Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
392 Cards in this Set
- Front
- Back
|
What connects bone to bone, and is made up of collagen fibrils
|
ligaments
|
|
|
What connects muscle to bone...and is made of collagen fibers?
|
tendons
|
|
|
Name examples of synovial joints.
|
knee
shoulder |
|
|
Name an example of cartilaginous joints.
|
vertebral bodies
|
|
|
Name an example of a fibrous joint.
|
skull sutures
|
|
|
What structures are considered articular?
|
-joint capsule
-articular cartilage -synovium -synovial fluid -intra-articular ligaments |
|
|
A pouch of synocial fluid that cushions the movement of tendons and muscles over bone/joins is known as what?
|
bursae
|
|
|
For each type of joint, define its level of mobility:
-synovial -cartilaginous -fibrous |
-synovial: freely
-cartilag: slightly movable -fibrous: no movement |
|
|
Give an example for each of these synovial joints:
-spheroidal -hinge -condylar |
-spheroidal: shoulder, hip
-hinge: IP joints hand/foot, elbow -condylar: knee, TMJ |
|
|
Hinge joints have what type of movement?
|
1 plane: flex, extend
|
|
|
What % of people have idiopathic low back pain? What would this be called?
|
-85%
-sprain, strain |
|
|
What types of things can cause MIDLINE low back pain?
|
-ligament injury
-disc herniation -vertebral collapse -spinal cord metx -epidural abcess |
|
|
What types of things can cause low back pain that is felt OFF of midline?
|
-sacroilitis
-trochanteric bursitis -sciatica -arthritis of hip |
|
|
If low back pain radiates into the legs (and has numbness/paresthesia), what might be the cause? What will make it worse?
|
-sciatica
-cough or valsava worsens |
|
|
If low back pain radiates into the legs, but will resolve with rest or forward flexion of the lumbar vertebrae- what might be the cause?
|
spinal stenosis
|
|
|
Low back pain with bowel/bladder dysfunction raises suspicion of what?
What are the bladder abnormalities seen? |
cauda equina syndrome (S2-4)
-see retention and overflow incontinence |
|
|
Name some red flags that should be considered if seen with low back pain.
-What might red flag issues w/ low back pain indicate? |
-50 y/o +
-hx of cancer -unexplained weight loss -pain 1 month+, no response to treatment -pain at night -pain worse w/ rest -hx IV drug use -infection present -these indicate 10% chance of serious systemic disease |
|
|
Radicular neck pain is due to what problem? WHat causes this?
What vertebrae is it commonly seen at? |
-spinal nerve compression
-due mainly to degen joint changes...some to herniation -#1= C7 -#2= C6 |
|
|
Polyarticular joint pain means what?
|
-several joints are painful
|
|
|
Migratory pattern of polyarticular joint pain is seen with what?
What about progressive additive polyarticular pain that is symmetrical? |
-rheumatic fever
-gonococcal arthritis -RA |
|
|
Generalized aches/pain in muscles are called what?
If there is pain but no evidence of arthritis, this is called? |
-myalgia
-arthralgia |
|
|
What are some features associated with articular joint pain?
|
-pain
-swelling -lose active & passive ROM -locking -deformity |
|
|
What are some features of nonarticular pain?
|
-tender outside joint
-lose active ROM only -no deformity |
|
|
Stiffness and limited ROM after being inactive is known as what? When can you see it?
-How long does it last? |
-gelling
-degen joint disease (OA) -lasts a few minutes |
|
|
How long does stiffness from RA usually last?
|
30mins+
|
|
|
Joint pain accompanied by a high fever and chills suggest a cause that is due to what?
|
-infection
|
|
|
Name the systemic disorder causing joint pain that is seen with:
-butterfly rash on cheeks |
SLE
|
|
|
Name the systemic disorder causing joint pain that is seen with:
-scaly skin rash, pitted nails |
psoriasis
|
|
|
Name the systemic disorder causing joint pain that is seen with:
-papules, pustules or vesicles that have red bases -will be on distal extremities |
gonococcal arthritis
|
|
|
Name the systemic disorder causing joint pain that is seen with:
-expanding erythematous rash |
lyme
|
|
|
Name the systemic disorder causing joint pain that is seen with:
hives |
-serum sickness
-drug reaction |
|
|
Name the systemic disorder causing joint pain that is seen with:
-erosions on junk -scaling lesions on soles/palms |
reiters syndrome (arthritis, urethritis, uveitis)
|
|
|
Name the systemic disorder causing joint pain that is seen with:
clubbing of nails |
-hypertrophic osetoarthopathy
|
|
|
Name the systemic disorder causing joint pain that is seen with:
conjunctivitis |
-reiters
-behcets syndrome |
|
|
Name the systemic disorder causing joint pain that is seen with:
-a sore throat right before it |
-acute rheumaticc fever
-gono arthritis |
|
|
Name the systemic disorder that can cause joint pain in addition to its primary signs of diarrhea, cramps and and pain.
|
-ulcerative colitis (cause arthritis)
-scleroderma |
|
|
WHat % of people experience low back pain in their life?
|
60-80%
|
|
|
__% of people with osteoporosic hip fractures will die within 1 year.
|
20%
|
|
|
When is bone mass at its highest?
|
2nd decade
|
|
|
Bone density is determined by what interactions
|
-bone mass
-new bone formation -bone resortpion |
|
|
What is bone quality?
|
-architecture, turnover, damage accumulation from micro fractures & mineralization
|
|
|
Bone mineral density accounts for what % of bone strength?
|
70%
|
|
|
A bone density 1-2.5 SD's below the mean for young adult white women is known as what?
|
-osteopenia
|
|
|
A bone density 2.5+ SD"s below the mean for young adult white women is known as what?
|
-osteoporosis
|
|
|
Where do you measure bone density?
|
-hip
-femoral neck -wards triangle (femoral neck) -greater trochanter -total hip (all measurements) |
|
|
A 10% drop in bone desity is equivalent to __ SD, which is associated with a ___% increase in fracture risk.
|
1 SD
20% increase |
|
|
Routine bone density screening is recommended for women of what ages?
|
-65+
-for young women with RF's |
|
|
Name some RFs for osteoporosis
|
-postmeno
-50 y/o + -weigh less than 70kg -fam hx -fracture hx -alchy -delayed period, early meno -smokers (current) -low vit D -use steroids for 2+ months -inflamm disorders |
|
|
What can be given to prevent osteoporosis that works by reducing age related hyperparathyroidism?
|
Ca intake
|
|
|
Name some anti-resoprtive agents that can be given to help osteoporosis.
|
-bisphosphonates
-SERMs -calcitonin -postmeno estrogen |
|
|
Palpable bogginess or doughiness of the synovial membrane indicates what? WHat might also be present?
|
-synovitis
-effusion |
|
|
You find tenderness & warmth over a thickened synovium. WHat might be the cause?
What if it is also red over the tender joint? |
-infection
-arthritis -RA |
|
|
The TMJ is formed by the articular tubercle of the ___ bone and the condyle of the ___.
|
-temporal
-mandible |
|
|
What is the most active joint in the body?
|
-TMJ
opens/close 2000x a day |
|
|
What type of joint is the TMJ?
|
-condylar synovial
|
|
|
What are the primary muscles that open the mouth?
Closing the mouth? |
-open: external pterygoid
close: masster, temporalis, internal pterygoid |
|
|
Where will swelling from TMJ problems show up?
|
-round bulge 1/2cm anterior to EAM
|
|
|
What problems will accompany TMJ syndrome?
|
-facial asymmetry
-U/L chronic pain w/ chewing -jaw clenching -teeth grinding -headache (w/stress) |
|
|
How can you locate the TMJ on exam?
|
-put fingers in front of tragus
-ask them to open mouth -fingertips will drop into joint space |
|
|
Where can you feel the masseter? Temporal muscle? Pterygoid?
|
-masseter: angle of mandible
-Temporal: when clench/relax jaw -pterygoid: internal b/t tonsillar pillars at the mandible |
|
|
The humeral head contacts less than ___ of the surface area in the glenoid fossa.
|
1/3
|
|
|
For the shoulder, what does a muscle that is known as a dynamic stabilizer do?
Static stabilizer? |
-its capable of movement
-static: no movement |
|
|
Name some dynamic & static stabilizers of the shoulder.
|
-dynamic (cause mvmt):
"scapulohumeral group"=SITS -move humerus, depress/stabilize head in fossa -static (do not cause movement) - shoulder girdle, labrum, GH ligaments |
|
|
What does the labrum do for the shoulder?
|
-fibrocart ring
-surrounds glenoid -deepens socket -more stability for humeral head |
|
|
Which of the SITS muscles attaches to the greater tubercle? Lesser?
|
-greater= SIT
-lesser: subscapularis |
|
|
Three major groups of muscles attach at the shoulder. What are they called?
|
-scapulohumeral (SITS)
-axoiscapular (trap, rhomboid, ser ant, levator) -axoihumeral (pecs, lat dorsi) |
|
|
Name the primary motions for these muscle groups at the shoulder:
-scapulohumeral -axioscapular -axiohumeral |
-scap:
rotate shoulder lateral depress/rotate head of humerus -axoiscap: rotate scap -axiohumeral: IR of shoulder |
|
|
Where is the subacromial bursa located?
What motion will compress it? |
-b/t acromion & head of humerus
-on top of supraspinatus tendon -abduction of the shoulder |
|
|
With subacromial inflammation, what types of movement will cause pain? Where will it be felt?
|
-tender below tip of acromion
-abduction/rotation cause pain |
|
|
2-3 weeks after a rotator cuff tear, you might see what change on the posterior aspect of the scapula?
|
-atrophy of infra/supraspinatus
-see prominence of scapular spine |
|
|
Where do the SITS muscles of the shoulder insert?
|
SIT= greater tubercle
subdscap= lesser |
|
|
What SITS muscle of the shoulder is directly under the acromion?
|
supraspinatus
|
|
|
Where are infraspinatus and teres minor located in respect to supraspinatus?
|
infra: post to supra
teres minor: post and inf to supra |
|
|
Local tenderness of the rotator cuff area can arise from what types of problems?
What about tenderness that is accompanied by an inability to raise the arm above shoulder level? |
-subacromial/subdeltoid bursitis
-degen changes -calcified deposits in rotator cuff Cant raise arm too: -sprains, tears, tendon rupture |
|
|
If you can palpate tenderness and effusion of the glenohumeral joint what could this mean?
What if the margins of the capsule and synovial membrane are palpable? |
-GH joint synovitis
-if can feel them large effusion present (smaller ants of effusion not palpable) |
|
|
Restricted ROM at the shoulder could be due to what?
|
-capsulitis
-bursitits -rotator cuff tears -sprains -tendinitis |
|
|
What are the principal muscles of movement for shoulder flexion?
|
-ant deltoid
-pec major (clavic head) -coracobrachialis -biceps (short head) |
|
|
What are the principal muscles of movement for shoulder extension?
|
-post deltoid
-lat dorsi -teres major -triceps (long head) |
|
|
What are the principal muscles of movement for shoulder abduction?
|
-supraspinatus
-middle deltoid -serr ant |
|
|
What are the principal muscles of movement for shoulder adduction?
|
-pec major
-coracobrachialis -lat dorsi -teres -subscapularis |
|
|
What are the principal muscles of movement for shoulder IR?
|
-subscapularis
-ant deltoid -pec major -teres major -lat dorsi |
|
|
What are the principal muscles of movement for shoulder ER?
|
-infraspinatus
-teres minor -post deltoid |
|
|
Patients over 60 who have a (+) drop arm test are likely to have what problem?
What additional findings will make this dx more likely? |
-rotator cuff tear
-VERY likely if also have all 3 of these: supra & infra= weak (+) impingement signs |
|
|
Name the test used to examine for problems of the AC joint.
|
cross over test (adduct arm across)
|
|
|
Pain with the cross over test (shoulder) suggests what kinds of problems?
|
AC joint arthritis or inflammation
|
|
|
Apleys scratch test looks for what problems?
|
-rotator cuff problems (IR/ER)
|
|
|
How is Neers impingement test done? What does it tell you?
|
-flex their arm up, pressing on scapula to prevent motion there
-will compress greater tuberosity against acromion -(+)= rotator cuff tear |
|
|
What does hawkins impingement sign test for? How is it done?
|
-flex shoulder and elbow
-IR of arm -compress coracoacromial ligament (+)= rotator cuff tear |
|
|
The empty can test will look at problems with what muscles? How is it done? What does a (+) test signify?
|
-supraspinatus
-elevate arms to 90, IR arms (thumbs pointing down) -ask them to resist you as you press down on their arms -weakness= rotator cuff tear |
|
|
How do you test for the strength of infraspinatus?
|
-put arms at side, flex elbows to 90
-thumbs up -ask them to press their arms outward as you resist them -weak= rotator cuff tear, bicipital tendinitis |
|
|
Pain during supination of the arm could be due to what?
|
-inflammation of biceps tendon (long head)
-rotator cuff tear |
|
|
What is the "drop arm sign"? What does it tell you?
|
-ask them to fully abduct arm to shoulder level and lower it slowly
-if they can't= rotator cuff tear |
|
|
Abduction of the shoulder from 90-120 is done by what muscle?
|
deltoid
|
|
|
Name the joints of the elbow.
|
-humeroulnar
-radiohumeral -radioulnar |
|
|
-What are the principal muscles of elbow movement for flexion?
|
-biceps
-brachialis -brachioradialis |
|
|
-What are the principal muscles of elbow movement for extension?
|
-triceps
-aconeus |
|
|
-What are the principal muscles of elbow movement for supination?
|
-biceps
-supinator |
|
|
-What are the principal muscles of elbow movement for pronation?
|
-pronator teres
-pronator quadratus |
|
|
What is found between the olecranon process and the skin? Is it normally palpable?
|
-olecranon bursa
-only palp when inflamed |
|
|
What runs posteriorly in the ulnar groove b/t the medial epicondyle and the olecranon process?
|
ulnar nerve
|
|
|
On the ventral forearm, what nerve is medial to the brachial artery?
|
median nerve
|
|
|
Swelling over the olecranon process is due to what?
What if you find inflammation or synovial fluid build up? |
-olecranon bursitis
-arthritis |
|
|
Lateral or medial epicondylitis: tennis elbow
|
-lateral
|
|
|
Lateral or medial epicondylitis: golfers/pitchers elbow
|
medial
|
|
|
What can cause posterior displacement of the olecranon?
|
-posterior dislocation of elbow
-supracondylar fracture |
|
|
If a patient who complains of elbow problems is able to reach full elbow extension, what problems are most likely eliminated?
|
-intra-articular effusion
-hemiarthrosis |
|
|
Name the carpal bones.
|
-Medial (by radius) to lateral
-scaphoid, lunate, triquet., -trapezium, trapezoid, capitiate, hamate |
|
|
What joint of the wrist provides the most flexion/extension?
|
-radiocarpal joint
|
|
|
What muscles of the hand cause flexion?
Abduction? Adduction? |
flex= lumbricals
abduct= dorsal interossei D(orsal)=ABduct (DAB) adduct= palmar interossei P(almar)=ADDuct (PAD) |
|
|
How many flexor and extensor tendons are found in the hand?
|
extensor= 6
flexor=2 |
|
|
What nerve goes thru the carpal tunnel?
|
median
if you don't know this, stab yourself. |
|
|
What ligament holds the tendons/tendon sheath of the carpal tunnel in place?
|
-flexor retinaculum
|
|
|
What lies between the flexor retinaculum and the tendon sheath of the carpal tunnel?
|
median nerve
|
|
|
Name the areas of sensation/ motor in the hand provided by the median nerve?
|
Sensation: 1st, 2nd, 3rd digits, half of 4th
-thumb motor: flex, abduct, opposition |
|
|
If the fingers are misaligned, what could be the cause?
|
flexor tendon damage
|
|
|
What kinds of joint issues of the hand will be seen with osteoarthritis?
|
-Heberdens nodes (DIP joint)
-Bouchards nodes (PIP joint) |
|
|
What joint damage of the hand will be seen with RA?
|
-symmetric deformities in PIP, MCP, wrist joints
(swan neck, boutonneire) -ulnar deviation of fingers |
|
|
What will cause thenar and hypothenar wasting?
|
-thenar: carpal tunnel (compress median n)
-hypothenar: ulnar n compression |
|
|
If you see flexion contractures in the 3rd, 4th or 5th digits what is the cause?
|
-dupuytrens contractures
-due to palmar fascia thickening |
|
|
Tenderness over the distal radius can be due to what type of fracture? What other things may hint at having a fracture?
|
-colles fracture
(as per the one liners...this causes a "dinner fork" appearance on X-ray other sign of fracture: -bony step offs/tenderness |
|
|
If you see tenderness over the extensor/abductor tendons of the thumb at the radial styloid, what could be the cause?
|
-de quervains tenosynovitis
-gonococcal tensynovitis -infections of tendon sheath, palmar space or fingers |
|
|
What is the most common injured carpal bone? Where will it produce tenderness? What is this area susceptible to?
|
-scaphoid
-snuff box -susceptible to avascular necrosis b/c of poor blood supply |
|
|
When is the snuff box area more visible?
|
-with lateral extension of the thumb away from the hand
|
|
|
When you shake a persons hand, they might feel pain if they have what type of problem?
|
-synovitis of MCP's (medial pressure from shaking hurts)
-RA has this (osteoarthritis rarely does) -may also see with post traumatic arthritis |
|
|
Carpometacarpal arthritis will cause pain where?
|
base of thumb
|
|
|
Psoriasis can cause pain at what joints of the hand?
|
DIP joint
|
|
|
What conditions will impair ROM at the wrist?
|
-arthritis
-tenosynovitis -dupuytren contracture |
|
|
What muscles are responsible for flexion at the wrist?
|
-flexor carpi radialis & ulnaris
|
|
|
What muscles are responsible for extension at the wrist?
|
-extensor carpi ulnaris
-extensor carpi radialis longus & brevis |
|
|
What muscles are responsible for adduction at the wrist (radial deviation)?
|
-flexor carpi ulnaris
|
|
|
What muscles are responsible for abduction at the wrist (ulnar deviation)?
|
-flexor carpi radialis
|
|
|
How many degrees of radial and ulnar deviation of the wrist are normally seen?
|
-radial: 20
-ulnar: 30 |
|
|
Name some things that can cause onset of carpal tunnel syndrome?
|
-repetitive motion
-preggo -RA -diabeetus -hypothyroidism |
|
|
On the palmar surface of the hand, what nerve provides sensation to 1/2 of the 4th digit and also the pinky?
|
-ulnar
|
|
|
On the dorsal side of the hand, what nerves provide sensation?
|
-ulnar: pinky, half of 4th
-median: tips of 1, 2, 3, 1/2 of 4th -radial: back of hand |
|
|
Name places that are best suited to test sensations of the nerves to the hand.
|
-pulp of index: median
-pulp of pinky: ulnar -dorsal web space of thumb & index finger: radial |
|
|
What actions does grip strength test? What does a weak grip signify?
|
-tests function of wrist joint, finger flexors, intrinsic hand muscles
weak= - weak finger flexors/intrinsic hand muscles -arthritis -carpal tunnel -epicondylitis -cervical radiculopathy |
|
|
What if you find a patient has a weak grip strength and also wrist pain?
|
-de quervians tenosynovitis
|
|
|
What is finkelsteins test?
|
-pt will grasp their thumb against their palm, then move the hand in ulnar deviation
-pain= de quervians tenosynovitis (inflammation of abductor pollicis longus, extensor pollicis brevis tendon, tendon sheaths) |
|
|
If a patient has weak abduction of the thumb what might this indicate?
|
-abductor pollicis longus (median n)
carpal tunnel |
|
|
Tinels and phalens can clue in to what problem?
How long should there be numbness/tingling to be positive? |
-carpal tunnel
-60 seconds |
|
|
What hand muscles cause flexion & extension of the PIP & DIP joints?
|
lumbricals
|
|
|
Trapezius causes what motion of the neck?
|
extension
|
|
|
SCM causes what motion of the neck?
|
-flex, rotate
|
|
|
What are the outermost muscles of the the back/neck?
|
-lat dorsi
-trap |
|
|
Splenius capitis causes what motion of the neck?
|
extension
|
|
|
If you see lateral deviation and rotation of the head, what is the cause?
|
-torticollis (SCM)
|
|
|
At which vertebral levels are the spinous processes most prominent? What position will accentuate this?
|
C7 & T1
-flexion |
|
|
What vertebral level is marked by the iliac crest?
|
L4
|
|
|
Where do facet joints of the cervical spine lie? How can you feel these the best?
|
1in lateral to SPs of C2-7
have neck muscles relaxed (since are deep to trap, may be hard to feel otherwise) |
|
|
What facet joints of the C spine are especially tender with arthritis?
|
C5-6
|
|
|
Where should you look for "step offs" between SPs to see if there are any prominent/recessed spaces?
What can cause changes in the normal step offs? |
-lumbar spine
-spondylolisthesis |
|
|
What feature can be used to identify the sacroiliac joint?
What might cause tenderness in this area? |
dimple of skin over PSIS
-sacroilitis -ankylosing spondylitis |
|
|
You should use the (ulnar or radial) surface of your fist to test "thumping" of the spine for tenderness. If there is tenderness, it could be due to what?
|
-ulnar surface
-osteoporosis, infection, cancer |
|
|
Age can cause what change in thoracic spine?
|
increased kyphosis
|
|
|
Name some signs on exam you might see for scoliosis.
|
-unequal shoulder height
-pelvic tilt |
|
|
Birthmarks, port wine stains, hairy patches and lipomas can often overlie what defects?
|
bony defects (spina bifida)
|
|
|
What types of things might you see in someone with neurofibromatosis?
|
-caufe au lait spots
-skin tags -fibrous tumors McCune-Albright syndrome: polyostotic fibrous dysplasia -multiple u/l bone lesions, endocrine problems (early puberty), cafe au laid spots |
|
|
What types of things can cause spasm of the paravertebral muscles?
|
-degen/inflamm processes in muscles
-bad posture -anxiety |
|
|
The largest nerve in the body is what? What are the levels?
|
-sciatic
-L4-S1 |
|
|
Where does the sciatic nerve lie?
|
-b/t greater trochanter and ischial tuberosity (as it does thru sciatic notch)
|
|
|
What can cause sciatic nerve tenderness?
|
-herniated disc
-mass lesion impinging on roots |
|
|
What is the most serious cause you should look in to when people complain of low back pain?
|
-cord compression (since it can cause paralysis)
|
|
|
What lumbar levels are most commonly herniated? WHat signs might they produce?
|
L5-S1 or L4-5
-tender SPs, intervertebral joints, paravertebral muscles, sciatic nerve, sciatic notch |
|
|
Aside from a herniated lumbar disc, what systemic problem may cause tender intervertebral joints?
|
RA
|
|
|
Aside from a msuculoskeletal problem, what can cause CVA tenderness?
|
kidney infection
|
|
|
Name the primary motion seen at:
OA AA C2-7 |
OA: F/E
AA: rotation C2-7: SB |
|
|
What muscles are responsible for flexion of the neck?
|
-SCM
-scalene -prevertebral |
|
|
What muscles are responsible for extension of the neck?
|
-splenius capitis & cervicis
-intrinsic neck muscles |
|
|
What muscles are responsible for rotation of the neck?
|
-SCM
-intrinsic neck muscles |
|
|
What muscles are responsible for SB of the neck?
|
-scalenes
-intrinsic neck muscles |
|
|
Tenderness from C1-2 due to what systemic disease can put a patient at risk for subluxation/ high cervical cord compression?
|
RA
|
|
|
What muscles are responsible for flexion of the back?
|
-Psoas
-quad lumborum -abdominal muscles (obliques, rectus) |
|
|
How do you measure flexion of the spine?
|
-mark spine at lumbosacral junction
-then mark 10cm above, and 5 cm below that point -A 4 cm increase b/t the upper mark is normal -the distance bwteen the lower marks shouldn't change |
|
|
The persistence of lumbar lordosis with flexion indicates what problems?
|
-muscle spasm
-ankylosing spondylitis |
|
|
What muscles cause extension of the back?
How should you support the patient while testing this motion? |
-deep intrinsic back muscles (erector spinae, transversospinalis)
-put your hand on PSIS with fingers pointing towards midline |
|
|
What muscles cause rotation of the back?
How should you stabilize the pt while testing this? |
-abdominal
-intrinsic back muscles -put one hand on hip, other hand on opposite shoulder -rotate the trunk by pulling the shoulder then the hip posteriorly |
|
|
What muscles cause SB of the back?
How should you stabilize the patient while testing this? |
-abdominal
-intrinsic back -put hand on the hip |
|
|
The hip joint lies below what portion of the inguinal ligament?
|
-below middle 1/3
|
|
|
What is the primary muscles of the hip causing flexion?
|
iliopsoas
|
|
|
What muscle will cause hip extension?
|
-glut max
|
|
|
What is the primary muscles of the hip causing abduction?
|
-glut med & min
|
|
|
What are the primary muscles of the hip causing adduction?
|
-adductor brevis, longus, magnus
-pectinueus -gracilis |
|
|
What are the primary muscles of the hip causing ER?
|
-obturator
-quad femoris -sup & inf gemelli |
|
|
What are the primary muscles of the hip causing IR?
|
-glut med & min (also do abduction)
|
|
|
What structure lies on the posterior surface of the greater trochanter?
|
-trochanteric bursa
|
|
|
-What lies under the ischial tuberoisity? What is this in close proximity to?
|
-ischial bursa
(not always present) -close to sciatic n |
|
|
WHat lies anterior to the psoas muscle?
|
-iliopsoas bursa (aka ileopectineal bursa)
|
|
|
When do most gait problems appear- during the stance or swing phase?
|
stance (weight bearing)
|
|
|
When the foot is on the ground and is bearing weight, this is the (stance/swing) phase
|
stance
|
|
|
What part of the walking cycle takes up 60%?
|
stance
|
|
|
When the foot moves forward during walking and does not bear weight, this is the (stance/swing) phase? What percent of the cycle does this make up?
|
-swing
-40% |
|
|
A wide based gait suggests what problems?
|
-cerebellar
-foot problems |
|
|
During walking, the width of the base should be how long from heel to heel?
|
2-4inches
|
|
|
Normal smooth walking with a constant rhythm is due in part to contraction of what muscles?
|
-abductors of weight bearing limb
-stabilizes the pelvis and helps keep balance |
|
|
What can cause the pelvis to drop to the opposite side during walking to produce a waddling gait?
|
-hip dislocation
-arthritis -abductor weakness |
|
|
Lack of flexion of the ___ will interrupt smooth gait.
|
knee
|
|
|
Loss of lumbar lordosis can be due to what?
WHat about having excessive lordosis? |
-loss: paravertebral spasm
-excess: flexion deformity of hip |
|
|
Name some things that produce leg length differences.
What if one leg is short and externally rotated? |
-abd/adduction deformities
-scoliosis -short & ER= hip fracture |
|
|
The widest part of the iliac crest is what?
|
-iliac tubercule
|
|
|
The pubic symphysis lies at the same level as what other structure?
|
greater trochanter
|
|
|
An imaginary line is often used along the PSIS to signify what vertebral level?
|
S2
|
|
|
Bulges along the inguinal ligament might signify what things.
|
-hernia
-aneurysm |
|
|
Enlarged LNs in the pelvic area can be due to what?
|
-pelvis/ LE infections
|
|
|
Tenderness in the groin area could be due to what?
|
-synovitis of hip
-bursitis -psoas abcess |
|
|
The inguinal ligament extends between what structures?
|
-ASIS to pubic tubercule
|
|
|
WHat is the mnemonic for remembering the contents that lie below the inguinal ligament?
|
NAVEL
- (LATERAL) femoral nerve, art, vein, empty, LN (MEDIAL) |
|
|
Trochanteric bursitis will have tenderness over what part of the trochanter and also what other signs?
|
-posterolateral surface of trochanter
-tendinitis/muscle spasm from referred hup pain |
|
|
What position is best to feel the trochanteric bursa?
|
-lay on side
-hip flexed & IR |
|
|
What is "weavers bottom?" Is this normally palpable? What may this mimic?
|
-ischiogluteal bursitis (over ischial tuberosity)
-not palp unless inflamed -close to sciatic, so may mimic sciatica |
|
|
What can you do when testing hip ROM to get full flexion?
|
-flex the knee
|
|
|
You monitor the back while testing hip flexion. What are you looking for?
|
-when you feel the back touch your hand here is normal flattening of the lumbar lordosis
-any further flexion will be from hip joint itself |
|
|
A flexion deformity of the hip will appear as what while testing ROM?
A flexion deformity can be masked by what problems? |
-when opposite hip is flexed, the affected hip doesn't allow full leg extension
-the affected thigh will look flexed (psoas test: bend one hip, if other leg starts to lift off table you have a dysfunction) -MASKED by: -increased lordosis and anterior pelvic tilt |
|
|
Restricted hip (adduction/abduction) is common with osteoarthritis?
|
abduction
|
|
|
How can you tell that maximal hip abduction has been reached?
|
-feel the ASIS move
|
|
|
The movement of what structure is used to define ER/IR of the hip?
|
-motion of head of femur in acetabulum
|
|
|
What way do you move the ankle to induce ER/IR of the hip?
|
-ER: make ankle go medial
IR: make ankle go lateral |
|
|
Restrictions in ER/IR of the hip are sensitive indicators for what disease?
|
-arthritis
|
|
|
What joint is the largest joint in the body? What type of joint is it?
|
knee
hinge joint |
|
|
The femoral condyles rest against what?
|
tibial plateau
|
|
|
Is the adductor tubercle on the medial or lateral side of the knee?
|
medial
|
|
|
The patella is embedded in the tendon of what muscle?
|
quad
|
|
|
The quad tendon continues below the patella to terminate as the ___ tendon that inserts where?
|
-patellar
-distal insertion on tibial tuberosity |
|
|
What forms the tibiofemoral joint?
|
-convex curves of femoral condyles
-articulate with concave condyles of tibia |
|
|
The patella slides on grooves of what?
|
-anterior aspect of distal femur= trochlear groove
|
|
|
What muscle causes extension of the leg? What about flexion?
|
-extend: quads
-flex: hamstrings |
|
|
What do the lateral & medial menisci of the knee help cushion?
|
-movement of femur on tibia
|
|
|
What does the MCL of the knee attach to?
|
-medial fem condyle to medial tibial condyle
-also attaches to medial meniscus |
|
|
What does the LCL of the knee connect to?
|
-lat fem condyle to head of fibula
|
|
|
What are the attachments of the ACL?
|
-cross obliquely
-anterior medial tibia to lat fem condyle |
|
|
WHat are the attachments of the PCL?
|
-posterior tibia/lateral meniscus t the medial femoral condyle
|
|
|
What space is located deep to the quad muscle of the thigh?
|
-suprapatellar pouch
|
|
|
Name the bursae that lie near the knee
|
-prepatellar: b/t patella and skin
-anserine: 1-2'' below knee, medial surface (close to attachment of medial hamstring muscles with tibia) -semimembranous: posterior & medial surface of knee |
|
|
What signs of quad weakness might be observed while walking?
|
-stumbling
-pushing the knee into extension using the hand during heel strike |
|
|
What is another term for "bow leg"
What about "knock knees" |
Bow= Varus
Knock= valgus |
|
|
Flexion contracture of the leg means an inability to...
|
fully extend limb
|
|
|
Swelling over the patella can be due to...
swelling over the tibial tubercle indicates what? What about if it is more medial? |
-prepatellar bursitis
-tibial: infrapatellar bursistis -medial: anserine bursitis |
|
|
When palpating the knee, if you notice tender bony ridges along the joint margins, a genu varum deformity or stiffness (30 mins of less) what might be the cause?
What might also be seen with this? |
-osteoarthritis
-crepitus |
|
|
What positions of the knee will facilitate feeling the menisci?
|
-medial: put the tibia in IR
-lateral: knee slight flexion |
|
|
A tear of which menisci of the knee is more common after trauma?
|
medial
|
|
|
The adductor tubercle of the femur is (anterior or posterior) to the medial femoral condyle
|
posterior
|
|
|
Which knee injury is more frequent: MCL or LCL tears.
|
MCL
|
|
|
If you ask your patient to cross one leg so that the ankle rests on the opposite knee, you will have an easy time feeling what ligament on the crossed knee?
|
LCL
|
|
|
What might you notice in terms of movement if someone has a partial/complete tear of the patellar tendon?
|
-tender over the tendon
-cant extend leg |
|
|
If pain and crepitus is felt during the patellar grind test what could be the cause?
What will the patient do on a daily basis that will cause the same pain? |
-roughening of underside of patella where it articulates with femur
-chondromalacia (aka degen patella..."patellofemoral syndrome") -going up stairs, get up from chair |
|
|
If you notice swelling above/near the patella, what does this signify?
How will you know its from osteoarthritis? |
synovial thickening/effusion of
knee joint -will feel thick, boggy, warm. Effusions= nontender |
|
|
To feel the supra patellar pouch, you should start how far above the patella?
|
10cm
|
|
|
What is "housemaids knee" also known as?
|
prepatellar bursitis (excessive kneeling)
|
|
|
What types of things can case anserine bursitis?
|
-running
-valgus knee deformity -fibromyalgia -osetoarthritis |
|
|
What process causes the appearance of a bakers cyst in the popliteal fossa?
What disease will cause this to happen? |
-distension of the gastric semi membranous bursa
-RA |
|
|
On what side of the knee can you feel the pre patellar and anserine bursae?
|
-posteromedial side of the knee (b/t MCL and tendons inserting on medial tibia)
|
|
|
What are the names of the 3 tests used to find effusion of the knee joint?
|
-bulge sign (minor effusion)
-balloon sign (major) -ballotting the patella |
|
|
Describe doing the bulge sign for the knee.
|
-extend knee
-put hand above knee and apply pressure to supra patellar pouch -this will displace or milk the fluid down -stroke down on medial side of knee to force fluid out -tap the knee behind lateral patella with other hand |
|
|
When doing the bulge sign test to the knee, what indicates a (+) test?
|
-fluid wave or bulge seen on medial side b/t patella and femur
=effusion (MINOR) |
|
|
Describe the balloon sign for finding knee effusions.
if present, what will you see? |
-put thumb and index on each side of patella
-with other hand compress the supra patellar pouch against the femur -feel for fluid entering or ballooning into space next to patella under thumb & index finger -if large effusion: compressing the supra patellar pouch will eject fluid into spaces adjacent to patella -see palpable fluid wave -the wave will then return to the pouch after (confirms effusion) |
|
|
describe how you would perform balloting of the patella. What will you see if effusion is present?
|
-compress the supra patellar pouch and push the patella sharply against femur
-watch for fluid returning to supra patellar pouch (confirms) |
|
|
Describe findings with achilles tendinitis.
|
-tenderness of tendon
-thickening of tendon above calcaneus -protuberant posterolateral bony process of calcaneus |
|
|
How can you test for integrity of the achilles tendon?
|
-pt is prone
-knee and ankle flexed to 90 -squeeze the calf and watch for plantar flexion or can ask the patient to kneel on a chair |
|
|
What is a positive finding for achilles tendon rupture on exam?
|
-absence of plantar flexion when squeezing the calf
|
|
|
What might a patient with achilles rupture complain of?
|
-sudden severe pain "gunshot wound"
-ecchymoses from calf into heel -flat footed gait w/ absence of "toe off" |
|
|
What muscles are responsible for flexion at the knee?
|
-hamstrings (biceps femoris, semitendinosus, semimembranosis)
|
|
|
What muscles are responsible for extension at the knee?
|
-quads (rectus femoris, vastus medialis/lateralis/intermedius)
|
|
|
What muscles are responsible for IR at the knee?
|
-sartorius
-gracilis -semitendinosis & semimembranosis |
|
|
What muscles are responsible for ER at the knee?
|
biceps femoris
|
|
|
What test is useful for evaluating the medial & lateral menisci of the knee?
|
-McMurray test
|
|
|
When doing the McMurray test...if you are applying a valgus stress/ER/extension and you hear a pop or click, what could be the cause?
|
-tear of posterior part of medial meniscus
-knee may lock on full extension |
|
|
What motion can be used to test for MCL integrity?
How is this done? Positive test is what? |
-abduction (valgus) stress
-supine, slight flex at knee -stabilize lateral knee/femur -other hand is on medial ankle -push knee medially, pull ankle laterally -opens joint on medial side of knee (=valgus stress) (+)= gap or pain in area |
|
|
What motion can be used to test for LCL integrity?
How is this done? Positive test is what? |
-adduction (varus) stress test
-same position as for MCL -but stabilize medial knee, other hand on lateral ankle -press in a medial direction on the knee (shove it midline) -pull ankle lateral -opens lateral side of knee (var us stress) (+)= gap or pain in area |
|
|
Integrity of the ACL can be tested using the anterior drawer test.
How is this done? Positive test is what? |
-anterior drawer test
-supine, hips and knees flexed to 90 -cup hands around knee, thumbs up at insertion of hamstrings -pull tibia forward and see if it slides forward from under femur (+): forward jerk showing contours of upper tibia (a few small degrees of forward movement is normal if equally found on opposite side) |
|
|
What is the lachman test? How is it done? What does a positive sign look like?
|
-supine
-flex knee to 15 -ER knee 0grab distal femur with one hand, upper tibia with other -move tibia forward and femur back -see how far forward it goes (+)= significant forward movement -ACL tear |
|
|
What motion can be used to test for PCL integrity?
How is this done? Positive test is what? |
-Posterior drawer sign
-supine, flex hip and knee -same hand positions for anterior drawer test -push tibia backwards, see how far it goes back relative to femur (+) big backwards movement |
|
|
The odds of having isolated PCL tears are....
|
rare
|
|
|
Name the 2 principal joints of the ankle.
|
-tibiotalar joint
-subtalar (talocalcaneal) joint |
|
|
The longitudinal arch is an imaginary line that spans from what to what?
|
-calcaneus --> along tarsal bones --> to metatarsals & toes
|
|
|
Where are the metatarsal heads palpable?
|
ball of foot
|
|
|
Where are the MP joints of the foot felt best?
|
-proximal to webs of toes
|
|
|
What muscles are responsible for plantar flexion?
Where do their tendons run? |
-gastroc
-soleus -plantaris -post tibial -tendons run behind malleoli |
|
|
What muscles are responsible for dorsiflexion of the foot?
|
-anterior tibial muscle
-extensor digitorum longus -extensor hallicus longus (tendons are on dorsum of ankle, anterior to malleoli) |
|
|
The deltoid ligaments are found on what side of the foot?
What do these prevent? |
medial
-emerge from below medial malleoli -prevent eversion stress (that brings ankle inwards) |
|
|
What 3 ligaments are found laterally along the foot?
|
-ant talofibular
-post talofibular -calcaneofibular -prevents inversion stress (that make ankle bow outward) |
|
|
What ligament found laterally along the food is most often injured from inversion injuries?
|
anterior talofibular
(ATF= always torn first) |
|
|
Where does the plantar fascia insert?
|
medial tubercle of calcaneus
|
|
|
What changes might RA induce to the achilles tendon?
|
rheumatoid nodules
|
|
|
What can RA do to the plantar fascia?
|
-plantar fascitis
|
|
|
What is the "ottowa ankle rule?"
|
-see after trauma
-cant bear weight after 4 steps -tender over posterior aspect of either malleoli (especially medial) = ankle fracture |
|
|
Compressing the MP joints of the foot by squeezing between the heads of the 1st and 5th metatarsals may help you detect what things?
|
-early sign of RA (tenderness)
-acute inflammation of 1st MP joint w/gout |
|
|
What is metatarsalgia?
|
-pain and tenderness of metatarsal heads
-see w/ trauma, arthritis, vasc compromise |
|
|
What issue can cause tenderness over the 3rd and 4th metatarsal heads (plantar surface)?
|
mortons neuroma
|
|
|
What muscles induce inversion of the ankle?
|
-ant & post tibial
|
|
|
What muscles induce eversion of the ankle?
|
fibularis longus & brevis
|
|
|
To test motion at the tibiotalar joint, what movements will you carry out?
|
-dorsi & plantarflexion
|
|
|
To test motion at the subtalar (talocalcaneal) joint, what movements will you carry out?
|
inverson & eversion of the FOOT
|
|
|
How can you tease apart pain on movement of the ankle that is due to arthritis vs a ligamentous strain?
|
-arthritis:
-hurts when move in any direction -lig sprain: -max pain when ligament is stretched |
|
|
To test motion at the transverse tarsal joint, what movements will you carry out?
|
inversion & eversion of the FOREFOOT
(not the whole foot like what was done for subtalar joint) |
|
|
How do you measure leg length?
|
-measure distance between ASIS and medial malleolus
-have tape cross the knee on medial side |
|
|
Name the normal range of motion (degrees) for:
-elbow flexion -supination of elbow -pronation of elbow |
-elbow flex (0-160)
-supination/pronation= 0-90 book sucks with this explanation |
|
|
For low back pain:
-what are some RFs that promote mechanical low back pain? |
-fat
-bad posture -occupation |
|
|
For mechanical low back pain, what signs might you see on the exam?
|
-paraspinal/facet tender
-lose normal lumbar lodosis -may have osteoporosis (increased thoracic kyphosis, tender SP on percussion, fractures) |
|
|
For sciatica:
-Pain shoots where? -what are some assoc sx? -what increases the sx |
-shoots down calf (Lateral leg L5, posterior leg S1)
-assoc: paresthesia, weak -aggravating: cough, sneeze, shitting (strain) |
|
|
On PE for someone with sciatica, what might you see?
|
-calf wasting (from herniation)
-weak ankle dorsiflexion -no ankle jerk -(+) crossed straight leg |
|
|
Chronic back stiffness can cause low back pain. Name 2 common reasons.
|
-ankylosing spondylitis
-diffuse idiopathic hyperostosis (DISH) |
|
|
What might you see on the PE for someone with chronic back stiffness.
|
-lose normal lordosis
-muscle spasm -dont flex or SB well -SB impaired most in thoracics |
|
|
Describe the pain pattern with lumbar spinal stenosis
|
-"pseudoclaudication pain" in back/legs
-bad when walking -better with rest and flexion -pain is vague but b/l |
|
|
What are some assoc sx with the pain of lumbar stenosis?
|
-paresthesias in legs
|
|
|
What causes lumbar spinal stenosis?
|
-hypertrophic degenerative disease
-ligamentum flavum thickens |
|
|
What might you see on PE in a patient with lumbar spinal stenosis?
|
-posture= flexed forward
-LE weak, hyporeflexia= LMN signs - (-) straight leg |
|
|
What are the causes of sciatica?
|
-herniated disc that compresses nerve roots
-sometimes from cancer -sometimes from cauda equina |
|
|
If someone has low back pain that is nocturnal in timing and is not relieved by rest, what might be the cause?
Name some examples. |
malignancy
ex: prostate, breast, lung, thyroid, kidney, multiple myeloma |
|
|
Low back pain might be due to referred pain from where? What does their pain feel like?
|
-ulcer, pancreatitis, panc cancer, chronic prostatitis, endometriosis, dissecting AA, retroperitoneal tumor
-deep, aching |
|
|
What effect will low back pain due to referred abdominal/pelvic issues have on spinal movements and ROM?
|
-both will be normal, no pain
|
|
|
Describe the causes and type of pain seen with mechanical neck pain.
|
-causes: bad posture, stress, poor sleep, poor head position while working
-pain -stiff, tight (upper backshoulder), headache -can last 6 weeks |
|
|
Prolonged poor neck posture and muscle spasm may lead to what?
|
torticollis
|
|
|
Mechanical neck pain may be seen with what disease?
|
fibromyalgia
|
|
|
Describe some sx seen with whiplash. WHen does it start? How long can it last?
|
-Starts next day
-can last more than 6 months (chronic) sx: -occip headache -paracervical pain -dizzy -tired -stiff -tender -decreased ROM |
|
|
Describe the pattern of pain felt with cervical radiculopathy.
|
-sharp
-burning -tingling -goes down neck and into 1 arm |
|
|
What pattern of sensory disruption will be seen with cervical radiculopathy?
|
-myotomal pain pattern (deep muscle)
NOT dermatomal |
|
|
Describe the way that a cervical radiculopathy causes pain.
Are there any associated sx? |
-spinal nerve is encroached upon
-may affect spinal nerve, nerve roots or both -feel paresthesia and weak |
|
|
What diseases/conditions can cause cervical radiculopathy?
|
-herniated disc
-MS -tumor -syrinx |
|
|
What nerve root is affected most w/ cervical radiculopathy? WHat will you see on the exam?
|
-C7 nerve root
-weak triceps -weak finger flexors & extensors |
|
|
What is the 2nd most common nerve root affected by cervical radiculopathy? What will you see on the exam?
|
-C6
-weak biceps, brachioradialis, wrist extensors |
|
|
What is cervical myelopathy? How is this different from radiculopathy? What can cause it?
|
-cervical cord compression
(radic= nerve root compression) -causes: -cervical spondylosis - disc herniation -osteoporosis induced stenosis - large central/paracentral disc herniation (cadua eq) |
|
|
What things will be seen in a patient with cervical myelopathy?
|
-neck pain
-b/l weak & paresthesias in UE & LE -urinary frequency -clumsy -hyperreflexia -clonus (wrist, knee, ankle) -(+) babinski -lhermittes sign |
|
|
What will exacerbate the sx seen with cervical myelopathy?
|
flexing neck
|
|
|
Name the cause of joint pain:
-inflammation of synovial membrane -erosion of cartilage/bone -common: PIP, MCP, MPJ -symmetrical, additive -persists in old ones as goes to new -comes and goes -SELDOM RED joint -worse for 1+ hr in AM or inactivity |
-RA
|
|
|
Name the cause of joint pain:
-lose cartilage -damages underlying bone, forming new bone at cartilage margin -additive but can be in 1 joint only -common in knees, hips, hands, C/L spine, wrists -may be small effusions in joint -may see bony enlargement -maybe tender, not red/swollen -briefly worse in am (5mins or less) or inactivity |
osteoarthritis
|
|
|
What is "degenerative joint disease" also known as?
|
osteoarthritis
|
|
|
Name the cause of joint pain:
-hot, red & tender joint -sudden onset (follows injury, surgery, fasting, excessive eating/alcohol) |
acute gout
|
|
|
Name the cause of joint pain:
-seen at base of big toe -early attacks confined to 1 joint -can last 2 weeks at first, then become more frequent/severe |
acute gout
|
|
|
Name the cause of joint pain:
-see tophi accumulate in joints, bursae, subcutaneous tissue -may see renal fail/stones |
-chronic gout
|
|
|
Name the cause of joint pain:
due to inflammatory rxn against micro crystals of sodium urate |
acute gout
|
|
|
Name the cause of joint pain:
due to MANY local accumulations of sodium urate in joints and tissues |
-chronic gout
|
|
|
What is polymyalgia rheumatic?
-WHere do you see it? -Name some assoc sx |
-unknown cause
-women 50+ -assoc w/ giant cell arteritis -muscles in hip, shoulder girdle -tired, depressed, lose weight, fever (are not truly weak) |
|
|
What is fibromyalgia?
Where do they feel pain? -What makes it worse? -assoc sx? |
-widespread musculoskel pain, tender points
-ALL OVER! esp neck, shoulders, hands, low back, knees -immobility, chronic use, chilling -assoc: sleep problems, morning fatigue |
|
|
With fibromyalgia, when is the stiffness worse during the day? What about the ROM?
|
-stiff worse in AM
-stiffness is worse at extremes in ROM |
|
|
For rotator cuff tendinitis:
-what tendon is most commonly involved? -what can cause it? -what will patients report is bothering them? -where will maximal tenderness be found? |
-supraspinatus
-cause: repeated shoulder motion (throw, swim) -complain they feel sharp catches, pain, grating, weak when lift arm overhead -if due to supraspinatus, maximal tenderness is below acromion tip |
|
|
For rotator cuff tears:
-forward flexion of the arm causes impingement of what? -you will see weakness/atrophy in what muscles -if complete tear, what one is most commonly torn? -what movements will be impaired? |
-impinge underside of acromion & coracoacromial lig
-supra, infra -complete tear: supraspinatus tendon -impaired mvmt: -active abduction, flexion (GH joint) |
|
|
What type of deformity of the shoulder and a (+) ___ test can confirm a diagnosis of rotator cuff tear (usually).
|
-shrugging of shoulder (effort upon raising)
-drop arm test |
|
|
What is calcific tendinitis?
What tendon is usually involved? What might the patient do to help minimize pain? Where is maximal tenderness? |
-degen process where have Ca salts deposit on tendon
-supra tendon -hold arm close to side (all motions are limited) -max tender: below acromion tip |
|
|
What bursa might be inflamed with calcific tendinitis of the supraspinatus tendon?
|
-subacromial bursa (it overlies that tendon)
|
|
|
Inflammation of the long head of the biceps tendon is known as what?
WHere will they feel pain? WHat is it often found co-existing with? |
-bicipital tendinitis
-ant shoulder pain -rotator cuff tendinitis |
|
|
Where will maximal tenderness be found w/ bicipital tendinitis?
How can you tease apart pain from bicipital vs supraspinatus tendinits? |
-ER and And the arm
-or w/ arm at side, flex elbow to 90, ask them to supinate the forearm against resistance -increased pain in biciptal groove confirms its bicipital (not supra) tendinitis |
|
|
What causes adhesive capsulitis?
WHat will it feel like? Prognosis? |
-fibrosis of GH joint
-diffuse, dull pain shoulder -progressive loss of active & passive ROM -no local tenderness -often a painful disorder b4 it -may resolve on own (partially) |
|
|
What motions can cause an anterior dislocation of the humerus?
What will happen when these movements are performed? |
-throwing, fall
-shoudler slips out of joint when arm is Abd & ER =(+) apprehension sign |
|
|
How will people try to minimize pain from anterior dislocations of the humerus? What might you notice looks different?
|
-hold arm in neutral at side
-shoulder is flat, not round |
|
|
Where will swelling be seen w/ olecranon bursitis?
|
-superficial to olec process
|
|
|
Where can you feel the synovial inflammation/fluid best with arthritis of the elbow?
|
-groove b/t olecranon & epicondyles on either side
-boggy, soft, swollen |
|
|
Where are rheumatoid nodules commonly seen?
How do they feel? |
-extensor surface of ulna @ pressure points
(other less common= achilles tendon, heart valves etc) -firm, not tender, not attached to overlying skin -may/not be attached to underlying periosteum |
|
|
Lateral epicondylitis is also known as...
What repetitive motions will cause it? |
-tennis elbow
-extension of wrist -pronation/sup of forearm |
|
|
Where is maximal pain felt with lateral epicondylitis?
How can you elicit the pain? |
-1cm distal to lateral epicondyle
-maybe pain in extensor muscles near by -elicit: -have them extend wrist against resistance |
|
|
Medial epicondylitis is also known as...
What repetitive motions will cause it? |
-golfers, pitchers, little league elbow
-wrist flexion (throwing) |
|
|
Where is maximal pain felt with medial epicondylitis?
How can you reproduce the pain? |
-lateral and distal to medial epicondyle
-have them flex wrist against resistance |
|
|
What joint disease causes fusiform or spindle shaped swelling in involved joints during the acute phase?
how will these joints look after it has become chronic? |
acute RA (PIP joints)
chronic RA: thick & swollen |
|
|
What disease causes "swan neck" or "boutonniere" deformities?
|
-RA (chronic)
|
|
|
Describe swan neck deformities. How do these differ from boutonniere?
|
-swan:
-PIP= hyperextend -DIP= fixed flexion -Boutonniere: opposite |
|
|
What way might fingers deviate with chronic RA?
|
ulnar side
|
|
|
Is the swelling and join damage a/symmetrical w/ RA?
|
symmetrical
|
|
|
Heberdens and bouchards nodes are seen with what disease?
|
osteoarthritis
|
|
|
Specific joint involvement in osteoarthritis differs from that of RA by in the hand in what way?
|
-OA does NOT affect the MCP joint
-MCP affected w/ RA |
|
|
With osteoarthritis... ____ nodes are seen on the dorsolateral sides of the DIP joints. ____ nodes are seen on the PIP joints.
Which is more common? How do they feel? |
PIP= bouchards
DIP= heberden -heberden is more common -feel hard, painless |
|
|
Knobby swellings and draining masses in the hand are seen with what joint disease?
|
chronic gout
|
|
|
The deformities of the hand seen with chronic gout are similar to those seen with what other issues?
|
-RA or osteoarthritis
|
|
|
One distinguishing feature between joint involvement in chronic gout vs RA is about how symmetrical the damage is. How do they differ?
|
-RA= symmetrical
-chronic gout= not |
|
|
The knobby swellings of what disease will ulcerate and discharge white chalk like substances?
|
-chronic gout
-substance is urates |
|
|
Name some basic differences in sx/presentation of acute vs chronic gout.
|
-Acute:
-usually 1 joint -sudden onset, night -no stiffness -maybe fever -Chronic -additive w/ joints -slow onset -stiff -fever, but also renal problems (fail, stones) |
|
|
The vagueness of clinical presentation/signs is in itself a clue to the presence of what syndrome?
|
fibromyalgia
|
|
|
On exam you see a thickened plaque over the ring & little finger flexor tendon (around distal palmar crease). You see that the skin there puckers and a thickened fibrotic cord has developed b/t the palm and finer. What is the cause?
What could eventually happen? |
-dupuytrens contracture
-may see flexion contractures of finger |
|
|
What causes trigger finger?
|
-painless nodule in flexor tendon near metacarpal head
-too big to enter easy into tendon sheath during extension -with extra effort, you can E then F the finger --> hear snap as it foes into tendon |
|
|
You are examining a patient and see a round, nontender swelling in the tendon sheath (or joint capsule). It is on the dorsum of the wrist. Flexing the hand makes it stand out more, extension tends to hide it. WHat is the cause?
|
-ganglion cyst
|
|
|
What other places besides the hand can ganglion cysts be found?
|
-wrist
-ankle -feet |
|
|
Infection of the flexor tendon sheaths is known as what?
What causes it? How will the affected area look? |
-acute tenosynovitis
-local injury causes it -see tender/swelling in tendon sheath (NOT JOINT) from MCP to DIP area. -finger held in slight flexion (extension hurts) |
|
|
If an infection from acute tenosynovitis passes from the ___ ___ into the ___ nearby, what will happen?
|
-tendon sheath into fascia nearby
-see spreading of tenderness and swelling to that area |
|
|
If you have an injury that causes an infection in the enclosed fascial spaces of the finger pad, this will cause what to form? How does it look?
|
-"felon"
-severe pain -local tenderness -swelling -dusky redness |
|
|
What can acute gouty arthritis of the great toe be mistaken for?
|
cellulitis
|
|
|
If upon standing you notice the longitudinal arch of a patients foot flattens, their sole touches the floor, medial concavity is lost (looks convex) and they have tenderness along the medial aspect of the foot- what is the cause?
What should you also inspect? |
-flat foot
-look at medial side of shoe (soles, heel) for excessive wear |
|
|
If the great toe is abnormally abducted (in relation to the 1st metatarsal), what is this called?
The 1st metatarsal itself will be deformed as well- how will it look? What else might you find on exam? |
-hallux valgus
-1st metatarsal: deviated medially -1st metatarsal head enlarges on medial side -bursa forms at pressure point (inflamed) |
|
|
A patient comes in complaining of pain over the bottom of their foot. It is localized to the 3rd & 4th metatarsal head-on the plantar side of the foot. They also complain of hyperesthesia, numbers, aching, burning in the same area. What is this called? What causes it?
|
mortons neuroma
-from entrapment of medial/lateral plantar nerves |
|
|
A patient complains of foot pain especially while active and moving. On exam you see a red overhanging nail fold, granulation, purulent discharge and tenderness. What is the cause? What is most commonly affected?
|
ingrown toe nail
-great toe= most |
|
|
How does a hammer toe look? What toe is most often involved?
|
-hyperextension of MPJ
-flexion of PIP -2nd toe |
|
|
What might form at areas of pressure points w/ hammer toe?
|
corns
|
|
|
What is a corn?
|
-painful conical thickening of skin
-from recurrent pressure on normally thin skin |
|
|
Where do corns usually develop? When would they be called "soft" corns?
|
-over bony prominences (like 5th toe)
-these places have thin skin there normally -"soft"- over moist areas (b/t 4th and 5th toes) |
|
|
The type of skin involved in corns vs calluses will differ how? The pain differs too- explain.
|
-corns: normally thin skin
-PAINFUL -callus: normally in thick skin (sole) -painLESS |
|
|
Where does the apex of a corn point?
|
-points inward
|
|
|
A callus should not be painful. If it is, what should you suspect?
|
-plantar wart underneath
|
|
|
What is another name for the plantar wart? Where are they often located?
|
-verruca vulgaris
-see in thick skin (sole) |
|
|
What might a plantar wart look like? What signs clue in to the presence of a plantar wart?
What happens to the skin nearby? |
-confuse w/ callus
(may actually be covered by one) -see small dark spots, make it look stippled -nl skin lines stop at the edge of the wart |
|
|
Describe neuropathic ulcers.
What will form around it to help in diagnosing it? |
-diminished pain sensation
-develop over pressure points -deep, infected, indolent -PAINLESS -callus formation around it helps dx |
|
|
As per the CE lecture...which gender most commonly has bow legs? Knock knees?
|
-Va(R)us= bow legs
-MALES (think of the R looking like a pot bellied male) -Valgus= knock knees -LADIES (vaLgus, Lateral, Ladies) |
|
|
As per the CE lecture...what is the stupid order of examination?
|
-Inspect
-palpate -ROM (active then passive) -strength -stability -special test |
|
|
What is a boxers fracture?
|
-displaced 5th metacarpal neck
|
|
|
Name some "nonarticular" problems.
|
-trauma
-fracture -fibromyalgia -polymyalgia rheumatica -bursitis -tendinitis |
|
|
The achilles tendon attaches which (2) muscles to the posterior calcareous?
|
-gastroc
-soleus |
