Chapter 17 - MSK

Question 1

How are diseases of the MSK system divided?

Answer 1

1. Systemic (RA, SLE, polymyositis)

2. Local (back pain, tennis elbow, arthritis)

Question 2

Describe patients w/local MSK disease:

Answer 2

Basically healthy individuals who suffer restriction of motion and pain from a single area

Question 3

Which system’s diseases rank 1st in cost to workers’ comp insurance carriers?

Answer 3

MSK

Question 4

What disorder ranks 2nd to cardiac disease as a cause of limitation of activity?

Answer 4

Arthritis

Question 5

What MSK disorders are extremely common (5+%) in 45+ yo?

Answer 5

• Low back pain
• Osteoarthritis
• Tendinitis or bursitis

Question 6

What MSK disorders are common (0.5-5% prevalence) in 45+ yo?

Answer 6

• Gout
• Fibromyalgia
• RA

Question 7

Define ganglion and what causes it

Answer 7

• Cyst at a joint or in a tendon sheath (usually back of the hand or wrist)
• Repetitive hand movements

Question 8

Define tendonitis

Answer 8

Inflammation of area where muscle and tendon join

Question 9

Define tenosynovitis

Answer 9

Inflammation of tendons or tendon sheaths

Question 10

What is the MC MSK disorder in the world?

Answer 10

Osteoporosis

Question 11

Describe Paget’s disease of the bone

Answer 11

• Disrupts normal architecture of bone

- Weakens bone

Question 12

Define symphysis

Answer 12

Slightly movable joint

Question 13

MC type of joint?

Answer 13

Synovial (movable)

Question 14

How are synovial joints classified?

Answer 14

By movement

• Hinge
• Pivot
• Condyloid
• Saddle
• Ball and socket
• Plane

Question 15

What type of movement does a hinge joint permit?

Answer 15

Only transverse axis - flexion or extension

Question 16

What type of movement does a pivot joint permit?

Answer 16

Rotation in longitudinal axis

Question 17

What type of movement does a condyloid joint permit?

Answer 17

Movement in 2 axes (oval articular surfaces, long and short diameters)

Question 18

Which type of joint is also called “egg in spoon” joints and why?

Answer 18

Condyloid

-Articular surfaces are oval

Question 19

What type of movement does saddle joint allow?

Answer 19

Movement in 2 axes (articular surfaces are saddle shaped)

Question 20

What types of joints allow biaxial movement?

Answer 20

Condyloid and saddle joints (synovial)

Question 21

What are polyaxial joints?

Answer 21

Motion is possible in many axes

• Ball and socket
• Plane

Question 22

What type of movement does a plane joint allow?

Answer 22

Polyaxial

Question 23

Stability of a joint depends on what?

Answer 23

• Shape of articular surfaces
• Ligaments
• Associated muscles

Question 24

Define valgus deformity

Answer 24

Distal portion of the bone is displaced away from midline

knock knees

Question 25

Define varus deformity

Answer 25

Distal portion of bone is displaced toward midline (bow leg)

Question 26

What is the largest tarsal bone?

Answer 26

Calcaneus

Question 27

Define migratory polyarthritis

Answer 27

One joint is affected, disease subsides, then another joint becomes involved

Question 28

Proximal muscle weakness is usually a ____ while distal weakness is usually a ____

Answer 28

Proximal - myopathy | Distal - neuropathy

Question 29

Define crepitus

Answer 29

Palpable crunching sensation

Question 30

What is impingement syndrome also known as?

Answer 30

Rotator cuff tendinitis

Question 31

What is adhesive capsulitis?

Answer 31

Frozen shoulder

Question 32

What is de Quervain's disease?

Answer 32

Tenosynovitis of thumb abductors and extensors

Question 33

What is the Trendelenburg test used to detect?

Answer 33

Disorder between pelvis and femur

Question 34

What is a positive Trendelenburg test?

Answer 34

Standing on bad leg, pelvis on opposite side falls

Question 35

What is hemarthrosis?

Answer 35

Swelling of knee indicating synovial effusion or bleeding into the joint

Question 36

What is a cavus foot?

Answer 36

Abnormally high arch

Question 37

What is the Thompson-Doherty squeeze test?

Answer 37

- Test of Achilles tendon - Squeeze calf - Normally, plantar flexion occurs - Ruptured Achilles produces little or no motion of foot

Question 38

Where is the MC place for Achilles tendon rupture?

Answer 38

1 to 2 inches proximal to its insertion on calcaneus | in poorest blood supply region "watershed area"

Question 39

What is the "watershed area"?

Answer 39

- Region of poorest blood supply of the Achilles | - 1 to 2 inches proximal to insertion on calcaneus

Question 40

What is podagra?

Answer 40

Acute attack of gout that manifests in first MTP joint

Question 41

What are the 2 main deformities of RA?

Answer 41

Swan neck | Boutonniere

Question 42

Describe swan neck deformity

Answer 42

- Occurs w/RA - Caused by shortening of interosseous muscles - Hyperextension of PIPs - Flexion of DIPs

Question 43

Describe boutonniere deformity

Answer 43

- Occurs w/RA - Flexion of PIPs - Hyperextension of DIPs

Question 44

What is arthritis mutilans?

Answer 44

Most deforming type of psoriatic arthritis

Question 45

What is opera glass deformity?

Answer 45

- Telescoping of digits | - Caused by osteolysis of phalangeal and MCP joints

Question 46

MC causes of plantar fasciitis

Answer 46

- Overpronation - Foot w/high arch - Sudden increase in exercise - Excessive weight on foot - Improperly fitting shoes

Question 47

What is Potts test?

Answer 47

- Heel of each hand is used to compress tibia against fibula at a point midway up the leg - Pain in ankle is positive for sprain

Question 48

What is a Maisonneuve fracture?

Answer 48

High fibular spiral fracture resulting from ER of ankle

Question 49

What is Mulder's sign?

Answer 49

Audible click w/Morton's neuroma

Question 50

Describe Hammer toes

Answer 50

Flexion contracture of PIPs of 1 or more lesser toes

Question 51

Limitus vs. rigidus

Answer 51

- Limitus refers to decreased motion of a joint early on | - Rigidus refers to little joint motion (later stage)