week 6- musculoskeletal Flashcards
(62 cards)
• Musculoskeletal disorders (MSDs) can affect the body’s:
o muscles, joints, tendons, ligaments and nerves.
• Musculoskeletal dos Etiology is very broad and can be due to:
o injury, inflammatory disease, mechanical degeneration, infection, metabolic disorders, crystal accumulation, cancer or environmental exposure.
• Joint Classifications:
o Synarthroses- ‘suture lines’ found in skull
o Amphiarthroses- adjacent bones bound by flexible fibrocartilage (ex: pubic symphysis, SI jt upper 2/3rds, intervertebral discs)
o Diarthroses-articular design, contain synovial membrane and synovial fluid (lower 1/3rd SI joint, crico arytenoid, TMJ, facets, knee, etc.)
• Synovial Fluid roles:
o Reduction of friction - lubricates the articulating joints
o Shock absorption - becomes more viscous under applied pressure.
o Nutrient and waste transportation
• Tenosynovium:
o Protective lining of tendons
• Articular Cartilage:
o Reduce friction and absorb shock
o 70% water
o Type II collagen
o Large proteoglycan
• Terms for # of joints involved:
o Monoarticular- involving one joint
o Pauciarticular- involving 2-4 joints
o Polyarticular- involving 5 or greater joints
• Types of inflammation of the synovium:
o Synovitis- Inflammation of the synovial membrane
o Tenosynovitis- Inflammation of a tendon and its enveloping sheath.
o Stenosing- swelling of a tendon sheath causing “triggering”
o Serous synovitis- synovitis with a large effusion of nonpurulent fluid
• General hx for M/S dos:
o Onset and progression o location of pain o Regional vs generalized o Symmetrical vs asymmetrical o Peripheral vs central o Acute vs chronic o Progressive vs static
• Specific hx for M/S do:
o Morning stiffness? (>1hr → inflam dz)
o quality of pain? Pain scale
o pain at rest? Time of day. How long does it last?
o ADLs impacted? Work, school, cooking, etc
o Modalities
o Travel?
o Swelling? ROM?
o Diet, Exercise, Hobbies, Sex hx, Toxic exposure, Hx trauma
o family members w similar problems?
• patterns of joint involvement in M/S dos:
o Symmetrical: RA, polymyalgia rheumatica, SLE, viral arthritis and drug/serum sickness reactions.
o Asymmetrical: gout, PsA, ReA
o Monoarthritis: infx, crystals, trauma, tumor
• Assoc sxs to ask about w M/S do:
o fever, weight loss, fatigue, weakness
o scalp tenderness, vaginal burning, penile discharge,
o deformity, locking, giving way, snapping?
o Assoc eye, bowel, skin rash, oral ulcers, pleurisy?
• General PE for M/S do?
o Temp o Eyes: inflammation o Skin: rashes, vasculitis o extensor aspects of forearms: nodules o Shins: erythema nodosum o Nail changes: PsA o suspect rheumatic fever, listen to heart o LA o Other systems if indicated
• Categories of abnormality in a jt exam:
o Deformity o Swelling (hard or soft?) o Color Change o Muscle atrophy o Changes in ROM o Changes in Gait
• Upper Extremity- ROM
o Observe dorsal and palmer surfaces for atrophy
o Spread all fingers (extension)
o Make a fist (flexion)
o Pronate and supinate with fist
o Flex/ext wrist, then elbow
o AROM of shoulder is all directions, place hands behind head of ext rotation assessment
• Lower Extremity- ROM
o Inspect (standing and lying)
o Hip flexion by lifting knee, then open for external rotation
o Return leg to neutral and internally rotate ankle for hip internal rotation
o Flex/extend knee
o Feel up the shin for cool knees
o Ballottement of the patella? Not the most sensitive test!
• Pattern of joint involvement for dos: Hands
o OA - DIPS, PIPS. rare MCP, wrist
o RA - PIPS, MCP’s, wrist. very rare DIPS
o Psoriatic - nails, asymmetric. DIP; PIP, MCP, sausage fingers
o SLE-similar to RA, interarticular dermatitis, periungual erythema
o Scleroderma - skin thickened, flexion contractures, Raynaud’s
o Crystal arthropathies, Sarcoidosis – DIP, PIP, MCP
• Jt patterns in elbow:
o loss of 180° of extension is early change in arthritis
o tennis elbow- pain w pressure over lat. Epicondyle
• jt patterns in shoulder:
o raise hands over head- assess ROM, weakness, pai
o RA- occ. Swellin
o bursitis- common are
o tendonitis- common
• jt patterns in feet and ankle:
o RA- rubbery below, front of, behind malleoli; MTP’s or whole midfoot swollen, tender
o ReA, PsA: IP synovitis
o Gout- IP synovitis, 1st MTP of great toe
• Jt patterns in spine:
o OA - ↓ cervical flexion, facet joints often affected
o Ankylosing spondylitis- ↓lumbar flexion, chest expansion
o Osteomyelitis, leukemia, CA, compression fxs, herniated disk- localized bone pain
o Fibromyalgia- trigger points
• Jt patterns in knee:
o look for meniscus tear, collateral ligament injuries, cruciate via M/S exam
o Assess for edema
• Jt patterns in hip:
o OA - large weight-bearing joints
o Arthritis- limp
o bursitis- tenderness over greater trochanter
• general labs for M/S dos:
o ESR- non-specific o CRP- more sensitive o Serum uric acid (gout) o CBC: infx, anemia (of chronic dz) o Urinalysis: any renal involvement (esp SLE)
