Clinical Skills - Exam 5 (MSK)

crepitus with walking

palpable or audible crunch

with or without pain

0 muscle strength

no muscle contracture

1 muscle strength

flicker or trace or contracture

2 muscle strength

active movement w/o gravity

3 muscle strength

active movement against gravity

4 muscle strength

active movement against gravity and some resistance

5 muscle strength

active movement against gravity and full resistance w/o evident fatigue

NORMAL

drop-arm sign

have pt abduct arm to shoulder level and lower slowly

weakness is positive for supraspinatus rotator cuff tear or bicipital tendinitis

what muscle does external rotation resistance test

infraspinatus stregth

what muscle does empty can test

supraspinatus strength

impingement syndrome

acromion, coracoacromial ligament, AC joint pinch on bursa, biceps tendon, and rotator cuff

signs and sx of impingement syndrome

gradual onset of anterior and lateral shoulder pain

-cannot sleep on affected side

positive impingement sign

decreased abduction

pain w/ flexion

rotator cuff tendonitis

a type of impingement

causes of rotator cuff tendonitis

repetitive overhead motions like throwing or swimming

signs and sx of rotator cuff tendonitis

pain when arm is overhead

positive impingement sign

rotator cuff tear

acute or chronic

from repeated impingement or FOOSH

tears partial or incomplete, graded on severity

symptoms of rotator cuff tear

weakness

pain

signs of rotator cuff tear

positive drop arm test

impaired active abduction - shrugging

calcific tendonitis

Degenerative process where tendon deposits calcium salts

-involvement of supraspinatus tendon

-more in F over 30

symptoms of calcific tendonitis

acute or chronic episodes of pain

signs of calcific tendonitis

arm held in close to the side

-all directions of movement increase pain

biceps tendonitis

inflammation of long head of biceps tendon

-can resemble rotator cuff tendonitis, or 2 can co-exist

symptoms of biceps tendonitis

anterior shoulder pain

signs of biceps tendonitis

positive yergason test

popeye defect

biceps rupture

adhesive capsulitis

fibrosis of glenohumeral joint capsule

-usually in females athletes 50-70

-h/o antecedent event like painful disorder of shoulder

symptoms of adhesive capsulitis

diffuse, dull ache

no point tenderness

worse at night

signs of adhesive capsulitis

progressive loss of ROM in all directions

cause of anterior dislocation of the humerus

shoulder instability

usually from fall or forceful throwing motion

signs and sx of anterior dislocation of the humerus

-positive apprehension sign

-pain when arm is abducted and externally rotated

-any ROM is painful

cause of acromioclavicular arthritis

degenerative changes to AC joint

usually from trauma

symptoms of acromioclavicular arthritis

pain at the AC joint

signs of acromioclavicular arthritis

-painful movement of scapula

-glenohumeral movement NOT painful

subacrominal bursitis

bursa between head of humerus and acromion is inflamed

-tender below tip of acromion

-pain w/ abduction and rotation

Cozen test

tests for lateral epicondylitis

-positive with pain in lateral elbow

olecranon bursitis

swelling and inflammation of olecranon bursa

from trauma, RA, gout

symptoms of olecranon bursitis

asymptomatic or painful

acute or chronic

signs of olecranon bursitis

swelling

lateral epicondylitis

tennis elbow

from repetitive extension of the wrist against resistance or repetitive pronation or supination of forearm

symptoms of lateral epicondylitis

pain and tenderness in lateral epicondyle

increased w/ movement against resistance

medial epicondylitis

Golfer's or Pitcher's elbow

repetitive flexion of wrist against resistance

ulnar nerve entrapment

impingement at elbow

trauma, prolonged bed rest, compression

symptoms of ulnar nerve entrapment

-numbness of 4+5 fingers

-tender ulnar groove

-decreased dexterity

-5th finger weakness

carpal tunnel syndrome

trauma to wrist

acute or chronic inflammation

overuse

pregnancy

amyloidosis

symptoms of carpal tunnel syndrome

numbness

burning

tingling in thumb, 2, 3, and 1/2 4th digit

wakes pt up at night

worse with flexion

signs of carpal tunnel syndrome

Phalan's - sx w/ sustained wrist flexion

Tinel's - sx w/ tapping on median nerve

Thenar atrophy

ganglion cyst

round, cystine structure with a stalk

-connects to joint capsule or tendon sheath

usually dorsal wrist

most common soft tissue tumor of the hand and wrist

ganglion cyst

symptoms of ganglion cyst

painless unless very large

dupuytren's contracture

thickened fibrotic plaque of flexor tendon of ring or middle finger

-progressive nodular thickening on distal palmar surface

dupuytren's contracture causes

associated w/ epilepsy meds, alcohol, DM, fhx

more males

symptoms of dupuytren's contracture

flexion contracture at MCP joint

cannot extend finger

DeQuervain's Tensynovitis

inflammation of the tendon sheaths of abductor pollicis longus and extensor pollicis brevis

symptoms of DeQuervain's Tensynovitis

pain at base of thumb in anatomical snuffbox when thumb is abducted and wrist is ulnarly deviated

ex: lifting a frying pan

DeQuervain's Tensynovitis sign

Positive Finkelstein test

trigger finger

painless nodule on flexor tendon trapped by annular pulley

more in diabetics

what does straight leg raise test for

radicular pain

red flags for low back pain

-over 50

-h/o CA w/ recent weight loss

-h/o immunocompromised or IVDU

-saddle anesthesia, incontinence, b/l sciatica

-major trauma

-more than 1 month

-noctural pain

1st degree strain

mild or slight pull

pain

spasm

swelling

ecchymosis

2nd degree strain

moderate pull

pain

spasm

swelling

torn muscle fibers

3rd degree strain

severe pull

loss of muscle function

palpable defect

ruptures muscle or tendon

possible avulsion fracture at attachment

classifications of low back pain

1. nonspecific - 85%

2. potential association w/ spinal condition

3. LBP associated w/ another cause

most herniated discs are at

L4-L5 (dorsiflexors)

L5-S1 (plantar flexors, achillies)

causes nerve root compression

pain in herniated disc comes from

-direct pressure on nerve root

-breakdown of nucleus pulposus

-dermatomal distribution

PE for herniated disc

straight leg raise w/ pain in first 30-70 degrees

dorsiflex foot or raise head for additional stretch on nerve

findings of a herniated disc

asymmetric DTRs

motor weakness

sensory deficit

sciatica symptoms

radicular pain below knees

increased with bending sneezing and coughing

positive SLR

pain when palpating SI

sensory changes

decreased Achilles reflex

spinal stenosis

some narrowing of spinal cord is physiologic and asymptomatic

-is degenerative

spinal stenosis causes slow onset of

1. diffuse, episodic pain w/ b/l paresthesia, dec strength

2. pain w/ position change - worse w/ extension and better w/ flexion

3. balance disturbance

spondylolysis

pars defect-bony defect

-vertebrae breakdown

-loosening of pars lamina

-"scottie dog" with collar on oblique XR

-L5

epidemiology of spondylolysis

-increased in athletes that hyperextend spine like gymnasts or weightlifters

symptoms of spondylolysis

asymptomatic or back/leg pain

spondylolisthesis

slipping forward of one vertebra on another

scottie dog is decapitated

L5S1 or L5L5

types of spondylolisthesis

congenital

degenerative (from spondylolysis)

traumatic

pathologic

cauda equina syndrome causes

infection

tumor

cauda equina syndrome

compression of end of spinal cord

sx of cauda equina syndrome

pain in butt, legs, loss of bowel and bladder function, saddle anesthesia

hip fracture

leg shortened and externally rotated

pain w/ ROM

3 types of hit bursitis

trochanteric

iliopsoas

ischial

trochanteric bursitis

-pain in lateral thigh

-pain w/ prolonged sitting, laying on affected side, can radiate down lateral thigh to knee

PE for trochanteric bursitis

pain and resistance to abduction

iliopsoas bursitis

bursa behind iliopsias muscle anterior to hip joint and lateral to femoral muscles

symptoms of iliopsoas bursitis

pain in groin and ant thigh

worse w/ hip extension

better w/ flexion

ischial bursitis

-bursa between ischium and glute max

-point tender over ischial tuberosity

-inflamed w/ trauma and prolonged sitting

-pain can radiate back of thigh

genu varus

knees out

"bow legged"

genu valgus

knees in

balloon sign evaluates for

ballottement

bulge sign

positive with effusion

balloon sign

rebounding is positive

do bulge, then push down

varus stress tests

LCL

valgus stress tests

MCL

MCL injury

positive laxity w/ valgus stress

LCL injury

positive laxity w/ varus stress

ACL injury

positive Lachman

Positive anterior drawer

PCL injury

positive posterior drawer

signs for meniscal tears

positive McMurray's - click or pop or pain

positive Apley grind

symptoms of meniscal tears

popping or clicking

pain

locking

esp w/ directional changes

unhappy triad

ACL

MCL

Medial meniscus

plica band syndrome

Band of synovial fluid

cause of plica band syndrome

exercises like biking or stepper

repetitive motions or direct injury