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549 Module 6
Musculoskeletal
118
Nursing
Graduate
10/13/2011

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Term
What are features of nerve pain?
Definition
-sharp
-burning
-numb
-tingling (follow nerve)
Term
What are features of bone pain?
Definition
-deep
-boring
-well-localized
Term
What are features of muscle pain?
Definition
-dull
-aching
-hard to localize
-increased with movement
Term
What are features of vascular pain?
Definition
-diffuse
-aching
-poorly localized
Term
Where does a sprain occur?
Definition
ligament
Term
Where does a strain occur?
Definition
muscle
Term
Where does effusion occur?
Definition
joint
Term
What is a Grade I sprain?
Definition
-stretching of tissue
-no joint instability
Term
What are features of Grade II sprain?
Definition
-partial tearing of tissue
-more bruising
-laxity but definite end-point
Term
What are features of Grade III sprain?
Definition
-significant tearing
-deformity
-swelling
-no definite end-point when stressed
Term
What are features of Grade I strain?
Definition
-minor degree of microscopic tearing
-no permanent defect
Term
What are features of Grade II tearing?
Definition
-incomplete disruption of muscle fibers
-some loss of muscle function
-
Term
Clinically, Grade I and II strains can be indistinguishable. T/F
Definition
true
Term
What are features of Grade III strains?
Definition
-complete rupture of muscle
-nearly complete or complete loss of muscle function
-usually associated with retraction, spasm, and shortening
Term
Arm length discrepancies are ___?___ common than leg length discrepancies.
Definition
less
Term
Knee, hip, and low back pain may be related to ___?___
Definition
leg length discrepancy
Term
What are the anatomical points of the arm?
Definition
-acromion
-olecranon
-distal ulnar styloid
Term
What are the anatomical points of the leg?
Definition
-anterior superior iliac spine (ASIS)
-medial malleolus
Term
Painful arc (pain bw 45/60 and 120 degrees) indicates ___?___
Definition
supraspinatus tendinitis
Term
What are the 3 tests for rotator cuff tears?
Definition
-supraspinatus weakness
-weakness in external rotation
-impingement in external or internal rotation or both
Term
What is Neer's test?
Definition
-arm fully pronated and placed in forced flexion
-pain indicates subacromial impingement
Term
What is Hawkin's test?
Definition
-elevate arm forward to 90 degrees, bend at elbow, forcefully internally rotate arm
-pain indicates subacromial impingement
Term
Passive extension of shoulder may improve palpation of ___?___ anterior to acromion.
Definition
subacromial bursa
Term
Adhesive capsulitis has pain with ___?___ ROM.
Definition
active and passive
Term
The deltoid is responsible for the 1st ___?___ degrees of abduction.
Definition
60 degrees
Term
What is a common name for adhesive capsulitis?
Definition
frozen shoulder
Term
What occurs in biceps tendinitis?
Definition
long head of biceps passes underneath acromion, enters groove bw greater and lesser tuberosities
Term
Shoulder instability peaks in the ___?___ and ___?___ decades of life, and recurrence is inversely related to age.
Definition
2nd and 6th
Term
___?___ is the major cause of shoulder instability, according to AAOS.
Definition
traumatic injury
Term
The most common type of shoulder instability is ___?___ and is due to ____?___.
Definition
anterior

deltoid weakness
Term
The deltoid muscle's major function is to ___?___.
Definition
abduct the arm
Term
How is the sulcus sign elicited?
Definition
-pt sitting or standing
-grab arm just above elbow
-watch lateral border of acromion
-pull arm downward
-feel a "suction cup" where the humeral head pulls out of the glenoid
Term
What does the sulcus sign indicate?
Definition
shoulder instability
Term
What types of shoulder instability can have voluntary dislocation?
Definition
-posterior and multidirectional
Term
What are causes of multidirectional instability?
Definition
-repetitive microtrauma (gymnastics, butterfly stroke)
-aberrant muscle firing
-abnormal connective tissue
Term
There are 6 grades of acromioclavicular joint separation; need to see a specialist after grade ___?___
Definition
3
Term
Acromioclavicular joint separations occur most often in ___?___
Definition
males in their 20s
Term
Radial head fractures usually require surgery. T/F
Definition
false: usually nonsurgical treatment and mobilization is key
Term
What is the fat pad sign in elbow fractures?
Definition
-displacement of normal fat pad by fluid (blood, effusion) in joint
-aka sail sign, bc triangle sail shape
Term
A positive fat pad sign is a more reliable indicator of elbow fracture in children than adults. T/F
Definition
true
Term
What is a common name of lateral epicondylopathy?
Definition
tennis elbow
Term
Lateral epicondylopathy involves ___?___ of the common extensor tendon and extensor carpi radialis brevis.
Definition
tissue degeneration
Term
What are findings in the exam of lateral epicondylopathy?
Definition
-swelling
-erythema
-increased pain with resisted wrist extension and supination
Term
What are the bones of the hand?
Definition
Scaphoid
Lunate
Triquetral
Pisiform
Hamate
Capitate
Trapezoid
Trapezium
Term
What are signs of scaphoid fracture?
Definition
pain:
-in anatomic snuffbox
-in scaphoid tuberosity
-with resisted pronation
Term
___?___ is the most commonly fractured carpal bone.
Definition
Scaphoid
Term
What is the clinical appearance of wrist fractures?
Definition
-point tenderness
-dinner fork deformity
Term
What is Colles fracture?
Definition
-aka dinner fork or bayonet deformity
-fracture of the distal radius of the forearm
-dorsal (posterior) displacement of the wrist and hand
Term
What is De Quervain's tenosynovitis?
Definition
-aka stenosing
-inflammation of 2 tendons: APL and EPB
Term
___?___ confirms the diagnosis of De Quervain's Tenosynovitis?
Definition
Finkelstein's Test
Term
What is Finkelstein's Test?
Definition
-grasp thumb
-sharply ulnar deviate
-positive: sharp pain along distal radius
Term
What is Eichoff's Test?
Definition
-thumb in palm
-fold over fingers
-ulnar deviate
-positive: sharp pain along distal radius indicates De Quervain's Tenosynovitis
Term
___?___ is the most common entrapment neuropathy and is idiopathic in 95% of cases?
Definition
carpal tunnel syndrome
Term
What is the etiology of carpal tunnel syndrome?
Definition
median nerve compressed at the wrist, resulting in numbness or pain
Term
What are signs of and tests for carpal tunnel syndrome?
Definition
-thenar wasting
-Tinel's test: tap wrist
-Phalen's test: backs of hands together
Term
The PIP joint the strongest ligament is the ___?___. It connects the proximal to the middle phalanx and prevents the joint from hyperextending.
Definition
volar plate
Term
Mallet finger is a ___?___ deformity of the finger.
Definition
soft flexion
Term
Why must hip fracture be treated expeditiously in young patients?
Definition
prevent vessel compromise, clear fracture hematoma that may reduce blood flow to femoral head
Term
What hip fracture treatment is favored in the elderly d/t difficulty achieving stable fixation in osteopenic/osteoporotic bone?
Definition
prosthetic replacement
Term
What sex and age group are most affected by avascular necrosis/osteonecrosis?
Definition
-male
-late 30s to early 40s
Term
___?___% of hip fracture cases are idiopathic; ___?___% are associated with trauma.
Definition
-33%
-10%
Term
What factors increase the risk of hip fracture?
Definition
-corticosteroid use
-ETOH abuse
-hypercoagulable states
-HIV
Term
What are features of sciatica?
Definition
-a symptom, not a dx
-pain in lower back, buttocks, leg, foot
-numbness
-muscular weakness
-difficulty in moving and controlling leg
-unilateral
Term
What is piriformis syndrome?
Definition
sciatic nerve entrapped in piriformis muscle
Term
Which is weaker and is more commonly injured: MCL or LCL?
Definition
MCL
Term
Valgus stress causes ___?___ and varus stress causes ___?___.
Definition
-valgus: MCL
-varus: LCL
Term
What causes ACL injuries?
Definition
-hyperextension
-sudden deceleration
-impact
-valgus
-external rotation
-anterior femoral displacement forces
Term
What causes PCL injuries?
Definition
-forced hyperextension
-direct blow to anterior tibia
Term
Contact injuries are common causes of ___?___ injury; non-contact injuries are common causes of ___?___.
Definition
-contact: MCL
-non-contact: ACL
Term
Which sex has 2-4 fold increase in ACL injuries when playing sports at the same level?
Definition
women
Term
MRI is a reliable way to confirm ACL tear. T/F
Definition
false- exam is mainstay of diagnosis
Term
What tests are used to diagnose ACL tear?
Definition
-Lachman's test
-anterior drawer test: nost as sensitive, but easier to perform
Term
How is Lachman's test performed?
Definition
-pt's knee flexed to 30 degrees
-hand anterior on thigh, posterior on tibia, thumb on tibial tuberosity
-pull tibia anterior
-an ACL deficient knee will have increased forward movement
Term
How is the anterior drawer test performed?
Definition
-pt hip flexed 45, knee 90
-grasp tibia below knee, thumbs on either side of patellar tendon, index fingers on hamstring tendons
-tibia drawn forward anteriorly
-an ACL deficient knee will have increased forward movement
Term
What does the PCL prevent?
Definition
posterior translation of the tibia
Term
What test is used to diagnose PCL tear?
Definition
posterior drawer test
Term
How is the posterior drawer test performed?
Definition
-pt hip flexed 45, knee 90
-grasp tibia below knee, thumbs on either side of patellar tendon, index fingers on hamstring tendons
-tibia pushed posteriorly
-an ACL deficient knee will have increased backward movement
Term
___?___ mm of posterior laxity is well-tolerated.
Definition
5-10
Term
What is the primary function of the meniscus?
Definition
evenly distribute weight-bearing load across the knee joing
Term
What causes and exacerbates meniscus tears?
Definition
-twisting injury
-descending stairs, entering/exiting vehicles
Term
What are symptoms of meniscus tear?
Definition
-effusion
-tibial joint line pain (often medial)
Term
What tests are used for a torn meniscus?
Definition
-McMurray's
-Steinmann's
Term
How is McMurray's test performed?
Definition
internally/externally rotate tibia while extending knee
Term
How is Steinmann's test performed?
Definition
suddenly twist flexed knee
Term
Which meniscal tears can be treated nonsurgically?
Definition
-stable longitudinal tears
-stable partial tears
-shallow radial tears
Term
What sex and age group usually suffers from patellofemoral pain?
Definition
-female
-adolescent, young adult
Term
What are signs of patellofemoral syndrome?
Definition
-malalignment
-quadriceps imbalance
Term
What are non-operative treatments for quad strengthening in patellofemoral syndrome?
Definition
-short-arc extensions
-patellar bracing
Term
Suprapatellar bursa communicates with knee joint, while others are extraarticular. T/F
Definition
true
Term
What is a differential diagnosis for septic bursitis?
Definition
gout
Term
What are Ottawa Ankle Rules used for?
Definition
-ruling out fracture and need for x-rays
Term
What type of ankle sprain is responsible for 80-85%?
Definition
-lateral ankle sprain
Term
What test is used to identify a sprain of the anterior talofibular ligament?
Definition
anterior drawer test
Term
What test is used to identify a sprain of the calcaneofibular ligament?
Definition
talar tilt test
Term
How is the talar tilt test performed?
Definition
adduct and invert the calcaneous into a varus position
Term
Ankle ligaments are most often injured in ___?___ order.
Definition
front-to-back
Term
What type of ankle sprain is responsible for 10-15%? Why more rare?
Definition
-deltoid sprain
-requires more force
Term
What is the function of the deltoid ligament?
Definition
-strengthen the joint
-hold the calcaneus and navicular bones against the talus
-maintain the medial longitudinal arch of the foot
-
Term
What x-ray views are needed for ankle pain?
Definition
-AP
-lateral
-mortise
Term
Fractures at or above the talar dome are more likely to cause a shift in mortise joint. T/F
Definition
true
Term
What activities are commonly involved in tendonitis/tendinosis?
Definition
-running
-dancing
Term
Who is more likely to have Achilles tendon rupture?
Definition
-recreational athlete
-relatively older, 30-50 years old
-previous Achilles tendon or rupture
-previous tendon injections
-previous fluoroquinolone use
Term
What test is used for Achilles tendon rupture?
Definition
Thompson test
Term
How is the Thompson test performed?
Definition
-pt prone
-squeeze calf
-normal: slight plantarflexion, positive: lack of ankle movement
Term
What are features of peroneal tendonitis?
Definition
-common in lateral sprain and fracture
-chronic pain post-sprain
-lateral ankle and foot pain
-resisted external rotation of foot
-subluxation of tendons
Term
What is a Lisfranc injury?
Definition
-tearing of inter-metatarsal ligaments
-1 or all of metatarsals displaced for tarsus
Term
The ___?___ area is most often affected by Morton's neuroma.
Definition
3rd and 4th interdigital area
Term
What are symptoms of Morton's neuroma?
Definition
-numbness
-tingling
-exacerbated by tight footwear, compression of metatarsal heads
Term
What are causes of metatarsalgia?
Definition
-synovitis
-ligament damage
-bunions
-arthritis
-repetitive high pressure loading of forefoot
-improper footwear
-high heels
Term
What are treatment options for metatarsalgia?
Definition
-RICE
-non-weight-bearing ambulation for 1st 24 hours
-passive ROM
-ultrasound tx
-metatarsal pads
-orthotic devices
Term
Point tenderness is more indicative of a fracture. T/F
Definition
true
Term
Why are buckle fractures only seen in children?
Definition
-periosteum thicker (~ snapping a pencil from within a straw)
Term
Why are spiral fractures indicative of child abuse?
Definition
uncommon for a child to have enough force to create
Term
The shoulder is a ___?___ joint held by tendons.
Definition
suspension
Term
___?___% of rotator cuff injuries don't require surgery.
Definition
80%
Term
What type of person is adhesive capsulitis usually seen in?
Definition
-female
- > 40 years old
-DM
Term
Adhesive capsulitis usually presents gradually. T/F
Definition
false- usually presents gradually
Term
Anterior fat pad sign is more clinically significant than posterior. T/F
Definition
false- posterior more significant
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