Tenderness over the extensor and abductor tendons of the thumb at the radial styloid. An inflammation. Also, when bending thumb in ROM, it may be jerky motion
What is the test for deQuervain's tenosynovitis?
Finkelstein's test. Make fist over thumb and then bend wrist in ulnar deviation. Positive test is pain in wrist (extensor pollicis brevis and abductor pollicis longus tendons)
When does increased thoracic kyphosis occur?
What is torticollis?
Muscle spasm of neck
What limited ROM does arthritis of the hip cause?
Restricts internal rotation of the hip, especially sensitive indicator in arthritis
What does patellar tendon tenderness and inability to extend the leg?
Suggests partial or complete tear of the patellar tendon
What does a positive bulge or balloon sign in the knee suggest? How is it elicited?
Can be seen if effusion in knee joint. Elicited by moving over the bursa then looking for bulge or fluid wave.
What does balloting the patella do?
Compress the patellar pouch and ballotte (push) the patella sharply against femur and watch for fluid.
How do you assess injury to the Medial collateral ligament (MCL)?
Abductor (valgus) stress test. Hold knee in medially while pulling ankle laterally. Pain equals positive partial tear of MCL
How do you assess injury to the lateral collateral ligament (LCL)?
Adductor (Varus) stress test. Hold knee laterally while pushing the ankle medially.
Who do you assess the Anterior Cruciate Ligament (ACL)?
By performing the Anterior Drawer Sign.
How do you perform the Anterior Drawer Sign? And what does it assess?
Supine position. Knees bent with feet flat on table. Cup hands around the knee and draw the tibia forward (anteriorly). A forward movement or jerking movement is positive for ACL tear.
How do you perform the Lachman Test? & What does it assess?
Lay flat. Knee flexed and externally rotated. One hand on femur other on tibia and move tibia forward and femur back. Forward excursion indicates ACL tear. Better diagnostic test than the anterior drawer test.
What does posterior drawer test?
Posterior Cruciate Ligament tear. Bend leg out laterally and push on tibia posteriorly and look at degree of femur posterior movement.
What does the McMurray Test check?
Meniscus. Checks for ligamental damage of medial meniscus and lateral meniscus
How do you perform the McMurray Test?
If a click is felt in join line during flexion and extension of knee. Or if tenderness is noted along joint line. Perform test by bending leg out laterally, and then grasp heel and flex knee. Rotate lower leg internally and then externally to assess medial and lateral meniscus.
What is the Thomas Test?
Evaluates Hip function and ROM
What motion is unable to be performed in presence of Achilles tendon rupture?
Cannot plantar flex the foot. Also, may have flat footed gait.
What is seen in plantar fasciitis?
Focal heel pain on palpation
What is seen in Carpal Tunnel syndrome when assessing thumb?
Thumb weakness on abduction
What does patient complain of in carpal tunnel?
Numbness and pain of ventral surface of first three digits of hand. Worse at night. Suggestive of median nerve compression.
How do you test Tinel's sign?
Tinel's-TAP median nerve and will complain of electric or tingling sensation in area of nerve distribution
How do you test Phalen's signs?
Hold patients hand in acute flexion, or alternatively have patient hold own hands with dorsal surfaces together in acute flexion. Hold either test for 60 seconds. This compresses median nerve and causes numbness and tingling along median nerve.
What does a positive straight leg raise indicate?
Sharp pain radiation down back of leg in L5-S1 distribution is highly suggestive of compression of nerve root, HNP. And dorsiflexing foot will further increase pain.
What is a positive crossed leg raise?
Pain in affected leg when opposite leg is raised.
Definition of involvement in Rheumatoid arthritis?
Chronic inflammation of synovial membranes with secondary erosions of adjacent cartilage and bone with damage to ligaments and tendons
Are joints in RA or OA warm or not?
RA has warm, tender joints. OA is rarely warm, rarely tender
What arthritis has subcutaneous nodules
What is process with Gout?
Inflammatory reaction to microcrystals of sodium urate
Where would you find a Boutonniere deformity?
Finger of someone with chronic RA. Persistent flexion of the PIP join with hyperextension of DIP.
Swan neck deformity is found?
Chronic RA, hyperextension of PIP with fixed flexion of DIP
Where are fusiform or spindle-shaped swellings noted?
Want to treat early to preserve function, limit deformity, and decrease inflammation and pain.
Treatments medications for RA?
Systemic oral corticosteroids for short course of 2-8 wks only. Plaquinil. Methotrexate.
What is best way to decrease deformity and preserve function in RA?
Early use of DMARDs- Disease modifying agent for rheumatoid arthritis disease. Methotrexate. Minocycline, hydroxychloroquine, monoclonal antibodies. Occasional steroid injections.
What is maximum steroid injection allowed per joint per year?
What is Ankylosing Spondylitis? What does it affect?
A chronic inflammatory disease affecting spine and SI joint causing severe arthritic changes. Can also affect hips, feet, shoulders
What musculoskeletal test is altered in ankylosing spondylitis?
Unable to have full ROM of lower spine
What does CXR reveal on Ankylosing spondylitis?
What can ankylosing spondylitis progress to?
What is cauda equina syndrome?
Acute pressure on sacral nerve root with results in pain, inflammation and ischemic nerve changes.
What neuro test is positive in cauda equina syndrome?
Pain on straight leg raise
What is the Spurling Test and what does it check for?
Pain or numbness noted in upper extremity when examiner pushes on the top of the head
What neuro change can be noted in cauda equina syndrome?
Loss of bowel and bladder sphincter tone.
What is the definition of tendinitis? How is it treated?
Micro tears in tendon which result in inflammation and pain. Usually due to repetitive injury. RICE
What is the definition of sprain?
Sprain is a LIGAMENT damage partial or complete. Grade I to III.
What is see in a Grade III ligamentous sprain?
Grade III is complete rupture of ligaments, complete instability. TX is orthopedic consult,
What area is sprained the most?
Ankle. Due to Inversion injury. Jumping, running.
What is seen on exam with sprains?
Edema, bruising, pain
What is supraspinatus tendinitis?
One of the main tendons in rotator cuff. Common cause of shoulder pain due to inflammation. Causes pain with elevation and abduction. Local point tenderness over tendon of anterior shoulder.
What may be seen in tendinitis on exam?
Bursitis often occurs with tendinitis
What injury is seen in tennis elbow?
Extensor tendon of lateral epicondyle is affected.
What injury is seen in golf elbow?
Extensor tendon of medial epicondyle is affected
What is epicondylitis?
Weakness and tenderness. Requires conservative treatment of NSAIDS and spot or short cast to stop movement to rest
What does patient complain about with a meniscus tear of the knee?
Joint locks up, pop sound and cannot kneel or squat
What is treatment for meniscus tear?
RICE, NSAIDS, arthroscopic repair if not better in 4-6 weeks
Prevention exercises for meniscus tear?
Quadriceps straight leg raises to strengthen
What is seen in a baker's cyst?
Pain pressure or asymptomatic ball-like mass in popliteal fossa that
What is seen in a ruptured baker's cyst?
Resembles cellulitis appearance. Rupture of baker's cyst causes leakage of synovial fluid, inflammation, tenderness, swelling
What joints are commonly affected by bursitis?
Subdeltoid, olecranon, trochanter, prepatellar
How is ROM limited in bursitis?
Pain limited ROM only.
What typically causes bursitis?
Joint overuse, trauma, infection, arthritis
What is MOA of corticosteroids and NSAIDS for pain control?
Inhibit COX 1 and COX 2.
Most common location for cervical disk problem?
Fingers 2 and 3
Fingers 4 and 5
Foot, sole and ankle
Biceps Reflex tests
Triceps Reflex tests
Knee Reflex tests
L2, L3, L4
Ankle Reflex tests
Plantar Reflex tests
What does positive Babinski look like and what does it indicate?
Goals of Sports physical?
Decrease risk of exercise inducted cardiac death and decrease the progression of CV function caused by exercise
What are the common causes of exercise related death in younger than 35 years of age?
Often occurs during team sport. Congenital Heart malformations, HCM, congenital Coronary artery abnormalities
What are the common causes of exercise related death in older than 35 years of age?
Due to atherosclerosis
What are important questions to ask during a Sports Physical?
Prior chest pain, syncope, SOB, hx murmur, HTN, + FHx of Sudden death, Marfans, Long QT, cardiomyopathy, arrhythmias.
What is important to assess in a Sports Physical?
Check for murmurs supine and then standing.
What is a Still's Murmur?
Vibratory, Innocent Murmur
What is the criteria for an innocent functional flow murmur?
Murmur that become more faint with standing
What does exercise cause when exercising with positive hypertrophic cardiomyopathy?
Exercise can cause outflow obstruction
What is the dose of calcium for osteoporosis?
1200 to 1500 mg daily for women. 1000 mg daily for men
What is the dose of vitamin D for osteoporosis?
600 � 900 IU daily
What role does the SERM Raloxifen (Evista) play in osteoporosis?
Safe alternative to Estrogen supplement, does not adversely affect breast or uterus
How do Biophosphonates work on the bone in osteoporosis?
Inhibits osteoclast activity and increases bone mass and decreases bone fracture
How should a patient be instructed to take a Biophosphonate?
Full glass of Water, Empty stomach x1 hour, erect x 1 hour
What is the definition of Fibromyalgia?
Central Pain Syndrome
What happens in Fibromyalgia?
Sensitization of CNS, causing diffuse hypersensitivity to pain. Also noted to see low serotonin.
What diagnostic exam and criteria for diagnosis of Fibromyalgia?
Need presence of tender Points specific to certain diagnostic locations, pectoral muscle at 2nd rib, shoulder, trapezius, piriformis area. Need pain in axial skeleton plus 4 other quadrants, more than 3 months. Need 11 out of 18 spots positive. (9 pairs)
What other symptoms are noted with Fibromyalgia?
Cognitive changes, constipation or diarrhea, altered moon
Non pharmaceutical Treatment of Fibromyalgia?
Physical activity, trigger point injection, topical capsaicin,
Non pharmaceutical Treatment of Fibromyalgia?
Pregabalin (Lyrica) and Duloxetine (Cymbalta) FDA approved for Fibromyalgia pain. Trazodone for sleep, TCAs. Antiepileptics Gabapentin.
Osteomalacia, what is it and what causes it?
Softening, rubbery deposit in bone causes an abnormal collagen matrix. Due to Vitamin D Deficiency.
What lab results are noted in Osteomalacia?
Increased Alkaline phosphatase and decreased serum calcium, serum phosphorus, creatinine, and urinary calcium.
What drugs can cause Vitamin D Deficiency?
Dilantin and Phenobarbital. Need 2-5x recommended Vitamin D Supplement
What medical problems can cause Vitamin D Deficiency?
Gastric Bypass, Liver and Renal disease
What is the Hollick's recommendation for Vitamin D Supplementation in deficiency state?
50,000 IU Vitamin D once a week x 8 weeks. Then 50,000 IU twice monthly plus daily lose dose supplements
How do you instruct cane walking?
Place can on side of GOOD leg. Move it in conjunction with affected leg. Cane should be at height of greater trochanter.
What is Dorsal Kyphosis?
Age related increase in convexity of T spine
What is Lordosis?
Pregnancy or obesity related increase in lumbar concavity
What is the Thompson Test?
Tests of Achilles tendon rupture by squeezing calf. If positive rupture, absent foot movement is noted
What nerve test is done to diagnose Myasthenia Gravis?
RNS test. Repetitive nerve stimulation test.
Comminuted Fracture dx?
Bone fragments in many pieces
Open Fracture (compound) dx?
Broken ends of bone poke through skin
Closed Fracture (simple) dx?
Even break, but no skin involvement
Compression Fracture dx?
What assessment is noted in a anterior dislocation of the shoulder?
More common. Unable to shoulder shrug, positive pain and arm lengthening