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77 Cards in this Set
- Front
- Back
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what are diarthroidal joints?
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freely moving articulations enclosed by a capsule of fibrous articular cartilage, ligaments, and cartilage covering the ends of opposing bones
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what type of joint is the wrist?
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condyloid
permits movement in 2 planes (F/E and radial and ulnar movement) |
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What type of joint is MCP?
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condyloid
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what type of joint is the elbow? what are its components?
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hinge (F/E)
single sinovial cavity surrounding 3 articular surfaces of radius/ulna/humerus bursa btw olecranon and skin |
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what are the 4 muscles of the rotator cuff?
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supraspinatus
infraspinatus teres minor subscapularis (SItS) (lower case t for teres MINOR) |
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what is the location of the TMJ? comoponents?
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depression just anterior to the tragus or ear (in front of ear)
mandible and temporal bone |
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what makes up the nucleus of the intervetebral disks?
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fibrogelatinous material
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what forms the posterior portion of the pelvis?
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fused sacrum and coccyx
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what bones comprise the knee joint?
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femur, tibia, patella
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which ligament protects the knee from hyperextension
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ACL
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what separates the patella, quads tendon, and muscle from the femur?
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suprapatellar bursa
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what bones comprise the tibiotalar (ankle) joint? what type of joint is it?
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tibia, fibula, talus
hinge (F/E) |
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which joints of the ankle permit pivot or rotation movement?
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talocalcaneal (subtalar)
transverse tarsal permit pronation and supination |
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what type of joints are the tarsal/metatarsal, metatarsal/phalanges, and middle and distal phalanges?
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condyloid
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what is the usual number of vertebrae?
Most people have ____ women have ____ |
85% have 24
11% have 23 (women) 5% have 25 |
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throughout infancy and childhood, how do bones increase in:
- diameter ? - length? - smaller bones? |
diameter- apposition of new bone tissue around bone shaft
length- increased proliferation of cartilage at the epiphyses (growth plates) smaller bones (eg carpals)- ossification centers form in calcified cartilage |
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when are ligaments stronger than bones?
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until adolescence
thus injuries to long bones are more likely to result in fractures than sprains |
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adolescents:
which Tanner stage? injury? when is bone growth complete? when is peak bone mass achieved? |
-rapid bone growth during Tanner Stage 3
(greater potential for injury) -growth complete at 20 - peak bone mass at 35 |
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How do increasing hormones affect the skeleton in preggos? At what week in gestation does this occur?
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-hormones (especially relaxin) contribute to the elasticity of ligaments and cartilage of pelvis at 12-20 wks
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how does the structure of the skeleton change in a preggo?
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Lordosis to compensate for enlargin uterus
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how does the cycle of bone deposition/resorption change in the elderly? how does it change specifically in a post-menopausal woman?
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-resorption dominates (CLAST)
-loss of estrogen increases resorption and decreases Ca deposition- bone loss and dec density, esp long bones and vertebrae |
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what are the risk factors for osteoarthritis (6)?
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obesity
Fam Hx hypermobility syndromes aging (>40) injury, high level of sports activities occupation requiring overuse of joints |
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what are the risk factors for osteoporosis (12)? (include race, diseases, drugs)
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-race (white/Azn/Native American), NW European descent, blonde or red hair, freckles
-light body frame/thin Fam Hx, gene for dec bone density -nulliparous -amenorrhea/menopause before 45, postmenopausal -sedentary; lack of wt bearing/aerobic exercise -constant dieting; inadequate Ca/Vit D, excessive carbonated soft drinks -scoliosis, RA, CA, MS, chronic illness -metabolic disorders (DM, hypercortisolism, hypogonadism, hyperthyroidism) -drugs that dec bone density (thyroxine, corticosteroids, heparin, lithium, anticonvulsants, antacids w/aluminum) -poor teeth, previous fractures -smoking or heavy alcohol use |
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when does muscle wasting occur?
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after injury as a result of pain, disease of the muscle, or damage to the motor neuron
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when can crepitus be palpated?
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*when two irregular bony surfaces rub together as a joint moves
*when two rough edges of a broken bone rub together movement of a tendon inside a tendon sheath * when tenosynovitis is present |
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how is muscle tone assessed?
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feel resistance to passive stretch
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how do active and passive ROM compare?
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passive often exceeds active by 5 degrees
-should be equal bilaterally |
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what is indicated by discrepancy btw active and passive ROM in a muscle?
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-may indicate true muscle weakness or joint disorder
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what is the next step after ROM testing a joint reveals a possible increase or limitation in motion?
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use a goniometer to precisely measure the angle
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when does loss of muscle strength indicate a disability?
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when it is graded as 3 or <
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what is the grading system for muscle strength?
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0- no movement
1- trace of movement 2- FROM w/o gravity 3- FROM w/gravity, no resistance 4- FROM w/gravity, some resistance, weak 5- FROM w/gravity and full resistance |
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what is indicated by deviation of fingers to ulnar side, boutonniere deformity, or swan neck deformity?
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RA
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how are the hand/finger joints palpated?
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palpate interphalangeal jts with thumb and index finger
palpate metacarpalphalangeal jts with both thumbs |
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how are the wrist and radiocarpal groove palpated?
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with thumbs on dorsal surface and fingers on palmar aspect of wrist
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what may be indicated by a firm mass over the dorsum of the wrist?
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ganglion
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What are indications of osteoarthritis in the DIPs (distal interphalangial)?
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bony overgrowths
felt as hard, nontender, nodules, usually 2-3mm diameter, sometimes encompassing the entire joint |
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what are Heberden nodes? bony overgrowth over _____
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DIPs
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what are Bouchard nodes? bony overgrowth over _____
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PIPs
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what condition is associated with painful, fusiform swelling of PIPs, causing spindle shaped fingers?
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acute RA
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What may indicate ganglia in the hand?
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cystic, round, nontender swellings along tendon sheaths or joint capsules that are more prominent with flexion
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what are the normal degrees of ROM for F/E metacarpalphalangeal joints?
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F= 90
E= 30 |
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what are the normal degrees of ROM for F/E of the wrist?
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F= 90
E= 70 |
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what are the normal degrees of ROM for radial and ulnar deviation of the wrist?
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radial- 20
ulnar- 55 |
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What two conditions may be indicated by subcutaneous nodules along pressure points of the ulnar surface of the elbow?
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RA
gouty tophi |
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What is the normal range for carrying angle of the elbow?
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5-15
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What findings on palpation of the elbow should lead you to suspect epicondylitis or tendonitis?
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boggy, soft or fluctuant swelling
point tenderness on the lateral epicondyle, or grooves of the olecranon process inc pain w/pronation/supination |
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what are the normal degrees of ROM for F/E of the elbow?
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F= 160
E= 180 |
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what are the normal degrees of ROM for pronation/supination of the elbow?
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90 each
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What should be suspected if the shoulder contour is asymmetric, and one shoulder has hollows in the rounding contour?
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shoulder dislocation
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What muscle is injured with winged scapula?
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serratus anterior (injury to long thoracic nerve)
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How is the biceps groove palpated?
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externally rotate the arm and forearm
locate the biceps near the elbow and follow muscle and tendon into the groove along the anterior humerus |
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what are the normal degrees of ROM for F/E of the shoulder? ABductio/aDduction? internal/external rotation?
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F 180
E= 50 aB= 180 aD= 50 int/ext = 90 |
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how is the TMJ located?expected/unexpected findings?
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place fingers just anterior to the tragus
expected: audible or palpable snapping or clicking unexpected: pain, crepitus, locking, popping- TMJ dysfunction |
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What are the normal findings for ROM for opening/closing the jaw and laterally moving the jaw?
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opening- 3-6cm btw upper and lower teeth
lateral- mandible should move 1-2cm in either direction |
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what are the normal degrees of ROM for F/E of the neck? side bending? rotation?
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F/E= 45
SB= 40 rotation= 70 |
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how should the head be positioned with respect to landmarks on the backside?
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head directly over gluteal cleft
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What is a gibbus? with which condition is it associated?
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-sharp angular deformity in the spine
-associated with collapsed vertebra from osteoporosis |
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How does one assess for spinal tenderness?
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percuss by tapping each spinal process with one finger, then each side of the spine along the paravertebral muscles with ulnar aspect of fist
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what are the normal degrees of ROM for F/E at the waist? SB? rotation?
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F= 75-90
E= 30 SB= 35 rotation= 30 |
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what are the normal degrees of ROM for F/E at the hip? ABduction/aDduction? int/external rotation?
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F= 90
E= 30 aB= 45 aD= 30 int rotation=40 ext rotation= 45 |
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What is the normal angle btw the tibia and the femur?
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<15
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What is recurvatum? What does it indicate?
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excessive hyperextension of the knee with weight bearing
weak quads |
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What is the normal ROM for F/E at the knee?
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F= 130
E= up to 15 of hyperextension |
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What is indicated by callouses or corns on the feet?
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chronic pressure or irritation
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What are pes varus/valgus?
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varus= in-toeing
valgus= out-toeing |
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Where should the weight bearing line of the foot be? Examples of conditions that could cause this to deviate?
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line from the heel to btw the 2nd/3rd toes
metatarsus varus/valgus, heel pronation, pain, or injury |
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What other deformity may be associated with pes cavus?
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claw toes
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What is hammertoe?
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hyperextension of the metatarsophalangeal joint w/flexion of the PIP
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What is a mallet toe?
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flexion deformity at the DIP
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what is claw toe?
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hyperextension of the metatarsophalangeal joint w/flexion of the PIP and DIP
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What is hallux valgus? ____ deviation of great toe
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lateral deviation of great toe
can cause formation od a bursa at the pressure point, which can become inflamed-> bunion |
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What should be suspected with inflamed metatarsophalangeal joint of the great toe?
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gouty arthritis
draining tophus may occasionally be present |
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What could be indicated by a persistently thickened Achilles tendon?
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tendonitis that can develop with spondyloarthritis xanthelasma of hyperlipidemia
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how should the metatarsophalangeal joints be palpated?
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using the thumb and fingers of both hands to compress the forefoot and palpate over each joint
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What are the normal ROM for dorsi/plantar flexion of the foot? inversion/eversion? aBduction/aDduction?
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D= 20
p= 45 inversion= 30 eversion= 20 aB= 10 aD= 20 |
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What are the Ottawa ankle rules for identifying pts needing an ankle xray?
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pain in malleolar zone and one of the following:
-bone tenderness along the distal 6cm of posterior edge of fibula or tip of lateral malleolus -bone tenderness along distal 6cm of posterior edge of tibia or tip of medial malleolus -inability to bear weight for 4 steps both immediately after the injury and in the emergency department |
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What are the absolute exclusion criteria for ankle radiograph (6)? (must get x ray not matter what)
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age <18, intoxication, multiple painful (distracting) injuries, pregnancy, head injury, neurologic deficit
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