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Muscoskeletal
| Question | Answer |
|---|---|
| A 34 year old presents with new onset elbow pain. Upon examination there is no pain with passive ROM but pain with active ROM | Tendonitis |
| Katz hand diagram | Median nerve integrity test |
| Straight leg raise | L4, L5 nerve root irritation test |
| McMurray Test | Knee, meniscal tear test |
| Varus-Valgus Stress test | Knee: medial and lateral collateral ligament stability |
| Neer test | Rotator cuff impingement/tear |
| Trendelenberg test | Hip abductor muscle weakness |
| 30 year old male with low back pain x 1 year. pain worsening now and involves the hips and buttocks | ankylosing spondylitis |
| 49 year old with acute onset back pain x 2 days after lifting heavy furniture. Pain radiates to right posterior thigh but is relieved with lying down | Herniated lumbar disc |
| 53 year old with low back pain with prolonged sitting and walking. Pain radiates to both legs | Lumbar stenosis |
| 51 year old F presents with complaints of joint pain in bilat hands x 6-8 months. It is progressively worsening. it is worse in the mornings after walking with stiffness lasting most of the morning. She has difficulty opening jars, is fatigued and has noticed swelling in her fingers which are tender to touch. Most likely Dx | RA |
| How do you test for effusion in the knee | Ballotment test |
| Part of the screening orthopedic component of the examination includes evaluating the person while | Duck walking |
| The checkout station for preparticipation physical exams is critical because | Data is reviewed and follow up actions coordinated |
| The goals of preparticipation sports evaluation include | Identify health problems that increase risk of injury or death |
| One of the most important aspects to consider in all portions of the orthopedic screening examination is | Symmetry |
| Which medical condition would exclude one from sports participation | Fever |
| Which of the following radiographic studies is no longer recommended by the American Academy of Pediatrics for individuals with Downs Syndrome | Cervical spine xrays |
| A parent is advised to restrict contact or collision sports participation for his or her child. An example of an acceptable sport would be | track |
| Which of the following may be a component of the female athlete triad | Binging and purging |
| Your 15 year old patient appears to have a too-thin body build. Radiography of the ankle injury reveals a stress fracture. You should question this patient about her | menstrual cycles |
| ZYou are conducting a preparticipation physical exam for a 10 year old girl with Down Syndrome who will be playing soccer. She has increased deep tendon reflexes, ankle clonus and a positive Babinski sign. What should your next course of action be | immediate referral to neurosurgeon |
| Which of the following statements are true regarding sports related concussions | They may or may not involve a loss of concussion |
| Excessive hyperflexion of the knee with weight bearing may indicate | weakness of the quadriceps muscle |
| Fasciculation occurs after injury to a muscle's | motor neuron |
| Anterior cruciate ligament integrity is assessed via the ____ test | Lachman test |
| Which of the following techniques is used to detect a torn meniscus | McMurray test |
| During a football game a player was struck on the lateral side of the left leg while his feet were firmly planted. He is complaining of left knee pain. To examine the left knee you should initially perform the ____ test | Valgus stress test |
| You note that a child has a positive Gower sign. You know that this indicates generalized | Muscle weakness |
| The cruciate ligaments within the knee provide for | Anterior and posterior stability |
| An increase in muscle tone is known as | Spasticity |
| Term infants normally resist | Knee extension |
| Bones around a joint are held together by | ligaments |
| Ligaments are stronger than bone until | Adolescence |
| Fluid that lubricates articular cavities is called | Synovial fluid |
| When performing the drawer test the examiner would place the patient in a supine position and flex the knee 45 to 90 degrees, placing the foot flat on the table and then | grasp the lower leg with both hands and draw the tibia forward and than backward |
| The glenhumeral joint is the other name for the | shoulder |
| Articulation of the radius and carpal bones is the | wrist |
| A three year old is brought to the clinic complaining of a painful right elbow. He is holding the right arm slightly flexed and pronated and refuses to move it. The mother states that symptoms started right after his older brother had been swinging him by the arms. This presentation supports a diagnosis of | radial head subluxation |
| Injuries to long bones and joints are more likely to result in fractures than sprains until | Adolescence |
| In differentiating osteoarthritis from rheumatoid arthritis the patient with OA typically exhibits | less weakness and fatigue |
| A tingling sensation radiating from the wrist to the hand on striking the median nerve is a positive ___ sign | Tinel |
| What technique is performed at every infant examination during the first year of life to detect hip dislocation | Barlow-Ortolani manuevers |
| What is a Bursae | Fluid filled sac at points of friction. Normally between skin and bone, tendons and muscles and muscle and muscle |
| What are ligaments | 1, Collagenous fibers that connect bone-bone. 2. Strengthen and stabilize joints |
| What are tendons | 1. Collagenous fibers that connect muscle-bone 2. Enables movement of joints |
| What is a Diarthroses joint | Freely moveable joint |
| What is a Amphiarthroses joint | Slightly movable joint -- Vertebrae |
| What is a Synarthroses joint | Immoveable joint -- Cranium |
| What does palpation of joints check for | Deformity, Synovial effusion, Ballottement, Thickend synovium, Tenderness, Warmth, Joint locking, Range of passive motion, Use of goniometer, muscle strength and fracture |
| What does a Goniometer do | Measures joint ROM |
| What is Abduction | Movement away from the body midline |
| What is Adduction | Movement towards body midline |
| What is flexion | Moving a joint closer together like flexing the arm to show bicep muscles |
| What is extension | Opposite of flexion. Like tilting head backwards. or straightening arm out after flexing it |
| What is hyperextension | extending a joint beyond its normal, healthy ROM |
| What is circumduction | 360 degree of movement ie.. shoulder |
| what is internal rotation | AKA medial rotation is rotation towards the body center |
| What is external rotation | AKA lateral rotation is rotation away from the body center |
| What is pronation | inward roll of the foot |
| What is supination | Outward roll of the foot. AKA Under-pronation |
| What is lateral bending | Bending body to the left or right |
| What is dorsiflexion | Bending foot up towards the body |
| What is Plantar flexion | bending the foot down away from the body |
| What is Inversion | Moving foot towards the midline of the body |
| What is Eversion | Moving the foot away from the midline of the body |
| How do you test the normal mouth opening and operation of the TMJ joints | Have patient try to fit 2-3 knuckles in their mouth |
| What shoulder muscle is most likely to get injured | Supraspinatus muscle |
| What is the Shoulder Drop test and what does it test for | To check for rotator cuff injury and impingement. Examiner grabs patients wrist and passively abducts the shoulder to 90 degrees. Examiner releases patients arm with instructions to slowly lower their arm. Weakness or pain is positive sign |
| What is the empty can test | Pretend to pour out a can of beverage while the examiner pushes down on the shoulders. Positive test illicit pain. Test for rotator cuff injury or impingement |
| What is the Neer test | Test for rotator cuff inflammation or tear. Have patient forward flex their arm up to 150 degrees and press down on the scapula. Positive test causes pain. Raise patients arm up to their ear. |
| What is the Hawkins test | Test for rotator cuff inflammation or tear. Abduct the patient's shoulder to 90 degrees while flexing the elbow to 90 degrees and then internally rotating the arm to its limit. |
| List the major muscles that make up the shoulder | Supraspinatus, Infaspinatus, Teres minor, Subscapularis |
| What are the usual shoulder movements | Abduction, Forward flexion, Extension and rotation |
| Name the parts of the elbow | 1. Medial and lateral Epicondyle 2. Olecranon Process -- Funny bone 3. Olecranon Bursa 4. Ulnar nerve 5. Range of motion |
| What bursa sac on the body is the most likely to become inflamed and infected | Olecranon Bursa. Closest to the outside of the body |
| Irritation to the Ulnar nerve produces what Sx | Numbness down arm from the elbow radiating into the pinky. Caused by leaning on elbows |
| What is the normal carry angle of the elbow | 5-15 degrees |
| What is another name for Lateral Epicondylitis and what is it | "Tennis Elbow" -- Inflammation of the extensor tendons of the elbow. From overuse of this muscle group. painters often get it as well. |
| How do you test for Tennis Elbow | 1. make a fist 2. Pronate, extend wrist against resistance 3 pain over lateral epicondyle is positive test |
| What is another name for Medial Epicondylitis | "Golfers Elbow" -- Also know as Nursemaids Elbow -- Caused by overuse of the extensor muscles cause inflammation in extensor tendon |
| What is the test for Medial Epicondylitis | 1. Supinate arm 2. Extend wrist and elbow 3. Pain at medial epicondyle positive result is pain |
| What are the major structures in the wrist (proximal to distal) | 1. Radius and ulna 2. Carpals 3. Metacarpals 4. Proximal phalanx 5. Middle phalanx 6. Distal phalanx |
| Name the joints in the hand | 1, MCP's -- Metacarpophalangeal joint 2. PIP's -- Proximal Interphalangeal joint 3. DIP -- Distal interphalangeal joint |
| What joints make up the thumb | Thumb only has IP joint |
| What does the Tinel Sign test for | have patient turn hand upward and tap on median nerve. Positive sign is pain and a sign of Carpal Tunnel Syndrome |
| What is the Phalen's sign and what is it testing for | backwards prayer position with patient's hands. Hold for at least 1 min. Positive sign is pain illicit. Another test for carpal tunnel syndrome |
| What movements can the hands and fingers make | Flexion, Extension, Ulnar and Radial deviation Thumb -- Adduction and opposition |
| What are Heberden's Nodes | Nodules on both sides of the DIP's. caused by OA. DIP's become inflamed, swollen and develop nodes |
| What are Bouchard's Nodes | Nodules on both sides of the PIP's caused by OA. Bone outgrowth at PIP joint of multiple digits of hand. |
| What is Ulnar deviation | Associated with chronic RA. Swelling to ulnar area of hand. |
| What is a way you can differentiate between OA and RA | Squeeze hands and if pain is elicited that's a sign of RA. RA is also bilateral |
| What are gluteal folds | Skin creases below the buttocks |
| Describe the normal curvature of the spine | 1. Cervical concavity 2. Thoracic convexity 3. Lumbar concavity |
| What is Kyphosis | Convexity of the thoracic spine. Also called "Humpback" |
| What is Lordosis | Concavity of the lumbar and cervical spine. Also called "Hollow back" |
| What is Scoliosis | Lateral deviation of the spine |
| What does the Straight Leg Raising Test check for | used to test for Nerve root irritation or lumbar disk herniation. |
| Describe the Straight Leg Raising Test | 1. Have patient lay supine with neck slightly flexed 2. Ask the patient to raise their leg keeping the knee extended 3. No pain should be felt below the knee with leg raising. Pain is associated with disk herniation. |
| What does "cross=over pain" during the Straight Leg Raising Test indicate | Sciatic nerve impingement |
| What direction does the spine bend | Flexion (forward bend), Extension (backward bend), lateral (sidebend right and left), Rotation (twist right and left), Axial extension (lengthen) |
| What is the Femoral Stretch Test | Used to detect inflammation of nerve root at the L1-L3 level and sometimes L4. Have patient lie prone and extend hip. lay face down and lift leg upwards. |
| What direction can the hip's move | 1. Flexion and Extension (forward and behind the body) 2. Abduction (lateral movement) 3. Adduction (Crosses midline) 4. Internal and External rotation |
| What is the FABER test | Test to distinguish hip and sacroiliac joint pathology from spine problems |
| How do you administer the FABER test | Flexion, Abduction and External Rotation of the hip |
| What is the Bulge sign testing for | test to determine the presence of excess in the knee. |
| How do you administer the BULGE test | with the patients knee extended, milk the medial aspect of the knee upward 2-3 times and then milk the lateral side of the patella. Observe for a bulge of returning fluid to the hollow area medial to the patella |
| What is Ballotting the patella test for | Used to detect the excess fluid or effusion in the knee. |
| How do you administer the knee Ballottment test | 1. with the knee extended apply downward pressure on the suprapatellar pouch with the web or forefinger of one hand. 2. Then push the patella sharply downward against the femur with a finger of your other hand 3. If an effusion is present a tapping or clicking will be sensed when the patella is pushed against the femur |
| How is the patella held in place | Tendons of the quadriceps muscle and patella tendon |
| Movements of the knee | Flexion and extension |
| The knee is the joint for which areas | Femur, Tibia and patella |
| What does the McMurray test assess for | Used to detect a torn medial or lateral meniscus |
| How do you administer the McMurray test | 1. have patient lay supine and flex one knee 2. Position your thumb and fingers on either ide of the joint space 3. Hold the heel with your other hand 4. Fully flexing the knee and rotate the foot and knee outward to a lateral position. 5. Extend and than flex the patient's knee. Any palpable or audible click, grind, pain or limited extension of the knee is positive forTORN MEDIAL MENISCUS 6. Repeat the procedure rotating the foot/knee inward. A palpable click, pain grinding = LATERAL MENISCUS TEAR |
| What is the most common ligament injury | Anterior Cruciate Ligament (ACL) tear |
| What is the DRAWER test assess for | To Assess for anterior and posterior cruciate ligament instability |
| How do you administer the DRAWER test | 1. Have patient lay supine and flex the knee 45 to 90 degrees placing the foot on the table 2. Place both hands on the lower leg with the thumbs on the ridge of the anterior tibia just distal to the tibial tuberosity 3. Draw the tibia forward , forcing the tibia to the slide forward of the femur 4. Then push the tibia backwards 5. Anterior or posterior movement of the knee greater than 5 mm is abnormal |
| What does the Appley's Grinding test assess for | Assess for problems with the meniscus in the knee |
| How do you administer the Appley Grinding test | 1. Place patient in the prone position with their knee flexed to 90 degrees 2. Patient's thigh is then rooted to the exam table with the examiners knee. 3. the examiner laterally nd medially rotates the tibia while pushing downwards on foot. 4. using examiners hands around the knee on one side and then the other feel for pop, clicks or pain while maneuvering. |
| Movements possible for the Ankle and foot | Dorsiflex, plantar flex, Inversion and eversion |
| List the structures comprising the ankle and foot | 1. Medial malleolus 2. Lateral malleolus Achilles tendon |
| What injury is most common with the ankle | Ankle sprain from rolling the ankle |
| Any time assessing the Musculoskeletal system also assess for what | Sensation and circulation |
| During an ankle palpation what should you assess | 1. ATFL 2. CFL 3. Distal tibiofibular syndesmotic ligaments 4. Deltoid ligaments 5. lateral malleolus 6. Medial malleolus |
| What tests assess for lateral ankle instability | 1. Anterior drawer test 2. Inversion stress test |
| What does the squeeze test assess for | Syndesmotic ligament injury |
| How do you administer the SQUEEZE test | have patient laying on their back. Squeeze the proximal end of the calf. The test is positive if pain is produced in the distal tibiofibular and interosseous ligaments |
| How are ankle sprains graded | 1. First degree = No instability 2. Second degree= 15 degree movement 3. Third degree= 30 degree movement |
| What is GOUT | Inflammatory process usually to the great toe area where it meets the foot. Causes redness and swelling and pain. Caused by high uric acid levels |
| What are Hallux signs | A bunion. Head of great toe enlarges on medial side. Created deviation towards other toes. Pain and irritation created at angle. This is a slow and insidious process |
| Red Flags in assessment of MS system | (1.) Hx of major trauma (2.) Hot or swollen joints (3.) Systemic/Constitutional Sx (4.) Focal or diffuse weakness (5.) Neurologic pain (6.) Claudication (7.) Unrelenting nighttime pain (8.) Poorly localized pain (9.) Recent joint surgery or procedure |
| Red flags in the assessment of patient's with low back pain | (1.) pain associated with neurological deficits (2.) Pain in a child (3.) Pain associated with fever and/or stiff neck (4.) Pain associated with unexplained weight loss w/ or w/out malignancy (5.) Pain worse at rest (6.) Pain associated with radiation to the abdomen (7.) Pain related to Hx of UTI's , drug use, or other infections (8.) pain increasing with coughing/sneezing or straining |
| Red flags in the assessment of patient's with neck pain | (1.) Hx of injury/trauma preceding onset of pain (2.) Associated neck stiffness with fever (3.) Neck pain in a child (4.) Unrelenting or worsening pain that has failed conservative Tx (5.) Acute severe pain upon awakening in the morning (6.) Pain relieved by raising the arm above the head on the side with pain (7.) Severe pain on flexion or extension of the neck (8.) Chronic neck pain with weakness of the upper or lower ext's (9.) pain with a hx of malignancies |
Created by:
robert.downs