ICM - Musculoskeletal Exam

what are 3 general types of joints?

synovial, cartilaginous, and fibrous are the main what?

what are the 3 types of synovial joints?

spheroid, hinge, condylar

synovial spheroidal joint examples

shoulder, hip

synovial hinge joint examples

digits

synovial condylar joint example

knee

ligament

dense collagen connective tissue-attaches bone to bone

tendon

attach muscle to bone

synovial joint

freely moveable joint that involves 2 bones covered by articular cartilage that are separated by a synovial capsule. The joint is held together and strengthened by the joint capsule and surrounding ligament.

cartilaginous joint

slightly moveable joints with fibrocartilagenous discs

fibrous joint

allow no movement, united by fibrous tissue

4 Main Physical Exam Components

IPAP: Inspection, Palpation, Auscultation, Percussion are the main components of what?

Palpation of the Inguinal Ligament

What crosses, perpendicularly to the following NAVEL (lateral to medial order, nerve, artery, vein, empty space, lymph node)

effusion

Escape of fluid from it's normal location

Musculoskeletal exam Components

Bilateral!
Unaffected side first
Inspection--alignment, symmetry, atrophy, etc
Palpation--skin, joint, tendons, ligaments, bursa
Range of Motion--active, passive, resist/strength
Special Maneuvers

ganglion cyst

benign cyst, overuse injury,
can burst on own
"bible busters

de Quervain's tenosynovitis

1. thickening of the tendons of the abductor pollicis longus and the extensor pollicis brevis as a result of acute or repetitive trauma
2. wrist pain on the radial side
3. Finkelstein test which is flexion of the thumb across the palm and then ulnar devia

Musculoskeletal exam of Hand

1. Inspect
2. Palpate wrist bones, mcp joints, pip & dip joints
3. ROM: w plams up hand flexion, extension, abduction, adduction, palms down fist extend and spread fingers & squeeze together
4. Thumb ROM
5. Phalen's (back of hands together 60 sec)
6. Tine

Musculoskeletal exam of the Shoulder

1. Inspect
2. Palpate spine of scapula, acromion, ac joint, coracoid process, bicipital tendon, clavicle, sc joint
3. Passively flex humerus & palpate subacromial bursa and SITS muscle insertions
4. Assess ROM: flexion, extension, abduction, adduction, in

Musculoskeletal exam of the Elbow

1. Inspect & support bent elbow
2. Palpate lateral & medial epicondyles, olecranon process & bursa
3. ROM: flexion, extension, w elbows @ 90 deg supination & pronation
4. Valgus and varus @ 30 deg

Musculoskeletal exam of Spine

1. Inspect w pt standing
2. Palpate curves and spinous processes & paravertebral muscles
3. Have pt bend & touch toes, bend laterally, extend, twist, stabilizing hips
4. Straight leg raise if pt has low back pain

Musculoskeletal exam of the Hips

1. Inspect & have pt do active & resisted ROM while still standing
2. Pt on side palpate superior-posterior iliac spine (dimples), greater trochanter
3. Pt on back palpate iliac crest, anterior-superior iliac spine
3. Pt on back passive ROM: flexion, exte

Finkelstein's test

pt grasp thumb in fist and bend tow. midline
pain indicates inflammation of abductor pollicis longus and extensor pollicis brevis (de Quervain's tenosynovitis)

Bulge sign

A test for effusion
1. knee extended
2. apply pressure on suprapatellar pouch w L hand, milk downward, forcing fluid into lateral area
3. Tap laterally w right hand

Balloon sign

Test for Major effusion
1. knee extended
2. place thumb and index of R hand on either side of patella (INFERIOR?)
3. compress suprapatellar pouch against femur
4. feel for fluid entering into space compressed by R hand

Ballotting

Assess large effusions
1. knee extended
2. push patella, with R thumb and index finger (close together), down & watch for fluid returning to suprapatellar pouch

McMurray's

Test for meniscus
1. while they are supine/cup patient heel and other hand cupped around anterior knee
2. bring pt heel in large circle, with one hand

Thompson's

Test for ruptured achilles
Pt stands with knee flexed and resting on stool
Squeeze pt calf
Lack of movement of foot is positive test.

genu varum

bow-legged

genu valgum

knock-kneed

Valgus Maneuver

Stress the Medial Collateral Ligament
With knee flexed @ 0 & 30 deg
Pt Supine, hold ankle area w one hand, apply pressure on LATERAL side of knee toward midline and pull ankle laterally
Tests for laxity of MCL

Varus Maneuver

Stress Lateral Collateral Ligament
With knee flexed @ 0 & 30 deg
Tests for laxity of LCL
push ankle toward midline and knee laterally

Drop Arm Test

The Drop Arm Test evaluates for a supraspinatous muscle tear. Passively abduct the shoulder to 90 degrees, flex to 30 degrees and point thumbs down. The test is positive if the patient is unable to keep arms elevated after the examiner releases.

Empty Can Test

Suprapinatous muscle strength. Passively abduct the shoulder to 90 degrees, flex to 30 degrees and point thumbs down. In this position, provide resistance as the patient lifts upward. Pain or weakness suggests possible tendonopathy or tear.

Sever's Disease

Osteochondrosis
Heal pain esp in adolescents, when bone grows faster than muscles and tendons

Sever's Disease test

Squeeze test

Comminuted

bone is broken in 3 or more places (often found with osteoporosis)

Greenstick

a partial fracture of a bone (usually in children)

Compartment Syndrome

pain, parasthesias, pallor, paralysis, pulsless, poikilothermia

Lachman

most sensitive test for an ACL tear

Lachman

move tibia forward and femur back to indicate an ACL tear

Boxer's Fracture

Fracture of the 5th metacarpal
Ulnar gutter splint

Displaced Fracture

bone ends are not aligned

Colle's

fracture of distal radius with dorsal displacement of distal fragments

Silver Fork Deformity

The dorsal deformity of the forearm that results from a Colles fracture

Tinel's

Percussing lightly over the median nerve in each wrist. If carpal tunnel syndrome is present, the client feels numbness, tingling, and pain along the median nerve.

Phalen's

Tests CTS, arms at shoulder height - press palms together for 30-60 sec, positive test results in pain/tingling within 60 sec = "reverse prayer

Carpal Tunnel Signs

night pain
numbness
parasthesias
weakness

Thenar Atrophy

late sign of carpal tunnel

Affects DIP joints

osteoarthritis

Affects MCP and PIP joints

rheumatoid arthritis

Heberden's nodes

osteoarthritis

Heberden's nodes

DIP swelling 2� to osteophytes

Mucous Cysts

Patients report swelling on the dorsum of the finger distal to the DIP joint with this cyst

Mucous Cysts

osteoarthritis

Bouchard's nodes

PIP swelling 2� to osteophytes

Bouchard's nodes

osteoarthritis

Kienbock's

avascular necrosis of the lunate

Affects carpometacarpal joint of the thumb

osteoarthritis

Sail sign

displacment of volar fat pad; indicative of elbow fracture

Gamekeeper's thumb

sprain or tear of the ulnar collateral ligament of thumb

Gamekeeper's thumb

weakness of pinch

Lateral epicondylitis

tendonous insertion of extensor carpi radialis brevis

Lateral epicondylitis

most common overuse injury of the elbow

Lateral epicondylitis

burning and pain with resisted wrist extension with elbow extension; pain with grip

Lateral epicondylitis

tennis elbow

Medial epicondylitis

Wrist flexors (common flexor tendon) and forearm pronators

Medial epicondylitis

pain with resisted wrist flexion & pronation

Medial epicondylitis

pitchers/golfers elbow

Meniscal tear

locking and giving way

Apley's test

test for miniscus tear
postive with click or pop

Ganglion Cyst

Apley's test

Osteoarthritis

RA Mnemonic

RF
HLA-DR
ESR + Extraarticular
Ulnar Deviation
Morning Stiffness
Atlantoaxial Joint Subluxation + AntiCCP
Tissue Swelling
Inflamed pannus
Symmetric + Spares DIP
MCP + PIP