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78 Cards in this Set

  • Front
  • Back
Sequence of joint exam:
temporomandibular
shoulder
elbow
wrist and hand
spine
hip
knee and lower leg
ankle and foot
Parts of joint assessment:
inspection, palpation, range of motion, maneuvers to test function and stability
articular structures include
joint capsule, articular cartilage, synovium and synovial fluid, intra-art. ligaments, juxta-art. bone
articular disease typically involves swelling and tenderness of _______ and limits both ____ and _____.
the entire joint, active and passive ROM
Extra-articular structures include:
periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin
Extra-articular disease involves:
selected regions of joint and types of movement.
Ligaments connect
bone to bone
tendons connect
muscl to bone
bursae are pouches of _____ that _____ the movement of tendons and muscles over bone or other joint structures
synovial fluid, cushion
3 types of joint articulation and their function:
1. synovial- freely movable (knee and shoulder)
2. cartilaginous - slightly movable (vertebral bodies)
3. fibrous- immovable (skull sutures)
In cartilaginous joints, _____ ____ separate the bony surfaces, and at the center of each is the ____ ____ that serves as cushion/shock absorber between bony surfaces.
fibrocartilaginous discs, nucleus pulposus
In this type of joint the bones touch:
fibrous
3 types of synovial joints and their stats:
1. spheroidal (ball and socket)- convex surface in concave cavity, wide ranging flexion, extension, abduction, adduction, rotation, circumduction (shoulder and hip)
2. hinge- flat and planar, motion in one plane, flexion and extension (elbow, interphalangeal joints of hand and foot)
3. condylar- convex or concave, movement of 2 articulating surfaces not dissociable, (knee, temporomandibular)
Describe idiopathic low back pain:
without a precise underlying cause
If low back pain is midline, consider:
musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, epidural abscess
if low back pain is not midline, consider:
sacroiliitis, trochaneteric bursitis, sciatica, hip arthritis
Leg pain that reslves with rest and lumbar forward flexion suggests
spinal stenosis
If pt has numbness and parasthesia radiation to leg in S1 distribution that increases w cough and valsalva, consider:
sciatica
Low back pain with associated bowel/bladder dysfunction suggests
cauda equina syndrome

associated w urinary retention and overflow incont.
In neck pain, the most likely location is ___ to ____, usually from _____________.
C7, C6
foraminal impingement from degeneraive joint changes
Polyarticular joint pain that spreads in a migratory pattern is seen in ___ or ____, and if spread is bilateral and symmetric this suggests ______
rheumatic fever, gonococcal arthritis, rheumatoid arthritis
Severe, rapid onset, redness, and swelling at joint suggests ____ or _____, and in children, suggests ____.
acute septic arthritis, gout, osteomyelitis
Fever, chills, warmth and redness over joint suggest these 4 things:
septic arthritis, gout, rheumatic fever, SLE
Articular vs non-articular joint pain
articular: pain, swelling, loss of active and passive ROM, "locking", deformity
non-art: loss of only active ROM, tenderness outside joint, no deformity
Gelling
stiffness and limited ROM after inactivity, seen in degen. joint disease

if lasts greater than 30 min, could be rheumatoid arthritis, fibromyalgia, PMR
Reiter's Syndrome involves:
erosions or scale on penis, crusted scaling papules on soles and palms, arthritis, urethritis, uveitis
This is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture; bone density T score less than -2.5
osteoporosis
bone density vs bone quality
density: interaction of bone mass, new bone formation, and bone resorption/loss
quality: architecture, turnover, damage accumulation from microfractures, and mineralization
osteopenia
bone density T score between -2.5 and -1.0
Osteoporosis risk factors:
postmenopausal, white, female, age > 50, weight <70 kg, family history of fx 1st deg relative, hx of fx, etoh, delayed menarche/early menopause, smoking, low 25-hydroxyvitamin D, use of corticosteroids, inflammatory disorders
______ is the single best predictor of low bone density, and ____ is the best predicutor of subsequent hip fx.
low body weight, bone density at femoral neck
Risk factors for falls:
impaired cognition vision or gait, neuromusc. deficits, medications affecting balance
Treatment of osteoporosis
-incr. calcium and Vit D intake
- antiresorptive agents
- anabolic agents
- regular exercise
Dupuytren's Contracture is characterized by
bow legs, knock knees
Crepitus
audible or palpable crunching during movement of tendons or ligaments over bone
Subcutaneous nodules are seen in rheumatic _____ and _____; effusions are seen in ______; crepitus is seen in _______.
arthritis and fever, trauma, osteoarthritis
Ligamentous laxity
joint instability from excess mobility of joint ligaments
Synovitis
palpable bogginess or doughiness of the synovial membrane, often accompanied by effusion
TMJ is this type of joint:
condylar synovial
Features of TMJ syndrome
facial asymmetry, unilateral chronic pain w chewing, jaw clenching, teeth grinding, assoc. w stress, headache
3 muscles for mastication (chewing)
masseters, temporal muscles, pterygoid muscles
Dynamic stabiliizers
capable of movement, the SITS muscles of rotator cuff which move the humerus and depress and stabilize the humeral head within the glenoid fossa
Static stabilizers
incapable of movement
bony structures of shoulder girdle, labrum, articular capsule, genohumeral ligaments
3 bones of shoulder
humerus, clavicle, scapula
3 joints of shoulder
1. glenohumeral- humerus to scapula, ball in socket
2. sternoclavicular- clavicle to upper sternum
3. acromioclavicular- clavical to acromion process on scapula
3 muscle groups of shoulder:
1. scapulohumeral group: SITS muscles of rotator cuff
2. Axioscapular: rotate scapula
3. axiohumeral: produce internal rotation of shoulder
____ makes one shoulder appear higher, ______ makes shoulder appear flattened
scoliosis, anterior dislocation
Rotator cuff tear signs
atrophy of supraspinatus and infraspinatus over post. scapula, increased scapular spine prominence within 2-3 wks
a (large/small) amt of synovial fluid is needed for joint capsule to appear distended
large
Sprains, tears, and and tendon ruptures in rotator cuff (usually supraspinatus) manifest in
tenderness over SITS muscle insertions, inability of lift arm above shoulder level
6 motions of shoulder girdle:
flexion, extension, abduction, ,adduction, internal and external rotation
Flexion command
raise your arms in front of you and overhead
extension command
raise your arms behind you
abduction command
raise your arms out to the side and overhead
adduction command
cross your arm in front of your body
internal rotation command
place one hand behind your back and touch shoulder blade
external rotation command
raise arm to shoulder level and bend elbow to point hand toward ceiling
At age >60 and positive dropped arm testmost likely identify
a rotator cuff tear
Acromioclavicular Joint test
cross over test for adduction
overall shoulder rotation test
touch opposite scapula from above and below
called the Apley scratch test

difficulty suggests rotator cuff injury
neer's impingement sign
rotator cuff tear test, push on scapula w one hand and raise pt arm w the other
____ makes one shoulder appear higher, ______ makes shoulder appear flattened
scoliosis, anterior dislocation
Rotator cuff tear signs
atrophy of supraspinatus and infraspinatus over post. scapula, increased scapular spine prominence within 2-3 wks
a (large/small) amt of synovial fluid is needed for joint capsule to appear distended
large
Sprains, tears, and and tendon ruptures in rotator cuff (usually supraspinatus) manifest in
tenderness over SITS muscle insertions, inability of lift arm above shoulder level
6 motions of shoulder girdle:
flexion, extension, abduction, ,adduction, internal and external rotation
These signs can indicate rotator cuff tear:
1. apley scratch test
2. neer's impingement sign
3. hawkin's impingement sign
4. supraspinatus strength ("empty can test")
5. infraspinatus strength
6. forearm supination
7. drop arm sign
tenderness on elbow palp distal to epicondyle
tennis elbow (lateral epicondylitis)
pitcher's/golfer's elbow (medial epicondylitis)
3 hand joints:
MCPs, PIPs, DIPs
Diffuse hand swelling suggests ____ or ____, whereas local swelling suggests ____.
arthritis or infection,
cystic ganglion
Osteoarthritis hand nodes
heberden's nodes at DIP joints and bouchards nodes at PIP joints
The most common injury of the carpal bones is called ____ fracture, and manifests with tenderness over the "_____". Poor blood supply puts this bone at risk for ____ ____.
scaphoid, "snuff box", avascular necrosis
Tenosynovitis
tenderness and swelling, inflammation of tendon sheaths
Onset of ____ ____ syndrome often related to repetitive motion with wrists flexed, pregnancy, RA, DM, and hypothyroidism.
carpal tunnel

aching at wrist, numbness in digits, dropping objects, trouble opening lids of jars
Testing sensation of nerves in hands:
1. median nerve
2. ulnar nerve
3. radial nerve
1. pulp of index finger
2. pulp of 5th finger
3. dorsal web of thumb and index
Pain during finkelstein's maneuver (grasping thumb inside fist and extending wrist down) indicates:
de Quervain's tenosynovitis
The tests for carpal tunnel:
1. thumb abduction
2. tinel's sign: tap over median nerve in inner wrist
3. phalen's sign: hold wrists in flexion for 60 sec and hold backs of hands together - cause numbness/tingling/aching?
Lateral deviation and rotation of the head suggest _____, from contraction of the sterocleidomastoid muscle.
torticollis