Bates Clinical Exam Musculoskeletal

Front 1

rank of low back pain among reasons for clinical visits and rank for most common symptom of patients seeking care

Back 1

5th highest reason
2nd most common symptom

Front 2

articular disease

Back 2

involves swelling and tenderness of entire joint and limits both active and passive ROM

Front 3

extra-articular disease

Back 3

involves selected regions of the joint and types of movement

Front 4

ligaments connect

Back 4

bone to bone

Front 5

list articular structures

Back 5

joint capsule and articular cartilage, synovium and synovial fluid, intra-articular ligaments, juxta-articular bone

Front 6

list extra-articular structures

Back 6

periarticular ligaments, tendons, bursae, muscles, fascia, bone, nerve, overlying skin

Front 7

tendons connect

Back 7

muscle to bone

Front 8

bursae

Back 8

pouches of synovial fluid that cushion movement of tendons and muscles over bone or other joints

Front 9

synovial joints

Back 9

bones do not touch each other- joint articulations are freely moveable
- covered with articular cartilage and separated by a synovial cavity filled with synovial fluid

Front 10

cartilaginous joints

Back 10

vertebral bodies
- slightly moveable
- fibrocartilaginous discs separate the bony surfaces
- center of each disc- nucleus pulposus

Front 11

fibrous joints

Back 11

- skull sutures
- intervening layers of fibrous tissue or cartilage hold the bones together
- allows no appreciable movement

Front 12

spheroidal (bone and socket)

Back 12

- convex surface in concave cavity
- shoulder, hip
- wide ranging flexion, ex, ab, ad, rot, circum

Front 13

hinge

Back 13

- flat, planar
- motion in one plane; flexion, extenion
- interphalangeal joints of hand and foot; elbow

Front 14

condylar

Back 14

- convex or concave
- knee; TMJ
- movement of two articulating surfaces not dissociable

Front 15

fraction of adults with low back pain

Back 15

2/3

Front 16

what percentage of patients have idiopathic back pain

Back 16

85%

Front 17

think what for midline back pain

Back 17

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

Front 18

think what for off the midline pain

Back 18

sacroiliitis, trochanteric bursitis, sciatica, hip arthritis

Front 19

presentation of sciatica

Back 19

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

Front 20

presentation of spinal stenosis

Back 20

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

Front 21

presentation of cauda equina syndrome

Back 21

bowel or bladder dysfunction (esp urinary retention and overflow incontinence)

Front 22

"red flags" for serious underlying systemic disease

Back 22

- age >50
- hx of CA
- unexplained wt loss
- pain > 1 month or that doesnt respond to treatment
- pain at night or increased by rest
- hx of IVD use
- presence of infection

Front 23

probability of serious systemic disease in cases of LBP (low back pain) plus a red flat

Back 23

10%

Front 24

most common radicular pain in the neck region

Back 24

spinal cord compression C7 followed by C6

Front 25

usual cause of radicular pain in the neck

Back 25

foraminal impingement from degenerative joint changes (not herniation)

Front 26

pain in one joint suggests

Back 26

trauma, monoarticular arthritis, tendinitis, bursitis

Front 27

lateral hip pain near greater trochanter suggests

Back 27

trochanteric bursitis

Front 28

migratory pattern of spread seen when

Back 28

rheumatic fever or gonococcal arthritis

Front 29

progressive additive pattern with symmetric involvement

Back 29

RA

Front 30

presentation of acute septic arthritis or gout

Back 30

severe pain of rapid onset in a red, swollen joint; maybe osteomyelitis in kids

Front 31

fever, chills, warmth, redness seen in?

Back 31

septic arthritis, gout, rhematic fever

Front 32

gelling

Back 32

stiffness and limited motion after inactivity in degenerative joint disease but usually lasts only a few minutes

Front 33

stiffness lasting 30 minutes or more

Back 33

RA

Front 34

systemic findings common in these arthritides

Back 34

RA, SLE, PMR

Front 35

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

Back 35

conococcal arthritis

Front 36

expanding erythematous patch early in illness

Back 36

Lyme

Front 37

hives

Back 37

serum sickness, drug rxn

Front 38

erosions or scale on the penis and crusted, scaling papules on soles and palms

Back 38

Reiter's syndrome- arthritis, uveiitis, urethritis

Front 39

red, burning, itchy eyes

Back 39

Reiter's; Behcet's syndrome

Front 40

diarrhea, abdominal pain, cramping

Back 40

arthritis with UC, regional enteritis, scleroderma

Front 41

urethritis

Back 41

reiter's; gonococcal

Front 42

percentage of americans who are lazy as shit and live sedentary lifestyles

Back 42

20- 30%

Front 43

vulnerable area of the lower back involved with lifting

Back 43

L5-S1

Front 44

what percentage of the population experiences low back pain in life

Back 44

60-80%

Front 45

leading cause of non-fatal injuries and account for rise in death rates after age 65

Back 45

falls

Front 46

general population vs. 65-74 y.o. population vs. 85+ population for death rates related to falls

Back 46

5/100,000
10/100,000
147/100,000

Front 47

fraction of patients who regain prior level of function and of those who require nursing home placement

Back 47

1/3 each

Front 48

how many americans have osteoporosis and how many are at increased risk

Back 48

10 million
34 million

Front 49

what percentage of patients with osteoporotic hip fractures die within 1 year

Back 49

20%

Front 50

osteopenia on the bone density scale

Back 50

1.0-2.5 standard deviations below the mean for young adult white women

Front 51

osteoporosis on bone density scale

Back 51

2.5 or more standard deviations below the mean for young adult white women

Front 52

who uses Z scores as a better measure

Back 52

young people, because it allows comparison with those of similar, age, ht, wt

Front 53

where is bone density measured

Back 53

hip, femoral neck, Ward's triangle, greater trochanter, total hip

Front 54

what drop in bone density is assd with what increase in risk for fracture

Back 54

10% drop in bone density is assd with a 20% increase in risk for fracture

Front 55

statistics for those with osteoporosis vs osteopenic groups and fracture risk

Back 55

relative risk is higher in those with osteoporosis but almost half of all fragility fractures occur in osteopenic group

Front 56

risk factors for osteoporosis

Back 56

- postmenopausal white women
- age >50
- wt less than 70 kg
- family hx 1st degree relative (fract)
- hx of fracture
- alcohol intake
- delayed menarche or early menopause
- current smokers
- low levels of 25-hydroxyvitamin D
- use of corticosteroids for >2mo
- other AI stuff

Front 57

treatment for osteoporosis

Back 57

- calcium
- vitamin D (up to 2/3 with fractures are deficient)
- antiresorptive agents- inhibit osteoclast activity and slow bone remodeling-- bisphosphonates, SERMs, calcitonin, postmenopausal estrogen
- anabolic agents- PTH- stimulate bone formation by acting primarily on osteoblasts

Front 58

subcutaneous nodules seen in

Back 58

RA or rheumatic fever

Front 59

effusions seen in

Back 59

trauama

Front 60

crepitus over inflamed joints

Back 60

osteoarthritis

Front 61

conditions where there is decreased ROM

Back 61

arthritis, inflammation, fibrosis around joint, bony fixation (ankylosis)

Front 62

palpable bogginess or doughiness of synovial membrane

Back 62

synovitis; accompanied by effusion

Front 63

osteomyelitis

Back 63

arthritis, tendinitis, bursitis

Front 64

DDx for nonarticular condition

Back 64

- trauma/fracture
- fibromyalgia
- polymyalgia rheumatica
- bursitis
- tendonitis

Front 65

possibilities if chronic noninflammatory arthritis that does not involve DIP, CMC1, hip, or knee joints

Back 65

- osteonecrosis
- Charcot joints

Front 66

possibilities if chronic inflammatory arthritis involving 1-3 joints

Back 66

- indolent infection
- psoriatic arthritis
- Reiter's
- pauciarticular JA

Front 67

most active joint in the body

Back 67

TMJ

Front 68

what makes up the TMJ

Back 68

fossa and articular tubercle of temporal bone and condyle of mandible
- midway between external acoustic meatus and zygomatic arch

Front 69

principle muscles that open the mouth

Back 69

external pterygoids

Front 70

muscles that close the mouth and their innervation

Back 70

cranial nerve V
- masseter, temporalis, internal pterygoids

Front 71

DDx for pain with chewing

Back 71

TMJ
trigeminal neuralgia
temporal arteritis

Front 72

dynamic stablers of the shoulder

Back 72

SITS
- Supraspinatus
- Infraspinatus
- teres minor
- Subscapularis

Front 73

function of SItS muscles

Back 73

move the humerus and depress and stabilize humeral head in glenoid fossa

Front 74

statis stabilizers of shoulder

Back 74

bone, labrum, articular capsule, glenohumeral ligaments

Front 75

labrum

Back 75

fibrocartilaginous ring that surrounds the glenoid and deepends its socker

Front 76

articular capsule

Back 76

formed by tendons of rotator cuff- adds to stability

Front 77

Supraspinatus

Back 77

- runs above glenohumeral joint; inserts on greater tubercle
- abduction

Front 78

infraspinatus and teres minor

Back 78

-cross glenohumeral joint posteriorly; insert on greater tubercle
- external rotation

Front 79

subscapularis

Back 79

- originates on anterior surface of scapula and crosses joint anteriorly; inserts on lesser tubercle
- internal rotation

Front 80

axioscapular group

Back 80

- attaches the trunk to the scapula
- trapezius, rhomboids, serratus anterior, levator scapulae
- rotate the scapula

Front 81

axiohumeral group

Back 81

- attaches trunk to humerus
- pectoralis major and minor and latissimus dorsi

Front 82

principal bursa of the shoulder

Back 82

subacromial bursa- between acromion and head of humerus and overlying supraspinatus

Front 83

when will subacromial bursa be painful if inflamed

Back 83

abduction and rotation

Front 84

shoulder muscles of flexion

Back 84

anterior deltoid, pectoralis major, coracobrachialis, biceps brachii

Front 85

shoulder muscles- extension

Back 85

lat, teres major, posterior deltoid, triceps brachii

Front 86

shoulder muscles- abduction

Back 86

supraspinatus, middle deltoid, serratus anterior

Front 87

how do you test pure glenohumeral motion

Back 87

raise arms to 90 degrees with palms facing down

Front 88

shoulder muscles adduction

Back 88

pec major, coracobrachialis, lat dorsi, teres major, subscapularis

Front 89

shoulder muscles- internal rotation

Back 89

subscapularis, anterior deltoid, pec major, teres major, lat

Front 90

shoulder muscles- external rotation

Back 90

infraspinatus, teres minor, posterior deltoid

Front 91

apley scratch test

Back 91

patient touches opposite scapula behind them; difficulty- rotator cuff

Front 92

neer's impingement sign

Back 92

press on scapula with one hand and raise pts arm with the other; compresses greater tuberosity of humerus against acromion

Front 93

hawkin's impingement sign

Back 93

flex patient's shoulder and elbow to 90 degrees with palm down; rotate arm internally; compress greater tuberosity against coracoacromial ligament

Front 94

empty can test- tests supraspinatus

Back 94

elevate arms to 90 degrees and internally rotate

Front 95

test infraspinatus how

Back 95

patient place arms at side and flex elbows to 90 degrees with thumbs up; resist as patient presses forearms out

Front 96

articulations of the radius, ulna, humerus

Back 96

humeroulnar joint, radiohumeral joint, radioulnar joint

Front 97

elbow flexion

Back 97

biceps brachii, brachialis, brachioradialis

Front 98

elbow extension

Back 98

triceps brachii, anconeus

Front 99

elbow supination

Back 99

biceps brachii, supinator

Front 100

elbow pronation

Back 100

pronator teres, pronator quadratus

Front 101

where does the ulnar nerve run by the elbow

Back 101

posteriorly in the ulnar groove between the medial epicondyle and the olecranon process

Front 102

location of the medial nerve at the elbow

Back 102

medial to the brachial artery

Front 103

tenderness distal to the epicondyle

Back 103

lateral epicondylitis

Front 104

when is the olecranon displaced posteriorly

Back 104

posterior disolcation of elbow and supracondylar fracture

Front 105

the carpal tunnel contains

Back 105

the sheath and flexor tendons of the forearm muscles and the median nerve

Front 106

median nerve sensory distribution (distal)

Back 106

palm and palmar surface of most of the thumb, second and third digits, and half of the fourth digit; innervates muscles of flexion, abduction, and opposition in thumb

Front 107

poor finger alignment seen in what kind of damage

Back 107

flexor tendon damage

Front 108

nodes in osteoarthritis

Back 108

Heberden's at DIPs
Bouchard's at PIPs

Front 109

ulnar deviation seen when

Back 109

RA

Front 110

thenar atrophy

Back 110

carpal tunnel syndrome

Front 111

flexion contractures in the ring, 5th, and 3rd fingers are what and arise from what

Back 111

Dupuytren's contractures; from thickening of palmar fascia

Front 112

colles' fracture produces pain where on exam

Back 112

distal radius

Front 113

de Wuervain's tenosynovitis and gonococcal tenosynovitis present how

Back 113

tenderness over the extensor and abductor tendons of the thumb at the radial styloid

Front 114

tenderness over the "snuffbox"

Back 114

scaphoid fracture- most common injury of carpal bones

Front 115

wrist flexion

Back 115

flexor carpi radialis, flexor carpi ulnaris

Front 116

wrist extension

Back 116

extensor carpi ulnaris, extensor carpi radialis longus, extensor carpi radialis brevis

Front 117

adduction (tested palm down)

Back 117

flexor carpi ulnaris

Front 118

abduction (tested palm down)

Back 118

flexor carpi radialis

Front 119

hand grip stregth tests

Back 119

wrist joints, finger flexors, intrinsic muscles of hand

Front 120

wrist pain and grip weakness

Back 120

deQuervain's tenosynovitis

Front 121

decreased grip strength

Back 121

arthritis, CTS, epicondylitis, cervical radiculopathy

Front 122

Finkelstein's test

Back 122

pain IDs de Quervain's tenosynovitis from inflammation of abductor pollicis longus and extensor pollicis brevis tendons and tendon sheaths

Front 123

why is there increased risk for disc herniation and subluxation, or slippage, of L5 on S1

Back 123

vertebral column angles sharply posterior at lumbosacral junction and becomes immovable

Front 124

neck stiffness think of

Back 124

arthritis, muscle strain, underlying pathology

Front 125

lateral deviation and rotation of the head suggest

Back 125

torticollis from contraction of SCM

Front 126

level of iliac crests

Back 126

L4

Front 127

tenderness in arthritis especially at the facet joints between which vertebrae

Back 127

C5 and C6

Front 128

"step-offs" felt on palpation of lower lumbar area in?

Back 128

spondylolisthesis

Front 129

spondylolisthesis

Back 129

forward slippage of one vertebra- may compress spinal cord

Front 130

tenderness over sacroiliac joint

Back 130

ankylosing spondylitis

Front 131

pain on percussion

Back 131

osteoporosis, infection, malignancy

Front 132

unequal shoulder heights seen in

Back 132

scoliosis, Sprengel's deformity of scapula; winged scapula; contralateral weakness of trap

Front 133

unequal heights of iliac crests of pelvic tilt

Back 133

leg length difference; scoliosis and hip abduction/adduction; listing in herniated lumbar disk

Front 134

what may overlie spina bifida

Back 134

birthmarks, port wine stains, hairy patches, lipomas

Front 135

cafe au lait spots in

Back 135

with skin tags and fibrous tumors in NF

Front 136

sciatic nerve roots and where it lies

Back 136

L4-S3; midway between the greater trochanter and ischial tuberosity as it leaves pelvis through sciatic notch

Front 137

most common herniated IV discs and tenderness they produce

Back 137

L5-S1; L4-L5; tenderness of spinous processes, IV joints, paravertebral muscles, sacrosciatic notch, sciatic nerve

Front 138

neck muscles of flexion

Back 138

SCM, scalene, prevertebral muscles

Front 139

neck muscles of extension

Back 139

splenius capitus and cervicis, small intrinsic neck muscles

Front 140

neck muscles of rotation

Back 140

SCM, small intrinsic neck muscles

Front 141

neck muscles of lateral bending

Back 141

scalenes and small intrinsic neck muscles

Front 142

muscles involved in flexion

Back 142

psoas major, psoas minor, quadratus lumborum; int/ext obliques and rectus abdominis

Front 143

muscles involved in extension

Back 143

erector spinae, transversospinalis

Front 144

bones of the pelvis, inferior and posterior connections

Back 144

- acetabulum, ilium, ischium
- inferiorly with symphysis pubis
- posteriorly with sacroiliac bone

Front 145

level of PSIS

Back 145

S2

Front 146

percentage of walking cycle when foot is on ground and bearing weight

Back 146

60%

Front 147

wide based gait suggests

Back 147

cerebellar problems

Front 148

hip dislocation, arthritis, abductor weakness can produce what type of gait

Back 148

cause pelvis to drop on opposite side- waddling gait

Front 149

width of the base from heel to heel

Back 149

2-4 inches

Front 150

leg shortening and external rotation suggests

Back 150

hip fracture

Front 151

inguinal ligament

Back 151

from ASIS to pubic tubercle

Front 152

relation of femoral contents to inguinal ligament

Back 152

structures bisect; NAVEL; lymph nodes are medial

Front 153

focal tenderness over the trochanter

Back 153

trochanteric bursitis

Front 154

"weaver's bottom"

Back 154

ischiogluteal bursitis; may mimic sciatica

Front 155

hip flexion

Back 155

iliopsoas

Front 156

hip extension

Back 156

gluteus maximus

Front 157

hip abduction

Back 157

gluteus medius and minimus

Front 158

hip adduction

Back 158

adductor brevis, adductor longus, adductor magnus, pectineus, gracilis

Front 159

hip external rotation

Back 159

internal and external obturators, quadratus femoris, superior and inferior gemelli

Front 160

internal rotation

Back 160

gluteus medius and minimus

Front 161

flexion deformity of the hip- when opposite hip is flexed

Back 161

affected hip does not allow full leg extension and affected thigh looks flexed

Front 162

quadriceps femoris muscles

Back 162

rectus femoris, vastus lateralis, vastus medialis

Front 163

hamstring muscles

Back 163

semimembranosus, gracilis, sartorius, semitendinosus

Front 164

describe medial and lateral menisci

Back 164

cushion action of femur on tibia; crescent-shaped; fibrocartilaginous

Front 165

describe MCL

Back 165

broad, flat ligament; connects medial femoral epicondyle to medial condyle of tibia

Front 166

describe LCL

Back 166

connects lateral femoral epicondyle to head of fibula

Front 167

describe ACL

Back 167

crosses obliquely from anterior medial tibia to lateral femoral condyle; prevents tibia from moving forward

Front 168

describe PCL

Back 168

crosses from posterior tibia and lateral meniscus to medial femoral condyle; prevents tibia from moving backwards

Front 169

prepatellar bursa lies where

Back 169

between patella and overlying skin

Front 170

anserine bursa lies where

Back 170

1-2 inches below the knee joint on the medial surface, proximal and medial to the attachments of the medial hamstring muscles on the proximal tibia

Front 171

signs of quadriceps weakness

Back 171

stumbling of pushing the knee into extension with the hand during heel strike

Front 172

genu varum vs genu valgum- lay terms

Back 172

- bowlegs
- knock-knees

Front 173

swelling over the patella

Back 173

prepatellar bursitis

Front 174

swelling over tibial tubercle

Back 174

infra-patellar or anserine bursitis

Front 175

think of what if presentation of bony ridges along joint margins, genu varum deformity, stiffness 30 minutes or less

Back 175

osteoarthritis

Front 176

which meniscus is more likely to tear

Back 176

medial (with trauma)

Front 177

pain and crepitus in patellofemoral grind test

Back 177

roughening of patellar undersurface where it articulates with femur; also when climbing or getting up from a chair

Front 178

pain with compression during grind

Back 178

chondromalacia or degenerative patella (patellofemoral syndrome)

Front 179

housemaid's knee

Back 179

prepatellar bursitis from excessive kneeling

Front 180

anserine bursitis commonly from

Back 180

running, valgus knee deformity, fibromyalgias, osteoarthritis

Front 181

popliteal or "baker's" cyst

Back 181

from distention of gastrocnemius semimembranous bursa

Front 182

bulge sign

Back 182

- for minor effusions
- have knee extended, left hand above knee, put pressure on suprapatellar puch and "milk" fluid downward
- stroke downward on medial aspect of knee
- tap lateral margin

Front 183

positive bulge sign

Back 183

fluid wave on medial side between patella and femur- consistent w effusion (minor)

Front 184

balloon sign

Back 184

place thumb and index finger on either side of patella; with L hand compress suprapatellar puch against femur; feel for fluid entering in spaces next to patella under R thumb and index finger

Front 185

positive balloon sign

Back 185

with a large effusion suprapatellar compression ejects fluid into spaces adjacent to patella

Front 186

ballotting the patella

Back 186

push patella sharply against femur and watch for fluid to return to pouch

Front 187

Achilles tendon is common to which two muscles

Back 187

gastrocnemius and soleus

Front 188

ruptured Achilles tendon

Back 188

defect in muscles with tenderness and swelling

Front 189

Achilles tendonitis

Back 189

thickening of tendon above calcaneus, with protuberant posterolateral bony process of calcaneus

Front 190

absence of plantar flexion

Back 190

positive to indicate rupture of Achilles tendon
- sudden, severe pain, ecchymosis from calf to heel, and flat foot gait with absence of "toe-off" may be present

Front 191

muscles of IR at knee

Back 191

sartorius, gracilis, semitendinosus, semimembranosus

Front 192

muscles of ER at knee

Back 192

biceps femoris

Front 193

McMurray test

Back 193

pt supine; grasp heel and flex knee; cup hand over knee joint with fingers and thumb along medial and lateral joint line; from heel- rotate lower leg internally and externally; push on lateral side to apply a valgus stress on medial side of the joint

Front 194

to test MCL

Back 194

apply valgus stress (abduction)
- (+) with pain or gap in medial joint line (ligamentous laxity and partial tear)

Front 195

to test LCL

Back 195

apply varus stress (adduction)

Front 196

positive anterior drawer sign makes ACL tear how many times more likley

Back 196

11.5

Front 197

lachman test

Back 197

knee in 15 degrees of flexion and external rotation
- grasp distal femur and upper tibia with other hand
- with thumb of tibial hand on joint line, move the tibia forward and femur back

Front 198

positive Lachman test makes ACL tear how many times more likely

Back 198

17

Front 199

principle joints of the ankle

Back 199

tibiotalar, subtalar (talocalcaneal)

Front 200

plantar flexion of ankle powered by what muscles

Back 200

gastrocnemius, posterior tibial muscle, toe flexors
- tendons run behind malleoli

Front 201

dorsiflexion powered by what muscles

Back 201

anterior tibial muscle, toe extensors
- lie on the anterior surface of the ankle, anterior to the malleoli

Front 202

deltoid ligament

Back 202

medially; fans out from inferior surface of medial malleolus to the talus and proximal tarsal bones- protects from eversion

Front 203

lateral ligaments

Back 203

- anterior talofibular ligament
- calcaneofibular ligament
- posterior talofibular ligament

Front 204

which ligaments of ankle are most likely to be injured

Back 204

lateral ligaments; most at risk from inversion= anterior talofibular ligament

Front 205

inserts on medial tubercle of calcaneus

Back 205

plantar fascia

Front 206

plantar fasciitis presentation

Back 206

focal heel pain on palpation of plantar fascia

Front 207

plantar fasciitis associated with

Back 207

prolonged standing or heel-strike exercise; RA, gout

Front 208

post-trauma; can't bear weight after 4 steps and tenderness over posterior aspect of either malleolus- especially medial- think what

Back 208

ankle fracture- Ottowa ankle rule

Front 209

metatarsalgia seen with what

Back 209

trauma, arthritis, vascular compromise

Front 210

Morton's neuroma

Back 210

tenderness over 3rd and 4th metatarsal heads on plantar surface

Front 211

muscles of ankle flexion (plantar flexion)

Back 211

gastrocnemius, soleus, plantaris, tibialis posterior

Front 212

muscles of ankle extension (dorsiflexion)

Back 212

tibialis anterior, extensor digitorum longus, extensor hallucis longus

Front 213

muscles of ankle inversion

Back 213

tibialis posterior and anterior

Front 214

muscles of ankle eversion

Back 214

peroneus longus and brevis

Front 215

difference between pain elicited in arthritic joint vs ligamentous sprain

Back 215

arthritic joint- pain when moved in any direction
ligamentous strain- pain when ligament is stretched