Musculoskeletal Red Print - Bates

Front 1

For midline back pain, assess for

Back 1

- musculoligamentous injury,

- disc herniation,

- vertebral collapse,

- spinal cord metastases,

- rarely, epidural abscess

Front 2

For back pain off of the midline, assess for

Back 2

muscle strain, sacroiliitis, trochanteric bursitis, sciatica, and hip arthritis;

also for renal conditions like pyelonephritis or stones

Front 3

Low Back Pain:

Sciatica is

Back 3

radicular gluteal and posterior leg pain in the S1 distribution that increases with cough or Valsalva

Front 4

Low Back Pain:

Spinal stenosis has

Back 4

leg pain that resolves with rest and /or lumbar forward flexion

Front 5

Low Back Pain:

Consider cauda equina syndrome from

Back 5

S2-4 midline disc or tumor if there is bowel or bladder dysfunction (usually urinary retention with overflow incontinence),

especially if there is saddle anesthesia or perineal numbness

Front 6

Black Print:

Low Back Pain - Key warning signs or "red flags" include:

Back 6

* age > 50 yrs,

* history of cancer,

* unexplained weight loss,

* pain lasting more than 1 month or not *

responding to treatment,

* pain at night or present at rest,

* history of intravenous drug use, or

* presence of infection

Front 7

In cases of low back pain plus another indicator (see red flags on previous card), there is:

Back 7

a 10% probability of serious systemic disease

Front 8

Neck Pain:

Radicular pain arises from:

Back 8

spinal nerve compression, most commonly C7 followed by C6

Front 9

Neck Pain:

Radicular pain is caused by:

Back 9

Unlike low back pain, it is usually caused by foraminal impingement from degenerative joint changes (70-75%),

rather than disc herniation (20-25%)

Front 10

Joint Pain:

Pain in one joint suggests

Back 10

injury, monoarticular arthritis, possible tendinitis, or bursitis

Front 11

Joint Pain:

Lateral hip pain near the greater trochanter suggests

Back 11

trochanteric bursitis

Front 12

Joint Pain (black print):

Tips for assessing joint pain

Back 12

* Ask pt to "point to the pain"

* Mechanism of injury (particularly if history of

trauma)

* Determine whether pain is chronic/acute, localized/diffuse, inflammatory/noninflamm

Front 13

Black Print:

Types of Joints

Back 13

Synovial - freely moveable (ie: knee, shoulder)

Cartilaginous - slightly moveable (ie: vertebra)

Fibrous - immovable (skull sutures)

Front 14

Black Print:

Synovial Joint Types

Back 14

* Spheroidal (ball and socket): wide ranging motion (ie - shoulder, hip)

* Hinge - motion in one plane, flexion/extension (finger joints, foot, elbow)

* Condylar - movement of two articulating surfaces not dissociable (ie: knee, temporo-mandibular joint)

Front 15

(Black print)

Monoarticular joint pain

Polyarticular joint pain

Extra-articular join pain

Back 15

Monoarticular: localized, involves one joint

Polyarticular: involves several joints, may have pattern of involvement

Extra-articular: involves bones, muscles, tissues around the joint (tendons, bursae, overlying skin)

Front 16

(Black print)

Myalgias defined

Arthralgias defined

Back 16

Myalgias - generalized "aches and pains" in muscles

Arthralgias - generalized "aches and pains" with pain but not evidence of arthritis

Front 17

Joint Pain:

Migratory pattern of spread is seen in

Back 17

rheumatic fever or gonococcal arthritis;

a progressive additive pattern with symmetric involvement in rheumatoid arthritis

Front 18

Joint Pain:

Inflammatory arthritides are more common in

Back 18

women

Front 19

Joint Pain:

Extra-articular pain occurs in

Back 19

inflammation of bursae (bursitis), tendons (tendinitis), or tendon sheaths (tenosynovitis);

also in sprains from stretching or tearing of ligaments

Front 20

Joint Pain:

Severe pain of rapid onset in a red, swollen joint suggests

Back 20

acute septic arthritis or gout

Front 21

Joint Pain:

Severe pain of rapid onset in a red, swollen joint in children consider

Back 21

osteomyelitis in bone contiguous to a joint

Front 22

Joint Pain:

Fever, chills, warmth, redness are seen in

Back 22

septic arthritis;

also consider gout or possible rheumatic fever

Front 23

Joint Pain:

Pain, swelling, loss of active and passive motion, or "locking" suggests

Back 23

articular joint pain

Front 24

Joint Pain:

Loss of active but not passive motion and tenderness outside the joints are seen in

Back 24

nonarticular pain

Front 25

Joint Pain:

Gelling is defined as and occurs in -

Back 25

Gelling is defined as stiffness and limited motion after inactivity

Gelling occurs in degenerative joint disease but usually lasts only a few minutes

Front 26

Joint Pain:

Stiffness lasting 30 minutes or more is present in

Back 26

rheumatoid arthritis and other inflammatory arthritides;

also occurs in fibromyalgia and polymyalgia rheumatica (PMR)

Front 27

Joint Pain:

Generalized symptoms (fevers, chlls, rash, anorexia, weight loss, and weakness) are common in

Back 27

rheumatoid arthritis, systemic lupus erythematosus (SLE), PMR, and other inflammatory arthritides

High fever and chills suggest an infectious cause.

Front 28

Joint Pain:

Leukemia and chemotherapy

Back 28

leukemia can infiltrate the synovium;

chemotherapy can also cause joint pain

Front 29

Joint Pain and Systemic Disorders:

A butterfly rash on the cheeks suggests

Back 29

systemic lupus erythematosus (SLE)

Front 30

Joint Pain and Systemic Disorders:

Scaly rash and pitted nails suggest

Back 30

psoriatic arthritis

Front 31

Joint Pain and Systemic Disorders:

A few papules, pustules, or vesicles on reddened bases, located on the distal extremities suggests:

Back 31

Gonococcal arthritis

Front 32

Joint Pain and Systemic Disorders:

An expanding erythematous patch early in an illness suggests:

Back 32

Lyme disease

Front 33

Joint Pain and Systemic Disorders:

Hives suggests

Back 33

Serum sickness, drug reaction

Front 34

Joint Pain and Systemic Disorders:

Erosion or scaling on the penis and crusted, scaling papules on the soles and palms suggests:

Back 34

Reiter's syndrome, which includes arthritis, urethritis, and uveitis

Front 35

Joint Pain and Systemic Disorders:

Maculopapular rash suggests:

Back 35

Arthritis of rubella

Front 36

Joint Pain and Systemic Disorders:

Clubbing of the fingernails suggests:

Back 36

Hypertrophic osteoarthropathy

Front 37

Joint Pain and Systemic Disorders:

Red, burning, and itchy eyes (conjunctivities) suggests:

Back 37

Reiter's syndrome, Behcet's syndome

Front 38

Joint Pain and Systemic Disorders:

Preceding sore throat suggests:

Back 38

Acute rheumatic fever or gonococcal arthritis

Front 39

Joint Pain and Systemic Disorders:

Diarrhea, abdominal pain, cramping suggests:

Back 39

Arthritis with ulcerative colitis, regional enteritis, scleroderma

Front 40

Joint Pain and Systemic Disorders:

Symptoms of urethritis suggests:

Back 40

Reiter's syndrome,

or possible gonococcal arthritis

Front 41

Joint Pain and Systemic Disorders:

Mental status change, facial or other weakness, stiff neck suggests:

Back 41

Lyme disease with central nervous system involvement

Front 42

Acute involvement of only one joint suggests:

Back 42

trauma, septic arthritis, or gout

Front 43

Polyarticular and symmetrical joint involvement suggests:

Back 43

Rheumatoid arthritis

Front 44

Joint deformities or malalignment of bones or joints is seen in

Back 44

Dupuytren's contracture,

Bowlegs (genu varum), or

Knock-knees (genu valgum)

Front 45

Look for subcutaneous nodules in

Back 45

rheumatoid arthritis or rheumatic fever

Front 46

Look for effusions in

Back 46

trauma

Front 47

Look for crepitus over inflamed joints or tendon sheaths in:

Crepitus defined -

Back 47

over inflamed joints in osteoarthritis, or

over the inflamed tendon sheaths of tenosynovitis

crepitus = audible or palpable crunching during movement of tendons/ligaments over bone or areas of cartilage loss

Front 48

Decreased range of motion is present in

Back 48

arthritis,

inflammation of issues around a joint,

fibrosis in or around a joint, or

bony fixations (ankylosis)

Front 49

Ligamentous laxity of the ACL occurs in

Back 49

knee trauma

Front 50

Muscular atrophy or weakness is seen in

Back 50

rheumatoid arthritis

Front 51

(black print)

Palpable swelling may involve

Back 51

1) the synovial membrane - feels boggy or doughy

2) effusion from excess synovial fluid within the joint space

3) soft tissue structures such as bursae, tendons, or tendon sheaths

Front 52

Palpable bogginess of doughiness of the synovial membrane indicates

Back 52

synovitis,

which is often accompanied by effusion

Front 53

Palpable joint fluid is present in

Back 53

effusion

Front 54

Tenderness over the tendon sheaths occurs in

Back 54

tendinitis

Front 55

Increased warmth is seen in

Back 55

arthritis, tendinitis, bursitis, osteomyelitis

(black print - use back of fingers to assess warmth and compare to contralateral joints)

Front 56

Diffuse tenderness and warmth over a thickened synovium suggest

Back 56

arthritis or infection

Front 57

Focal tenderness suggets

Back 57

injury

Front 58

Redness over a tender joint suggests

Back 58

septic or gouty arthritis,

or possible rheumatoid arthritis

Front 59

(Black print)

The least common sign of inflammation near the joints is

usually seen where?

Back 59

Redness is the least common sign of inflammation near the joints.

Usually seen in superficial joints like fingers, toes, knees

Front 60

Scoliosis may cause

Back 60

elevation of one shoulder

Front 61

Upon inspection in anterior dislocation of the shoulder -

Back 61

the rounded lateral aspect of the shoulder appears flattened

Front 62

What can occur within 2-3 weeks of a rotator cuff tear?

Back 62

atrophy of the supraspinatus and infraspinatus with increased prominence of scapular spine

Front 63

What is needed before the glenohumeral joint capsule appears distended?

Back 63

A significant amount of synovial fluid

Front 64

Swelling of the acromioclavicular joint is easier to identify why?

Back 64

Because it is more superficial

Front 65

Tenderness over the SITS muscle insertions and inability to abduct the arm above the shoulder level are seen in

Back 65

sprains, tears, and tendons rupture of the rotator cuff,

most commonly seen in the supraspinatus muscles (directly under the acromion)

Front 66

Tenderness and effusion (of the shoulder) suggest:

Back 66

synovitis of the glenohumeral joint

Front 67

Shoulder:

If the margins of the capsule and synovial membrane are palpable -

Back 67

a moderate to large effusion is present

Front 68

Shoulder:

If synovitis is minimal then -

Back 68

it cannot be detected on palpation

Front 69

Shoulder:

Restricted range of motion occurs in

Back 69

bursitis,

capsulitis,

rotator cuff cuff tears or sprains, and

tendinitis

Front 70

Diffuse swelling (of the wrist and hand) is common in

Back 70

arthritis or infection

Front 71

Local swelling in the wrist or hand suggests

Back 71

a ganglion

Front 72

Noting deformities and angulations of the hand and wrist:

In osteoarthritis, look for

Back 72

Heberden's nodes at the DIP joints, and

Bouchard's nodes at the PIP joints

Front 73

Noting deformities and angulations of the hand and wrist:

In rheumatoid arthritis, look for

Back 73

symmetric deformity in the PIP, MCP, and wrist joints,

as well as ulnar deviation

Front 74

Observing contours of the hand:

Thenar atrophy occurs in

Back 74

median nerve compression from carpal tunnel syndrome

(thenar eminence is the ridge on the thumb side)

Front 75

Observing contours of the hand:

Hypothenar atrophy occurs in

Back 75

ulnar nerve compression

(hypothenar eminence is the ridge of the hand on the pinkie side)

Front 76

Flexion contractions in the ring, fifth, and third fingers is called?

arises from?

Back 76

Dupuytren's contractures,

arises from thickening of the palmar fascia

Front 77

Tenderness over the distal radius occurs in

Back 77

Colles' fracture from a fall,

especially in patients with osteoporosis

Front 78

Tenderness or bony step-off during palpation of the wrist is suspicious for

Back 78

fracture

Front 79

Suspect rheumatoid arthritis if

Back 79

swelling and tenderness of the hand and wrist is bilateral and of several weeks duration

Front 80

Tenderness over the extensor and abductor tendons of the thumb at the radial styloid suggests

Back 80

de Quervain's tenosynovitis, and

gonococcal tenosynovitis

Front 81

Tenderness over the "snuffbox" suggests

Back 81

scaphoid fracture,

the most common injury of the carpal bones

Front 82

Poor blood supply puts the scaphoid bone at risk for

Back 82

avascular necrosis

Front 83

Upon palpating the MCPs, pain with pressure indicates

Back 83

synovitis,

an important point to remember when shaking hands

Front 84

MCPs are often boggy or tender in

Back 84

rheumatoid arthritis

Front 85

MCPs are rarely involved in

Back 85

osteoarthritis

Front 86

Pain with compression of MCPs

(when squeezing the hand from each side between thumb and fingers, or each MCP joint individually)

Back 86

occurs in posttraumatic arthritis

Front 87

PIP changes are seen in

Back 87

rheumatoid arthritis

Front 88

Bouchard's nodes occur in

Back 88

osteoarthritis

Front 89

Pain at the base of the thumb occurs in

Back 89

carpometacarpal arthritis

Front 90

Hard dorsolateral nodules on the DIP joints are called,

they are common in -

Back 90

Called Heberden's nodes

common in osteoarthritis

Front 91

DIP joints are also involved in which condition?

Back 91

psoriatic arthritis

Front 92

Tenderness and swelling upon palpation of the tendons inserting on the thumb and fingers are seen in

Back 92

tenosynovitis, or inflammation of the tendon sheaths

Front 93

De Quervain's tenosynovitis involves the

Back 93

extensor and abductor tendons of the thumb as they cross the radial styloid

Front 94

Decreased sensation of the median nerve distribution characterizes

Back 94

carpal tunnel syndrome

(median nerve affects the sensation of the volar/palmar surface of the thumb, index, and middle fingers)

Front 95

Decreased grip strength in a positive test for

Back 95

weakness of the finger flexors and/or intrinsic muscles of the hand

may also result from pain from degenerative joint changes

Front 96

Wrist pain and grip weakness occur in

Back 96

de Quervain's tenosynovitis

Front 97

Decreased grip strength also occurs in

Back 97

arthritis, carpal tunnel syndrome, epicondylitis, and cervial radiculopathy

Front 98

When gripping thumb with fingers and then moving the wrist toward the midline in ulnar deviation (called Finkelstein's test),

Pain during this maneuver identifies

Back 98

de Quervain's tenosynovitis,

from inflammation of the abductor pollicis longus and etensor pollicis brevis tendons and tendon sheaths

Front 99

de Quervain's tenosynovitis and carpal tunnel syndrome is more common in

Back 99

women

Front 100

What is a positive sign in the thumb abduction test (asking pt to raise thumb while applying pressure) ?

Back 100

Weakness,

the abductor pollicis longus is innervated only by the median nerve

Front 101

Weak thumb abduction, diagrams that confirm sensory symptoms in the hand, and decreased sensation roughly doubles the likelihood for

Back 101

carpal tunnel disease

Front 102

What is a positive sign for Tinel's Test?

(Tinel's test - lightly tapping over the course of the median nerve on the anterior wrist over the carpal tunnel)

Back 102

Aching and numbness in the median nerve distribution is a positive test

Front 103

What is a positive sign for Phalen's Test?

(asking pt to push the back of hands together in wrist flexion for 60 seconds)

Back 103

Numbness and tingling in the median nerve distribution withing 60 seconds is a positive test.

Front 104

Tinel's and Phalen's signs do not reliably predict

Back 104

positive electrodiagnosis of carpal tunnel disease

Front 105

Lateral deviation and rotation of the head suggest

Back 105

torticollis,

from contraction of the sternocleidomastoid muscle

Front 106

Tenderness on palpation of the spinous processes of the vertebra suggests

Back 106

fracture or dislocation if preceded by trauma,

underlying infection, or

arthritis

Front 107

Tenderness on palpation of the facet joints in the cervical vertebrae suggest

Back 107

arthritis,

especially at the facet joints between C5 and C6

Front 108

In the lower lumbar area, look for step-offs which occur in

Back 108

spondylolisthethis, or forward slippage of one vertebra, which may compress the spinal cord

Front 109

Lumbar vertebral tenderness is suspicious for

Back 109

infection, or

fracture

Front 110

Tenderness upon palpation over the sacroiliac joint is common in

Back 110

sacroiliitis,

may also be produced by Ankylosing spondylitis

Front 111

Pain on percussion of the spine may arise from

Back 111

osteoporosis, infection, or malignancy

Front 112

Increased thoracic kyphosis occurs

Back 112

with aging

Front 113

In children with a spinal structural deformity

Back 113

a correctable structural deformity should be pursued

Front 114

There is lateral and rotatory curvature of the spine to bring the head back to midline in which condition?

Back 114

Scoliosis

Front 115

When does scoliosis become evident

Back 115

in adolescence, often before symptoms appear

Front 116

Unequal shoulder heights occur in

Back 116

* scoliosis;

* Sprengel's deformity of the scapula, from the attachment of an extra bone or band between the upper scapula and C7;

* "winging" of the scapula, from loss of * innervation of the serratus anterior muscle by the long thoracic nerve; and

* contralateral weakness of the trapezius

Front 117

Unequal heights of the iliac crests, or pelvic tilt, suggests

Back 117

* unequal length of the legs and disappear when a block is placed under the shorter limb,

* scoliosis, or

* hip abduction or adduction

Front 118

"Listing" of the trunk to one side is seen in

Back 118

herniated lumbar disc

Front 119

Birthmarks, port-wine stains, hairy patches, and lipomas often overlie

Back 119

bony defects such as spina bifida

Front 120

Cafe-au-lait spots (discolored patches of skin), skin tags, and fibrous tumors are common in

Back 120

neurofibromatosis

Front 121

Spasm of the paravertebral muscles occurs in

Back 121

*degenerative and inflammatory processes of muscles,

*overuse,

*prolonged contraction from abnormal posture,

*anxiety

Front 122

Sciatic nerve tenderness suggests

Back 122

a herniated disc or mass lesion impinging on the contributing nerve roots

sciatic nerve difficult to palpate in most patients

Front 123

(black print)

Low back pain warrants careful assessment of

Back 123

cauda equina compression

the most serious cause of pain b/c of risk of paralysis of the affected limb or loss of bladder/bowel control

Front 124

(black print)

Largest nerve in the body

Back 124

sciatic nerve

Front 125

Herniated intervertebral discs, most commonly L5-S1 or L4-L5 may produce

Back 125

tenderness of:

*spinous processes,

*intervertebral joints,

*paravertebral muscles,

*sacrosciatic notch, and

*sciatic nerve

Front 126

Tenderness of the intervertebral joints may also be caused by

Back 126

rheumatoid arthritis

Front 127

Tenderness of the costovertebral angles may signify

Back 127

kidney infection rather than a musculoskeletal problem

Front 128

Limitations in range of motion of the neck can arise from

Back 128

*arthritis,

*pain from trauma,

*overuse, or

*muscle spasm such as torticollis

Front 129

It is important to assess any complaints or findings of neck, shoulder, or arm pain, numbness, or weakness for possible

Back 129

cervical cord or nerve root compression

Front 130

Tenderness at C1-C2 in rheumatoid arthritis suggests possible risk for

Back 130

subluxation and high cervical cord compression,

needs prompt additional assessment

Front 131

Deformity of the thorax on foward bending, especially differences in height of the scapula suggest

Back 131

scoliosis

Front 132

Persistence of lumbar lordosis suggests

Back 132

muscle spasm or ankylosing spondylitis

Front 133

Decreased spinal mobility is common in

Back 133

osteoarthritis and ankylosing spondylitis,

among other conditions

Front 134

What occurs in flexion deformity of the hip as the opposite hip is flexed (with thigh to chest) ?

Back 134

The affected hip does not allow full hip extension, and the affected thigh appears flexed

(affected leg is bent when it should be straight)

Front 135

Flexion deformity of the hip may be masked by

Back 135

an increase in lumbar lordosis and an anterior pelvic tilt (rather than flattening)

Front 136

Restricted abduction of the hip is common in

Back 136

osteoarthritis

Front 137

Restriction of internal and external hip rotation indicates

Back 137

hip disease such as arthritis

Front 138

Problems with patellar tracking,

for example in patients with shallower grooves - especially women

Back 138

can lead to arthritis, anterior knee pain, and patellar dislocation

Front 139

In women, quadriceps contraction tend to have

Back 139

a more lateral pull (Q angle) that alters patellar tracking, contributing to anterior knee pain

Front 140

Stumbling or giving way of the knee during heel strike suggests

Back 140

quadriceps weakness or abnormal patellar tracking

Front 141

When checking alignment and contour of the knees, what are common conditions to note

Back 141

Bowlegs (genu varum),

Knock-knees (genu valgum)

Front 142

Flexion contracture (inability to extend the knee fully) is seen in

Back 142

limb paralysis or hamstring tightness

Front 143

Swelling over the patella suggests

Back 143

prepatellar bursitis

Front 144

Swelling over the tibial tubercle suggests

Back 144

infrapatellar bursitis,

or if more medial, anserine bursitis

Front 145

Osteoarthritis is likely when

Back 145

*tender bony ridges along the joint margins,

*genu varum deformity, and

*stiffness lasting 30 minutes or less

crepitus may also be present

Front 146

Medial meniscus tear with point tenderness is more common when?

Back 146

after trauma

Front 147

MCL tenderness after injury is suspicious for what?

Back 147

MCL tear;

LCL injuries are less frequent

Front 148

Tenderness over the patellar tendon or inability to extend the knee suggests

Back 148

a partial or complete tear of the patellar tendon

Front 149

Pain and crepitus when compressing the patella against the underlying femor and gently moving it suggests

Back 149

roughening of the patellar undersurface that articulates with the femur

similar pain may occur with climbing or going down stairs, or getting up from a chair

Front 150

Pain with compression and with patellar movement during quadriceps contraction suggests

Back 150

chondromalacia, or

degenerative patella (the patellofemoral syndrome)

Front 151

Swelling above and adjacent to the patella suggests

Back 151

synovial thickening or effusion in the knee

Front 152

Thickening, bogginess, or warmth in the areas of the suprapatellar pouch, prepatellar bursa, and anserine bursa indicate

Back 152

synovitis, or

nontender effusions from osteoarthritis

Front 153

Prepatellar bursitis (also known as "housemaid's knee") arises from

Back 153

excessive kneeling

Front 154

Anserine bursitis arises from

Back 154

running, valgus knee deformity, fibromyalgias, osteoarthiritis

Front 155

A popliteal or "baker's" cyst occurs from

Back 155

distention of the gastrocnemius semimembranosus bursa

from underlying arthritis or trauma

Front 156

When palpating the knee, putting downward pressure and then applying lateral pressure:

a fluid wave or buldge on the medial side between the patella and the femur is considered

Back 156

a positive buldge sign consistent with an effusion

tests for minor effusions

Front 157

When the knee joint contains a large effusion, what happens?

Back 157

Suprapatellar compression ejects fluid into the spaces adjacent to the patella.

Front 158

When testing for balloon sign for major effusions, what constitutes a positive sign?

Back 158

A positive sign is a palpable fluid wave

A returning wave into the suprapatellar pouch confirms an effusion - palpable fluid confirms a large effusion

Front 159

A palpable patellar click with compression may occur

Back 159

with effusion, but yields more false positives

Front 160

A defect in the muscles of the ankle (gastrocnemius and soleus muscles) with tenderness and swelling suggests;

Back 160

ruptured Achilles tendon

Front 161

Tenderness and thickening of the Achilles tendon above the calcaneus on palpation,

sometimes with a protuberant bony process of the calcaneus, suggests

Back 161

Achilles tendinitis

Front 162

With the patient prone with knee flexed to 90 degrees, squeeze the the calf and watch for plantar flexion at the ankle.

What is a positive test?

Back 162

Positive test = absence of plantar flexion, and indicates rupture of the Achilles tendon

Sudden severe pain "like a gunshot wound," an ecchymosis from the calf to the heel, and a flat-foot gait with absence of "toe-off" may also occur

Front 163

Crepitus with flexion and extension of the knee suggests

Back 163

osteoarthritis

Front 164

A click or pop along the medial joint with valgus stress, external rotation, and leg extension suggests

Back 164

a probable tear of the posterior portion of the medial meniscus

The tear may displace meniscal tissue, causing "locking" on full knee extension.

Click/pop occurs during McMurray Test (pt supine, grasp the heel and flex the knee, externally rotate the foot and flex/extend knee)

Front 165

A McMurry sign and locking suggest

Back 165

a medial meniscus tear and make it 8.2 and 3.2 times more likely

Front 166

In the Abduction (or Valgus) Stress Test:

Pain or a gap in the medial joint line points to

Back 166

ligamentous laxity and a partial tear of the medial collateral ligament.

Front 167

Most knee injuries are on the

Back 167

medial side

Front 168

Explain the Abduction (or Valgus) Stress Test

Back 168

Pt supine and the knee slightly flexed, move the thigh about 30 degrees laterally to the side of the table. Push medial knee with one hand and pull medial ankle laterally to open the knee joint on the medial side (valgus stress)

Front 169

Adduction (or Varus) Stress Test

Back 169

With the thigh and knee in the same position - 30 degrees laterally to the side of the table, lying supine. Place one hand on the medial side of the knee and the other side of the lateral ankle, push laterally against knee and pull medially at the ankle to open the knee on the lateral side (varus stress)

Front 170

Adduction (or Varus) Stress Test:

Pain or a gap in the lateral joint line points to

Back 170

ligamentous laxity and a partial tear of the lateral collateral ligament

Front 171

Anterior Drawer Sign Test - explain how to perform and what it tests for

Back 171

Pt supine, hips flexed and knees flexed to 90 degrees and feet flat on table, cup hands around knees with thumb on medial and lateral joint line and pull the tibia forward like a drawer

Tests the anterior cruciate ligament (ACL)

Front 172

Positive Anterior Drawer sign -

Back 172

A forward jerk showing the contours of the upper tibia;

Positive sign makes an ACL tear 11.5 times more likely

Front 173

Positive Anterior Drawer test with a few degrees of forward movement is

Back 173

normal if equally present on the opposite side

Front 174

ACL injuries occur with

Back 174

hyperextension and direct blows to the knee and with twisting or landing on an extended hip or knee

Front 175

Posterior Drawer Test explain how to do it and what it tests for.

Back 175

Position the patient and place yours hands in the positions described in the anterior drawer test - push the tibia posteriorly and observe the degree of backward movement in the femur.

Assesses PCL (posterior cruciate ligament)

Front 176

When do you get a positive posterior drawer sign?

Back 176

If the PCL is injured and the proximal tibia falls back (slides back like a drawer)

Front 177

Isolated PCL tears are less common and usually result from

Back 177

a direct blow to the proximal tibia

Front 178

The metatarsophalangeal joint of the big toe is the initial site of attack in 50% of episodes of

Back 178

Acute Gouty arthritis

Front 179

Acute Gouty Arthritis

- characteristics

- areas commonly involved

Back 179

characterized by very painful and tender, hot, dusky red swelling that extends beyond the margin of the joint

areas commonly involved include: ankle, tarsal joints, and knee

Front 180

Condition of the foot commonly mistaken for cellulitis

Back 180

Acute Gouty Arthritis

Front 181

Flat feet - characteristics

Back 181

*May be apparent only when person stands or may become permanent,

arch approaches or touches floor - concavity becomes convex

*Tenderness may be at the medial malleolus down along the medial-plantar surface of the foot

*Swelling may develop anterior to the malleoli

Front 182

Flat foot may be a normal variant or arise from

Back 182

posterior tibial tendon dysfunction, seen in obesity, diabetes, and prior foot injury

inspect shoes for inside wear on the sides of the soles

Front 183

Women are 10x more likely to get this foot condition than men

Back 183

Hallus Valgus (bunion)

Front 184

Hallux Valgus

Back 184

lateral deviation of the great toe and enlargement of the head of the first metatarsal on the medial side forming a bursa or bunion,

Bursa may become inflamed

Front 185

Condition with tenderness on the plantar surface of the foot between the 3rd and 4th metatarsal heads,

with symptoms of hyperesthesia, numbness, aching, and burning from the metatarsal heads into the 3rd and 4th toes -

Back 185

Morton's Neuroma

Front 186

Morton's Neuroma

- reason for occurence

- examination

Back 186

Occurs from perineural fibrosis of the common digital nerve due to repetitive nerve irritation (NOT a true neuroma)

Examination - press on the plantar interspace and squeeze the metatarsals with your other hand - pain will radiate to the toes

Front 187

Acute Rheumatoid Arthritis

- areas most affected

- symptoms

Back 187

Areas most affected: proximal interphalangeal (PIP), metacarpophalangeal (MCP), and wrist joints

Symptoms: tender, painful, stiff joints with symmetric involvement on both sides of the body; fusiform or spindle-shaped swelling of the PIP joints in acute disease

Front 188

Chronic Rheumatoid Arthritis

Back 188

*Swelling and thickening of the PIP & MCP joints,

*Range of motion becomes limited and fingers deviate to the ulnar side

*The interosseous muscles atrophy on the back of the hand

*Fingers may show "swan neck" deformities or boutonniere deformity

Front 189

Rheumatoid nodules occur

Back 189

in both acute and chronic stage

Front 190

Osteoarthritis (Degenerative Joint Disease)

Back 190

*MCP joints NOT affected

*Heberden's nodes on the DIP joints on the dorsolateral aspect from bony overgrowth (usually hard and painless - affect middle-age and elderly)

*Bouchard's nodes on the PIP joints less common

Front 191

Chronic Tophaceous Gout

Back 191

*Knobby swellings around the hand joints ulcerate and discharge white chalk-like urates

*Deformities can mimic rheumatoid arthritis and osteoarthritis; acute inflammation may be present

Front 192

Olecranon Bursitis

Back 192

swelling and inflammation of the olecranon bursa may result from: trauma, gout or RA

Swelling is superficial and may reach 6 cm in diameter --> consider aspiration for both diagnosis and symptomatic releif

Front 193

Rheumatoid Nodules

- characteristics

- where they occur

Back 193

Firm/nontender nodules form at pressure points along ulnar extensor surface, not attached to skin, may be attached to underlying periosteum

Can occur in olecranon bursa, but often occur more distally

**Occurs in both RA and rheumatic fever

Front 194

Arthritis of the Elbow

- characteristics

- symptoms

- causes

Back 194

Synovial inflammation of fluid is felt best in grooves btwn olecranon process and eipcondyles on either side (palpate for boggy, soft, or fluctuant swelling and tenderness)

Pt's report pain, stiffness, restricted motion

Caused by RA, gout, pseudogout, trauma, osteoarthritis

Front 195

Lateral Epicondylitis

Back 195

Tennis elbow - follows repetitive extension of the wrist or pronation-supination of the forearm

Pain and tenderness develop 1 cm distal to the lateral epicondyle

*Wrist extension against resistance increases pain

Front 196

Medial Epicondylitis

Back 196

Pitchers/Golfer's/Little League Elbow - follows repetitive wrist flexion (as in throwing)

Tenderness occurs lateral and distal to the medial epicondyle

*Wrist flexion against resistance increases pain

Front 197

Rheumatoid Arthritis

- process

- Locations

- pattern of spread / progression & duration

Back 197

Process: chronic inflammation of synovial membrane with 2ndary erosion of adjacent cartilage,bone, ligaments, tendons

Locations: PIP/MCP/metatarsophalangeal joints, feet, knees, ankles, wrists, elbows

Pattern of Spread: symmetrically additive, progressing to other joints

Insidious onset, often chronic

Front 198

Rheumatoid Arthritis - Associated Symptoms

Back 198

*Frequent swelling of synovial tissue in joints and tendon sheaths; subcutaneous nodules

*Tender and warm (seldom red)

*Stiffness 1+hr after inactivity or in the morning

*Limitation of motion develops

*Generalized symptoms of weakness, fatigue, weight loss, and low fever common

Front 199

Osteoarthritis (Degenerative Joint Disease)

- process

- locations

- pattern of spread

- onset

Back 199

*Slowly progressive loss of cartilage within joints and formation of new bone, damage to underlying bones,

*Hands (DIP,PIP), knees, hips, cervical/lumbar spine, wrists, previously injured/diseased joints,

*Additive, but only one joint may be involved

Front 200

Osteoarthritis - Associated Symptoms

Back 200

*small effusions in joint may be present (especially knees), bony enlargement

*possibly tender (seldom warm/red)

*stiffness 5-10 min in morning/ after inactivity

*Limitation of motion often develops

*Generalized symptoms usually absent

Front 201

Gouty Arthritis (Acute Gout)

Back 201

*An inflammatory rxn to microcrystals of monosodium urate;

*Location - base of big toe, ankles, feet, knees elbows

*Occasional isolated attacks lasting days -2 wks

*Sudden onset, often night or after injury, surgery, fasting, or excessive alcohol/eating

*Early attacks usually confined to 1 joint

Front 202

Gouty Arthritis (Acute Gout) - Associated Symptoms

Back 202

*Exquisitely tender, hot, and red

*No stiffness

*Motion limited by pain

*Swelling in/around joint

Front 203

Chronic Tophaceous Gout

Back 203

*Multiple local accumulations of sodium urate in the joints and other tissues (tophi)

*Feet, ankles, wrists, fingers, elbows

*Additive NOT symmetric

*Gradual development

*Chronic symptoms with acute exacerbations

Front 204

Chronic Tophaceous Gout - Associated Symptoms

Back 204

* Present as tophi in joints, bursae, subcutaneous tissues (check ears, extensor surfaces for tophi)

* Tenderness, warmth, redness

* Stiffness present

* Pt may develop symptoms of renal failure and renal stones

Front 205

Polymyalgia Rheumatica

Back 205

* Unclear process, > 50 yrs, more often in women, overlaps with giant cell arteritis

* Muscles of hip, shoulder, neck; symmetric

* Abrupt, can appear overnight

* Chronic, but ultimately self-limiting

Front 206

Polymyalgia Rheumatica - Associated Symptoms

Back 206

* Swelling and edema over dorsum of hands, feet, wrists

* muscles often tender (not warm or red)

* Pain restricts movement

* No true muscle weakness, malaise, depression, weight loss, fever

Front 207

Fibromyalgia Syndrome

Back 207

* Widespread musculoskeletal pain and tender points.

* Aberrant pain signaling and amplification

* "All over" - especially neck, shoulders, hands, low back, knees

* Pattern of spread shifts unpredictably, with cold, immobility, excessive use

* Chronic with ups and downs

Front 208

Fibromyalgia Syndrome - associated symptoms

Back 208

*No swelling

*Multiple specific and symmetric tender "trigger points," not discovered until examination

*NO limitation of motion

*Disturbance of sleep, morning fatigue, overlaps with depression

Front 209

Dupuytren's Contracture

Back 209

*1st sign - thickened nodule over flexor tendon of ring finger and possibly little finger near distal palmar crease.

*Skin puckers and thickened fibrotic cord develops btwn palm and finger.

*Flexion normal, extension limited

*Flexion contraction of the fingers may ensure

Front 210

Trigger Finger

Back 210

Caused by painless nodule in flexor tendon in the palm near metacarpal head.

Nodule too big to easily enter tendon sheath during extension from flexed position - causes audible/palpable snap.

Front 211

Thenar Atrophy

Hypothenar Atrophy

Back 211

Suggests a median nerve disorder such as carpal tunnel syndrome

Hypothenar atrophy suggests an ulnar nerve disorder

Front 212

Ganglion

Back 212

Cystic, round, usually nontender swellings along with tendon sheaths or joint capsules, frequently at dorsum of wrist

*Flexion makes ganglia more prominent, extension obscures them

*Occur at hands, wrists, ankles, and feet - may go away on their own

*Contains synovial fluid from tearing/ erosion of joint capsule, or tendon sheath