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138 Cards in this Set
- Front
- Back
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What is important subjective info for Musculoskeletal system?
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Joints, pain, stiffness, swelling, heat, redness, limiitation of movement, muscle pain (cramps), weakness, bones- pain, deformity, trauma (fractures, sprains, dislocations), functional assessment (activities of daily living) ADL's, self care behaviors
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Any problems with your joints? Any pain? What is the rationale
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Joint pain and loss of function are the most common musculoskeletal concerns that prompt a person to seek care
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What questions would you ask regarding Joints?
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1. Joints.
•Any problems with your joints? Any pain? •Location: Which joints? On one side or both sides? •Quality: What does the pain feel like: aching, stiff, sharp or dull, shooting? Severity: How strong is the pain? •Onset: When did this pain start? •Timing: What time of day does the pain occur? How long does it last? How often does it occur? •Is the pain aggravated by movement, rest, position, weather? Is the pain relieved by rest, medications, application of heat or ice? •Is the pain associated with chills, fever, recent sore throat, trauma, repetitive activity? •Any stiffness in your joints? •Any swelling, heat, redness in the joints? •Any limitation of movement in any joint? Which joint? |
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What joint pain is worse in the morning?
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RA pain is worse in morning
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Exquisitely tender with acute inflammation is what type of MS pain?
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Joint
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What type of Arthritis involves symmetric joints; other musculoskeletal illnesses involve isolated or unilateral joints.
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Rheumatoid arthritis (RA) involves symmetric joints; other musculoskeletal illnesses involve isolated or unilateral joints.RA stiffness occurs in morning and after rest periods
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What arthritis is worse later in the day?
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osteoarthritis is worse later in the day
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What joing pain is worse in morning improves during the day?
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tendinitis is worse in morning, improves during the day
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Movement increases most joint pain except in what Arthritis that which movement decreases pain?
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Rheumatoid Arthritis
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Joint pain withthin-_____ days after an untreated strep throat suggests rheumatic fever. Joint injury occurs from trauma, repetitive motion?
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10-14 days
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What does swelling, heat, redness in the joints suggest?
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Suggests acute inflammation.
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Decreased ROM may be due to joint?
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joint injury to cartilage or capsule, or to muscle contracture. Joint injury occurs from trauma, repetitive moment.
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What subjective questions would you ask regarding Muscles of MS system?
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Muscles.
•Any problems in the muscles, such as any pain or cramping? Which muscles? •If in calf muscles: Is the pain with walking? Does it go away with rest? •Are your muscle aches associated with fever, chills, the “flu”? •Any weakness in muscles? •Location: Where is the weakness? How long have you noticed weakness? •Do the muscles look smaller there? |
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_____________ is usually felt as cramping or aching.
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Myalgia is usually felt as cramping or aching.
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What Suggests intermittent claudication with muscle?
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pain or cramping with muscles, calf muscle, pain with walking may go away with rest.
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Viral illness often includes __________.
Weakness may involve musculoskeletal or __________ systems. |
myalgia.
neurologic systems |
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Atrophy?
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Muscles look smaller
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What subjective MS questions would you ask regarding Bones?
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Bones.
•Any bone pain? Is the pain affected by movement? •Any deformity of any bone or joint? Is the deformity due to injury or trauma? Does the deformity affect ROM? •Any accidents or trauma ever affected the bones or joints: fractures, joint strain, sprain, dislocation? Which ones? •When did this occur? What treatment was given? Any problems or limitations now as a result? •Any back pain? In which part of your back? Is pain felt anywhere else, like shooting down leg? •Any numbness and tingling? Any limping? |
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__________ causes sharp pain that increases with movement. Other bone pain usually feels “dull” and “deep” and is unrelated to movement.
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Fracture causes sharp pain that increases with movement. Other bone pain usually feels “dull” and “deep” and is unrelated to movement.
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What subjective questions asked about functional ADL assesment?
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Functional assessment (ADL). Do your joint (muscle, bone) problems create any limits on your usual activities of daily living (ADLs)? Which ones? (Note: Ask about each category; if the person answers “yes,” ask specifically about each activity in category.)
•Bathing—getting in and out of the tub, turning faucets? •Toileting—urinating, moving bowels, able to get self on/off toilet, wipe self? •Dressing—doing buttons, zipper, fasten opening behind neck, pulling dress or sweater over head, pulling up pants, tying shoes, getting shoes that fit? •Grooming—shaving, brushing teeth, brushing or fixing hair, applying makeup? •Eating—preparing meals, pouring liquids, cutting up foods, bringing food to mouth, drinking? •Mobility—walking, walking up or down stairs, getting in/out of bed, getting out of house? •Communicating—talking, using phone, writing? |
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Functional assessment screens?
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Functional assessment screens the safety of independent living, the need for home health services, and quality of life (see Chapter 30).
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The rationale for Impaired physical mobility, and Impaired Verbal communication is important to determine what Assesment?
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Functional assesment (ADL)
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What subjective questions asked for self care behaviors?
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Self-care behaviors. Any occupational hazards that could affect the muscles and joints? Does your work involve heavy lifting? Or any repetitive motion or chronic stress to joints? Any efforts to alleviate these?
•Tell me about your exercise program. Describe the type of exercise, frequency, the warm-up program. •Any pain during exercise? How do you treat it? •Have you had any recent weight gain? Please describe your usual daily diet. (Note the person's usual caloric intake, all four food groups, daily amount of protein, calcium.) •Are you taking any medications for musculoskeletal system: aspirin, anti-inflammatory, muscle relaxant, pain reliever? •If person has chronic disability or crippling illness: How has your illness affectedYour interaction with familyYour interaction with friendsThe way you view yourself |
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Rationale for self care behaviors.
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Assess risk for back pain or carpal tunnel syndrome.
Self-care behaviors. Assess for •Self-esteem disturbance •Loss of independence •Body image disturbance •Role performance disturbance •Social isolation |
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What additional history questions would be asked for the Aging Adult?
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1.Any change in weakness over the past months or years?
2.Any increase in falls or stumbling over the past months or years? 3.Do you use any mobility aids to help you get around: cane, walker |
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What is the purpose of objective data?
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The purpose of the musculoskeletal examination is to assess function for ADL and to screen for any abnormalities. You already will have considerable data regarding ADL through the history. Note additional ADL data as the person goes through the motions necessary for an examination: gait, posture, how the person sits in a chair, raises from chair, takes off jacket, manipulates small object such as a pen, raises from supine.
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Inspection of Musculoskeletal system are:
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Note the size and contour of the joint. Inspect the skin and tissues over the joints for color, swelling, and any masses or deformity. Presence of swelling is significant and signals joint irritation.
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Abnormal Findings of Inspection of Musculoskeletal system are?
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Swelling may be excess joint fluid (effusion), thickening of the synovial lining, inflammation of surrounding soft tissue (bursae, tendons) or bony enlargement.Deformities include dislocation (one or more bones in a joint being out of position), subluxation (partial dislocation of a joint), contracture (shortening of a muscle leading to limited ROM of joint), or ankylosis (stiffness or fixation of a joint).
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Palpation of MS consist of?
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Palpate each joint, including its skin for temperature, its muscles, bony articulations, and area of joint capsule. Notice any heat, tenderness, swelling, or masses. Joints normally are not tender to palpation. If any tenderness does occur, try to localize it to specific anatomic structures (e.g., skin, muscles, bursae, ligaments, tendons, fat pads, or joint capsule).
The synovial membrane normally is not palpable. When thickened, it feels “doughy” or “boggy.” A small amount of fluid is present in the normal joint, but it is not palpable. |
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Abnormal Palpation of MS?
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Palpable fluid is abnormal. Because fluid is contained in an enclosed sac, if you push on one side of the sac, the fluid will shift and cause a visible bulging on another side.
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active ROM
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While stabalizing body area proximal to that being moved
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Passive ROM
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If you see a limitation, gently attempt passive motion. Anchor the joint with one hand whle your other hand slowly moves it to its limit.
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True or Fale: The normal ranges of active and passive motion should be the same.
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true
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Normal Range of findings for joint motion?
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Joint motion normally causes no tenderness, pain, or crepitation. Do not confuse crepitation with the normal discrete “crack” heard as a tendon or ligament slips over bone during motion, such as when you do a knee bend.
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Abnormal findings of joint motion?
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Crepitation is an audible and palpable crunching or grating that accompanies movement. It occurs when the articular surfaces in the joints are roughened, as with rheumatoid arthritis
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Muscle Testing?
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Test the strength of the prime mover muscle groups for each joint. Repeat the motions you elicited for active ROM. Now ask the person to flex and hold as you apply opposing force. Muscle strength should be equal bilaterally and should fully resist your opposing force. (Note: Muscle status and joint status are interdependent and should be interpreted together. Chapter 23 discusses the examination of muscles for size and development, tone, and presence of tenderness.)
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How is muscle graded?
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Grade
Description % Normal Assessment 5 Full ROM against gravity, full resistance 100 Normal 4 Full ROM against gravity, some resistance 75 Good 3 Full ROM with gravity 50 Fair 2 Full ROM with gravity eliminated (passive motion) 25 Poor 1 Slight contraction 10 Trace 0 No contraction 0 Zero |
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With the person seated, inspect the area just anterior to the ear. Place the tips of your first two fingers in front of each ear and ask the person to open and close the mouth. Drop your fingers into the depressed area over the joint, and note smooth motion of the mandible. An audible and palpable snap or click occurs in many healthy people as the mouth opens. This is a test of?
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Temporomandibular Joint
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What is an abnormal finding of Temporomandibular joint?
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Swelling looks like a round bulge over the joint, although it must be moderate or marked to be visible.
Crepitus and pain occur with temporomandibular joint dysfunction. |
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Abnormal findings of TM Joint?
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Lateral motion may be lost earlier and more significantly than vertical.
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Abnormal findings of Temporomandibular joint?
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Abnormal Findings
Swelling looks like a round bulge over the joint, although it must be moderate or marked to be visible. Crepitus and pain occur with temporomandibular joint dysfunction. |
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Abnormal Findings
Head tilted to one side. Asymmetry of muscles. Tenderness and hard muscles with muscle spasm. ??? |
Cervical spine
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Lateral motion may be lost earlier and more significantly than vertical. True or False?
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true
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Abnormals of Cervical Spine?
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Abnormal Findings
Head tilted to one side. Asymmetry of muscles. Tenderness and hard muscles with muscle spasm. Limited ROM, Pain with movement. Person cannot hold flexion |
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When should you not peform cervical spine assesment?
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Do not attempt if you suspect neck trauma
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What are the abnormal findings of the Upper extremity (shoulders)?
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Redness.
Inequality of bony landmarks. Atrophy, shows as lack of fullness. Dislocated shoulder loses the normal rounded shape and looks flattened laterally. Swelling from excess fluid is best seen anteriorly. Considerable fluid must be present to cause a visible distention because the capsule normally is so loose |
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when would you not want to perform assesment of shoulder pain?
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Be aware that shoulder pain may be from local causes or it may be referred pain from a hiatal hernia or a cardiac or pleural condition, which could be potentially serious. Pain from a local cause is reproducible during the examination by palpation or motion.
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Abnormal finding of subacromial bursa?
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Abnormal Findings
Swelling of subacromial bursa is localized under deltoid muscle and may be accentuated when the person tries to abduct the arm. |
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Abnormal Findings
Swelling. Hard muscles with muscle spasm. Tenderness or pain. |
Abnormaility of shoulder
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Abnormal Findings
Limited ROM. Asymmetry. Pain with motion. Crepitus with motion. Rotator cuff lesions may cause limited ROM, pain, and muscle spasm during abduction, whereas forward flexion stays fairly normal.??? |
Abnormal Range of Motion
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Subluxation?
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Subluxation of the elbow shows the forearm dislocated posteriorly.
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Swelling and redness of olecranon bursa are localized and easy to observe because of the close proximity of the bursa to skin. Abnormal finding of ?
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Elbow
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Effusion or synovial thickening shows first as a bulge or fullness in groove on either side of the olecranon process, and it occurs with _______.
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gouty arthritis.
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Epicondyles, head of radius, and tendons are common sites of ?
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inflammation and local tenderness, or “tennis elbow.”
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Abnormal findings of Elbow tissue?
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Abnormal Findings
Soft, boggy, or fluctuant swelling in both grooves occurs with synovial thickening or effusion. Local heat or redness (signs of inflammation) can extend beyond synovial membrane. |
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Subcutaneous nodules?
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Subcutaneous nodules are raised, firm, and nontender, and overlying skin moves freely. Common sites are in the olecranon bursa and along extensor surface of the ulna. These nodules occur with RA
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Abnormal Findings of wrist and Hand?
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Subluxation of wrist.
Ulnar deviation; fingers list to ulnar side. Ankylosis; wrist in extreme flexion. Dupuytren's contracture; flexion contracture of finger(s). |
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the thenar eminence?
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rounded mound proximal to the thumb
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Abnormal findings of Wrist and hand?
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Abnormal Findings
Swan-neck or boutonnière deformity in fingers. Atrophy of the thenar eminence Ganglion in wrist. Synovial swelling on dorsum. Generalized swelling. Tenderness. |
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_____ and ________nodules are hard and nontender and occur with osteoarthritis?
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Heberden's and Bouchard's
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What abnormal findings are associated with the ROM of the wrist and hand?
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Abnormal Findings
Loss of ROM here is the most common and most significant functional loss of the wrist. Limited motion. Pain on movement. |
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How many muscle tests are there?
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2
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Tinel's Sign.
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Tinel's Sign.
Direct percussion of the location of the median nerve at the wrist produces no symptoms in the normal hand |
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Abnormal Tinel's sign?
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Abnormal Findings
In carpal tunnel syndrome, percussion of the median nerve produces burning and tingling along its distribution, which is a positive Tinel's sign |
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Phalen's Test.
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Phalen's Test.
Ask the person to hold both hands back to back while flexing the wrists 90 degrees. Acute flexion of the wrist for 60 seconds produces no symptoms in the normal hand |
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Abnormal result of Phalen's Test?
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Abnormal Findings
Phalen's test reproduces numbness and burning in a person with carpal tunnel syndrome |
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Abnormal finding of Lower extremity (hip)?
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Abnormal Findings
Pain with palpation. Crepitation |
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Abnormal ROM of lower extremity (hip)?
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Abnormal Findings
Limited motion. Pain with motion. Flexion flattens the lumbar spine; if this reveals a flexion deformity in the opposite hip, it represents a positive Thomas test. Limited internal rotation of hip is an early and reliable sign of hip disease. Limitation of abduction of the hip while supine is the most common motion dysfunction found in hip disease. |
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Abnormal findings of knee?
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Abnormal Findings
Shiny and atrophic skin. Swelling or inflammation (see Table 22-6). Lesions (e.g., psoriasis). Inspect lower leg alignment. The lower leg should extend in the same axis as the thigh. Abnormal Findings Angulation deformity: •Genu varum (bowlegs) (see p. 636) •Genu valgum (knock knees) •Flexion contracture |
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Abnormaility of Knee shape and contour?
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Abnormal Findings
Hollows disappear; then they may bulge with synovial thickening or effusion. Check the quadriceps muscle in the anterior thigh for any atrophy. Because it is the prime mover of knee extension, this muscle is important for joint stability during weight bearing. |
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Abnormal Findings
Atrophy occurs with disuse or chronic disorders. First, it appears in the medial part of the muscle, although it is difficult to note because the vastus medialis is relatively small. |
Check quadriceps muscle in the anterior thigh for any atrophy. (knee) This muscle is important for joint stability during weight bearing.
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The knee should not have these findings:
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Abnormal Findings
Feels fluctuant or boggy with synovitis of suprapatellar pouch. |
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When swelling occurs, you need to distinguish whether it is due to soft tissue swelling or increased fluid in the joint. what is this test called?
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The tests for the bulge sign and ballottement of the patella aid this assessment
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The bulge sign occurs with very small amounts of effusion, ______ ml, from fluid flowing across the joint
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4-8
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Ballottement of the Patella
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Ballottement of the Patella.
This test is reliable when larger amounts of fluid are present. Use your left hand to compress the suprapatellar pouch to move any fluid into the knee joint. With your right hand, push the patella sharply against the femur. If no fluid is present, the patella is already snug against the femur |
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Ballottement Abnormal findings:
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Abnormal Findings
If fluid has collected, your tap on the patella moves it through the fluid, and you will hear a tap as the patella bumps up on the femoral condyles |
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Abnormal palpations on the knee?
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Abnormal Findings
Irregular bony margins occur with osteoarthritis. Pain at joint line. Pronounced crepitus is significant and it occurs with degenerative diseases of the knee. |
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Abnormal findings of knee ROM?
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Abnormal Findings
Limited ROM. Contracture. Pain with motion. Limp. |
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Sudden locking
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Sudden locking—the person is unable to extend the knee fully. This usually occurs with a painful and audible “pop” or “click.” Sudden buckling, or “giving way,” occurs with ligament injury, which causes weakness and instability
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Check muscle strength by asking the person
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Check muscle strength by asking the person to maintain knee flexion while you oppose by trying to pull the leg forward. Muscle extension is demonstrated by the person's success in rising from a seated position in a low chair or by rising from a squat without using the hands for support.
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Special Test for Meniscal Tears?
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McMurray's Test.
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When would you perform the McMurray's Test?
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Perform this test when the person has reported a history of trauma followed by locking, giving way, or local pain in the knee. Position the person supine as you stand on the affected side. Hold the heel and flex the knee and hip. Place your other hand on the knee with fingers on the medial side. Rotate the leg in and out to loosen the joint. Externally rotate the leg and push a valgus (inward) stress on the knee. Then slowly extend the knee. Normally the leg extends smoothly with no pain
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Abnormal result of McMurrays test?
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Abnormal Findings
If you hear or feel a “click,” McMurray's test is positive for a torn meniscus |
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Abnormal findings of Ankle and foot?
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Abnormal Findings
Hallux valgus (see Table 22-7). Hammertoes. Claw toes. Swelling or inflammation. Calluses. Ulcers. |
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Abnormal findings of metatarsophalangeal joints?
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Abnormal Findings
Swelling or inflammation. Tenderness. |
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Abnormal findings of Ankle and foot ROM?
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Abnormal Findings
Limited ROM. Pain with motion |
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A difference in shoulder elevation and in level of scapulae and iliac crests occur with ______.
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scoliosis
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Abnormal Findings
Lateral tilting and forward bending occur with a ________- |
herniated nucleus pulposus
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Abnormal: spine
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Abnormal Findings
Spinal curvature. Tenderness. Spasm of paravertebral muscles |
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While the person is bending over, mark a dot on each spinous process. When the person resumes standing, the dots should form a straight vertical line. An abnormal result would be?
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Abnormal Findings
If the dots form a slight S-shape when the person stands, a spinal curve is present. |
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Abnormal spine ROM?
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Abnormal Findings
Limited ROM. Pain with motion. |
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Straight Leg Raising or LaSegue's Test.
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These maneuvers reproduce back and leg pain and help confirm the presence of a herniated nucleus pulposus. Straight leg raising while keeping the knee extended normally produces no pain. Raise the affected leg just short of the point where it produces pain. Then dorsiflex the foot
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LaSegue's Test.Abnormals?
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Abnormal Findings
LaSegue's test is positive if it reproduces sciatic pain. If lifting the affected leg reproduces sciatic pain, it confirms the presence of a herniated nucleus pulposus. Raise the unaffected leg while leaving the other leg flat. Inquire about the involved side If lifting the unaffected leg reproduces sciatic pain, it strongly suggests a herniated nucleus pulposus. |
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Measure Leg Length Discrepancy
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Perform this measurement if you need to determine whether one leg is shorter than the other. For true leg length, measure between fixed points, from the anterior iliac spine to the medial malleolus, crossing the medial side of the knee (Fig. 22-45). Normally these measurements are equal or within 1 cm, indicating no true bone discrepancy
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Abnormals of Leg Lenght Discrepancy
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Abnormal Findings
Unequal leg lengths. Sometimes the true leg length is equal, but the legs still look unequal. For apparent leg length, measure from a nonfixed point (the umbilicus) to a fixed point (medial malleolus) on each leg. Abnormal Findings True leg lengths are equal, but apparent leg lengths unequal—this condition occurs with pelvic obliquity or adduction or flexion deformity in the hip. |
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The Pregnant Female
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The Pregnant Female
Proceed through the examination described in the adult section. Expected postural changes in pregnancy include progressive lordosis and, toward the third trimester, anterior cervical flexion, kyphosis, and slumped shoulders (Fig. 22-53, A). When the pregnancy is at term, the protuberant abdomen and the relaxed mobility in the joints create the characteristic “waddling” gait |
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The Aging Adult
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The Aging Adult
Postural changes include a decrease in height, more apparent in the eighth and ninth decades (Fig. 22-54). “Lengthening of the arm-trunk axis” describes this shortening of the trunk with comparatively long extremities. Kyphosis is common, with a backward head tilt to compensate. This creates the outline of a figure 3 when you view this older adult from the left side. Slight flexion of hips and knees is also common Contour changes include a decrease of fat in the body periphery and fat deposition over the abdomen and hips. The bony prominences become more marked. |
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Adaptations for Aging Adult
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INSTRUCTIONS TO PERSON
COMMON ADAPTATION FOR AGING CHANGES 1. Walk (with shoes on). 2. Climb up stairs. 3. Walk down stairs. 4. Pick up object from floor. 5. Rise up from sitting in chair. 6. Rise up from lying in bed. Shuffling pattern; swaying; arms out to help balance; broader base of support; person may watch feet. Person holds hand rail; may haul body up with it; may lead with favored (stronger) leg. Holds hand rail, sometimes with both hands. If the person is weak, he or she may descend sideways, lowering the weaker leg first. If the person is unsteady, he or she may watch feet. Person often bends at waist instead of bending knees; holds furniture to support while bending and straightening. Person uses arms to push off chair arms, upper trunk leans forward before body straightens, feet planted wide in broad base of support. May roll to one side, push with arms to lift up torso, grab bedside table to increase leverage. |
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Rheumatoid Arthritis (RA)?
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Rheumatoid Arthritis (RA)
This is a chronic, systemic inflammatory disease of joints and surrounding connective tissue. Inflammation of synovial membrane leads to thickening; then to fibrosis, which limits motion, and finally to bony ankylosis. The disorder is symmetrical and bilateral and is characterized by heat, redness, swelling, and painful motion of the affected joints. RA is associated with fatigue, weakness, anorexia, weight loss, lowgrade fever, and lymphadenopathy. Associated signs are described in the following tables, especially |
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Osteoarthritis (Degenerative Joint Disease)?
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Chronic progressive inflammation of spine, sacroiliac, and larger joints of the extremities, leading to bony ankylosis and deformity. A form of RA, this affects primarily men by a 10:1 ratio, in late adolescence or early adulthood. Spasm of para-spinal muscles pulls spine into forward flexion, obliterating cervical and lumbar curves. Thoracic curve exaggerated into single kyphotic rounding. Also includes flexion deformities of hips and knees.
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Atrophy
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Atrophy
Loss of muscle mass is exhibited as a lack of fullness surrounding the deltoid muscle. In this case, atrophy is due to axillary nerve palsy. Atrophy also occurs from disuse, muscle tissue damage, or motor nerve damage. |
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Joint Effusion
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Joint Effusion
Swelling from excess fluid in the joint capsule, here from rheumatoid arthritis. Best observed anteriorly. Fluctuant to palpation. Considerable fluid must be present to cause a visible distention because the capsule normally is so loose. |
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Dislocated Shoulder
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Dislocated Shoulder
Anterior dislocation (95%) is exhibited when hunching the shoulder forward and the tip of the clavicle dislocates. It occurs with trauma involving abduction, extension, and rotation (e.g., falling on an outstretched arm or diving into a pool). |
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Tear of Rotator Cuff
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Tear of Rotator Cuff
Characteristic “hunched” position and limited abduction of arm. Occurs from traumatic adduction while arm is held in abduction, or from fall on shoulder, throwing, or heavy lifting. Positive drop arm test: If the arm is passively abducted at the shoulder, the person is unable to sustain the position and the arm falls to the side. |
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Frozen Shoulder—Adhesive Capsulitis
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Frozen Shoulder—Adhesive Capsulitis
Fibrous tissues form in the joint capsule, causing stiffness, progressive limitation of motion, and pain. Motion limited in abduction and external rotation; unable to reach overhead. It may lead to atrophy of shoulder girdle muscles. Gradual onset; unknown cause. It is associated with prolonged bed rest or shoulder immobility. May resolve spontaneously. |
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Subacromial Bursitis
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Subacromial Bursitis (not illustrated)
Inflammation and swelling of subacromial bursa over the shoulder cause limited ROM and pain with motion. Localized swelling under deltoid muscle may increase by partial passive abduction of the arm. Caused by direct trauma, strain during sports, local or systemic inflammatory process, or repetitive motion with injury. |
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Olecranon Bursitis
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Olecranon Bursitis
Large soft knob, or “goose egg,” and redness from inflammation of olecranon bursa. Localized and easy to see because bursa lies just under skin. |
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Subcutaneous Nodules
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Subcutaneous Nodules
Raised, firm, nontender nodules that occur with rheumatoid arthritis. Common sites are in the olecranon bursa and along extensor surface of arm. The skin slides freely over the nodules. |
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Gouty Arthritis
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Gouty Arthritis
Joint effusion or synovial thickening, seen first as bulge or fullness in grooves on either side of olecranon process. Redness and heat can extend beyond area of synovial membrane. Soft, boggy, or fluctuant fullness to palpation. Limited extension of elbow. |
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Epicondylitis—Tennis Elbow
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Epicondylitis—Tennis Elbow
Chronic disabling pain at lateral epicondyle of humerus, radiates down extensor surface of forearm. Pain can be located with one finger. Resisting extension of the hand will increase the pain. Occurs with activities combining excessive pronation and supination of forearm with an extended wrist (e.g., racquet sports or using a screwdriver). Medial epicondylitis is rarer and is due to activity of forced palmar flexion of wrist against resistance. |
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Ganglion Cyst
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Ganglion Cyst
Round, cystic, nontender nodule overlying a tendon sheath or joint capsule, usually on dorsum of wrist. Flexion makes it more prominent. A common benign tumor; it does not become malignant. |
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Ankylosis
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Ankylosis
Wrist in extreme flexion, due to severe rheumatoid arthritis. This is a functionally useless hand because when the wrist is palmar flexed, a good deal of power is lost from the fingers, and the thumb cannot oppose the fingers. |
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Colles' Fracture
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Colles' Fracture (not illustrated)
Nonarticular fracture of distal radius, with or without fracture of ulna at styloid process. Usually from a fall on an out-stretched hand; occurs more often in older women. Wrist looks puffy, with “silver fork” deformity, a characteristic hump when viewed from the side. |
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Carpal Tunnel Syndrome with Atrophy of Thenar Eminence
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Carpal Tunnel Syndrome with Atrophy of Thenar Eminence
Atrophy occurs from interference with motor function from compression of the median nerve inside the carpal tunnel. Caused by chronic repetitive motion; occurs between 30 and 60 years of age and is five times more common in women than in men. Symptoms of carpal tunnel syndrome include pain, burning and numbness, positive findings on Phalen's test, positive indication of Tinel's sign, and often atrophy of thenar muscles. |
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Dupuytren's Contracture
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Dupuytren's Contracture
Chronic hyperplasia of the palmar fascia causes flexion contractures of the digits, first in the fourth digit, then the fifth digit, and then the third digit. Note the bands that extend from the midpalm to the digits and the puckering of palmar skin. The condition occurs commonly in men past 40 years of age and is usually bilateral. It occurs with diabetes, epilepsy, and alcoholic liver disease and as an inherited trait. The contracture is painless but impairs hand function. |
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Swan-Neck and Boutonnière Deformity
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Swan-Neck and Boutonnière Deformity
Flexion contracture resembles curve of a swan's neck. Note flexion contracture of metacarpophalangeal joint, then hyperextension of the proximal interphalangeal joint, and flexion of the distal interphalangeal joint. It occurs with chronic rheumatoid arthritis and is often accompanied by ulnar drift of the fingers. boutonnière deformity the knuckle looks as if it is being pushed through a buttonhole. It is a relatively common deformity and includes flexion of proximal interphalangeal joint with compensatory hyperextension of distal interphalangeal joint |
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Degenerative Joint Disease or Osteoarthritis
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Degenerative Joint Disease or Osteoarthritis
Osteoarthritis is characterized by hard, nontender nodules, 2 to 3 mm or more. These osteophytes (bony overgrowths) of the distal interphalangeal joints are called Heberden's nodes, and those of the proximal interphalangeal joints are called Bouchard's nodes. |
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Ulnar Deviation or Drift
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Ulnar Deviation or Drift
Fingers drift to the ulnar side because of stretching of the articular capsule and muscle imbalance. Also note subluxation and swelling in the joints and muscle atrophy on the dorsa of the hands. This is caused by chronic rheumatoid arthritis. |
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Acute Rheumatoid Arthritis
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Acute Rheumatoid Arthritis
Painful swelling and stiffness of joints, with fusiform or spindle-shaped swelling of the soft tissue of proximal interphalangeal joints. Fusiform swelling is usually symmetric, the hands are warm, and the veins are engorged. The inflamed joints have a limited range of motion. |
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Mild Synovitis
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Mild Synovitis
Loss of normal hollows on either side of the patella, which are replaced by mild distention. Occurs with synovial thickening or effusion (excess fluid). Also note mild distention of the suprapatellar pouch. |
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Swelling of Menisci
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Swelling of Menisci
Localized soft swelling from cyst in lateral meniscus shows at the midpoint of the anterolateral joint line. Semiflexion of the knee makes swelling more prominent. |
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Chondromalacia Patellae
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Chondromalacia Patellae (not illustrated)
Degeneration of articular surface of patellae. The condition occurs most often in females, and its cause is unknown. May produce mild effusion. Joint motion is painless, but crepitus may be present. Pain starts with kneeling. |
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Prepatellar Bursitis
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Prepatellar Bursitis
Localized swelling on anterior knee between patella and skin. A tender fluctuant mass indicates swelling; in some cases, infection spreads to surrounding soft tissue. The condition is limited to the bursa, and the knee joint itself is not involved. Overlying skin may be red, shiny, atrophic, or coarse and thickened. |
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Osgood-Schlatter Disease
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Osgood-Schlatter Disease
Painful swelling of the tibial tubercle just below the knee, probably from repeated stress on the patellar tendon. Occurs most in puberty during rapid growth and most often in males. Pain increases with kicking, running, bike riding, stair climbing, or kneeling. The condition is usually self-limited, and symptoms resolve with rest. |
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Achilles Tenosynovitis
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Achilles Tenosynovitis
Inflammation of a tendon sheath near the ankle (here, the Achilles tendon) produces a superficial linear swelling and a localized tenderness along the route of the sheath. Movement of the involved tendon usually causes pain. |
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Tophi With Chronic Gout
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Tophi With Chronic Gout
Hard, painless nodule (tophi) over metatarsophalangeal joint of first toe. Tophi are collections of sodium urate crystals due to chronic gout in and around the joint that cause extreme swelling and joint deformity. They sometimes burst with a chalky discharge. |
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Acute Gout ▸
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Acute Gout ▸
Acute episode of gout usually involves first the metatarsophalangeal joint. Clinical findings consist of redness, swelling, heat, and extreme tenderness. Gout is a metabolic disorder of disturbed purine metabolism, associated with elevated serum uric acid. It occurs primarily in men over 40 years of age. |
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Callus
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Hypertrophy of the epithelium develops because of prolonged pressure, commonly on the plantar surface of the first metatarsal head in the hallux valgus deformity. The condition is not painful.
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Plantar Wart
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Plantar Wart (not illustrated)
Vascular papillomatous growth is probably due to a virus and occurs on the sole of the foot, commonly at the ball. The condition is extremely painful. |
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Tophi With Chronic Gout
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Tophi With Chronic Gout
Hard, painless nodule (tophi) over metatarsophalangeal joint of first toe. Tophi are collections of sodium urate crystals due to chronic gout in and around the joint that cause extreme swelling and joint deformity. They sometimes burst with a chalky discharge. |
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Hallux Valgus With Bunion and Hammertoes
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Hallux Valgus With Bunion and Hammertoes
Hallux valgus is a common deformity from rheumatoid arthritis. It is a lateral or outward deviation of the great toe with medial prominence of the head of the first metatarsal. The bunion is the inflamed bursa that forms at the pressure point. The great toe loses power to push off while walking; this stresses the second and third metatarsal heads, and they develop calluses and pain. Chronic sequelae include corns, calluses, hammertoes, and joint subluxation. Note the hammertoe deformities in the second, third, fourth, and fifth toes. Often associated with hallux valgus, hammertoe includes hyperextension of the metatarsophalangeal joint and flexion of the proximal interphalangeal joint. Corns (thickening of soft tissue) develop on the dorsum over the bony prominence from prolonged pressure from shoes |
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Acute Gout ▸
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Acute Gout ▸
Acute episode of gout usually involves first the metatarsophalangeal joint. Clinical findings consist of redness, swelling, heat, and extreme tenderness. Gout is a metabolic disorder of disturbed purine metabolism, associated with elevated serum uric acid. It occurs primarily in men over 40 years of age. |
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Callus
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Hypertrophy of the epithelium develops because of prolonged pressure, commonly on the plantar surface of the first metatarsal head in the hallux valgus deformity. The condition is not painful.
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Plantar Wart
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Plantar Wart (not illustrated)
Vascular papillomatous growth is probably due to a virus and occurs on the sole of the foot, commonly at the ball. The condition is extremely painful. |
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Hallux Valgus With Bunion and Hammertoes
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Hallux Valgus With Bunion and Hammertoes
Hallux valgus is a common deformity from rheumatoid arthritis. It is a lateral or outward deviation of the great toe with medial prominence of the head of the first metatarsal. The bunion is the inflamed bursa that forms at the pressure point. The great toe loses power to push off while walking; this stresses the second and third metatarsal heads, and they develop calluses and pain. Chronic sequelae include corns, calluses, hammertoes, and joint subluxation. Note the hammertoe deformities in the second, third, fourth, and fifth toes. Often associated with hallux valgus, hammertoe includes hyperextension of the metatarsophalangeal joint and flexion of the proximal interphalangeal joint. Corns (thickening of soft tissue) develop on the dorsum over the bony prominence from prolonged pressure from shoes |
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Ingrown Toenail
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Ingrown Toenail (not illustrated)
A misnomer; the nail does not grow in, but the soft tissue grows over the nail and obliterates the groove. It occurs almost always on the great toe on the medial or lateral side. It is due to trimming the nail too short or toe-crowding in tight shoes. The area becomes infected when the nail grows and its corner penetrates the soft tissue. |
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Herniated Nucleus Pulposus
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Herniated Nucleus Pulposus ▸
The nucleus pulposus (at the center of the intervertebral disk) ruptures into the spinal canal and puts pressure on the local spinal nerve root. Usually occurs from stress, such as lifting, twisting, continuous flexion with lifting, or fall on buttocks. Occurs mostly in men 20 to 45 years of age. Lumbar herniations occur mainly in interspaces L4 to L5 and L5 to S1. Note: sciatic pain, numbness, and paresthesia of involved dermatome; listing away from affected side; decreased mobility; low back tenderness; and decreased motor and sensory function in leg. Straight leg raising tests reproduce sciatic pain. |
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Scoliosis
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Scoliosis
Lateral curvature of thoracic and lumbar segments of the spine, usually with some rotation of involved vertebral bodies. Functional scoliosis is flexible; it is apparent with standing and disappears with forward bending. It may be compensatory for other abnormalities such as leg length discrepancy. Structural scoliosis is fixed; the curvature shows both on standing and on bending forward. Note rib hump with forward flexion. When the person is standing, note unequal shoulder elevation, unequal scapulae, obvious curvature, and unequal hip level. At greatest risk are females 10 years of age through adolescence, during the peak of the growth spurt. |
