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