random tidbits from readings--msk

most common form of juvenile idiopathic arthritis

asymmetric oligoarticular

difference between polyarticular and oligoarticular arthritis?

polyarticular involve 5 or more joints
oligoarticular involves 4 or fewer joints

with a PCL sprain what exercise would be MOST INAPPRORIATE to perform?

hamstring exercise

Achilles tendonitis is seen in patients with the following EXCEPT

foot supination

all of the following are appropriate s/s someone may have a RTC tear, EXECPT which of the following?

pain over lateral epicondyle of humerus

what nerve is affected with ape hand deformity

median n.

describe ape hand deformity

• wasting of thenar eminence

• thumb falls back in line with fingers

  • bc of extensor muscs

• pt unable to flex or oppose thumb

ape hand deformity

bishop’s hand or benediction affects what nerve

primarily high median n.(at level of elbow or forearm) or could be ulnar nerve

• common cause is fracture from FOOSH at distal humerus

hand of benediction or bishop’s hand deformity

describe bishop’s hand or benediction

• hyperextension of MCP joint

• flexion of IP joint

• seen when trying to make a fist (inability to flex index or middle finger)

• (if ulnar nerve involvement: wasting of hypothenar muscles, interossei, and 2 medial lumbrials)

describe the meniscus vascular zones

• outer third (red zone)

  • good blood supply and heals well

• middle third (red-white zone)

  • limited blood supply

• inner third (white zone)

  • avascular, heals poorly

McMurray’s test: what forces applied to test MEDIAL meniscus?

valgus stress + ER

as you extend the knee

McMurray’s test: what forces applied to test LATERAL meniscus?

varus stress + IR

as you extend the knee

what is the “golden rule of collateral testing”

• at 30 deg of knee flexion, the posterior capsule is slack

  • thus isolating the collateral ligament

• at 0 degs (full knee extension), you are stressing the collateral ligaments PLUS the capsule PLUS possibly the cruciate ligaments

(if you find more laxity at 0 deg,,, think MULTI-ligamentous or capsular involvement)

squinting patella (inward facing kneecaps) results from:

• femoral anteversion

• foot pronation

• VMO weakness

• tight medial retinaculum

frog-eyed patella (patella outward facing) results from:

• femoral retroversion

• patella alta (high kneecaps)

• genu varum

PFPS is characterized by

• anterior/retropatellar pain

• pain aggravated by deep knee flexion

  • squats, stairs, prolonged sitting (movie goer’s sign)

think females and athletes

precautions for ACL

1. knees must never move past toes in squats

2. avoid quadriceps strengthening between 60-90 deg of flexion

   1. aka no deep squats

3. avoid knee extension 45-30 in OKC for first 6-12 weeks

MOI for ACL

Planted foot + tibial ER + hypertension

What is the terrible triad?

Injury to MCL, ACL, and medial meniscus

(Knee collapses into valgus with rotation while foot is planted)

LAPS protocol for ACL

L- Lachmens Test

A-anteriorl drawer test

P- pivot shift

S-slocums test

Grade 1 ligament tear

Minimal pain

Minimal laxity

Grade 2 ligament tear

Moderate to severe pain

Moderate laxity

Grade 3 ligament tear

Little to no pain

High laxity

Which meniscus attaches to MCL making it more prone to injury?

Medial meniscus

MOI of meniscus

Compression

Rotation

Flexion

(Twisting on a loaded, bent knee)

Pain with compression + rotation during Apley’s may indicate what injury

Meniscus injury

Pain with distraction + rotation may indicate what

Ligament injury

Clarke’s sign tests for what

PFPS

• What is Clarke’s sign?

• Apply downward pressure on superior patella

• Ask pt to contract quad

(+): retropatellar pain or crepitus

McConnell’s Test purpose

PFPS

McConnell’s test

• isometric resisted knee extension at different angles

• Whenever discover pain= repeat contraction but add medial patellar mobilization

  • If relieved pain with this then can provide taping and test is POSITIVE

For PFPS what OKC AND CKC angle to avoid

OKC: avoid last 30° of extension

CKC: limit 60-90° of flexion

Where is point tenderness for jumpers knee (patellar tendinitis)

Inferior pole of the patella

What limitations are often seen in people with Jumper’s knee (patellar tendinitis)

Decreased ankle DF

Decreased quad flexibility

What type of exercise has strong evidence for tendon healing

Isometric exercises

IT band friction syndrome symptoms

Sharp lateral knee pain at 30° flexion

-pain with repetitive motion (cycling) or climbing/descending stairs

Noble compression test purpose

Assess friction syndrome for IT band

Noble Compression test

• apply pressure over the lateral femoral epicondyle

• Extend knee from 90° of flexion

(+) pain around 30° of flexion

1. Osteochondritis dissects (ocd) involves what and affects who

• involved subchondral bone

  • Can separate and become necrotic

• Affects 10-20 y/o

  • bones are developing and growing

• Wilsons’s test

For OSTEOCHONDRITIS DISSECANS

• pt extend knee against resistance from 90° while keeping tibia IR

• if pain around 30°, have pt ER foot

(+): if pain relieved when ER at 30° flexion

Hughstons plica test

Moving knee through flexion and extension while applying IR to tibia and medial glide to patella

(+): popping of plica band

Following TKA, ambulation without an AD is only recommended once:

1. Full knee extension is achieved

2. Adequate strength of quads and hip are present

Why have hinged brace at 0° for PCL injury

Gravity will cause tibia to sag posteriorly

How long to maintain all postural drainage positions

5-10 min

What are the most common fractures seen in ppl with severe osteoporosis

• Vertebral compression fx

• Colles wrist fx

• Hip fx

Severe osteoporosis criteria

1. T-score below -2.5

2. Presence of one or more fragility fractures

Small (<= 1 cm) RTC tear requires how long immobilized

1-2 was in sling

(Can remove for exercise POD1)

Medium to large (1-5 cm) RTC tear requires how long immobilized

Sling/abduction orthotics for 3-6 weeks

(Remove for exercise POD1-2)

Massive (> 5cm) RTC tear requires how long immobilized

Sling/abduction orthotics for 4-8 weeks

Remove for exercise POD1-3

claw fingers (aka intrinsic MINUS) hand involve what nerve

ulnar n. (can also affect median n.)

(ulnar) claw hand

claw hand characteristics

• hyperextension at MCP

• flexion at IP

• loss of ABD/ADD in all 4 fingers

(loss of intrinsic muscle and overaction of extensors)

drop-wrist deformity affects what nerve

radial n.

(often from humeral shaft fx or compression at axilla)

wrist drop deformity (saturday night’s palsy)

wrist drop deformity characteristics

• inability to extend the wrist

dupuytren's contracture

dupuytren's contracture characteristics

• contracture of palmar fascia

  • fixed flexion of MCP and PIP

• usually in ring or pinky

• men>women

mallet finger

mallet finger characteristics

• distal phalanx in flexion at rest

mallet finger caused by rupture or avulsion of

extensor tendon at distal phalanx

boutonniere deformity

boutonniere deformity characteristics

• extension of MCP and DIP

• flexion of PIP

boutonniere deformity is the result of a rupture of the __________

central tendinous slip of the extensor hood

boutonniere deformity most common after

trauma or in RA

swan neck deformity

swan neck deformity characteristics

• extension of PIP

• flexion of MCP and DIP

swan neck deformity due to contracture of what

intrinsic ma or tearing of Volar plate
(common in RA)

trigger finger (aka tenovaginitis stenosans) usually occurs

in 3rd or 4th finger

trigger finger (aka tenovaginitis stenosans) is the result of

-thickening of flexor tendon sheath (Notta’s nodule)

(sticking of tendon when pt attempts to flex finger—when finger “let’s go” a snap occurs)

-low inflammation of proximal flexor tendon

trigger finger (aka tenovaginitis stenosans) most often associated with

RA and is worse in the morning

trigger finger

de quervain’s tenosynovitis

de quervain’s tenosynovitis is the inflammation of

the extensor pollicis brevis (EPB)

and

abductor pollicis longus (APL)

(at 1st dorsal compartment)

de quervain’s tenosynovitis commonly seen during

pregnancy

de quervain’s tenosynovitis positive for

• pain at anatomical snuffbox

• swelling

• decreased grip and pinch strength

• (+) Finkelstein’s test

carpal tunnel syndrome is the compression of

median n.

• common in pregnancy, DM, RA

positive Tinel’s sign

colles fracture

colles fracture: ______displacement of the distal fragment of the radius

dorsal

smiths fracture: ____displacement of the distal fragment of the radius

volar

what is a chronic degenerative condition of the ECRB ; characterized by painful passive wrist FLEXION and active wrist EXTENSION

lateral epicondylitis (tennis elbow)

lateral epicondylitis special tests

cozen’s test

mill’s test

maudsley’s test

what is the degenerative condition of the pronator teres and flexor carpi radialis ; characterized by painful passive wrist extension and active wrist flexion?

medial epicondylitis (golfer’s elbow)

describe supracondylar fracture

• fracture at distal humerus

• common in kids (FOOSH)

• AIN (from median n.) and brachial artery at risk

• requires ORIF

complications of supracondylar fracture

• Volkmann’s ischemic contracture

• gun stock deformity (cubital varus)

• MALUNION!

describe nursemaid’s elbow (pulled elbow)

• usu 2-3 y/o

• how?

  • longitudinal traction on extended elbow

  • slippage of annular ligament over head of radius

• radial n. can be injured

position of arm with nursemaid’s elbow after slippage

arm at side with hand pronated

AIN (anterior interosseous nerve) syndrome

weakness of FPL and FDP (index finger)

weakness of pronator quadratus

(see weird “OK” sign)

biceps tendon rupture (distal)

• swelling and ecchymosis (bruising)

• palpable gap in biceps tendon

• WEAK elbow flex and supination

myositis ossificans

bone forms inside of muscle

(common in brachialis from trauma or aggressive stretching)

• avoid stretching, massage, resistive exercises, heat

brachialis strain

pain on ANTERIOR distal part of arm

painful resisted elbow flexion with forearm PRONATED

thoracic outlet primary sites for compression or entrapment

1. interscalene triangle

   1. brachial plexus in between anterior and middle scalene

      1. stretch scalene

2. costcoclavicular space

   1. between the clavicle and first rib

      1. mobilize 1st rib

3. axillary interval

   1. between pec minor and coracoid process

      1. stretch pec minor

arterial s/s of TOS

cool and pale extremity

venous s/s of TOS

swelling

mottled discoloration

neurological s/s of TOS

numbness

tingling

weak grip

loss of intrinsics/dexterity