grade it as 5, basi ang grade ya is only 4)
Overgrading
313
→ Occurs when the examiner is not aware of the effects of muscle contracture on ROM; the muscle appears to lack full ROM when it has achieved its full available ROM (if there is lack of ROM in a particular joint and you grade is as 3, pwede na sya ma grade as 5, most probably ang ROM ya is only up to that joint)
Undergrading
314
BONES OF THE SHOULDER GIRDLE
Scapula
| Clavicle
315
medial side, widest bone in the elbow
Ulna-
316
lateral side, widest bone in the wrist
Radius-
317
It is the junction between the acromion (part of the scapula that forms the highest point of the shoulder) and the clavicle
Acromioclavicular joint
318
Five joints in the wrist that articulate the distal row of carpal bones and the proximal bases of the five metacarpal bones.
Carpometacarpal
319
Proximal interphalangeal joints" (PIJ or PIP), those between the first (also called proximal) and second (intermediate) phalanges.
Proximal Interphalangeal
320
Distal interphalangeal joints" (DIJ or DIP), those between the second (intermediate) and third (distal) phalanges.
Distal Interphalangeal
321
Action:
| Supraspinatus
Abduction
322
Action:
| Infaspinatus
External Rotation
323
Action:
| Teres Minor
External Rotation
324
Action:
| Subscapularis
Internal Rotation
325
MUSCLES OF THE ARM
| ANTERIOR COMPARTMENT
Biceps brachii
Coracobrachialis
Brachialis
326
MUSCLES OF THE ARM
| POSTERIOR COMPARTMENT
Triceps
327
MUSCLES OF ANTERIOR FOREARM
```
Pronator Teres
Flexor Carpi Ulnaris
Flexor Carpi Radialis
Palmaris Longus
Flexor Digitorum Superficialis
Flexor Pollicis Longus
Flexor Digitorum Profundus
Pronator Quadratus
```
328
MUSCLES OF POSTERIOR COMPARTMENT
```
Extensor Carpi Radialis Brevis
Extensor Digitorum
Extensor Digiti Minimi
Extensor Carpi Ulnaris
Anconeus
Supinator
Abductor Pollicis Brevis
Extensor Pollicis Brevis
Extensor Indicis
```
329
MUSCLES OF LATERAL COMPARTMENT
Brachioradialis
| Extenso Carpi Radialis Longus
330
SMALL MUSCLES OF THE HAND
Palmaris brevis
4 Lumbricals
8 Interossei
331
SHORT MUSCLES OF THE THUMB
Opponens Pollicis
Adductor Pollicis
Abductor Pollicis Brevis
Flexor Pollicis Brevis
332
SHORT MUSCLES OF THE LITTLE FINGER
Abductor Digiti MInimi
Opponens Digiti Minimi
Flexor Digiti Minimi
333
Caused by an acromioclavicular dislocation with the distal end of the clavicle lying superior to the acromion process
STEP DEFORMITY
334
STEP DEFORMITY indicates?
When seen at rest, it indicates both the acromioclavicular and coracoclavicular ligaments have been torn.
335
Appears when traction is applied on the arm
| Caused by multidirectional instability or loss of muscle control due to nerve injury or stroke
SULCUS SIGN
336
SULCUS SIGN indicates?
Inferior subluxation of the glenohumeral joint.
337
You can see this when you let the patient do resisted isometric elbow flexion and extension.
POPEYE SIGN
338
POPEYE SIGN indicates?
Indicates third-degree strain/rupture of long head of Biceps tendon
339
You let the patient push forward
SCAPULAR WINGING
340
implies the winging is the result of muscle weakness of one of the scapular muscle stabilizers that, in turn, disrupts the normal muscle force couple balance of the scapulothoracic complex.
Primary scapular winging
341
implies that the normal movement of the scapula is altered because of pathology in the glenohumeral joint.
Secondary scapular winging
342
SCAPULAR WINGING indicates?
Elevation of scapula indicated muscle weakness, pathology of glenohumeral joint and lesion of long thoracic nerve.
343
may be caused by a lesion of the long thoracic nerve affecting serratus anterior, trapezius palsy (spinal accessory nerve), rhomboid weakness, multidirectional instability, voluntary action, or a painful shoulder resulting in splinting of the glenohumeral joint, which in turn causes reverse scapulohumeral rhythm.
Dynamic scapular winging (i.e., winging with movement)
