Nurs 605: Musculoskeletal System

Front 1

what are articular structures

Back 1

Joint capsule, articular cartilage, synovium & synovial fluid, intra-articular ligaments & juxta-articular bone

Front 2

What are s/s articular disease

Back 2

swelling & tenderness of entire joint & limits active/passive ROM

Front 3

what are extra-articular structures

Back 3

periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, & overlying skin

Front 4

What does extra-articular dz typically involve?

Back 4

selected regions of the joint & types of movement

Front 5

Ligaments are

Back 5

ropelike bundles of collagen firbrils that connect bone to bone (extra-articular)

Front 6

Tendons are

Back 6

collagen fibers connecting muscle to bone (extra-articular)

Front 7

Bursae are

Back 7

pounches of synovial fluid that cushion mvt of tendons & muscles over bone/jt (extra-articular)

Front 8

What are the three types of joint articulations

Back 8

synovial
cartilaginous
fibrous

Front 9

describe characteristics of synovial jt & give example

Back 9

freely moveable/knee or shoulder
bones do not touch
bones covered w/articular cartilage & separated by synovial cavity w/synovial fluid & jt capsule

Front 10

describe cartilaginous jt

Back 10

slightly moveable/ vertebral bodies of spine
fibrocartilaginous discs separate bony surface
center of disc is nucleus pulposus (cushion)

Front 11

describe fibrous jt

Back 11

immovable, skull
bones almost in direct contact

Front 12

describe shape, movement & give example of spheroidal jt (synovial jt)

Back 12

convex surface in concave cavity
wide range flex, extension, adb, add, rotation, circumduction
Shoulder, hip

Front 13

describe shape, movement & give example Hinge synovial jt

Back 13

flat, planar shape
motion in one plane: flex/extension
interphalangeal jt hand, ft, elbow

Front 14

describe shape, mvt, give example condylar synovial jt

Back 14

convex or concave
mvt of 2 articulating surfaces
knee, TMJ

Front 15

Bursae do what

Back 15

ease joint action
disc-shaped synovial sacs that allow adjacent muscle(s) & tendon(s) to glide over each other during mvt

Front 16

3 tips to assess joint pain

Back 16

1. Point to pain
2. clarify/record mechanism of injury
3. localized/diffuse; acute/chronic; inflammatory/noninflammatory

Front 17

what is idiopathic low back pain

Back 17

no precise cause

Front 18

If midline back pain assess

Back 18

musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, epidural abscess

Front 19

if pain off midline, assess

Back 19

sacroiliitis, trochanteric bursitis, sciatica or hip arthritis

Front 20

if radiation to legs, assess

Back 20

radicular gluteal & posterior leg pain in S1 distribution in sciatica that INCREASES w/ cough/valsalva

Front 21

leg pain that resolves w/rest &/or lumbar forward flexion maybe:

Back 21

spinal stenosis

Front 22

if bowel/bladder dysfunction (retention/overflow incontinence) accompany low back pain consider this (think Kara--sorry Kara :)

Back 22

cauda equina syndrome S2-S4 midline disc/tumor

Front 23

What are 'red flags' for systemic dz associated w/low back pain

Back 23

age>50 years
hx CA
unexplained weight loss
pain > 1 month or not responding to tx
pain at night/or increased by rest
Hx IVDA, infection

Front 24

Radicular pain from spinal nerve compression is most commonly

Back 24

C7 followed by C6
usually from foraminal impingement from degenerative jt changes rather than disc herniation

Front 25

pain in one jt suggests:

Back 25

trauma
monoarticular arthritis
tendinitis
bursitis

Front 26

lateral hip pain near greater trochanter may be this

Back 26

trochanteric bursitis

Front 27

migratory pain spread in this or this

Back 27

rheumatic fever or gonococcal arthritis

Front 28

progressive additive pattern w/symmetric involvement in this

Back 28

rheumatoid arthritis

Front 29

what type of pain in inflammation of bursae (bursitis), tendons (tendinitis), or tendon sheaths (tenosynovitis), also sprains

Back 29

extra-articular pain

Front 30

generalized aches & pains are called this

Back 30

myalgias if in muscles & arthralgias if there is pain but no evidence of arthritis

Front 31

you see severe pain or rapid onset in a red swollen jt in this

Back 31

acute septic arthritis or gout
osteomyelitis in kids

Front 32

if you have fever, chills, warmth redness consider this

Back 32

septic arthritis, gout or rheumatic fever

Front 33

articular joint pain may involve these characteristics

Back 33

pain, swelling, loss of active & passive motion, locking, deformity

Front 34

Loss of active but not passive motion, tenderness outside the jt, absence of deformity in this

Back 34

nonarticular pain

Front 35

stiffness & limited motion after inactivity is sometimes called this; how long does it last

Back 35

gelling
only few minutes
typical in degenerative jt dz

Front 36

stiffness lasting 30 minutes or more in

Back 36

rheumatoid arthritis & other inflammatory arthritides

Front 37

Stiffness may also be seen in

Back 37

fibromyalgia & polymyalgia rheumatica

Front 38

generalized symptoms are comon in

Back 38

rheumatoid arthritis, SLE, polymyalgia rheumatica (PMR)

Front 39

butterfly rash on cheeks indicates

Back 39

SLE

Front 40

scaly rash & pitted nails

Back 40

psoriatic arthritis

Front 41

papules, pustules or vesicles on reddened bases located on distal extremities

Back 41

gonococcal arthritis

Front 42

expanding erythematous patch early in illness

Back 42

lyme dz

Front 43

hives

Back 43

serum sickness, drug reaction

Front 44

erosions or scale on penis, crusted papules on soles/palms, also red burning itchy eyes

Back 44

Reiter's syndrome, also includes arthritis, urethritis, uveitis

Front 45

maculopapular rash of rubella

Back 45

arthritis of rubella

Front 46

clubbing of fingernails

Back 46

hypertrophic osteoarthropathy

Front 47

sore throat

Back 47

acute rheumatic fever/gonococcal arthritis

Front 48

lymes dz w/CNS involvement s/s

Back 48

mental status changes, facial or other weakness, stiff neck

Front 49

most vulnerable part of skeleton

Back 49

low back esp. L5-S1

Front 50

these are the leading cause of nonfatal injuries & death rates after 65 years

Back 50

falls

Front 51

bone strength reflects these two things

Back 51

density(bone mass, new bone, bone loss/resorption)
quality (archetecture, mineralization)

Front 52

the WHO uses this to define osteopenia & osteoporosis

Back 52

bone density

Front 53

osteopenia is bone density

Back 53

1-2.5 SD below mean in young white women

Front 54

osteoporosis is bone density

Back 54

>= 2.5 SD below mean in young white women

Front 55

US preventative task force on bone density testing

Back 55

recommends for women >=65 years & young women at risk

Front 56

risk factors for osteoporosis

Back 56

postmenopausal
age >50
weight <70kg
hx (family, fracture)
ETOH, delayed menarch/early menopaus
smokers, low vit D, use steriods > 2months, inflammatory do

Front 57

these inhibit osteoclast activity & slow bone remodeling

Back 57

antiresorptive agents

Front 58

US PSTF use of estrogen/progestin for prevention of chronic conditions in postmenopausal women

Back 58

against routine use

Front 59

Rheumatoid arthritis typically involves

Back 59

several jts, symmetrically distributed

Front 60

joint deformities/malalignment of bones may be

Back 60

Dupuyten's contracture
bowlegs
knock knees

Front 61

bony fixation is known as

Back 61

ankylosis

Front 62

crepitus is felt over

Back 62

inflammed jt

Front 63

palpable bogginess/doughiness of the synovial membrane in this

Back 63

synovitis

Front 64

tenderness & warmth over thickened synovium suggests

Back 64

arthritis or infection

Front 65

the principle muscles opening the mouth are

Back 65

external pterygoids

Front 66

closing the mouth are muscles innervated by

Back 66

CN 5, trigeminal
masseter, temporalis, internal pterygoids

Front 67

facial asymmetry in

Back 67

TMJ

Front 68

TMJ characteristics

Back 68

facial asymmetry
unilateral chronic pain w/chew
jaw clenching/grinding teeth
pain/tenderness

Front 69

dynamic stabalizers of shoulder

Back 69

SITS muscles of rotator cuff (supraspinatus, infraspinatus, teres minor, subscapularis)

Front 70

atrophy of supraspinatus & infraspinatus over posterior scapula w/increased prominence of scapular spine within 2-3 wks of this

Back 70

rotator cuff tear

Front 71

crossover test is what & evaluates what

Back 71

adduct arm across chest
localized pain/tenderness suggests inflammation/arthritis of acromioclavicular jt

Front 72

most common cause of shoulder pain

Back 72

rotator cuff (supraspinatus tendon)

Front 73

what tests to evaluate rotator cuff

Back 73

Neer's impingement sign (positive)
Hawkin's impingement sign (positive)
Apley scratch test
supraspinatous strength
infraspinatous stength
drop arm sign
forearm spination

Front 74

what is the Neer's sign & if positive what does it mean

Back 74

press scapular w/one hand, raise pt arm w/ other. Compresses greater tuberosity of humerus agst acromion; + in rotator cuff tear

Front 75

What is Hawkin's sign & what does it indicate

Back 75

Flex pt shoulder & elbow 90 deg w/palm down. Rotate arm internally. This compresses greater tuberosity agst coracoacromial ligament; + in rotator cuff tear

Front 76

What is the Apley scratch test

Back 76

pt to touch opposite scapular in two ways (arm over back, arm under & up) as if scratching scapular

Front 77

describe supraspinatous strength test (empty can test) & what may a + indicate

Back 77

elevate arm 90 deg & internally rotate w/thumb down as if emptying a can; ask pt to resist as you push down

Front 78

supraspinatous strength test is also called this

Back 78

empty can test

Front 79

infraspinatous strength test describe

Back 79

arms at side & flex elbows 90 deg w/thumbs up; provide resistance as pt presses forearms outward; weakness is + for rotator cuff/bicipital tendinitis

Front 80

describe drop arm sign

Back 80

ask pt to fully abduct arm to shoulder 90 deg & lower slowly; If pt can not hold arm fully abducted at shoulder is + for rotator cuff tear

Front 81

tennis elbow

Back 81

tenderness distal to epicondyle in lateral epicondylitis;
repetive extension of wrist/pronation-supination of forearm

Front 82

pitcher's/golfer's elbow or Little League elbow

Back 82

medial epicondylitis;
follows repetive wrist flexion as in throwing

Front 83

supination

Back 83

turn palms up

Front 84

pronation

Back 84

turn palms down

Front 85

in osteoarthritis; Heberden's nodes at ____joints, Bouchard's nodes at _______joints

Back 85

Heberden at DIP jt (distal interphalangeal)
Bouchard at PIP jt (proximal interphalangeal)

Front 86

rheumatoid arthritis SYMMETRIC deformity in these joints

Back 86

PIP
MCP (metacarpophalangeal) & wrist joints w/ ulnar deviation

Front 87

thenar atrophy in median nerve compression in this

Back 87

carpal tunnel syndrome

Front 88

Flexion contractures in ring, 5th & 3rd fingers arise from thickening of palmar fascia in this

Back 88

Dupuytren's Contractures

Front 89

tenderness in distal radius in this

Back 89

colles fracture

Front 90

synovitis in MCPs is painful w/pressure remember this when

Back 90

shaking hands

Front 91

Heberden's nodes are described as

Back 91

hard dorsolateral nodules on the DIP jts, common in osteoarthritis

Front 92

tenderness of thumb think

Back 92

de Quervain's

Front 93

Finkelstein's test

Back 93

ask if wrist pain by asking pt to grasp thumb agst palm & move wrist toward midline (test thumb)

Front 94

what tests in carpel tunnel & what is nerve involved

Back 94

thumb abduction
tinels
phalens
Median nerve

Front 95

tinel's sign

Back 95

compress by tap lightly over median nerve
aching & numbness + carpal tunnel

Front 96

phalen's sign

Back 96

pt to hold wrist in flexion for 60 sec, alternatively ask pt to press back of hands together to form right angles
numb & tingle within 60 sec + carpel tunnel

Front 97

lateral deviation & rotation of head suggest

Back 97

torticollis from contraction of sternocleidomastoid muscle

Front 98

lateral & rotatory curvature of spine

Back 98

scoliosis

Front 99

birthmarks, port wine stain, hairy patches & lipomas over bony defects may indicate this

Back 99

spina bifida

Front 100

remember tenderness in the CVA may indicate this rather than musculoskeletal problem

Back 100

kidney infection

Front 101

ischiogluteal bursitis is also known as

Back 101

weaver's bottom, b'c adjacent sciatic nerve may mimic sciatica

Front 102

housemaid's knee is this

Back 102

prepatellar bursitis from excessive kneeling

Front 103

baker's cyst is this

Back 103

popliteal cyst from distention of gastrocnemius semimembranosus bursa

Front 104

a palpable fluid wave in knee jt is this sign

Back 104

balloon sign & indicates effusion

Front 105

this indicates rupture of achilles tendon

Back 105

abscence of plantar flexion is positive test
also, sudden severe pain 'like gunshot wound' ecchymosis from calf to heel & flat foot gait

Front 106

McMurray sign

Back 106

if click felt during flex/ext of knee

Front 107

valgus stress test

Back 107

abduction -knee flexed move thigh lat 30 deg, push medially agst knee

Front 108

varus stress test

Back 108

adduction-push agst knee medially

Front 109

anterior drawer sign

Back 109

knees & hips flex 90 deg, feet flat on table, draw tibia forward see if slides like a drawer; if forward jerk +, makes ACL tear likely

Front 110

Lachman test

Back 110

knee in 15 deg flex & ext rotation; move tibia forward & femur back; significant forward excursion +, indicates ACL tear

Front 111

ACL what's it stand for & name two tests

Back 111

Anterior cruciate ligament
Anterior drawer sign: forward knee jerk
Lachman's test: sign. forward excursion of knee

Front 112

focal heel pain

Back 112

plantar fascitis

Front 113

Ottowa ankle rule

Back 113

after trauma, inability to bear weight after 4 steps & tender over malleoulus (esp medial) is suspicious for ankle fracture

Front 114

Heberden's nodes at DIP, Bourchard's nodes at PIP, boggy synovium suggest

Back 114

osteoarthritis

Front 115

shooting pain below knee w/low back pain indicates

Back 115

sciatica

Front 116

pseudoclaudication pain in legs w/walking that improves w/rest, lumbar flexion indicates

Back 116

lumbar spinal stenosis

Front 117

nocturnal back pain unrelieved by rest consider this

Back 117

metastatic malignancy to spine

Front 118

cervical radiculopathy

Back 118

sharp burning/tingle pain in neck & one arm
C7; C6

Front 119

cervical myelopathy

Back 119

neck pain w/bilat weakness & parathesia; may see Lhermitte sign: neck flex w/sensation of electric shock down spine

Front 120

Lhermitt sign

Back 120

neck flexion w/resulting sensation of electric shock radiating down spine (seen in cervical myelopathy)

Front 121

big toe tender, hot, red onset often at night

Back 121

gouty arthritis (acute gout)

Front 122

widespread MSC pain & tender points "all over"

Back 122

fibromyalgia syndrome

Front 123

positive apprehension sign

Back 123

shoulder seems to slip out of jt when arm abducted & ext rotated (anterior disclocation of humerus)

Front 124

acute RA describe joints

Back 124

tender, PAINFUL, stiff w/symmetric involvement; PIP, MCP, wrist most common, fusiform & spindle shaped swelling in PIP

Front 125

describe Osteoarthritis (degenerative jt dz) joints

Back 125

Heberden's (DIP)--think dD); Bouchard (PIP)
hard painLESS

Front 126

chronic RA jt signs

Back 126

Swan neck deformity: hyperextension of PIP w/ fixed flexion DIP); swelling of MCP & PIP, fingers deviate to ulnar side, boutonniere deformity-persistent flexion of PIP w/ hyperextension of DIP; nodules

Front 127

Swan neck deformity is & is seen in

Back 127

hyperEXTENSION u of PIP w/fixed flexion of DIP
seen in chronic RA

Front 128

Boutonniere deformity seen in

Back 128

chronic RA
persistent FLEXION of PIP ^ w/hyperextension of DIP

Front 129

tophi in joints, bursae, SC tissue is seen in this

Back 129

chronic tophaceous gout; multiple local accumulations of sodium urate

Front 130

frozen shoulder aka

Back 130

adhesive capsulitis

Front 131

repeated shoulder motion as in throwing & swimming may result in this

Back 131

rotator cuff tendinitis involving the supraspinatus tendon

Front 132

characteristic shrugging of shoulder & a positive drop arm test seen in this

Back 132

rotator cuff tears