rapid fire PD MSK overview

remember to do this shuffled

passive vs active has greater ROM

passive

big concern in all MSK injuries

sensation (neuro) and pulses (popliteal artery dmg)

cervical and lumbar

lordosis

kyphosis

thoracic

iliac crest level

s4

scapular level

t7

spine w/ most ROM

cervical spine

most common rotator cuff muscle injured

supraspinatus

second most common rotator cuff injured

infraspinatus

left shoulder pain = what critical

MI (STEMI)

what pop will MI look different in?

women, children, elderly

tests for impingement (general) =

neer’s sign and hawkin’s kenedy =

most common impingement muscle injured

supraspinatus

occurrence of meniscus issues

twisting injury

chronically w/ degenerative changes

findings in meniscus issues

• Impaired knee ROM -> joint effusion

• Sensation of clicking/locking with ROM

what injury can cause joint effusion?

meniscus issues, acl tears, etc

nexus criteria

• neck pain/trama

• alertness

• NO posterior midline cervical spine tenderness

• NO neuro deficits

nexus criteria met, when MUST you get x-ray?

any evidence of intoxication

painful distracting injury, gma comes in with a broken hip, what should you x-ray other than hip?

head

radiculopathy

pinched nerve spine root, pain shooting down limbs

fall on shoulder, clavicle sticking out = ?

AC joint separation

attached to muscle

tendon

tendon

bone to bone

dislocation of humerus/shoulder, what direction?

anterior

Teenager is extending their arm and somebody comes and hits their arm and their arm will drop out anteriorly = ?

shoulder dislocation

direction of hip dislocation

posterior

harder to dislocate

swan or boutonnière sign = what pathology

osteoarthritis

joint not involved in RA

DIP

joint not involved in osteoarthritis

MCP

boutonniere sign

extension at DIP and flexion PIP

swan sign

flexion at DIP and extension at PIP

mid-foot role

Shock absorption

Weight distribution

Flexibility and adaptability

Postural support

mallet finger

injury to extensor tendon of DIP

DIP is flexed

forced flexion, extensor tendon injured = ?

mallet finger

test for ankle sprains

Ottawa Ankle and Foot Rules

jersey finger

stuck in extension

can NOT flex at DIP

common comorbities of Duputren’s Contracture

alcohol use disorder

DM

fingers affected by Duputren’s contracture

ring and pinky affected most

duputren’s contracture vs. trigger finger

DC: can NOT push past it

TF: CAN push past it

#1 rotator cuff muscle most injured

supraspinatus

#2 most injured rotator cuff muscle

infraspinatus

rotator cuff issue s/sx

shoulder pain

weakness/limited ROM

rotator cuff issue findings

atrophy

tenderness @ muscle/insertion

limited ROM

weak strength

special test that may be positive in rotator cuff issues

apley scratch test

drop arm test for

supraspinatus disorder

bicipital tendinitis

empty can test is

most specific for supraspinatus disorder

infraspinatus test looks for

infraspinatus disorder

teres minor disorder

lift off test looks for

subscapularis disorder

belly press looks for

subscapularis disorder

rotator cuff issues TOC

PT

rotator cuff issues work-up

MRI (most specific)

x-ray

U/S

Impingement Syndrome

compression of structures around glenohumeral joint (Supraspinatus or Subacromial bursa)

Impingement Syndrome findings

muscular atrophy

Abduction, flexion, external rotation ROM/strength weak/painful

Impingement Syndrome tests

neer’s sign

hawkin’s kennedy

Impingement Syndrome RF

Poor muscular dev

Repetitive overhead sports or work above shoulder

neer’s and hawkin-kennedy sign

supraspinatus impingement

rotator cuff tendonitis

sub-acromial bursitis

shoulder bursitis findings

shoulder bursitis affecting ROM

limited flexion, abduction, rotaton

movement compresses shoulder bursitis

abduction

forward flexion

Shoulder Bursitis s/sx

pain worse with movements compressing bursa

possible swelling

Shoulder Bursitis RF

trauma

prolonged pressure to area

crystal-induced arthropathy (gout)

overuse

inflammatory arthritis

Infections

Shoulder Bursitis workup

Imaging only if conservative treatment does not work

AC Joint Separation RF

Trauma (superior or lateral direct blow to shoulder with arm adducted) or fall on outstretched arm (driving humeral head into acromion)

Male

Sports

AC Joint Separation exam findings

Prominent AC joint (sticking out)

AC Cross over test: pain when compressing AC joint

Tenderness over AC joint

ROM affected d/t pain

neuro/vascular exam intact

Adhesive Capsulitis “Frozen Shoulder” RF

Immobilization (after surgery/injury)

Female

DM (without evidence of osteoarthritic changes)

Thyroid disease

Adhesive Capsulitis “Frozen Shoulder” sx

Limited ROM (passive and active)

Generalized shoulder pain

Adhesive Capsulitis “Frozen Shoulder” test

Positive Apley Scratch Test

Adhesive Capsulitis “Frozen Shoulder” exam

Painful glenohumeral joint on palpation

Dec active/passive ROM on impacted side (intermediate phase only)

Nothing on inspection

initial panful phase of Adhesive Capsulitis

diffuse, severe/disabling pain, worse at night, ROM intact

intermediate phase of Adhesive Capsulitis

stiffness/dec ROM with dec amount of pain

recovery phase of Adhesive Capsulitis

return of ROM (5-24 m)

Bicipital Tendinitis s/sx

Pain worsened with pulling/lifting

catching/snapping sensation

Possible nighttime

Bicipital Tendinitis exam findings

Asymmetry on inspection

Pain in bicipital groove

Pain with elbow flexion/forearm supination

Bicipital Tendinitis tests

Speed’s test

Yergason’s Test

Bicipital Tendinitis RF

repetitive motion (pulling/lifting/reaching)

Male

Inc with age

Prior hx of rotator cuff pathology/issues with scapular stabilization

Bicipital Tear findings

“Pop” with pain if acute tear

“Popeye arm”

Anterior shoulder pain worse with lifting/pulling

swelling/mass in arm

#1 critical for Anterior shoulder pain

MI

#1 cause of Anterior Dislocation of shoulder

fall or forceful throwing motion

(ie falling on outstretched arm or arm overreached in elevated/externally rotated position)

Anterior Shoulder Dislocation cause

Trauma to abducted/externally rotated/extended arm (ie blocking bball)

Anterior Shoulder Dislocation s/sx

Neurologic paresthesia

Shoulder pain

Limited ROM

Anterior Shoulder Dislocation exam findings

Loss of “rounded shoulder appearance”

Neurovascular eval required d/t axillary nerve dysfunction being common complication

Arm held slightly abducted/externally rotated

Resistance to passive/active ROM

Possible asymmetry

Tenderness to palpation

Anterior Shoulder Dislocation test

positive apprehension test

Anterior Shoulder Dislocation work-up

x-rays

Neurovascular eval required d/t axillary nerve dysfunction being common complication

Anterior Shoulder Dislocation treatment

reduction

major complication of anterior shoulder dislocation

axillary nerve dysfunction

Epicondylitis s/sx

Elbow pain*

Weakness

Epicondylitis exam findings

Localized tenderness/point tenderness

Pain with resistance

Possible atrophy

Epicondylitis tests

golfers elbow test

tennis elbow test

Epicondylitis RF

Repetitive movements

Older age

Smoking

Obesity

golfers elbow test

medial epicondylitis (flexion)

tennis elbow test

lateral epicondylitis (extension)

Radial Head Subluxation pop

<5 y/o

ligament strong 5+

Radial Head Subluxation s/sx

Radial Head Subluxation exam findings

Active ROM limited

Passive ROM intact to flexion but pain with supination

Little distress

Arm held close to body extended/slightly flexed

Possible tenderness

Radial Head Subluxation tx

Hyperpronation method

Flexion-extension method

olecranon bursa has in risk for

trauma/inflammation d/t limited vascularity

Olecranon Bursitis s/sx

Swelling over olecranon bursa

tender/soft/firm

If infection: erythema and warmth

Possible pain

Olecranon Bursitis exam findings

Swelling of olecranon bursa

Palpation +/- tenderness or warmth

ROM intact

Olecranon Bursitis work up

bursal aspiration

Rheumatoid Nodules

Firm and NON-tender nodules

on pressure points along extensor surface of ulnar (lateral)