PD II - Quiz 2 MSK Spine, Shoulder, Elbow

MSK diseases

• sprains / strains

• bursitis

• tendinitis

• RA

• SLE

• polymyositis

• pain

• swelling

• weakness

• stiffness

• limitation of movement

• joint clicking

• deformity

• soft tissue swelling, erythema, deformity, asymmetry, nodules atrophy, masses

• symmetry of joints and motion, alignment, deformity, scars

• skin changes, muscle atrophy, subcutaneous nodules, swelling

• gait and posture, limitation of movement, instability, joint specific inspection

• tenderness, temperature, crepitus, swelling, effusions

• subcutaneous nodules, masses, defects, step offs

motion achieved by patient using their own muscle strength

motion achieved by examiner moving the joint

• limitation of motion

• instability

• range of joint movement

• muscle appearance, tone and strength

• sensation

• pulses

• deep tendon reflexes

no muscular contraction detected

active movement against full resistance (“normal”)

bones and soft tissues

• open mouth

• close mouth

• protrusion

• lateral motion

• unilateral or bilateral jaw pain (worse in AM or after eating)

• clicking

• NSAIDs

• soft diet to limit chewing

• night guard

anterior column

posterior column

C7, T1

L4

lordosis

kyphosis

lordosis

kyphosis

• posture

• curvatures

• deformities

• symmetry of scapula and pelvis

• range of motion

• surrounding skin and musculature

angular deformity due to a collapsed vertebrae

• osteoporosis

• metastasis

• TB spine (Potts disease)

abnormal curvature of the spine

• idiopathic

• congenital

• neuromuscular

• tenderness or spasm

• spinous process

• paraspinous muscles

• soft tissue

• flexion

• extension

• lateral rotation

• lateral bending

• cervical spine and UE muscle strength

• UE reflexes

• UE sensation

• UE pulses

• sprain / strain

• degenerative disc

• herniated disc

• arthritis (osteo, RA, psoriatic)

• primary tumors

• metastatic disease

• deformities (scoliosis, kyphosis)

• trauma (fracture, dislocation)

imaginary line from T1 through mid gluteal cleft

• general inspection

• skin creases

• skin changes

• spinal curvatures

• deformities

• shoulder heights

• bony prominences

• paraspinal muscles

• soft tissue

• flexion

• extension

• lateral bending

• rotation

• straight leg raise

• crossed straight leg raise

• true leg length measurement

passively raise extended leg in supine pt OR extend knee in sitting pt

reproduction of pt’s symptoms (back / leg pain)

ankle dorsiflexion

symptoms in the affected side with passive flexion of the opposite leg / hip is associated with confirmation of radicular pain

measure from the ASIS to the medial malleolus with measuring tape, crossing the medial aspect of the knee

• muscle strength

• LE reflexes

• sensation

• distal pulses

• humerus

• clavicle

• scapula

• sternoclavicular joint

• acromioclavicular joint

• glenohumeral joint

• scapulothoracic articulation

• scapulohumeral group

• axioscapular group

• axiohumeral

scapula to humerus

• deltoid

• teres major

• rotator cuff

SITS

• supraspinatus

• infraspinatus

• teres minor

• subscapularis

internal / external rotation and aBduction

trunk to scapula

• trapezius

• rhomboids

• serratus anterior

• levator scapulae

allow the shoulder to be pulled backward

trunk to humerus

• pectoralis major

• pectoralis minor

• latissimus dorsi

aDduction and internal rotation

ball and socket joint

shallow glenoid cavity

rim of cartilage that slightly deepens the glenoid cavity

fibrous articular capsule formed by tendons of rotator cuff and other capsular muscles

subacromial bursa

betw the acromion and head of humerus and overlying supraspinatus tendon

aBduction of the shoulder

pain below the acromion with aBduction and rotation

muscle tendons

tendon to the long head of the bicep

• general inspection

• swelling

• skin nodules, masses

• asymmetry

• deformity

• atrophy

• winging of scapula

• articulations

• bony structures

• tenderness

• warmth

• crepitus

• soft tissue

active

• aBduction

• aDduction

• extension

• flexion

• internal / external rotation

• subacromial bursitis

• subdeltoid bursitis

• bicipital tendinitis

• drop arm test

• apprehension test

ask pt to aBduct to 90º and apply downward pressure to lower arm

arm drops with slight pressure

rotator cuff tear

aBduct and externally rotate shoulder and apply pressure on GH joint

apprehensive facies or pain upon pressure

glenohumeral instability

• CAD

• pulmonary tumors

• GBD

• rotator cuff tendonitis

• rotator cuff tears

• shoulder bursitis

• shoulder dislocation

• acromioclavicular arthritis

• adhesive capsulitis

• calcific tendonitis

• labral tear

• biceps tendonitis

• pain (often PM)

• weakness

• loss of motion

apprehension test

• rotator cuff tear

• calcific tendinitis

• shoulder subluxation

• biceps tendon rupture

• adhesive capsulitis

• AC arthritis

• RA

• gout

• Lyme

• SLE

• avascular necrosis

• rest

• ice

• NSAIDs

• PT

• steroid injections

aBduction

over greater tuberosity

“shoulder shrug”

subacromial bursa OR subdeltoid bursa

• rest

• ice

• NSAIDs

• PT

• steroid injections

anterior

MVA or falling on outstretched arm

• shoulder pain

• arm held at side, slightly away from body with forearm outward

• loss of normal contour of shoulder

ensure no nerve or blood vessel damage

shoulder dislocation or trauma

• pain with shoulder movement

• bringing arm across chest compresses AC joint, recreates pain

• NSAIDs, PT

• surgery if severe

PAIN and CONTRACTURE

disease in structures outside the synovial capsule GH joint

• DM

• hyper / hypothyroid

• hypertriglyceridemia

• hypoadrenalism