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113 Cards in this Set
- Front
- Back
Synovial joint: def and ex
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- Freely moveable
- Bones covered by articular cartilage and separated by a synovial cavity that cushions mvmt - Ex: knee and shoulder |
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Spheroidal synovial joint: def, mvmts, and ex
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- Ball and socket
- Wide range flex, ext, abd, add, rotation, circum. - Ex: *shoulder, *hip |
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Hinge synovial joint: def, mvmts, ex
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- Motion in one plane
- Flex, ext -Ex: *IP joints of hand and foot, *elbow |
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Condylar synovial joint: def, mvmt, ex
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- Mvmt of 2 articulating surfaces
- Not dissociable - Ex: *knee, *TMJ - Oval articulating surface sits in depression of another |
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Cartilaginous joint: def and ex
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- Slightly moveable
- Ex: *Vertebral bodies of spine, public symphysis |
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Fibrous joints: def and ex
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- Immoveable, bones almost in direct contact
- Ex: *skull sutures |
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Common or concerning MSK sx
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- LBP
- 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 |
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One of the leading complaints of pts seeking health care
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Joint pain
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Assessing joint pain
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- *"Point to pain"
- Clarify and record *MOI* - *Determine if pain is localized or diffuse, acute or chronic, inflammatory or non-inflammatory |
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LBP reg flags
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- > 50yo
- Hx of CA - Weight loss - Nocturnal pain or pain increased w/ rest - Hx of IVDU - Presence of inf or fever |
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LBP red flags + bowel/blader dysfunction =
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CES
- Lesion L1-S5 |
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Leg or LBP that improves w/ rest and/or lumbar flexion =
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Spinal stenosis
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Joint pain + Conjunctivitis + urethritis =
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Reiter's Syndrome
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Joint pain w/ a preceding sore throat, think...
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*Acute rheumatic fever or gonococcal arthritis
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Joint pain, diarrhea, and abd pain, think...
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Ulcerative colitis or scleroderma
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S/S of inflammation and arthritis
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- *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 |
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TMJ: description
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- Most active joint in body
- Condylar synovial joint cushioned by fibrocartilaginous disc |
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Principal mm opening and closing mouth
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- Opening - pterygoids
- Closing - masseter, temporalis, internal pterygoids (all CN V) |
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Normal ROM of TMJ
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- Opening and closing - normal 3 fingers can be inserted
- Protrusion and retraction - Lateral |
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TMJ Syndrome: features, PE, DDx, and Trauma
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- 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 |
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Shoulder anatomy: joints
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Glenohumeral, Sternoclavicular, AC
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MM of the shoulder joint
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- *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 |
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Bony landmarks to palpate on shoulder exam
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- *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* |
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How to palpate subacromial bursae
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- Passively extend humerus, inferior and lateral to acromion
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MM under subacromial bursae
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SITS mm
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Most damaged m of rotator cuff
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Supraspinatus
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Pain in bicipital groove
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Bicipital tendonitis
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MM involved w/ flex of shoulder
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- Ant deltoid
- Pec major - Biceps - Coracobrachialis |
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MM involved w/ ext of shoulder
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- Lat dorsi
- Teres major - Post deltoid - Triceps |
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MM involved w/ abd of shoulder
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- Suprapsinatus
- Middle deltoid - Serratus anterior |
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Scapulothoracic motion
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After raising arm 90 degrees (glenohumeral motion), raising additional 60 degrees w/ palm up is scapulothoracic
- final 30 degrees is combined scapulothoracic and glenohumeral |
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Assessing add ROM of shoulder joint tests___ and mm involved are _____
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- *AC joint stability - AKA crossover sign*
- MM: pec major, coracobrachialis, lat dorsi, teres major, subscapularis |
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MM involved w/ internal rotation of shoulder joint
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- Subscapularis, anterior deltoid, pec major, teres major, lat dorsi
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MM involved w/ external rotation of shoulder joint
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- Infraspinatus, teres minor, post deltoid
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Special maneuver used to assess overall shoulder rotation/AC joint stability
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- *Apley scratch test
- Scratching the opposite scapula (over the head and under) - Difficulty doing this suggests rotator cuff disorder |
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Impingement of rotator cuff mm occurs b/w ____ and ____
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Head of humerus and acromion
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*Neer's sign: What does it test, how is it performed, and what does + mean?
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- Special maneuver to test for impingement of rotator cuff
- Hold scapula to prevent motion and raise pt's arm - Positive = Pain |
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*Hawkin's sign: What does it test, how is it performed, and what does + mean?
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-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 |
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*Empty can test: What does it test, how is it performed, and what does + mean?
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- Special maneuver to test for supraspinatus strength
- Have pt resist pressure applied to forearms - Positive = weakness (possible rotator cuff tear) |
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*Drop arm test: What does it test, how is it performed, and what does + mean?
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-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) |
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*Yergason's test: What does it test, how is it performed, and what does + mean?
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- 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) |
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*Speed's test: What does it test, how is it performed, and what does + mean?
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- Special maneuver to test biceps for pathology
- Flex shoulder to 90 w/ supination - Have pt flex elbow while you resist - Positive = Pain |
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*Sulcus sign: What does it test, how is it performed, and what does + mean?
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- 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 |
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*Apprehension test: What does it test, how is it performed, and what does + mean?
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- 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)* |
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Area of maximum tenderness in rotator cuff tendonitis w/ suprapinatus involved
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Just below tip of acromion
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Rotator cuff tendonitis - MOI, pts c/o, MC involved tendon, and MC pt demographic
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- 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 |
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Rotator cuff tear: when arm is raised in forward flexion, the rotator cuff may impinge against _______ and _____.
MOI 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 |
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In a complete tear of supraspinatus tendon, PE will show
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- "Shrugging of shoulder" during active abd and forward flex of GH joint
- Positive "drop arm" test |
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Calcific tendinitis: def, m MC involved, age, presentation
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- 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 |
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Bicep tendonitis: def, pain where, PE
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- 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 |
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Adhesive capsulitis: def, age, PE findings
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- "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 |
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AC arthritis: def, MOI, pain w/ ....
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- 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 |
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Humerus MC dislocates
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Anteriorly, normally rounded shoulder appears flat
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Joints of the elbow
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- Radiohumeral
- Humeroulnar - Radioulnar |
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Elbow PE: inspect for these 5 things
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- Joint symmetry
- Alignment - Bony deformities - Swelling - Color changes |
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Elbow PE: palpate these 4 things
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- Olecranon
- Medial epicondyle - Lateral Epicondyle - Epicondylar grooves |
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*Medial epicondylitis: def, MOI, pain where and when
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- *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 |
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Olecranon is displaced _____ in _____ and ________
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Displaced posteriorly in posterior elbow dislocation and supracondylar fx
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Elbow flex mm
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- Biceps
- Brachialis - Brachioradialis |
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Elbow ext mm
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- Triceps
- Anconeus |
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Supinator mm
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- Biceps
- Supinator |
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Pronator mm
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- Pronator quadratus and teres
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*Lateral epicondylitis: def, MOI, pain where and when
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- *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 |
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Olecranon bursitis: def, MOI, PE findings, common in ____
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- Swelling and inflammation of bursa
- D/t trauma, RA, or gouty arthritis - Swelling superficial to olecranon process - Common in truck drivers and students |
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Assessing for arthritis of the elbow joint
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- 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 |
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RA nodules: description, location
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- 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 |
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Nursemaid's elbow: description and d/t tear in ....
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- Radial head subluxation d/t tear in annular ligament
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Wrist joints
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- Radiocarpal - "wrist joint"
- Distal radioulnar joint - Intercarpal joints |
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___ ext tendons cross wrist and hand
___ flex tendons cross wrist and hand |
6
2 |
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*Herberden's nodes
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OA nodules @ DIP
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*Bouchard's nodes
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OA nodules @ PIP
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Compression of what nerve causes *thenar atrophy? AKA...
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- Carpal tunnel syndrome D/t compression of median n
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Compression of what n causes hypothenar atrophy?
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- Dt/ compression of ulnar nerve
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Duputyren's contractures
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- 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 |
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Signs of RA in hands and wrist
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- Symmetrical deformity in PIP, DIP, MCP, and wrists w/ *ulnar deviation
- Often boggy and tender metacarpals |
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de Quervain's Tenosynovitis
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- "Gamer's thumb"
- Inflammation of the thumb ext and abd tendon and sheaths |
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Carpal Tunnel Syndrome: Def, S/S, and 3 tests to assess for CTS
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- 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 |
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*Tinel's sign
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Tap lightly over course of median nerve to test for carpal tunnel syndrome
Positive = aching and numbness when tapped |
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*Phalen's sign
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- Hold wrists in flex for 60 sec. (dorsum of hands together)
- Positive = numbness and tingling in median n distribution |
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*Testing grip strength
Causes of poor grip strength |
- Assesses strength of intrinsic hand mm
- Causes: arthritis, CTS, epicondylitis, cervical radiculopathy |
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*Finkelstein's test: how to perform test, what positive means, and Dx
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- 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 |
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Acute RA PE findings in hands
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- Fusiform or spindle-shaped swelling of PIP joints in acute disease
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Signs of chronic tophaceous gout
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- Not usually symmetrical
- Acute inflammation may be present - Knobby swelling around joints ulcerate and discharge white chalk-like urates |
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Ganglion: def, location, PE findings
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- 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. |
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Trigger finger: def, PE findings
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- 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 |
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Acute tenosynovitis: def, presentation, possible complication
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- 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 |
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Curves of spine
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Cervical- lordosis, concave
Thoracic- kyphotic, convex Lumbar - lordotic, concave Sacrococcygeal - kyphotic, convex |
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Area of back especially vulnerable to injury
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L5-S1, d/t sharp posterior angle
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Types of LBP
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- 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 |
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Inspecting spine
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- Observe *posture
- Assess for erect position of head, smooth, coordinated neck mvmts, and ease of gait - Landmarks - Spinal curves |
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Spine landmarks
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- Spinous processes
- Paravertebral mm - Iliac crests - PSIS - L4 (draw an imaginary line across iliac crests) - Shoulder symmetry |
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Unequal shoulder heights seen in...
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- Scoliosis
- Winging of scapula - Trapezius weakness |
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Areas to palpate on spine exam
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- Spinous processes (w/ thumb) - note any "step offs"
- Cervical facets (w/ relaxed neck) - SI joint - Paravertebral mm - Sciatic nerve (L4-S3 nerve roots) |
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Spondylolithesis: def
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Forward slippage of vertebrae that can cause compression of spinal cord
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Tenderness of SI joint suggests ...
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Ankylosing spondylitis
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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 |
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Things that can cause tenderness of spinous proccesses
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Fx, infection, arthritis, or dislocation
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Percussion of spine
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Not usually done
If done, gently use ulnar surface of fist More common to individually percuss vertebrae for fx |
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Mechanical LBP
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- 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, |
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Sciatica
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- 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 |
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Lumbar spinal stenosis
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- 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 - |
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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 |
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MM involved w/ rotation at C1/C2
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SCM, small intrinsic neck mm
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MM involved w/ lateral bending at C2-C7
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Scalenes and small intrinsic neck mm
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MM involved w/ flex of spine
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Psoas major and minor, quadratus lumborum, abd mm attaching to anterior vertebrae (ie: int and ext abd obliques and rectus abdominis)
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MM involved w/ ext of spine
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Deep intrinsic mm of back (ie: erector spinae and transversospinalis groups)
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MM involved w/ rotation of spine and lateral bending
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Abd mm, intrinsic mm of back
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Spina bifida occulata s/s
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- Birthmarks: port-wine stains
- Hairy patches - Lipomas - All these often overlie bony defects, can be possibly unknown to pt |
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Neurofibromatosis s/s
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- Chronic disease
- Cafe-au-lait spots - Skin tags - Fibrous tumors |
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Osteoporosis risk factors
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- 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 |
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Bone density is...
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The interaction of bone mass, new bone formation, and bone resorption/loss
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Bone quality refers to ...
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Bone architecture
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Bone density accounts for ____% of bone strength and is measured by _____.
Interpretations of bone density scores |
70%
Dexascan Osteopenia: T score = -2.5 to -1 Osteoporosis: T score less than -2.5 |