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Details

Clinical assessment Test 4
n/a
176
Medical
Graduate
04/23/2011

Additional Medical Flashcards

 


 

Cards

Term
____ complaints are the leading cause of visits to healthcare providers. __ is #1, and ___ is #2
Definition

musculoskeletal

 

back pain, shoulder pain

Term
Joint type?

___ - freely moveable, found in knee, shoulder, hip

___ - slightly movable, found in vertebral bodies of the spine

___ - immovable, skull sutures
Definition

synovial

cartilaginous

fibrous

Term
Synovial joint types:

___ - convex surface in concave cavity. Flexion, extension, abduction, adduction, rotation, circumduction. shoulder, hip.


___ - flat, planar. motion in one plane, flexion, extension. PIP joints of the hand and foot, elbow.


___ - convex or concave, movement of two articulating surfaces not dissociable. knee, tmj.
Definition

spheroidal (ball and socket)

hinge

condylar

Term
___ joints allow some side to side (velgus and varus) motion
Definition
condylar
Term
____ are the joints between the pubic symphysis and vertebrae.
Definition
cartilaginous
Term
___ are roughly disc-shaped synovial sacs that allow adjacent muscles & tendons to glide over each other during movement. two most significant?
Definition

bursae

 

prepatellar, subacromial

Term
Possible causes of pain...

1. on the spine (midline)
2. off the spine
Definition

midline - herniation, dislocation, fracture

off - muscular

Term
Red flags for low back pain - do imaging before other tests
Definition

>50 y/o

history of cancer

weight loss

pain > 1 month

pain not responding to treatment

pain at night

pain increased wtih rest

history of IV drug use

infection

Term
Causes of localized joint pain v. diffuse/systemic
Definition

localized: osteoarthritis, sprain, dislocation

diffuse: RA, OA

Term
Example of insidious onset joint pain?

Example of rapid onset joint pain?
Definition

Insidious - arthritis

Rapid - gout

Term
Have pt rate joint pain with 4 questions...
Definition

Right now?

At worst?

At best?

Day to day?

Term
Joints potentially affected by RA and OA

Most commonly affected joint of gout?
Definition

RA: PIP, MCP, MTP (feet), wrists, knees, elbows, ankles

 

OA: knees, hips, hands, (DIP, PIP), C and L spine, wrists, joints injured or diseased, weight-bearing joints

 

Gout: 1st MTP joint (base of big toe)

Term
Systemic symptoms associated with arthritis
Definition
flu-like : fever, chills, rash, weight loss, anorexia, weakness
Term
what genetic disorder is characterized by blue sclera and very brittle bones?
Definition
osteogenesis imperfecta
Term
1 out of __ women and 1 out of __ men will have a fx secondary to osteoporosis
Definition
2, 4
Term
Risk factors for osteoporosis
Definition

low body weight (greatest predictor of low bone density)

>65 y/o

estrogen deficiency

white race

Family hx of osteoporosis

smoking

 hx of vertebral fx

Term
What kind of arthritis?

Acute involvement of one joint
Several joints (symmetrical)
Definition

trauma, sepsis, gout

RA

Term
What is a condition (joint) in which this would be present:

subcutaneous nodule?
effusion?
muscle atrophy?
Definition

RA or rheumatic fever

trauma/arthritis

carpal tunnel

Term
Examples of decreased ROM in a joint or increased ROM?
Definition

decreased - arthritis, inflammation, fibrosis, bony fixation (ankylosis)

 

Increased (laxity) - Ligamentous injury/tear

Term
3 joints of the shoulder
Definition

AC, sternoclavicular, glenohumeral

 

glenohumeral is ball and socket

Term
What might cause problems in the glenohumeral joint? in the AC joint?
Definition

GH - arthritis, high-riding humerus

AC - arthrtis with clavicular hypertrophy

Term
6 scapulohumeral group muscules - what do they do?
Definition

deltoid, lat, rotator cuff (supraspinatus, nfraspinatus, teres minor, subscapularis)

 

rotate shoulder laterally and depress and rotate humerus

Term
5 axioscapular group muscles - what do they do?
Definition

trap, rhomboid major, rhomboid minor, serratus ant, levator scapulae

 

pulls hsoulder back and rotates scapula

Term
3 axiohumeral group muscles - what do they do?
Definition

pec major, minor, lat

 

rotate shoulder internally

Term
biceps and triceps do what movment of shoulder?
Definition
abduction
Term
Tenderness below tip of acromion, pain with abduction and rotation and loss of smooth movment, and pain with reaching over the head. suggests what?
Definition
subacromial bursitis
Term
___ is also called hitchhiker's roattion (shoulder ROM)
Definition
internal rotation
Term
What test is done to test AC joint arthritis?
To test supraspinatus?
Subscapularis?
infraspinatus & teres minor?
Definition

crossover

supra - push out against clinician with chicken wings OR empty can test

infra/teres - hold pt arm at 90 deg and resist clinicina outward with forearm

subscapularis - liftoff

Term
A postitive drop arm test indicates what?
Definition
rotator cuff tear
Term
What elbow muscles are responsible for each action?

Flexion
Extension
pronation
supination
Definition

flexion - biceps, brachialis, brachioradialis

extension - triceps/anconeus

pronation - pronator teres and quadratus

supination - supinator and biceps

Term
Special test for lateral epicondylitis?

for medial epicondylitis?
For ulnar neuropathy?
Definition

lateral - cozen's test - pain and lateral epicondyle with wrist extended

 

medial - pain immediately distal to medial epicondyle with resisted wrist flexion

Ulnar neuropathy (cubital tunnel) - palpation of ulnar nerve wtihin ulnar groove just posterior to medial epicondyle with elbow flexed

Term
The ___ nerve runs through the carpal tunnel and provides sensation to the plamar surface of thumb, second, third, and half of the fourth digit
Definition
median
Term
What are some possible causes of decreased grip strength?
Definition
de quervain's tenosynovitis, arthritis, carpal tunnel, epicondylitis, cervical radiculopathy
Term
What musculoskeletal problem is characterized by trouble picking up a frying pan or a baby out of a crib? Tested by Finkelstein's test.
Definition
de quervain's tenosynovitis
Term
What condition? Pain or numbneess of first three fingers and medial half of fourth finger esp at night or with repetitive movement

What test is most sensitive to test for it?
Definition

carpal tunnel syndrome

 

weak abduction of thumb - most sensitive

also tinels or phalen's

Term
Vertebrae:

Herniation usually occurs anteriorly/posteriorly
___ encolses the spinal cord
___ creates an opening for spinal nerve roots
___ is opening for vertebral artires
Definition

posteriorly

vertebral foramen

intervertebral foramen

transverse foramen

Term
Superficial and deep muscles of the back
Definition

superficial - trap, lat

deep: splenius capitis, splenius cervicis, sacrospoinalis

Term
what might cause unequal shoulder heights?

unequal iliac crests?
Definition

shoulder - scoliosis, sprengel's deformity of scapula, winging of scapula, contralateral weakness of trap

 

iliac - unequal leg lengths, scoliosis, hip abduction or adduction, herniated lumbar disc

Term
what population is at greatest risk for scoliosis?
Definition
girls in growth spurt
Term
two kinds of scoliosis:

___ - flexible, apparent with standing and disappears with bending fwd, may be compensatory for unequal leg length

___ - fixed, rub humb, curvature on standing and bending, unequal shoulders and hips
Definition

functional

structural

Term
4 signs of scoliosis
Definition

rib hump

uneven shoulders/scapula

curvature of spine

uneven pelvic girdle

Term
What condition?

1. characterized by birthmarks, port-wine stains, hairy patches and lipomas overlying bony defects

2. cafe-au-lait spots, skin tags, fibrous tumors
Definition

spina bifada

 

neurofibromatosis

Term
What are "radicular" symptoms
Definition
numbness/tingling that radiates from a spot upon palpation
Term
Raise a pt leg while they're sitting and extend their knee - if pt leans bkwd, indicates?

raise pt leg while pt supine until the knee bends or pt reports pain in butt or back, indicates?
Definition

sciatic tension

lumbar herniation

Term
3 bursa of the hip
Definition

psoas

greater trochanter

ischial

Term
2 phases of gait
Definition
swinging (non-weight bearing) and stance (weight bearing)
Term
Normal width of footsteps
Definition

2-4 in heel to heel

 

Term
___ sign - the "sexy walk" - positive with weak hip abductors
Definition
trendelenberg's
Term
Pt with trouble getting into/out of car and pain when laying on side?
Definition
trochanteric bursitis
Term
Contents of inguinal space
Definition

nerve

artery

vein

empty space

lymphatics

 

NAVEL

Term
positive ___ test - pull knee to chest and other knee flexes
Definition
thomas
Term
pos ___ test - pt supine, place heel of one foot over knee of the other. stabilize pelvis with one and and press down on thigh with other. pain = pos
Definition
faber or figure 4 test
Term
____ test - pt supine. roll leg into internal and ext rotation. pain in groin or anterior hip indicates acetabular fx or femoral head fx
Definition
log roll
Term
Leg extensor and flexor muscles
Definition

extensor - quads

flexor - hamstrings

Term
3 bursa of knee
Definition

prepatellar

anserine

semimembranous

Term
The ___ is the cavity thtat covers the anterior, medial, and lateral surfaces of the knee
Definition
suprapatellar pouch
Term
varus stance is normal in ___
valgus is normal in ___
Definition

babies

female children

Term
3 ways to assess swelling in knee
Definition

bulge sign - milk fluid downward and apply medial pressure and tap laterally

 

balloon sign - thumb and first finger on either condyle. compress inferiorly. check for fluid superiorly

 

balotte - compress suprapatellar pounch and push patella sharply against femur - watch for fluid returning to pouch

Term
Normal degrees of flexion and extension of knee
Definition

flexion - 135-145

extension - 0

Term
Valgus stress tests the ___ ligament
varus stress tests the ___
Definition

MCL

LCL

Term
2 ankle joints
Definition

tibiotalar

subtalar

Term
Plantar flexor muscles
Dorsiflexor msucles
Definition

plantar - gastroc, posterior tib, toe flexors

 

dorsi - anterior tib, toe extensors

Term
___ test assesses achilles tendon integrity
Definition
thompson
Term
The ___ ligament protects against eversion

The ___ ligament is the highest risk of injury from inversion
Definition

deltoid

anterior talofibular

Term
Slight ___ alignment of heels is normal
Definition
valgus
Term
___ happen where a person places the majority of stress on their foot when they walk
Definition
calluses
Term
Hot, red, tender, swollen first MCP joint - think ___
Definition
gout
Term
The lateral squeeze test of the foot tests for?
Definition
morton's neuroma
Term
Which lobe of the brain is responsible for these?

voluntary movement
motor integration
expressive language
social functioning
inhibition of impulse
emotions
lack of initiative
short term memory
Definition
frontal
Term
Which lobe of the brain is responsible for these?

sensation
fine discrimination
pain and touch
comprehension of speech and reading
production of writing and calculation
awareness of spatial relationships, size, and height
Definition
parietal
Term
which lobe of the brain is responsible for visual perception?
Definition
occipital
Term
Which part of the brain is responsible for coordination & balance?
Definition

cerebellum

 

Term
Which part of the brain is responsible for these?
hearing
smell
long term memory
receptive language
musical awareness
Definition
temporal
Term
Which part of the brain is responsible for these?
chewing
appetite
swallowing
hearing and balance
wakefulness
motor speech
upper intestine peristalsis
regulation of pulse, resp, BP
vision
eye and eyelid muscles
smell
fascial and neck muscles
facial sensation
tastse
Definition
brain stem
Term
5 parts of the neurologic exam
Definition

mental status

cranial nerve

motor

sensory

reflexes

Term
What does obtunded mean?

What are circumlocutions?

What are paraphasias?
Definition

Obtunded: the lights are on but no body's home

 

Circumlocutions: substituting phrases when you can't find the right word... instead of saying "pen", saying "the thing you write with"

 

Paraphasias: malformed words - "I write with a den"

Term
What are some ways to assess pt attention?
Definition
digit span, serial 7s, spelling bkwd
Term
Cognitive fxns to check
Definition

orientaiton

attention

remote memory

recent memory

new learning ability

Term
Higher cognitive fxns to check
Definition

information and vocabulary

calculating ability

abstract thinking

constructional ability

Term
Tests to test frontal lobe
Definition

working memory

judgement

fund of knowledge

task organization

set generation

Term
____ area is in the temporal lobe and is the receptive speech area

___ area is in the frontal lobe and is the expressive speech area
Definition

wernicke's

broca's

Term
What lobe is responsible for perception and interpretaiton of sensory info, visual-spatial fxn, and praxis (execution of motor acts)
Definition
parietal
Term
What are three parietal lobe fxn tests?
Definition

Agnosia - inability to identify objects by tactile exploration

Apraxia - inability to perform purposeful motor acts on command

Constructional apraxia - inability to draw objects which require use of visual spatial organization

Term
_____ - decreased level of consciousness

___ - lack of orientation to person, place, time. lobe?

___ - memory loss. lobe?

___ - speech problems. Lobes?

___ inappropriate emotions. lobes?

___ - inability to recognize objects. lobe?

___ - inability to follow orders. Lobe?
Definition

coma

disorientatino - temoral

amnesia - temporal

aphasia - frontal, temporoparietal

inappropriate affect - bilateral cerebral

apraxia - frontal

Term
The ___ lobe is responsible for perception of visual informaiton
Definition
occipital
Term
Occipital lobe function tests
Definition

visual fields

naming objects

naming colors

recognition of faces

Term
What is the first thing you should look for in mental status assessment?
Definition
level of alertness
Term
____:

Acute global change
increased in hospitalized
physiologic derangement
usually reversible


___:

global cortical dysfunction
slow & progressive
uncommon <50
increased markedly with age
usually not associated with illness
Definition

delirium

dementia

Term
Brainstem:


___ is CN 3&4
___ is CN 5-8
___ is CN 9-12
Definition

midbrain

pons

medulla

Term
Lesion in which CN?

1. loss of consensual light reflex
2. loss of direct light reflex
Definition

III

II

Term
EOM test which cranial nerves?
Definition

SO4 - superior oblique CN 4

LR 6 - lateral rectus CN 6

ATR 3

Term
____ - pupils that accomodate but do not react to light reflex
Definition
argyll robertson
Term
What condition

Miosis, ptosis, and anhydrosis
Definition
horner's syndrome
Term
What condition?

Large, regular pupils
Light reflex absent or slow
Constriction to near is slow & tonic
Definition
adie's pupil
Term
3 branches of the trigeminal nerve
Definition

opthalmic

maxillary

mandibular

Term
Which CN is affected?

dysphagia and gagging
Definition
9 & 10
Term
Assessing the trap and SCM is assessing which CN?
Definition
11
Term
Thenar atrophy implies what disorder?
Definition
carpal tunnel
Term
____ is visible, irregular flickerings over the surface of the affected muscle
Definition
fasciculations
Term
Most common kind of tremor
Definition
benign essential  tremor
Term
4 kinds of tremor
Definition

benign essential

postural

intention

rest

Term
____ - rapid shock-like muscle contractions

caused by?
Definition

myoclonus

 

uremia

cereral hypoxia

hyperosmolar nonketotic states

Term
____ - flapping tremor of the outstretched hands or feet
Definition

asterixis

 

hepatic, renal, & pulmonary encephalopathy

Drug intoxication

Term
___ - abnormal movements that are slow, sinuous, and writihing in character

___ - sustained ^^^
Definition

athetosis

dystonia

Term
___ - presence of abnormal, involuntary movements due to problem in the basal ganglia

3 kinds:

1. irregular, spasmodic, involuntary moevements of limbs or facial muscles
2. autosomal dominants disorder
3. type of involuntary movement affecting proximal limbs. jerking, flinging, movement of extremities
Definition

duskinesia -

chorea

huntington's

ballismus

Term
Sudden, recurrent, quick, coordinated, abnormal movments tat can be imitated without difficulty
Definition
tics
Term
____ - resistance to passive movment of a relaxed limb

Decreased of this usually seen in ___ disorders
Definition

tone

 

lower motor neuron or peripheral nerve disorders

Term
___ is the complete absence of tone
Definition
flaccidity
Term
___ - impaired muscle strength

___ - absence of muscle strength

___ - symmetrical weakness of proximal muscles

___ - symmetrical weakness of distal muscles
Definition

paresis

paralysis

myopathy

polyneuorpahty

Term
Which part of the brain is responsible for... ?

maintaining equilibrium
trajectory, velocity, acceleration
rapid and repetitive movements
sequential movements
Definition
cerebellum
Term
___ - cerebellar dysfunction characterized by decomposition of movements, dysmetria (clumsiness, unsteadiness, inappropriate varying in speed, force, direction)
Definition
ataxia
Term
Cerebellar fxn tests
Definition

station romberg

walking

tandem gait (heel to toe)

rapid alternating movements

toe to finger

heel to shin

speech

Term
Station Romberg test: what would these outcomes indicate?

1. pt has difficulty standing with eyes open or closed

2. pt stands well with eyes open but is unsteady with eyes closed
Definition

cerebellar ataxia

dorsal column disease

Term
Pronator drift tests for lesions in the ___.
Definition

coritcospinal tract

 

if right hand drifts - lesion in left hemisphere

Term
____ gait - inability to perform a familiar, purposeful movement in the absence of paralysis and other sensory motor impairment. problem in frontal lobe such as hydrocephalus or progressive dementing disorder
Definition
apraxic
Term
____ gait - wide-based with lateral veering, unsteadiness and irregularity of steps. tendency to fall to one side, forward, or backward. Suggests drunkenness or unilateral lesions
Definition
cerebelar ataxic
Term
___ gait - wide-based & throw feet forward and outward and bring down first on heels then on toes with double tapping sound. Pos romberg sign.
Definition
sensory ataxic
Term
____ gait - drag feet or lift them too high with knees flexed and bring them down wiht a slap

___ gait - stiff with each leg advanced slowly. thighs tend to cross at each step. Appears to be walkign through water.
Definition

steppage gait

scissors gait

Term
___ gait - one arm held immobile and flexed close to the side. leg extended and plantar flexion of foot. drags for circumduction. seen in stroke pts.
Definition
spastic
Term
____ is the primary symptom of cerebellar disease
Definition
incoordination
Term
5 primary sensory modalities
Definition

light touch

pain

temperature

vibration

joint position

Term
Dorsal column tract:

important for ___ and ____. sensory impulses cross over in ___.
Definition

proprioception and vibration

medulla

Term
spinothalamic tract:

important for ___ & ____.
Sensory impulses cross over at the ___.
Definition

Pain & temp

spinal cord

Term
____ (neuro test) is represented in both the spinothalamic and dorsal column tests but is not specific screening for either system
Definition
light touch
Term
3 dorsal column fxn tests
Definition

vibratory sensation

position sense

discriminative sensation

Term
On exam, the sensory level helps you determine where spinal cord disease is, although the sensory deficit will be about 1-2 spinal cord segments above/below the actual lesion
Definition
below
Term
Sensory deficit from a ___ will have a dermatomal distribution

Sensory deficit from a ___ will have a stocking and glove distribution bc the longest axons are the most affected
Definition

spinal nerve lesion

polyneuropathy

Term
Grading reflexes
Definition

0 - no contraction

1+ - decreased, but present

2+ - normal

3+ - supernormal

4+ - clonus

Term
Reflexes: which nerve is being tested on each?
Definition

Triceps - radial

Biceps - musculocutaneus

brachioradialis - radial

patellar - femoral

achille's - sciatic

Term
hyperreflexivity suggests what disease?
Definition
hyperthyroidism
Term
Babinksi reflex assesses Upper or lower motor neurons?
Definition
upper
Term
abnormal babinski in adults
Definition
great toe dorsiflexes and toes fan out
Term
Both ___ & ___ signs will be positive in subarachnoid hemorrhage
Definition
brudzinski's and kernig's
Term
What kind of posturing?

elbows, wrists, fingers flexed
Legs extended and internally rotated
Destructive lesion of corticospinal tracts within or near cerebral hemispheres
Definition
decorticate
Term
What kind of posturing?

arms adducted and stiffly extended at elbows
forearms pronated, wrists & fingers flexed

lesion in diencephalon, midbrain, ponts
hypoxia or hypoglycemia
Definition
decerebrate
Term
Shoulder is the most common site of joint pain. Most common disorders?
Definition
subacromial impingement and rotator cuff tears
Term
Visceral pain referrals from thorax is mostly in what areas?
Definition
right shoulder, left shoulder, left arm
Term
____ - disorder of initiating and maintaining sleep.
Definition
insomnia
Term
Most common causes of chronic insomnia (7)
Definition

caffeine

alcohol

sleep apnea

medical disorders

nocturia

anxiety

depression

Term
Transient (short term) insomnia lasts less than ___ weeks
Definition
3
Term
Medical term for bed-wetting
Definition
noctural enuresis
Term
Insomnia in children most commonly caused by ___
Definition
psychological stress
Term
People with ___ (Disorder) experience insomnia characterized by delayed sleep onset, frequent waking, and classic early-morning wakefullness
Definition
depression
Term
2 types of vertigo:

___ - illusion that one's surroundings are moving
___ - feeling that , with eyes closed, one's body is moving/turning in space

2 other classificiations:

___ : caused by brain stem or cerebellar lesions
___ : caused by problem of inner ear or vestibular nerve
Definition

objective

subjective

 

central

peripheral

Term
___ is the hallucination of movement
Definition
true vertigo
Term
____ - sensation of being about to faint (near syncope)
Definition
lightheadedness/dizziness
Term
___ is the most common cause of falls in elderly
Definition
orthostatic hypotension
Term
In general, ____ cuases of foot pain occur at rest, whereas ___ cuases occur with ambulation and decrease with rest
Definition

systemic (gout, RA, diabetes)

biomechanical (sprains, spurs, breaks)

Term
Bacheache is most common in what age group?
Definition
20-50
Term
Does radiation of pain from backache always mean nerve compression?
Definition
no
Term
90% of disc herniations happen where?
Definition
L4-5 or L5-S1
Term
____ - episodic memory impairment w/o dementia. seen in older pts

___ - more severe, extensive congnitive impairments

___ - gradual loss of memory in otherwise healthy elderly individuals
Definition

AAMI - age-associated memory impairment

AACD - age-associated cognitive decline

BSF - benign senescent forgetfulness

Term
Most common precipitating cause of forgetfulness
Definition
depression
Term
4 regions of the brain
Definition

cerebrum

diencephalon

brainstem

cerebellum

Term
What do the basal ganglia regulate?

What does the hypothalamus regulate?
Definition

basal ganglia - movement

hypothalamus - homeostasis, temp, HR, BP, emotions, sex drive

Term
What is the reticular activating system?
Definition
in the brainstem and diencephalon - regulates consciousness
Term
What spinal cord level is cauda equina?
Definition
L1/2
Term
___- involuntary, stereotypical response that may involve as few as two neurons across a single synapse
Definition
reflex
Term
Reflexes.. what spinal segments are responsible for each?

Ankle
Knee
Supinator
Biceps
Triceps
Upper abdominal
Lower abdominal
Plantar
Definition

Triceps: C6-7

Biceps & brachioradialis (supinator): C5-6

upper abdominal: T8-10

Lower abdominal: T10-12

knee: L2-4

Ankle: s1

Plantar: L5-S1

Term
When upper motor neuron systems are damaged above the crossover of its tracts in the medulla, motor impairment develops on the ___ side. In damage below the crossover, motor impairment occurs on the ___ side.
Definition

contralateral

ipsilateral

Term
___ - slowness, lack of spontaneous automatic movements.
Definition
bradykinesia
Term
Lesion in the sensory cortex of the brain - symptoms?
Definition
pt unable to discriminate size, shape, or texture of an object but would be able to discriminate hot, cold, pain, position
Term
Dermatomes:

Front & back of neck
Nipples
thumb
ring and little fingers
umbilicus
inguinal
knee
anterior foot/ankle and sole of foot
Definition

C3 - neck

T4 - nipples

C6 - thumb

C8 - ring and little fingers

T10 - umbilicus

L1 - inguinal

L4 - knee

L4&5 - anterior foot/ankle/sole

Term
2 most common symptoms in neurologic disorders
Definition
headache and dizziness
Term
paroxysmal disorder caused by sudden excessive electrical discharge in the cerebral cortex
Definition
seizure
Term
___ is the 3rd leading cause of death in US
Definition
cerebravascular disease
Term
risk factors for stroke
Definition

HTN

diet

dyslipidemia

heavy alcohol use

physical inactivity

obesity

diabetes

Term
4 muscles of quads
4 muscles of hamstrings
Definition

quads - rectus femoris

vastus lateralis

vastus medialis

vastus intermedius

 

hamstrings:

semitendinosus

semimembranosus

gracilis

sartorius

Term
What's the most likely diagnosis?

1. sciatic pain. caused by lifting.

2. inability to perform movement. occurs when tendon is stressed.

3. boggy, doughy feeling swelling

4. not necessarily visible swelling. pain with repetitive overhead activities.

5.
Definition

1. disk herniation

2. tendon rupture

3. synovitis

4. subacromial bursitis

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