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113 Cards in this Set

  • Front
  • Back
Synovial joint: def and ex
- Freely moveable
- Bones covered by articular cartilage and separated by a synovial cavity that cushions mvmt
- Ex: knee and shoulder
Spheroidal synovial joint: def, mvmts, and ex
- Ball and socket
- Wide range flex, ext, abd, add, rotation, circum.
- Ex: *shoulder, *hip
Hinge synovial joint: def, mvmts, ex
- Motion in one plane
- Flex, ext
-Ex: *IP joints of hand and foot, *elbow
Condylar synovial joint: def, mvmt, ex
- Mvmt of 2 articulating surfaces
- Not dissociable
- Ex: *knee, *TMJ
- Oval articulating surface sits in depression of another
Cartilaginous joint: def and ex
- Slightly moveable
- Ex: *Vertebral bodies of spine, public symphysis
Fibrous joints: def and ex
- Immoveable, bones almost in direct contact
- Ex: *skull sutures
Common or concerning MSK sx
- Neck pain
- Mono or polyarticular joint pain
- Inflammatory or infectious joint pain
- Joint pain w/ systemic features - chills, fever, rash, anorexia, weight loss, weakness
- Joint pain w/ sx from other organ systems
One of the leading complaints of pts seeking health care
Joint pain
Assessing joint pain
- *"Point to pain"
- Clarify and record *MOI*
- *Determine if pain is localized or diffuse, acute or chronic, inflammatory or non-inflammatory
LBP reg flags
- > 50yo
- Hx of CA
- Weight loss
- Nocturnal pain or pain increased w/ rest
- Hx of IVDU
- Presence of inf or fever
LBP red flags + bowel/blader dysfunction =
- Lesion L1-S5
Leg or LBP that improves w/ rest and/or lumbar flexion =
Spinal stenosis
Joint pain + Conjunctivitis + urethritis =
Reiter's Syndrome
Joint pain w/ a preceding sore throat, think...
*Acute rheumatic fever or gonococcal arthritis
Joint pain, diarrhea, and abd pain, think...
Ulcerative colitis or scleroderma
S/S of inflammation and arthritis
- *Swelling - synovial membrane boggy or doughy?, effusion w/in joint space?, soft-tissue swelling?
- *Warmth - use backs of fingers to assess
- *Tenderness
- *Redness - least common sign of inflammation near the joints
TMJ: description
- Most active joint in body
- Condylar synovial joint cushioned by fibrocartilaginous disc
Principal mm opening and closing mouth
- Opening - pterygoids
- Closing - masseter, temporalis, internal pterygoids (all CN V)
Normal ROM of TMJ
- Opening and closing - normal 3 fingers can be inserted
- Protrusion and retraction
- Lateral
TMJ Syndrome: features, PE, DDx, and Trauma
- Unilateral chronic pain w/ chewing, jaw clenching, or teeth grinding, often assoc. w/ stress (may also present w/ HA)
- PE: swelling, tenderness, and decreased ROM
- DDx: temporal arteritis, trigeminal neuralgia
- Trauma: possible dislocation, palpable crepitus, or clicking in poor occlusion, meniscus injury, or synovial swelling from trauma
Shoulder anatomy: joints
Glenohumeral, Sternoclavicular, AC
MM of the shoulder joint
- *Scapulohumeral group - SITS - lateral rotation (rotator cuff)*
- Axioscapular group - trap, rhomboids, serratus anterior, lev scap - pulls shoulder back
- Axiohumeral group: pec major and minor, and lat dorsi - internal rotation
Bony landmarks to palpate on shoulder exam
- *SC joint to AC joint*
- Papate spine of scapular laterally to * acromion and * AC joint
- *Coracoid process
- *Greater tubercle of humerus
- *Bicipital groove
- * Subacromial and subdeltoid bursae and SITS mm*
How to palpate subacromial bursae
- Passively extend humerus, inferior and lateral to acromion
MM under subacromial bursae
Most damaged m of rotator cuff
Pain in bicipital groove
Bicipital tendonitis
MM involved w/ flex of shoulder
- Ant deltoid
- Pec major
- Biceps
- Coracobrachialis
MM involved w/ ext of shoulder
- Lat dorsi
- Teres major
- Post deltoid
- Triceps
MM involved w/ abd of shoulder
- Suprapsinatus
- Middle deltoid
- Serratus anterior
Scapulothoracic motion
After raising arm 90 degrees (glenohumeral motion), raising additional 60 degrees w/ palm up is scapulothoracic
- final 30 degrees is combined scapulothoracic and glenohumeral
Assessing add ROM of shoulder joint tests___ and mm involved are _____
- *AC joint stability - AKA crossover sign*
- MM: pec major, coracobrachialis, lat dorsi, teres major, subscapularis
MM involved w/ internal rotation of shoulder joint
- Subscapularis, anterior deltoid, pec major, teres major, lat dorsi
MM involved w/ external rotation of shoulder joint
- Infraspinatus, teres minor, post deltoid
Special maneuver used to assess overall shoulder rotation/AC joint stability
- *Apley scratch test
- Scratching the opposite scapula (over the head and under)
- Difficulty doing this suggests rotator cuff disorder
Impingement of rotator cuff mm occurs b/w ____ and ____
Head of humerus and acromion
*Neer's sign: What does it test, how is it performed, and what does + mean?
- Special maneuver to test for impingement of rotator cuff
- Hold scapula to prevent motion and raise pt's arm
- Positive = Pain
*Hawkin's sign: What does it test, how is it performed, and what does + mean?
-Special maneuver to test for impingement of rotator cuff
- Flex pt's shoulder and elbow to 90 degrees w/ palm down
- Holding arm and forearm, rotate internally
- Positive = Pain
*Empty can test: What does it test, how is it performed, and what does + mean?
- Special maneuver to test for supraspinatus strength
- Have pt resist pressure applied to forearms
- Positive = weakness (possible rotator cuff tear)
*Drop arm test: What does it test, how is it performed, and what does + mean?
-Special maneuver to test for supraspinatus strength
- Abduct pt's arm to 90 degrees and have pt lower arm slowly
- Positive = unable to lower smoothly (possible rotator cuff tear)
*Yergason's test: What does it test, how is it performed, and what does + mean?
- Special maneuver to test biceps for pathology via supination
- Flex elbow to 90 degrees w/ pronation
- Have pt supinate as you resist holding the wrist
- Positive = pain and clicking, biceps tendon injury (or possible rotator cuff tear - text)
*Speed's test: What does it test, how is it performed, and what does + mean?
- Special maneuver to test biceps for pathology
- Flex shoulder to 90 w/ supination
- Have pt flex elbow while you resist
- Positive = Pain
*Sulcus sign: What does it test, how is it performed, and what does + mean?
- Special maneuver that tests GH joint stability
- With pt's arm relaxed at side, grasp forearm and pull downward while observing joint
- Positive = Sulcus sign
*Apprehension test: What does it test, how is it performed, and what does + mean?
- Special maneuver that tests anterior stability of shoulder
- Abd shoulder to 90 and externally rotate
- *Positive = pain or apprehension (arm seems to "slip out of the joint" w/ abd and ext rotation)*
Area of maximum tenderness in rotator cuff tendonitis w/ suprapinatus involved
Just below tip of acromion
Rotator cuff tendonitis - MOI, pts c/o, MC involved tendon, and MC pt demographic
- MOI: repeated shoulder motion, ie: throwing, swimming
- Pain aggravated by activity
- Pts c/o catches of pain, grafting, and weakness when lifting arm overhead
- MC involves the supraspinatus tendon
- Pts are MC athletically active
Rotator cuff tear: when arm is raised in forward flexion, the rotator cuff may impinge against _______ and _____.
MC in pts _____
Can lead to ....
- Impingement against undersurface of the acromion and the coracoacromial ligament
- Injury from fall or repeated impingement may weaken rotator cuff , causing a partial or complete tear
- MC > 40yo
- Weakness and atrophy of the supraspinatus and infraspinatus mm, pain and tenderness may ensue
In a complete tear of supraspinatus tendon, PE will show
- "Shrugging of shoulder" during active abd and forward flex of GH joint
- Positive "drop arm" test
Calcific tendinitis: def, m MC involved, age, presentation
- Tendon degenerates d/t deposition of Ca salts
- Usually involves supraspinatus
- Acute, disabling attacks of shoulder pain, MC in pts > 30yo (more often in women)
- Arm is held close to side
- All motions severely limited by pain
Bicep tendonitis: def, pain where, PE
- Inflammation of long head tendon and tendon sheath
- Causes ant shoulder pain resembling and often coexisting w/ rotator cuff tendinitis
- Max tenderness in bicipital groove
- Ext rotate and abd arm to separate this area from subacromial tenderness or supraspinatus tendinitis
- Yergason's positive
Adhesive capsulitis: def, age, PE findings
- "Frozen Shoulder Syndrome"
- Fibrosis of GH joint capsule
- Diffuse, dull, aching pain in shoulder and progressive restriction of active and passive ROM
- Usually no localized tenderness
- Usually unilateral and occurs in ppl 50-70yo
- Chronic, lasting months- yrs
AC arthritis: def, MOI, pain w/ ....
- Uncommon
- Usually arising form direct injury to the shoulder girdle w/ resulting degenerative changes
- Tenderness over AC joint
- GH joint motion not painful, but mvmt of scapula (ie: shoulder shrugging) is painful
Humerus MC dislocates
Anteriorly, normally rounded shoulder appears flat
Joints of the elbow
- Radiohumeral
- Humeroulnar
- Radioulnar
Elbow PE: inspect for these 5 things
- Joint symmetry
- Alignment
- Bony deformities
- Swelling
- Color changes
Elbow PE: palpate these 4 things
- Olecranon
- Medial epicondyle
- Lateral Epicondyle
- Epicondylar grooves
*Medial epicondylitis: def, MOI, pain where and when
- *Pitcher's/ golfer's/ Little League elbow
- D/t repetitive wrist flexion (ie: throwing)
- Tenderness max lateral and distal to medial epicondyle
- Pain increased w/ wrist flex against resistance
Olecranon is displaced _____ in _____ and ________
Displaced posteriorly in posterior elbow dislocation and supracondylar fx
Elbow flex mm
- Biceps
- Brachialis
- Brachioradialis
Elbow ext mm
- Triceps
- Anconeus
Supinator mm
- Biceps
- Supinator
Pronator mm
- Pronator quadratus and teres
*Lateral epicondylitis: def, MOI, pain where and when
- *Tennis elbow
- D/t repetitive ext of wrist or pro-sup of forearm
- Pain & tenderness @ lateral condyle and possibly ext mm close by
- Pain increases when ext the wrist against resistance
Olecranon bursitis: def, MOI, PE findings, common in ____
- Swelling and inflammation of bursa
- D/t trauma, RA, or gouty arthritis
- Swelling superficial to olecranon process
- Common in truck drivers and students
Assessing for arthritis of the elbow joint
- Synovial inflammation of fluid is felt best in grooves b/w olecranon process and epicondyles
- Palpate for boggy, soft, or fluctuant swelling and for tenderness
RA nodules: description, location
- Subq nodules develop @ pressure points along ext surface of ulna in RA pts (or in pts w/ acute rheumatic fever)
- Firm, non-tender
- Moveable: (Not attached to overlying skin and may or may not be attached to the underlying periosteum)
- May develop in area of the olecranon bursa, but often occur more distally
Nursemaid's elbow: description and d/t tear in ....
- Radial head subluxation d/t tear in annular ligament
Wrist joints
- Radiocarpal - "wrist joint"
- Distal radioulnar joint
- Intercarpal joints
___ ext tendons cross wrist and hand
___ flex tendons cross wrist and hand
*Herberden's nodes
OA nodules @ DIP
*Bouchard's nodes
OA nodules @ PIP
Compression of what nerve causes *thenar atrophy? AKA...
- Carpal tunnel syndrome D/t compression of median n
Compression of what n causes hypothenar atrophy?
- Dt/ compression of ulnar nerve
Duputyren's contractures
- Flexion contractures in 3rd, 4th, and 5th fingers d/t thickening of palmar fascia
- 1st sign = thickened plaque overlying the flexor tendon of the ring finger and possibly the little finger @ level of distal palmar crease
- Skin in this area puckers and thickened fibrotic cord develops b/w palm and finger
- May gradually ensue
Signs of RA in hands and wrist
- Symmetrical deformity in PIP, DIP, MCP, and wrists w/ *ulnar deviation
- Often boggy and tender metacarpals
de Quervain's Tenosynovitis
- "Gamer's thumb"
- Inflammation of the thumb ext and abd tendon and sheaths
Carpal Tunnel Syndrome: Def, S/S, and 3 tests to assess for CTS
- Compression of median n
- S/S: dropping things, can't twist off lids, wrist pain, numbness in 2nd, 3rd, and half of 4th finger
-* Test for using thumb abd test* (raising thumb against resistance): weakness = positive.
- Other tests: *Tinel's sign or *Phalen's sign
*Tinel's sign
Tap lightly over course of median nerve to test for carpal tunnel syndrome
Positive = aching and numbness when tapped
*Phalen's sign
- Hold wrists in flex for 60 sec. (dorsum of hands together)
- Positive = numbness and tingling in median n distribution
*Testing grip strength
Causes of poor grip strength
- Assesses strength of intrinsic hand mm
- Causes: arthritis, CTS, epicondylitis, cervical radiculopathy
*Finkelstein's test: how to perform test, what positive means, and Dx
- Make fist w/ thumb tucked inside fist and ulnar deviate the wrist
- Positive = pain
- Dx: de Quervain's tenosynovitis d/t inflammation of abd pollicus longus and ext pollicus brevis tendons and shealths
Acute RA PE findings in hands
- Fusiform or spindle-shaped swelling of PIP joints in acute disease
Signs of chronic tophaceous gout
- Not usually symmetrical
- Acute inflammation may be present
- Knobby swelling around joints ulcerate and discharge white chalk-like urates
Ganglion: def, location, PE findings
- Cystic, round, usually non-tender swellings along tendon sheaths or joint capsules
- Commonly @ dorsum of hand
- More prominent w/ flexion of wrist
- May also develop elsewhere on hands, wrists, ankles and feet.
Trigger finger: def, PE findings
- D/t painless *nodule in flexor tendon* in palm near metacarpal head
- During flex/ext nodule pops into tendon sheath - "popping"/"snapping"
- Watch, listen, and palpate nodule while pt flex and ext fingers
Acute tenosynovitis: def, presentation, possible complication
- Infection of the flex tendon sheaths, may follow local injury
- Finger is held in slight flexion
- Ext is very painful
- If infection progresses, can extend from tendon into adjacent fascial spaces in palm
- Early dx and tx are important
Curves of spine
Cervical- lordosis, concave
Thoracic- kyphotic, convex
Lumbar - lordotic, concave
Sacrococcygeal - kyphotic, convex
Area of back especially vulnerable to injury
L5-S1, d/t sharp posterior angle
Types of LBP
- Muscular pain/spasm
- Joint sprain, inflammation, or arthritis
- Discogenic pain: bulging, protruding, herniation, infection
- Bone: fx, tumor, etc.
-Neurologic: compression or injury to the peripheral nerves, spinal cord, or components of cord
Inspecting spine
- Observe *posture
- Assess for erect position of head, smooth, coordinated neck mvmts, and ease of gait
- Landmarks
- Spinal curves
Spine landmarks
- Spinous processes
- Paravertebral mm
- Iliac crests
- L4 (draw an imaginary line across iliac crests)
- Shoulder symmetry
Unequal shoulder heights seen in...
- Scoliosis
- Winging of scapula
- Trapezius weakness
Areas to palpate on spine exam
- Spinous processes (w/ thumb) - note any "step offs"
- Cervical facets (w/ relaxed neck)
- SI joint
- Paravertebral mm
- Sciatic nerve (L4-S3 nerve roots)
Spondylolithesis: def
Forward slippage of vertebrae that can cause compression of spinal cord
Tenderness of SI joint suggests ...
Ankylosing spondylitis
How to palpate *sciatic n
Tenderness of sciatic n suggests
W/ flexed hip, lying on side - n is midway b/w greater trochanter and ischial tuberosity as it leaves pelvis via sciatic notch
Herniated disc
Things that can cause tenderness of spinous proccesses
Fx, infection, arthritis, or dislocation
Percussion of spine
Not usually done
If done, gently use ulnar surface of fist
More common to individually percuss vertebrae for fx
Mechanical LBP
- Pain in lumbosacral area, may radiate into lower leg
- Absence of neoplasm, infectious, or inflammatory disease
- Usually acute, benign, self-limiting
- Work -related, obesity, poor conditioning, etc.
- MC d/t muscle or ligament injuries
- Paraspinal m or facet tenderness, pain w/ back mvmt,
- Radicular LBP
- Shooting pain below knee, MC into lateral leg or post calf
- Usually accompanies LBP
- Paresthesias, weakness
- Bending, sneezing, coughing, straining during BM - worsen pain
- Very sensitive and specific for disc herniation
- MC L5-S1
- Most likely sciatica if calf wasting, weak ankle dorsiflex, absent ankle jerk, + crossed straight-leg raise
Lumbar spinal stenosis
- Pseudocladication w/ walking
- Relieved by rest and/or lumbar flex
- Vague pain, usually bilateral, w/ paresthesias in one or both legs
- Arises from hypertrophic degenerative disease of 1 or more vertebral facets and thickening of ligamentum flavum - narrowing of canal centrally or laterally
- More common > 60 yo
- Posture may be flexed forward w/ LE weakness and hyporeflexia
- SLR usually -
Flex and ext of neck occurs...
MM involved
Primarily b/w skull and C1
Flex: SCM, scalene, prevertebral mm
Ext: Splenius capitus and cervicis, small intrinsic neck mm
MM involved w/ rotation at C1/C2
SCM, small intrinsic neck mm
MM involved w/ lateral bending at C2-C7
Scalenes and small intrinsic neck mm
MM involved w/ flex of spine
Psoas major and minor, quadratus lumborum, abd mm attaching to anterior vertebrae (ie: int and ext abd obliques and rectus abdominis)
MM involved w/ ext of spine
Deep intrinsic mm of back (ie: erector spinae and transversospinalis groups)
MM involved w/ rotation of spine and lateral bending
Abd mm, intrinsic mm of back
Spina bifida occulata s/s
- Birthmarks: port-wine stains
- Hairy patches
- Lipomas
- All these often overlie bony defects, can be possibly unknown to pt
Neurofibromatosis s/s
- Chronic disease
- Cafe-au-lait spots
- Skin tags
- Fibrous tumors
Osteoporosis risk factors
- Post- menopausal white women
- > 50yo
- < 70kg
- Hx of fx
- FHx
- High alcohol intake
- Delayed menarche or early menopause
- Smoker
- Low vit D
- Use of corticosteroids > 2m
Bone density is...
The interaction of bone mass, new bone formation, and bone resorption/loss
Bone quality refers to ...
Bone architecture
Bone density accounts for ____% of bone strength and is measured by _____.
Interpretations of bone density scores
Osteopenia: T score = -2.5 to -1
Osteoporosis: T score less than -2.5