Advanced Physical Assessment
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| Risk factors for osteoporosis | show 🗑
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| To treat osteoporosis | show 🗑
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| show | both the right and left limbs to determine what is normal for the patient
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| show | swelling, warmth, redness, tenderness
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| Crepitus | show 🗑
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| show | grades 0-5, look for the middle which is 3- Can move joint against gravity but not against resistance
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| show | dislocation or subluxation should be performed each time you examine the infant during the first year of life
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| Allis sign to detect hip dislocation: | show 🗑
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| show | sternoclavicular joint, acromioclavicular joint and glenohumeral joint
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| Shoulder girdle is supported by the | show 🗑
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| show | genu valgum
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| Bowlegs | show 🗑
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| show | is commonly seen in children with in-toeing associated with femoral anteversion
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| Abduction for the shoulder | show 🗑
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| show | asymmetry, swelling of joints, inflammation, dislocation, crepitus, The masseters: externally at the angle of the mandible, The temporals: externally, during clenching/ relaxation of jaw, The pterygoids: internally, between tonsillar pillars & mandible
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| show | swelling, tenderness & ↓ROM, also trauma and pain & tenderness with palpation respectively
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| The shoulder is made of 3 joints > shoulder girdle | show 🗑
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| show | Supraspinatus, Infraspinatus, Teres minor, and Subscapularis→responsible for stability the head of the humerus in the glenoid fossa, but they also contribute to some movements of the shoulder.
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| Adduction for the shoulder | show 🗑
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| show | abduction but relies on the supraspinatus muscle to initiate abduction.
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| show | pectoralis major, teres major, and the latissimus dorsi.
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| show | humerus, while the infraspinatus and teres minor externally rotate (laterally rotate) the humerus.
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| show | extension, while the anterior deltoid, pectoralis major, coracobrachialis, and biceps mediate flexion.
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| 5 maneuvers to assess the SITS/rotator cuff d/o | show 🗑
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| Test Painful arc test | show 🗑
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| show | Fully abduct the patient’s arm from 0∘ to 180∘- Shoulder pain from 60∘ to 120∘ is a + test for the following disorders: subacromial impingement* & rotator cuff tendinitis.
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| show | tendon is trapped between 2 moving bones
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| show | Gleno-humeral joint dislocation, Degenerative cervical disc, Impingement syndrome: THE MOST COMMON CAUSE, Calcific tendinitis, bicipital tendinitis, Tears/Inflammation of the rotator cuff
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| Gleno-humeral joint dislocation (Anterior dislocation of the humerus) | show 🗑
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| Degenerative cervical disc | show 🗑
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| show | Calcification and degeneration of a rotator cuff tendon (most commonly the supraspinatus), X-ray,Diabetes and hypothyroidism increase the risk
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| show | The tendon of the long head of the biceps passes into the shoulder joint through the bicipital groove- is the usual site of bicipital tendinitis- just cut it
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| show | MRI
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| show | pinky to thigh- ulna, radius goes with thumb
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| Tenderness: distal to the epicondyle is common | show 🗑
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| show | 1) Olecranon bursitis (trauma, gout, RA)- separate from->septic arthritis hurts more, 2) SQ rheumatoid nodules near ulna, 3) arthritis (OA, RA or septic), 4)cubital tunnel syndrome (Tinel’s sign), 5)epicondilytis/lateral or medial
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| show | ulnal nerve, medial side of the elbow- tinel’s sign (funny bone)-Numbness and tingling of the ring and small fingers, particularly at night – keeping the elbow flexed long time causes this
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| Lateral epicondylitis | show 🗑
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| show | golfer’s elbow- inside- repetitive wrist flexion-Wrist flexion against resistance increases pain- Complications: Ulnar nerve neuropathy and/or palsy (long-term pressure/damage) Complains of numbness/tingling on the little finger and weakness of the hand.
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| Worse-case scenario of medial epicondylitis/ golfer’s elbow | show 🗑
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| show | can be missed in XR- needs to be repeated in a couple of weeks- painful and takes a long time to heal- sometimes doesn’t heal normal
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| show | RA loves
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| DIP | show 🗑
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| Carpal tunnel | show 🗑
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| show | loss of cartilage and friction-new bone formation- Heberden nodes in DIP joints & Bouchard nodes in PIP joints
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| RA deformities in hands | show 🗑
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| show | median nerve compression causes thenar atrophy (more common)
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| Ulnar nerve compression | show 🗑
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| show | with the wrist in ulnar deviation and pain at the scaphoid tubercle are suggestive for occult scaphoid fx.
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| Anatomic snuffbox | show 🗑
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| show | in RA but are rarely involved In OR
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| OA: Heberden nodes hard dorsolateral nodules on DIP ONLY in | show 🗑
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| show | DIP joints are also involved
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| show | Median- thumb, pointer, index, ½ ring (↓carpal tunnel) Ulnar: 5th finger/pinky and ½ ring, Radial: web of thumb and index finger
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| show | 1) degenerative arthritis 2)epicondylitis 3) carpal tunnel syndrome 4) cervical radiculopathy- Grip weakness + wrist pain = de Quervain tenosynovitis
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| show | (Finkelstein test)-grasp the thumb against the palm for an ulnar deviation of wrist- Pain= de Quervain tenosynovitis from inflammation of the abductor pollicis longus and extensor pollicis brevis tendons and tendon sheathe
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| Carpal tunnel compression testing for median nerve compression- none very good | show 🗑
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| show | tender, painful, stiff joints, usually symmetric involvement on both sides of the bodyThe MCP, PIP, and wrist are commonly affected; (DIP much less commonly affected)
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| Chronic Rheumatoid arthritis | show 🗑
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| Osteoarthritis: (Degenerative joint disease) | show 🗑
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| Chronic Tophaceous Gout | show 🗑
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| show | Thickened band overlying the flexor tendons of the 4th (or 5th ) finger- Subsequently the skin puckers and a fibrotic cord develops between the palm & finger
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| show | Caused by a painless nodule in the flexor tendon of a finger in the palm. A palpable& audible snap is noticed on attempting extending/flexing the finger with extra effort/assistance. (watch, listen & palpate the nodule on ext./flex.)
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| Thenar Atrophy | show 🗑
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| show | Cystic, round, usually nontender swellings along tendon sheathes or joint capsules, frequently at the dorsum of the wrist (but could happen anteriorly too). They can disappear spontaneously, or might need aspiration or excision
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| show | Inflammation of the flexor tendon sheaths may follow local injury, overuse, or infections; tenderness& swelling along the course of the tendonThe finger is held in slight flexion, finger extension is very painful
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| show | tenosynovitis of APL and EPB tendons- caused by repetitive grasping, turning/wringing motions (golfers, racquet sports)- also postpartum- pain,creaking w/movement of thumb & gripping or raising objects-may go up forearm or down the thumb. do Finkelstein
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| avulsion fracture | show 🗑
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| Colle’s fracture left wrist | show 🗑
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| Anatomy to know in the hip | show 🗑
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| show | appendicitis
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| Stance phase | show 🗑
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| show | when walking- 40% walking cycle
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| show | Anterior: Iliac crest, Iliac tubercle, Anterior superior iliac spine, Greater trochanter, Pubic tubercle, Posterior: Posterior superior iliac spine, Greater trochanter, Ischial tuberosity, Sacroiliac joint
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| show | inguinal ligament (Anterior superior iliac spine to Pubic tubercle) Lat. To Med NAVEL: Nerve- Artery- Vein- Empty space- Lymph node
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| Causes of groin tenderness are | show 🗑
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| Palpate the Trochanteric bursa | show 🗑
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| show | For tenderness of ischiogluteal bursitis or “weaver’s bottom” from prolonged sitting
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| show | Is used to Detect flexion contractures of hip masked by excessive lumbar lordosis Lifting the extended leg off the examining table indicates hip flexion contracture in the extended leg
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| show | Detect weak hip abductor muscle When the iliac crest drops on the side of the lifted leg, the hip abductor muscles on the weight-bearing side are weak
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| FABER Test (AKA Patrick's test) | show 🗑
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| FABER Test (AKA Patrick's test) positive result | show 🗑
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| FADIR Test | show 🗑
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| Greater Trochanteric bursitis | show 🗑
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| show | herniated lumbar disc may cause sharp or "lightning like" pain in the hip or buttocks due to pain radiation down the dermatome of the involved nerve root
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| Intra-abdominal pathology | show 🗑
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| show | would present with inability to bear weight and severe acute pain that worsens with attempted hip ROM (range of motion), including with log roll.
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| 7 things to look for in the knee | show 🗑
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| What do you look for in a knee exam | show 🗑
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| show | Swelling over the patella occurs in prepatellar bursitis (housemaid’s knee). Swelling over the tibial tuberosity suggests infrapatellar bursitis
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| Medial & Lateral Menisci | show 🗑
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| Prepatellar bursitis | show 🗑
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| anserine buritis | show 🗑
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| Baker cyst | show 🗑
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| show | diagnosed by any two of the following- pain with quadriceps contraction- pain with squatting- pain with palpation of the posteromedial/or lateral patellar border
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| Knee joint effusion testing- The bulge sign | show 🗑
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| The balloon sign:(for major effusions) | show 🗑
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| What is the test for meniscus injury | show 🗑
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| A palpable click or pop along the medial joint line is a positive test for | show 🗑
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| Can you get back to the game with meniscus injury? | show 🗑
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| show | Posterior Drawer Sign: If the proximal tibia falls back, this is a positive test for PCL injury-
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| Test question? Which test do you start with, the anterior or the posterior drawer? | show 🗑
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| Testing the Anterior Cruciate Ligament* | show 🗑
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| show | for ACL also- Significant forward excursion of the tibia is a sign of ACL tear (better in chronic cases)- always test PCL 1st
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| show | knee hyperextension, direct blows to the knee, and twisting or landing on an extended hip or knee
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| Ottawa Knee Rules: Knee X-ray Indications, A knee x-ray is required for knee injury patients in any of the following FIVE conditions | show 🗑
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| Abnormalities of the knee- Degenerative Arthritis (Osteoarthritis) | show 🗑
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| show | Inflammation and thickening of bursa seen in repetitive motion and overuse syndromes- prepatellar bursa (“housemaid’s knee”) or pes anserine bursa medially (runners)
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| Iliotibial band friction syndrome | show 🗑
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| show | Exam shows tenderness over the lateral femoral epicondyle, and the lateral knee pain is reproduced when the patient squats- runners/bicyclists
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| show | Aggravation of ant knee pain during wt bearing w/the knee in flexion (stair climbing, arising from a sitting position) suggests chondromalacia of articular surface of the patella (AKA patellofemoral syndrome)- +grind - quadriceps are weak- young female
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| chondromalacia develops when the patella is | show 🗑
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| show | in chostochondritis- the patella tracks in the shape of a J, starting too far lateral when the knee is fully extended, and then “jumping” into the trochlear groove early in flexion
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| show | the medial and anterior
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| How do we test for the posterior and the anterior? | show 🗑
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| How do you test for meniscal tear? | show 🗑
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| Special tests for meniscal tear? | show 🗑
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| Test question- Meniscal tear is r/t | show 🗑
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| ACL tears commonly occur | show 🗑
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| PCL tears occur | show 🗑
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| show | on the back/popliteal surface – occurs in RA- complaints of aching or fullness behind the knee.
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| show | an infection inside the knee joint that would present with inability to bear weight and severe acute painthat worsens with attempt
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