1- Articular structures include-

1- Articular structures include the joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments, and juxta-articular bone.

1-Extra-articular structures include-

1-Extra-articular structures include periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin.

• Ligaments are ropelike bundles of collagen fibrils that connect-
• Tendons are collagen fibers connecting-
• Bursae are-

• Ligaments are ropelike bundles of collagen fibrils that connect bone to bone.
   
• Tendons are collagen fibers connecting muscle to bone.
• Bursae are pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures.

1-There are three primary types of joint articulation—

synovial, cartilaginous, and fibrous—allowing varying degrees of joint movement

Synovial-

Cartilaginous-

Fibrous-

1-extent of movement

2-Example of joint

3 types of synnovial joints

1-For midline back pain, assess for

2-For pain off the midline, assess for

1-For midline back pain, assess for musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, or rarely epidural abscess.

2-For pain off the midline, assess for sacroiliitis, trochanteric bursitis, sciatica, or hip arthritis.

1-Monoarticular Pain (in one joint) suggests

2-Lateral hip pain near the greater trochanter suggests

1-Monoarticular Pain (in one joint) suggests trauma, monoarticular arthritis, possible tendinitis, or bursitis.

2-Lateral hip pain near the greater trochanter suggests trochanteric bursitis

polyarticular pain

1-Migratory pattern of spread seen in

2-progressive additive Symmetric polyarticular pain seen in

1-Migratory pattern of spread seen in rheumatic fever or gonococcal arthritis

2-progressive additive Symmetric polyarticular pain seen in rheumatoid arthritis

myalgias-

arthralgias-

myalgias-Generalized “aches and pains” in muscles

arthralgias- generalized “aches and pains”if there is pain but no evidence of arthritis

Severe pain of rapid onset in a red, swollen joint

1-in adults consider- 

2-In children consider-

1-in adults consider- acute septic arthritis or gout.

2-In children consider- osteomyelitis in bone contiguous to a joint.

1-Stiffness and limited motion after inactivity, sometimes called gelling, seen in

2-stiffness lasting 30 minutes or more after inactivity seen in

Stiffness also with fibromyalgia and polymyalgia rheumatica (PMR)

1-Stiffness and limited motion after inactivity, sometimes called gelling, seen in degenerative joint disease but usually lasts only a few minutes;

2-stiffness lasting 30 minutes or more after inactivity seen in rheumatoid arthritis

Stiffness also with fibromyalgia and polymyalgia rheumatica (PMR)

Skin conditions w/ joint pain

1-butterfly rash on the cheeks

2-scaly rash and pitted nails of

3-few papules, pustules, or vesicles on reddened bases, located on the distal extremities

4-expanding erythematous patch early in an illness

5-Hives

6-Erosions or scale on the penis and crusted, scaling papules on the soles and palms

7-maculopapular rash of rubella

these symtoms assoc. w/ joint pain suggest

Scoliosis may cause elevation of one shoulder.

With anterior dislocation of the shoulder, the rounded lateral aspect of the shoulder appears?

With anterior dislocation of the shoulder, the rounded lateral aspect of the shoulder appears flattened

Age 60 years or older and a positive dropped-arm test are the individual findings most likely to identify a 

The combined findings of supraspinatus weakness, infraspinatus weakness, and a positive impingement sign increase the likelihood of a 

Age 60 years or older and a positive dropped-arm test are the individual findings most likely to identify a rotator cuff tear

The combined findings of supraspinatus weakness, infraspinatus weakness, and a positive impingement sign increase the likelihood of a tear

Localized tenderness or pain with adduction of arm accross chest suggests?

whats the name of this test?

inflammation or arthritis of the acromioclavicular joint. But sensitivity and specificity of tenderness is

“crossover test.”

************

Ask the patient to touch the opposite scapula, difficulty with these motions suggests?

whats the name of the test? 

Difficulty with Overall Shoulder Rotation

 suggests rotator cuff disorder.

(the Apley scratch test).

**********

 Press on the scapula to prevent scapular motion with one hand, and raise the patient's arm with the other. Pain during this maneuver is a positive test indicating?

this test is called?

  possible rotator cuff tear.

Test Neer's impingement sign.

 Flex the patient's shoulder and elbow to 90° with the palm facing down. Then, with one hand on the forearm and one on the arm, rotate the arm internally.

name of test?

Pain during this maneuver is a positive test indicating possible rotator cuff tear.

Test Hawkin's impingement sign.

*********** 

Elevate the arms to 90° and internally rotate the arms with the thumbs pointing down, as if emptying a can. Ask the patient to resist as you place downward pressure on the arms.

Weakness during this maneuver is a positive test indicating possible rotator cuff tear.

Testing supraspinatus strength (sometimes called the “empty can test”).

Weakness during this maneuver is a positive test indicating possible rotator cuff tear or bicipital tendinitis

Test infraspinatus strength

inflammation of the long head of the biceps tendon and possible rotator cuff tear.

Test forearm supination.

*********

 Ask the patient to fully abduct the arm to shoulder level (or up to 90°) and lower it slowly. If the patient cannot hold the arm fully abducted at shoulder level?

name of test? 

the test is positive, indicating a rotator cuff tear

the “droparm” sign.

Diffuse swelling (hand) in?

local swelling (hand) from?

Diffuse swelling (hand) in arthritis or infection;

local swelling (hand) from cystic ganglion

Which joints of the hands are affected in rheumatoid arthritis?

what else happenes

1-where is the thenar

2-where is the hypothenar

which fingers do these nerves innervate

Ulnar Nerve-

Medial Nerve-

Radial Nerve-

 1-thenar-palm, the pad proximal to thumb

2-hypothenar- palm proximal to pinky finger

ventral 

Ulnar Nerve- 5th and half of 4th

Medial Nerve-1,2,3, and half of 4

Radial Nerve-half of 1

dorsal

Ulnar Nerve- 5th and half of 4th

Medial Nerve-distal-1,2,3, and half of 4

Radial Nerve-half of 1 and proximal 2,3 and 1/2of4

Synovitis in the MCPs

a point to remember when shaking hands

Tenderness and swelling in tenosynovitis, or inflammation of the tendon sheaths.

De Quervain's tenosynovitis over the extensor and abductor tendons of the thumb as they cross the radial styloid

repetitive motion with wrists flexed (as in keyboard use, mail-sorting), pregnancy, rheumatoid arthritis, diabetes, hypothyroidism

Ask the patient to grasp the thumb against the palm and then move the wrist toward the midline in ulnar deviation Pain during this maneuver identifies

name of test?

de Quervain's tenosynovitis

Finkelstein's test

carpal tunnel

Tinel's sign- for median nerve compression

carpal tunnel disease

Test Phalen's sign for median nerve compression

lSwelling and thickening of the MCP and PIP joints

“Swan neck” deformity:

“Swan neck” deformity: hyperextension of the PIP joint with fixed flexion of the DIP joint

spondylolisthesis, or forward slippage of one vertebra, which may compress the spinal cord.

Vertebral tenderness is suspicious for fracture or infection

Focal tenderness over the trochanter in

Tenderness over the posterolateral surface of the greater trochanter in

Focal tenderness over the trochanter in trochanteric bursitis.

Tenderness over the posterolateral surface of the greater trochanter in localized tendinitis or muscle spasm from referred hip pain

Bowlegs is called  

 knock-knees is called  

Back knees is called  

 flexion contracture is called and seen in

Bowlegs (genu varum or varus) 

 knock-knees (genu valgum or valgus) 

Back knees (genu recurvatum)

 flexion contracture (inability to extend fully) in limb paralysis

Swelling above and adjacent to the patella suggests

Thickening, bogginess, or warmth in these areas indicate

synovial thickening or effusion in the knee joint.

synovitis or nontender effusions from osteoarthritis

The Bulge Sign (for minor effusions). With the knee extended, place the left hand above the knee and apply pressure on the suprapatellar pouch, displacing or “milking” fluid downward. Stroke downward on the medial aspect of the knee and apply pressure to force fluid into the lateral area. Tap the knee just behind the lateral margin of the patella with the right hand.

A fluid wave or bulge on the medial side between the patella and the femur is considered a positive bulge sign and suggests an 

rupture of the Achilles tendon.

Sudden severe pain “like a gunshot wound,” an ecchymosis from the calf into the heel, and a flat-footed gait with absence of “toe-off” may also be present.

 If a click is felt or heard at the joint line during flexion and extension of the knee, or if tenderness is noted along the joint line, further assess the meniscus for a posterior tear.
With the patient supine, grasp the heel and flex the knee. Cup your other hand over the knee joint with fingers and thumb along the medial and lateral joint line. From the heel, rotate the lower leg internally and externally. Then push on the lateral side to apply a valgus stress on the medial side of the joint. At the same time, rotate the leg externally and slowly extend it.

name of test?

McMurray Test.

Medial meniscus and lateral meniscus

with the McMurray test if

A click or pop along the medial joint with valgus stress, external rotation, and leg extension

 With the patient supine and the knee slightly flexed, move the thigh about 30° laterally to the side of the table. Place one hand against the lateral knee to stabilize the femur and the other hand around the medial ankle. Push medially against the knee and pull laterally at the ankle to open the knee joint on the medial side

name of test?

Abduction (or Valgus) Stress Test.

for Medial collateral ligament (MCL)

ligamentous laxity and a partial tear of the medial collateral ligament (MCL) 

Most injuries are on the medial side.

 Now, with the thigh and knee in the same position, change your position so you can place one hand against the medial surface of the knee and the other around the lateral ankle. Push medially against the knee and pull laterally at the ankle to open the knee joint on the lateral side

name of test?

Anterior and Posterior (draw) Drawer Sign.

positive draw sign- see a ridge at the upper tibia and no stopping

positive Lachman Test

knee at 15 degrees with FWD excursion suggests

Tenderness on compression is an early sign of 

Acute inflammation of the first metatarsophalangeal joint suggests

Tenderness on compression is an early sign of rheumatoid arthritis.

Acute inflammation of the first metatarsophalangeal joint suggests gout

The Ankle (Tibiotalar) Joint. Dorsiflex and plantar flex the foot at the ankle.