clinical skills musculoskeletal system (part one)

myalgia

what is the medical term for muscle pain?

arthralgia

what is the medical term for joint pain?

fibrous, synovial, cartilaginous

list 3 types of joints

fibrous joint

what type of joint is immovable (ex: skull)?

synovial joint

what type of joint is freely moveable?

synovial membrane, synovial cavity, joint capsule, and ligaments

what is a synovial joint comprised of?

spheroidal, hinge, condylar

list examples of synovial joints

hinge

what type of synovial joint has one plane?

condylar

what type of synovial joint has convex/concave surfaces?

cartilagenous joints

what type of joints have less movement (ex: vertebrae)?

annulus fibrosis

what makes up the outer part of the fibrocartilaginous disc found in cartilaginous joints?

nucleus pulposis

what makes up the inner part of the fibrocartilaginous disc found in cartilaginous joints?

bursae

what are disc shaped, fluid filled sacs that lie at the points of friction?

movement

what do bursae facilitate?

1. heel strike

2. flat foot

3. midstance

4. push off

what are the four stages of gait?

swelling, tenderness, warmth, erythema

what are signs of inflammation/edema/effusion?

crepitus

what is a palpable or audible crunch that can be with or without pain?

no muscle contracture

what is a strength of 0?

flicker or trace of contracture

what is a strength of 1?

active movement without gravity

what is a strength of 2?

active movement against gravity

what is a strength of 3?

active movement against gravity and some movement

what is a strength of 4?

active movement against gravity and full resistance without evident fatigue

what is a strength of 5?

5

what strength grade 0-5 is normal?

goniometer

what can you use to test ROM?

crossover test

what test is used to test the acromioclavicular joint?

adduct patient's arm across the chest

describe crossover test

to test ROM

what is the Apley Scratch test used for?

ask pt to scratch their back

describe Apley scratch test

fully abduct arm from 0-180 degrees, looking for pain or decreased ROM

describe painful arc test

subacromial impingement/rotator cuff tendinitis disorder

what does pain during Neer's impingement sign indicate?

supraspinatus impingement/rotator cuff tendinitis disorder

what does pain during Hawking's impingement sign indicate?

subacromial impingement/rotator cuff tendinitis disorder (pa)

painful arc test: shoulder pain from 60 to 120 is a positive test for what?

supraspinatus and infraspinatus disorders

external rotation lag test: inability of the pt to maintain external rotation is a positive test for what?

subscapularis disorder

internal rotation lag test: inability of the patient to hold the hand in this position is a positive test for what?

have pt abduct arm to shoulder level and lower slowly

describe drop-arm sign

supraspinatus rotator cuff tear or bicipital tendinitis

drop-arm sign: weakness is positive for what?

infraspinatus strength

what does the external rotation resistance test test for?

supraspinatus strength

what does the empty can test test for?

supraspinatus, infraspinatus, teres minor, subscapularis

the rotator cuff is made up of the tendons of what four mm?

when the coracoacromial ligament, AC joint, or coracoid process impinge (pitch) on bursa, biceps tendon, and rotator cuff

what is impingement syndrome?

gradual onset of anterior and lateral shoulder pain, can't sleep on affected side

what are symptoms of impingement syndrome?

+ impingement sign, decreased abduction, pain with flexion

what are signs of impingement syndrome?

under the acromion

in rotator cuff tendonitis, how is the cuff pinched?

repetitive overhead motions that cause the rotator cuff to be pinched under the acromion (ex: throwing, swimming)

what is rotator cuff tendonitis caused by?

pain when arm is overhead

what are symptoms of rotator cuff tendonitis?

+ impingement sign

what are signs of rotator cuff tendonitis?

repeated impingement (heavy lifting) or FOOSH

what can cause rotator cuff tear?

severity

rotator cuff tears can be partial or complete and are graded by...

weakness, pain

what are symptoms of rotator cuff tear?

+ drop arm test, impaired active abduction- end up shrugging instead

what are signs of rotator cuff tear?

degeneration of a tendon with deposits of calcium salts

what is calcific tendonitis?

supraspinatus tendon

calcific tendonitis usually involves what tendon?

females +30 yo

who is calcific tendonitis more common in?

acute or chronic episodes of pain

what are symptoms of calcific tendonitis?

arm held close to side, all direction of movement increase the pain

what are signs of rotator cuff tear?

inflammation of the long head of the biceps tendon

what is biceps tendonitis?

rotator cuff tendonitis

biceps tendonitis may resemble a ___ or the two may coexist

anterior shoulder pain

what are symptoms of biceps tendonitis?

+ Yergason test

what are signs of biceps tendonitis?

ask patient to flex, supinate, and pronate against resistance

describe Yergason test

Biceps rupture, Popeye defect

what is this condition?

frozen shoulder

what is adhesive capsulitis aka?

fibrosis of glenohumeral joint capsule

what is adhesive capsulitis?

unilateral, females> males, 50-70yo, older athletes

adhesive capsulitis is normally...

history of antecedent event such as painful disorder of the shoulder or a disabling illness

what do people with adhesive capsulitis sometimes have?

diffuse, dull ache, no point tenderness, worse at night

what are symptoms of adhesive capsulitis?

progressive loss of ROM, all directions

what are signs of adhesive capsulitis?

shoulder instability, usually result of fall or forceful throwing motion

what is anterior dislocation of humerus?

arm is abducted and externally rotated

what is a + apprehension sign with anterior dislocation of humerus?

yes

is acromioclavicular arthritis common?

degenerative changes to the AC joint usually as a result of trauma

what is acromioclavicular arthritis?

pain at AC joint

what are symptoms of acromioclavicular arthritis?

movement of scapula is painful, movement of glenohumeral joint is not painful

what are signs of acromioclavicular arthritis?

bursa between the acromion and head of humerus inflames

what is subacromial bursitis?

below tip of acromion

with subacromial bursitis, where is there tenderness?

abduction and rotation

with subacromial bursitis, there is pain with...

lateral epicondylitis (Tennis elbow)

what does Cozen test test for?

reproduction of lateral elbow pain

what is a positive Cozen test?

swelling and inflammation of olecranon bursa

what is olecranon bursitis?

trauma, RA, gout

what can olecranon bursitis be secondary to?

asymptomatic or painful, acute or chronic

what are symptoms of olecranon bursitis?

swelling, can become quite large

what are signs of olecranon bursitis?

tennis elbow

what is lateral epicondylitis called?

repetitive extension of wrist against resistance or repetitive pronation/supination of forearm

what is lateral epicondylitis secondary to?

pain and tenderness of medial/lateral epicondyle, increased with movement against resistance

what are symptoms of medial AND lateral epicondylitis?

pitcher's, golfer's or little league elbow

what is medial epicondylitis aka?

repetitive flexion of wrist against resistance

what is medial epicondylitis secondary to?

ulnar nerve is impinged at the elbow

what is ulnar nerve entrapment?

trauma, prolonged bed rest, compression

what might ulnar nerve entrapment be due to?

numbness of 4th and 5th finger, tender ulnar groove, decreased dexterity, 5th finger weakness

what are symptoms of ulnar n entrapment?

Phalen's and Tinel's tests

what are the tests for carpal tunnel syndrome (CTS)?

flex wrists against one another x 1 min

describe Phalen's test

tap on volar wrist

describe Tinel's test

transverse carpal ligament on the palmar side

the carpal tunnel lies along the palmar aspect of the wrist, covered by the...

thumb, 2nd, 3rd, and half of 4th digits

the median n runs through the carpal tunnel innervating the...

pts with trauma to wrist, acute or chronic inflammation, overuse, pregnancy, amyloidosis

carpal tunnel syndrome (CTS) epidemiology

numbness, burning, tingling in thumb, 2, 3, and 1/2 4th digits. awakens pt at night, worse with driving, typing, phone

what are the symptoms of carpal tunnel syndrome (CTS)?

Phalen's sign, Tinel's sign, thenar atrophy

what are the signs of carpal tunnel syndrome (CTS)?

ganglion

what is the most common soft tissue tumor of the hand and wrist?