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25 Cards in this Set
- Front
- Back
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Periarticular pain -> bursa, ligaments, tendons
MRI |
A patient presents with joint pain in the surrounding joint. What structures could be involved?
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Referred pain from elsewhere
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A patient presents with joint pain that is well above the affected joint. Etiology?
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Palpation/Cross arm test
The AC joint is palpated for swelling and tenderness. Flex shoulder to 90 degrees and draw the arm cross the chest towards the other shoulder, which pushes the acromion into the distal end of the clavicle. |
A patient presents with shoulder pain. You want to test the acromioclavicular joint (AC joint). What tests should you perform?
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Hawkin's Test
Flex the shoulder forward to 90 degrees with elblow flexed up. Internally rotate the arm (forearm goes downward). This pushes the supraspinatus tendon against the inferior edge of the coracroamial ligament. Painful Arc Test Ask the patient to abduct the arm with the hand supinated |
You want to test the subacromian space for impingement. What tests can you perform?
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Empty can test
Patient abducts the arms to 90 degrees with about 30 degrees of forward flexion with the hands pronated down. The examiner tries to push the arms down while the patient resists. Pain without weakness implies tendon inflammation. Pain with weakness implies tendon tear. |
You want to test the supraspinatus muscle and tendon in a patient with shoulder pain. What tests can you perform?
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The patient flexes both elbows to 90 degrees. The examiner resists external rotation of the arms.
Pain and normal strength implies infraspinatus tendon inflammation. Pain and weakness implies a tendon tear. |
You want to test the infraspinatus and teres minor muscles. What maneuver should you do?
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"lift off" test
This muscle internally rotates the shoulder. The patient places a hand at the mid-lumbar region with a hand slightly off the back. The examiner pushes the hand toward the back while the patient resists. A positive test is weakness (compared to the other side) |
You want to test the subscapularis muscle and tendon.
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Patient flexes the bicep up with hand in supination.
The examiner places one hand on the shoulder, feeling the biceps tendon with the fingertips. With the other hand the examiner resists flexion of the arm. A positive test is reproduction of pain in the biceps under the examiner's fingertips. |
You want to test the bicep's tendon for inflammation.
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Rotate the head toward the affected shoulder while pressing down, which puts an axial load on the cervical spinal column.
A positive test is reproduction of the patient's shoulder or arm pain. |
You want to check for cervical root impingement.
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Glenohumeral
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What is the difference between glenohumeral and extra glenohumeral pain?
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Look
Feel Move - 3 ways 1. Active ROM 2. Passive ROM 3. Provocative tests |
What are the three steps of the musculoskeletal exam for shoulder pain?
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Shoulder flexion
Shoulder extension Shoulder adduction and abduction Internal Rotation External Rotation Horizontal Rotation |
What are the six active ROM you should ask the patient to do to evaluate shoulder pain?
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Glenohumeral pathology
1. Rotator cuff tendinitis or subacromial bursitis 2. Adhesive capsulitis 3. Joint laxity with recurrent anterior shoulder dislocation |
A patient presents with lateral pain in the deltoid area of the arm. What is your immediate differential?
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1. Biceps tendinitis
2. Acromioclavicular joint arthritis |
A patient presents with anterior shoulder pain. Differential?
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Injury to the infraspinatus or teres minor muscles.
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A patient presents with posterior shoulder pain. Differential?
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Suggests an extrinsic source of pain including
1. Neck; nerve root compression with radiation of pain to the shoulder 2. Abdomen; with irritation of the diaphragm and radiation to the shoulder |
A patient presents with poorly localized and diffuse pain. Differential?
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Oligocarticular
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A patient presents with more than one joint in pain but less than four. What is this called?
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Polyarticular
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A patient presents with more than four joints in pain. What is this called?
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Periarticular; surrounding the joint
Could be bursa, ligaments or tendons |
A patient presents with shoulder pain during active exertion rather than passive motion. Range of motion is preserved. What is the likely type of joint pain?
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What are the nursing responsibilities for a patient with hyperemesis gravidarum?
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Strict I/O, emotional support.
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Rheumatoid Arthritis, Lupus
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A patient presents with 'additive' joint pain in which new joints are becoming involved while the original site of pain is still affected. Whats your two disease differential?
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Disseminated gonococcal infection
Acute Rheumatic Fever |
A patient presents with migratory joint pain that started in the shoulder but has since moved to the knee and then to the hands. What is your two disease differential?
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Gout
pseudogout |
A patient presents with intermittent joint pain where her big toe hurts like hell for a few weeks and then the pain dissappears for a year. Differential?
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Cultures from urethra, vaginal, rectal, or skin. Likely a gonococcal infection.
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A 21 year old female presents with joint pain in her knee. She reports recent sexual intercourse and vaginal discharge. How can you confirm your suspicion?
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Pseudogout
Aspirate the joint to look for calcium pyrophosphate dihydrate crystals |
A patient presents with a painful swollen joint. The patient reports a history of hyperparathyroidism. What disease should you suspect?
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