Ce 21 Msk Part 2

Front 1

Special procedures for evaluation of the MSK system: condition detected by Neer test, Hawkins

Back 1

shoulder rotator cuff impingement or tear

Front 2

Special procedures for evaluation of the MSK system: condition detected by Katz hand diagram, thumb aBduction test, tinel, phalen

Back 2

Median nerve integrity

Front 3

Special procedures for evaluation of the MSK system: condition detected by straight leg raising?

Back 3

L4, L5, S1 nerve root irritation

Front 4

Special procedures for evaluation of the MSK system: condition detected by the femoral stretch test

Back 4

L1, L2, L3, L4 nerve root irritation

Front 5

Special procedures for evaluation of the MSK system: condition detected by Ballottement, bulge sign

Back 5

effusion in the knee

Front 6

Special procedures for evaluation of the MSK system: condition detected by McMurray test

Back 6

torn meniscus in knee

Front 7

Special procedures for evaluation of the MSK system: condition detected by the Anterior/posterior drawer tests

Back 7

ACL and PCL integrity

Front 8

Special procedures for evaluation of the MSK system: condition detected by the Varus/valgus stress tests

Back 8

MCL or LCL ligament instability in the knee

Front 9

Special procedures for evaluation of the MSK system: condition detected by the Lachman test

Back 9

ACL integrity

Front 10

Special procedures for evaluation of the MSK system: condition detected by the Thomas test

Back 10

flexion contracture of the hip

Front 11

Special procedures for evaluation of the MSK system: condition detected by the Trendelenburg sign

Back 11

weak hip aBductor muscles

Front 12

What PE findings increase the likelihood that a patient will have a positive electrodiagnostic study for carpal tunnel?

Back 12

-weakened thumb aBduction
-Katz hand diagram
-less pain along thumb/median nerve distribution
-Tinel and Phalen are less acurate

Front 13

How is the Neer test performed?

Back 13

-forward flex pt's arm to 150 degrees while depressing the scapula
-this presses the greater tuberosity and supraspinatus muscle against the anteroinferior acromion
-increased pain is associated with rotator cuff inflammation or tear

Front 14

How is the Hawkins test performed?

Back 14

-aBduct shoulder to 90
-flex elbow to 90
-internally rotate arm to its limit
-increased pain is associated with rotator cuff inflammation or tear

Front 15

How is muscle strength of the subscapularis tested?

Back 15

-have pt hold arm at side, elbow flexed to 90, rotate forearm medially against resistance

Front 16

How is the straight leg raise test performed?

Back 16

-have pt lie supine with neck slightly flexed
-have pt raise leg, keeping knee extended
-no pain should be felt below the knee
-radicular pain below the knee in a dermatome pattern may be associated with disk herniation
-flexion of knee often eliminates pain with leg raising
-repeat procedure on unaffected leg
-crossover pain in the affected leg with this maneuver is more supportive of sciatic nerve impingements
-tests nerve root irritation or lumbar disk herniation at the L4, L5, S1 levels

Front 17

What is the femoral stretch test used to evaluate? how is it performed?

Back 17

-detects flexion contractures of the hip that may be masked by excessive lumbar lordosis
-pt supine, fully extend one leg flat on table
-flex other leg with knee to chest
-observe pt's ability to keep extended leg flat on table
-lifting the extended leg off table indicates hip flexion contracture in the extended leg

Front 18

What is evaluated by the Trendelenburg test? How is it performed?

Back 18

-weak hip aBductor muscles
-ask pt to stand and balance on one foot then the other
-observe from behind, note any asymmetry or change in level of iliac crests
-when iliac crest drops to side of lifted leg, hip aBductor muscles on wt bearing side are weak

Front 19

What is assessed by ballottement? how is it performed?

Back 19

-knee effusion
-knee extended, apply downward pressure on knee

Front 20

What is the bulge sign and how is it elicited?

Back 20

-presence of excess fluid in the knee
-pt's knee extended, milk medial aspect of knee upward 2-3x, then milk lateral side of patella
-observe for bulge of returning fluid to the hollow area medial to the patella

Front 21

What is the procedure for the McMurray test?

Back 21

-used to detect torn medial or lateral meniscus
-pt supine, one knee flexed
-position your thumb and fingers on either side of the joint space
-hold heel with other hand, fully flexing knee, rotate foot and knee out (valgus stress) to lateral position- extend then flex pt's knee
-any palpable/audible click, grinding, pain, or limited extension of the knee is positive sign of torn medial meniscus
-repeat procedure, rotating foot and knee in (varus stress)- positive test is torn lateral meniscus

Front 22

how are the anterior and posterior Drawer tests performed?

Back 22

-ID instability of ACL and PCL
-pt supine, knee flexed to 45-90, foot flat on table
-place both hands on lower leg, with thumbs on ridge of anterior tibia just distal to tibial tuberosity
-draw tibia forward, forcing tibia to slide forward on femur
-then push tibia backward
ant/post movement > 5mm in either direction is positive

Front 23

how is the Lachman test performed?

Back 23

-evaluates ACL integrity
-pt supine, knee flexed 10-15 with heel on table
-place one hand above the knee to stabilize femur, place other hand around proximal tibia
-while stabilizing femur, pull tibia anteriorly
-increased laxity >5mm compared to other side indicates injury

Front 24

What are the Ottawa knee rules for identifying pts who should have knee XR?

Back 24

->55
-tenderness at head of fibula
-isolated tenderness at patella
-inability to flex knee to 90

Front 25

how are the varus/valgus stress tests performed?

Back 25

-identify instability of MCL/LCL
-pt supine, knee extended
-stabilize femur with one hand, hold ankle with other
-apply varus force against the ankle (toward midline) and internal rotation
-excessive laxity is felt as joint opening, indicated injury to LCL
-then apply valgus stress (away from midline) and externally rotate
-laxity indicated injury to MCL
-repeat with knee flexed to 30, no excessive medial or lateral movement is expected

Front 26

how is leg length measured?

Back 26

from ASIS tp medial malleolus, crossing knee on medial side

Front 27

how is arm length measured?

Back 27

acromion process thru the olecranon process, to the distal ulnar prominence

Front 28

what is the maximum discrepancy in limb length or circumference that is normally found?

Back 28

1cm

Front 29

what is the general procedure for observing MSK system in the infant

Back 29

-use warming table with newborn, fully undress
-observe posture and spontaneous movements
-no localized or generalized muscular twitching is expected

Front 30

what is indicated by a mass near the spine of an infant that transilluminates?

Back 30

meningocele or myelomeningocele

Front 31

at what age should the infant be able to lift the head and trunk from the prone position?

Back 31

2months
gives an indication of forearm strength

Front 32

What are expected findings in an infant who can't yet sit without support?

Back 32

kyphosis in thoracic and lumbar spine

Front 33

With what anomaly are unequal limb length and circumference associated in newborns?

Back 33

intraabdominal neoplasms

Front 34

Why are newborns also examined in the fetal position?

Back 34

to observe how that may have contributed to any asymmetry of flexion, position, or shape of extremities
-newborns have some resistance to full extension of elbows, hips, and knees

Front 35

What are expected findings when examining a newborn's LE?

Back 35

-flat footed
-slight varus curvature of tibias (tibial torsion) or forefoot adduction (metatarsus adductus) from fetal positioning
midline may bisect the 3rd/4th digits instead of 2nd/3rd
forefoot should be flexible and straighten with abduction

Front 36

Is it necessary to intervene when apparent MSK problems are found when examining the newborn?

Back 36

not usually necessary
just follow closely

Front 37

with which condition is a single palmar crease associated?

Back 37

Down syndrome

Front 38

What is one of the most easily missed findings in a newborn?

Back 38

fractured clavicle
may be evident as bump on collarbone caused by callus that forms on the healing clavicle

Front 39

How is the newborn spine examined?

Back 39

-trunk flexed, palpate each spinous process
-should feel thin and well formed
-could feel split indicating bifid defect

Front 40

What is assessed by the Barlow-Ortolani maneuver? How is it performed?

Back 40

-detects hip dislocation
-should be performed at each exam during the 1st yr
-using little force, test one hip at a time, stabilizing pelvis with opposite hand
-infant supine, doc at feet
-flex hip and knee to 90
-for Barlow, grasp leg with thumb on inside of thigh, base of thumb on knee, fingers gripping outer thigh with fingertips resting on greater trochanter
-adduct thigh and gently apply downward pressure on femur in attempt to disengage femoral head from acetabulum
-+ sign in clunk or sensation felt as femoral head exits acetabulum posteriorly
-Ortolani
-slowly aBduct thigh while maintaining axial pressure
-with fingertips on greater trochanter, exert lever movement in opposite direction so that fingertips press head of femur back toward acetabulum center
-if head of femur slips back into acetabulum with palpable clunk when pressure is exerted, suspect hip subluxation or dislocation
-high pitched clicks are common/expected
by 3m, muscles and ligaments tighten, limited abduction is most reliable sign

Front 41

What is assessed by the Allis sign? How is it elicited?

Back 41

-detects hip dislocation or shortened femur
-infant supine, flex both knees, keeping feet flat on table and femurs aligned
-observe height of knees from kid's feet
+ if one knee appears lower than other

Front 42

how is shoulder muscle strength tested in an infant?

Back 42

hold infant upright with hands under axillae
-adequate strength if infant maintains upright position
-weakness if infant begins to slip thru fingers

Front 43

What posture is expected when observing a child standing?

Back 43

lumbar curvature with protuberant abdomen

Front 44

How do the attainment of motor milestones differ between black and white infants/kids?

Back 44

the motor development of black infants is often advanced over white; may reach milestones earlier
white infants catch up by 3yrs

Front 45

With which abnormality is sitting in the W or reverse tailor position associated?

Back 45

intoeing associated with femoral anteversion
places stress on joints of hips, knees, and ankles

Front 46

What obscures the longitudinal arch in kids?

Back 46

a fat pad
present until age 3
afterwards, only apparent when not weight bearing

Front 47

How do the feet of a toddler rotate?

Back 47

pronate inward until 30 months, afterwards wt bearing shifts to midline of foot

Front 48

How is tibial torsion of the toddler evaluated?

Back 48

-kid prone on examining table
-flex one knee to 90, and align the midline of the foot parallel to the femur
-use thumb and index finger of one hand to grasp the medial and lateral malleoli of the ankle; grasp the knee placing thumb and index finger on same side of the leg
-tibial torsion is present if thumbs aren't parallel

Front 49

How is tibial torsion corrected?

Back 49

-residual effect of fetal positioning
-expected to resolve within several years after weight bearing

Front 50

How is genu varum evaluated in the child? How does this relate to the tibiofemoral angle? When is this an expected finding?

Back 50

-bowleg
-kid standing, facing you, knees at eye level
-measure distance between knees with medial malleoli of ankles together
-genu varum exists if the space is 2.5cm or 1" between the knees
-the expected 10-15 tibiofemoral angle increases with genu varum, but remains b/l symmetric
-common in toddlers until 18months
-asymmetry of tibiofemoral angle or space between knees should not exceed 4cm/1.5"

Front 51

How is genu valgum evaluated in a child?

Back 51

-knock knee
-kid standing, knees eye level
-measure distance between medial malleoli with knees together
-genu valgum exists if space of 2.5cm/1" between medial malleoli
-tibiofemoral articulation angle will increase
-common between 2-4 yrs-asymmetry of tibiofemoral angle or space between medial malleoli should not exceed 5cm/2"

Front 52

how is muscle strength evaluated in a kid?

Back 52

ask child to stand, rising from a supine position
should not need to use arms for leverage

Front 53

What is the Gower sign?

Back 53

-kid rises from a sitting position by placing hands on legs and pushing the trunk up
-indicates generalized muscle weakness

Front 54

What are expected findings for the spine of an adolescent? What is the normal distance between the scapulae?

Back 54

-spine smooth and balanced with concave and convex curves
-no lateral curvature or rib hump
-shoulders and scapulae level within 1/2"
-distance btw scapulae of 3-5"
-may have slight kyphosis and rounded shoulders with an interscapular space of 5-6"

Front 55

How does a woman's spinal mechanics change during pregnancy?

Back 55

-center of gravity shifts forward, increasing lordosis and causing a compensatory forward cervical flexion
-stooped shoulders and large breasts exaggerate the spinal curvature
-inc mobility and instability of sacroiliac joints and symphysis pubis contribute to waddling gait

Front 56

Common findings in pregnant women when walking?

Back 56

-pain from symphysis pubis down into the inner thigh when standing and may have feeling that bones are moving or snapping when walking

Front 57

How is lumbosacral hyperextension evaluated in a preggo?

Back 57

-bend forward at waist toward toes
-palpate distance btw L4 and S1 spinous processes
-as woman rises to standing, from full flexion to full extension note when the distance btw L4 and S1 becomes fixed
-if fixed before fully extended, she'll be hyperextended when walking, possibly resulting in LBP
-most resolves 6m after delivery

Front 58

What wrist abnormality is common in preggos?

Back 58

carpal tunnel associated with fluid retention
-symptoms abate after delivery

Front 59

What aspects of the Hx will give the examiner a good indication of the pt's joint muscle agility in the elderly?

Back 59

fine and gross motor skills required to perform activities of daily living

Front 60

How might an elderly pt's posture appear?

Back 60

increased dorsal kyphosis
flexion of hips and knees
long extremities if the trunk has been shortened by vertebral collapse

Front 61

what causes the reduction in total muscle mass in the elderly?

Back 61

atrophy either from disuse, as in pt's with arthritis, or from the loss of nerve innervation, as in pt's with DM