PD II - Quiz 2 MSK Spine, Shoulder, Elbow

what is the most common cause of severe, long-term pain, and disability?

MSK diseases

what are examples of local MSK diseases?

• sprains / strains

• bursitis

• tendinitis

what are examples of systemic MSK diseases?

• RA

• SLE

• polymyositis

what are the most common MSK symptoms?

• pain

• swelling

• weakness

• stiffness

• limitation of movement

• joint clicking

• deformity

what should you inspect for on MSK exam?

• soft tissue swelling, erythema, deformity, asymmetry, nodules atrophy, masses

• symmetry of joints and motion, alignment, deformity, scars

• skin changes, muscle atrophy, subcutaneous nodules, swelling

• gait and posture, limitation of movement, instability, joint specific inspection

what should you palpate for on MSK exam?

• tenderness, temperature, crepitus, swelling, effusions

• subcutaneous nodules, masses, defects, step offs

what is active range of motion?

motion achieved by patient using their own muscle strength

what is passive range of motion?

motion achieved by examiner moving the joint

what are you looking for when performing range of motion?

• limitation of motion

• instability

• range of joint movement

what neurovascular components are important supplements to the MSK exam?

• muscle appearance, tone and strength

• sensation

• pulses

• deep tendon reflexes

what does a muscle (motor) strength of 0/5 indicate?

no muscular contraction detected

what does a muscle (motor) strength of 5/5 indicate?

active movement against full resistance (“normal”)

what should you palpate for on the TMJ?

bones and soft tissues

how is active range of motion tested for the TMJ?

• open mouth

• close mouth

• protrusion

• lateral motion

what symptoms are associated with TMJ disorders?

• unilateral or bilateral jaw pain (worse in AM or after eating)

• clicking

how are TMJ disorders treated?

• NSAIDs

• soft diet to limit chewing

• night guard

what spinal column supports weight bearing?

anterior column

what spinal column encloses the spinal cord?

posterior column

what vertebrae are prominent with neck flexion?

C7, T1

at what vertebrae are the iliac crests?

L4

what is the normal curvature of the cervical vertebrae?

lordosis

what is the normal curvature of the thoracic vertebrae?

kyphosis

what is the normal curvature of the lumbar vertebrae?

lordosis

what is the normal curvature of the sacral vertebrae?

kyphosis

what should you inspect for on thoracic and lumbar spine exam?

• posture

• curvatures

• deformities

• symmetry of scapula and pelvis

• range of motion

• surrounding skin and musculature

what is a Gibbus on radiology?

angular deformity due to a collapsed vertebrae

what causes a Gibbus on radiology?

• osteoporosis

• metastasis

• TB spine (Potts disease)

what is scoliosis?

abnormal curvature of the spine

what causes scoliosis?

• idiopathic

• congenital

• neuromuscular

what needs to be palpated on cervical / thoracic spine exam?

• tenderness or spasm

• spinous process

• paraspinous muscles

• soft tissue

what cardinal movements are tested for the cervical spine exam?

• flexion

• extension

• lateral rotation

• lateral bending

what should be identified on a neurovascular cervical spine exam?

• cervical spine and UE muscle strength

• UE reflexes

• UE sensation

• UE pulses

what pathology is associated with the cervical, thoracic, or lumbar spine?

• sprain / strain

• degenerative disc

• herniated disc

• arthritis (osteo, RA, psoriatic)

• primary tumors

• metastatic disease

• deformities (scoliosis, kyphosis)

• trauma (fracture, dislocation)

what is the Plum line?

imaginary line from T1 through mid gluteal cleft

what should you inspect for on lumbar spine examination?

• general inspection

• skin creases

• skin changes

• spinal curvatures

• deformities

• shoulder heights

what should you palpate for on lumbar spine examination?

• bony prominences

• paraspinal muscles

• soft tissue

what cardinal movements are tested for the lumbar spine exam?

• flexion

• extension

• lateral bending

• rotation

what special tests are used during the lumbar spine exam?

• straight leg raise

• crossed straight leg raise

• true leg length measurement

what is a straight leg raise?

passively raise extended leg in supine pt OR extend knee in sitting pt

what is a positive straight left raise?

reproduction of pt’s symptoms (back / leg pain)

what maneuver can reproduce pain in a similar manner to a straight leg raise?

ankle dorsiflexion

what is a crossed straight leg raise?

symptoms in the affected side with passive flexion of the opposite leg / hip is associated with confirmation of radicular pain

what is a true leg length measurement?

measure from the ASIS to the medial malleolus with measuring tape, crossing the medial aspect of the knee

what should be identified on a neurovascular lumbar spine exam?

• muscle strength

• LE reflexes

• sensation

• distal pulses

what bones makes up the shoulder?

• humerus

• clavicle

• scapula

what makes up the shoulder girdle?

• sternoclavicular joint

• acromioclavicular joint

• glenohumeral joint

• scapulothoracic articulation

what muscle groups attach at the shoulder?

• scapulohumeral group

• axioscapular group

• axiohumeral

what do the scapulohumeral muscles attach?

scapula to humerus

what muscles make up the scapulohumeral group?

• deltoid

• teres major

• rotator cuff

what are the rotator cuff muscles?

SITS

• supraspinatus

• infraspinatus

• teres minor

• subscapularis

what are the actions of the scapulohumeral group?

internal / external rotation and aBduction

what do the axioscapular muscles attach?

trunk to scapula

what muscles make up the axioscapular group?

• trapezius

• rhomboids

• serratus anterior

• levator scapulae

what are the actions of the axioscapular group?

allow the shoulder to be pulled backward

what do the axiohumeral muscles attach?

trunk to humerus

what muscles make up the axiohumeral group?

• pectoralis major

• pectoralis minor

• latissimus dorsi

what are the actions of the axiohumeral group?

aDduction and internal rotation

what type of joint is the shoulder?

ball and socket joint

where does the head of the humerus sit?

shallow glenoid cavity

what is the glenoid labrum?

rim of cartilage that slightly deepens the glenoid cavity

what surrounds the glenohumeral joint?

fibrous articular capsule formed by tendons of rotator cuff and other capsular muscles

what is the principal bursa of the shoulder?

subacromial bursa

where is the subacromial bursa?

betw the acromion and head of humerus and overlying supraspinatus tendon

what compresses the subacromial bursa?

aBduction of the shoulder

what results from inflammation of the subacromial bursa?

pain below the acromion with aBduction and rotation

what contributes most to the stability of the shoulder?

muscle tendons

what is the super-stabilizer of the shoulder?

tendon to the long head of the bicep

what should you inspect for on the shoulder exam?

• general inspection

• swelling

• skin nodules, masses

• asymmetry

• deformity

• atrophy

• winging of scapula

what should you palpate for on the shoulder exam?

• articulations

• bony structures

• tenderness

• warmth

• crepitus

• soft tissue

should active or passive range of motion be tested first?

active

what cardinal movements are tested for the shoulder exam?

• aBduction

• aDduction

• extension

• flexion

• internal / external rotation

what can be palpated on shoulder exam?

• subacromial bursitis

• subdeltoid bursitis

• bicipital tendinitis

what special tests are used during the shoulder exam?

• drop arm test

• apprehension test

what is the drop arm test?

ask pt to aBduct to 90º and apply downward pressure to lower arm

what is a positive drop arm test?

arm drops with slight pressure

what does a positive drop arm test indicate?

rotator cuff tear

what is an apprehension test?

aBduct and externally rotate shoulder and apply pressure on GH joint

what is a positive apprehension test?

apprehensive facies or pain upon pressure

what does a positive apprehension test indicate?

glenohumeral instability

what can cause referred pain in the shoulder?

• CAD

• pulmonary tumors

• GBD

what are DDx for shoulder pain?

• rotator cuff tendonitis

• rotator cuff tears

• shoulder bursitis

• shoulder dislocation

• acromioclavicular arthritis

• adhesive capsulitis

• calcific tendonitis

• labral tear

• biceps tendonitis

what history is associated with rotator cuff tendonitis (impingement syndrome)?

• pain (often PM)

• weakness

• loss of motion

what test should be performed if rotator cuff tendonitis is suspected?

apprehension test

what are DDx for rotator cuff tendonitis?

• rotator cuff tear

• calcific tendinitis

• shoulder subluxation

• biceps tendon rupture

• adhesive capsulitis

• AC arthritis

• RA

• gout

• Lyme

• SLE

• avascular necrosis

how is rotator cuff tendinitis treated?

• rest

• ice

• NSAIDs

• PT

• steroid injections

what movement is severely limited with rotator cuff tears?

aBduction

where is tenderness experienced with rotator cuff tears?

over greater tuberosity

what is the characteristic of rotator cuff tears?

“shoulder shrug”

where can shoulder bursitis be found?

subacromial bursa OR subdeltoid bursa

how is shoulder bursitis treated?

• rest

• ice

• NSAIDs

• PT

• steroid injections

which shoulder dislocation is the most common?

anterior

what history is common with shoulder dislocations?

MVA or falling on outstretched arm

what signs / symptoms are associated with shoulder dislocations?

• shoulder pain

• arm held at side, slightly away from body with forearm outward

• loss of normal contour of shoulder

what is important to consider when reducing a shoulder dislocation?

ensure no nerve or blood vessel damage

what history is associated with acromioclavicular arthritis?

shoulder dislocation or trauma

what signs / symptoms are associated with acromioclavicular arthritis?

• pain with shoulder movement

• bringing arm across chest compresses AC joint, recreates pain

how is acromioclavicular arthritis treated?

• NSAIDs, PT

• surgery if severe

what are the principle characteristics of adhesive capsulitis (frozen shoulder)?

PAIN and CONTRACTURE

what causes loss of ROM in adhesive capsulitis?

disease in structures outside the synovial capsule GH joint

what are the risk factors of adhesive capsulitis?

• DM

• hyper / hypothyroid

• hypertriglyceridemia

• hypoadrenalism