YEAR 1 MED > Examining joints > Flashcards

Examining joints Flashcards

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1
Q

What causes a waddling gait (Trendelenburg gait)?

A
  • loss of hip abductor function / weak gluteus medius
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2
Q

What causes an antalgic gait (painful limp)?

A
  • caused by any painful condition (patient tries to offload the painful limb by quickening and shortening the weight-bearing stance phase of the gait cycle)
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3
Q

What causes a short-leg gait (dipping off shoulder on affected side)?

A
  • any condition causing significant leg discrepancy
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4
Q

What causes a high-stepping gait (knee is flexed and foot is lifted high to avoid foot dragging on floor)?

A
  • nerve palsy (peroneal or sciatic)
  • sometimes called foot drop
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5
Q

What causes a stiff knee gait (knee cleared of floor by swinging out away from the body)?

A
  • fusion of knee
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6
Q

What are the main steps to an examination?

A
  • LOOK: check for swelling, muscle wasting, scars, erythema, and deformity
  • FEEL: palpate the joint, noting any effusions, tenderness, and heat
  • MOVE: demonstrate joint movement actively and passively
  • SPECIAL TESTS
  • note: also examine joints above and below
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7
Q

Lower limb dermatomes…

A

Reflexes tested…
- knee: L3-L4
- ankle: L5-S1
- plantar

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8
Q

Upper limb dermatomes…

A

Reflexes tested…
- biceps: C5-C6
- triceps: C7
- brachioradialis: C6-C7

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9
Q

Vertebral column diagram…

A
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10
Q

Testing lower-limb muscle function (myotomes)…

A

Nerve roots tested : muscle action

  • L1, L2 : hip flexion (iliopsoas)
  • L3 : knee flexion (quadriceps)
  • L4 : ankle dorsiflexion (tibialis anterior)
  • L5 : great toe extension (extensor hallucis longus)
  • S1 : ankle plantar flexion (soleus/gastrocnemius)
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11
Q

Testing upper-limb muscle function (myotomes)…

A

Nerve roots tested : muscle action

  • C5 : shoulder abduction
  • C6, C7 : shoulder adduction
  • C5, C6 : elbow flexion
  • C7, C8 : elbow extension
  • C6, C7 : wrist flexion / extension
  • C7, C8 : MCP/IP flexion/extension
  • T1 : MCP abduction/adduction
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12
Q

How do you measure true-leg length in a hip examination?

A
  • measure both limbs from ASIS (anterior-superior iliac spine) to medial malleolus and compare the values
  • (note: apparent leg length is belly button to medial malleolus)
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13
Q

What does tenderness over the greater trochanter indicate?

A
  • trochanteric bursitis
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14
Q

What movements are tested in a hip examination?

A
  • hip flexion / extension
  • hip abduction / adduction
  • hip internal / external rotation
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15
Q

What special tests are carried out in a hip examination?

A
  • Thomas’ test (test for fixed flexion deformity): patient positioned supine, opposite hip is flexed fully, lordosis is felt, if extended hip lifts off couch then positive test
  • Trendelenburg test (test for weak hip abductors / weak gluteus medius): patient holds onto your hands and lifts leg off ground, if hip tilts down then positive test for opposite leg
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16
Q

What are you looking for in an examination of the knee?

A
  • quadriceps wasting (measure thigh circumference)
  • note any effusions, scars, erythema, or evidence of psoriasis
  • varus/valgus deformities
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17
Q

Why do we palpate the posterior aspect of the knee in a knee examination?

A
  • a Baker’s cyst or bursa may be present
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18
Q

What movements are tested in a knee examination?

A
  • knee flexion/extension (feel for patella crepitus)
  • note any fixed flexion or hyperextension of the knee
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19
Q

What special tests are carried out in a knee examination?

A
  • patellar tap test (test for effusion): fluid pushed from suprapatellar pouch, if patellar bounces then +ve
  • swipe test (test for effusion): more sensitive to smaller effusions
  • anterior/posterior draw test (ACL/PCL)
  • (posterior sag: tibia falls posteriorly if PCL ruptured)
  • lateral/medial collateral ligaments
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20
Q

What are you looking for in an ankle/foot examination?

A
  • erythema, swelling, scars
  • any evidence of psoriatic changes to nails and skin
  • note: synovitis of ankle usually produces diffuse swelling (lateral and medial malleoli contours not clear)
  • flat feet (Pes planus): can cause valgus deformity of the heel
  • hallux valgus: deformity of great toe (abducted at MTP joint)
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21
Q

What movements are tested in an ankle/foot examination?

A
  • inversion/eversion (subtalar joint)
  • plantar flexion and dorsiflexion: midtarsal joint
  • inversion/eversion: midtarsal joint (stabilise heel and move foot)
  • movements of MTP, PIP, and DIP joints should also be tested
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22
Q

What special test is performed in an ankle/foot examination?

A
  • squeeze patient’s calf to check for Achilles tendon rupture
  • +ve test: foot does not plantar flex
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23
Q

What are you looking for in a spinal examination?

A
  • patient’s posture: check for cervical lordosis, thoracic kyphosis, and lumbar lordosis
  • muscle wasting, asymmetry, scoliosis (scoliosis more clearly seen when patient bends over)
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24
Q

What are we feeling in a spinal examination?

A
  • spinous processes
  • paraspinal muscles
  • sacroiliac joints
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25
What movements do we do for cervical spine examination?
- cervical spine flexion/extension - cervical spine lateral flexion - cervical spine rotation
26
What movements do we do for thoracolumbar examination?
- thoracolumbar flexion/extension - thoracolumbar lateral flexion - thoracolumbar rotation
27
What special test do we perform in a spinal examination (tests for nerve root irritation/radiculopathy)?
- straight-leg raise - with patient supine, elevate affected leg passively (keeping it straight) - next step is to bend the knee (this will relieve tension on the nerve so symptoms should go away) - if pain radiates to foot then positive test (indicated nerve radiculopathy, eg. sciatica)
28
What do we look for in a shoulder examination?
- patient's posture and any asymmetry - muscle wasting: can be due to nerve pathology, rotator cuff tendinopathy, or chronic disuse - any swelling, scars, erythema
29
What do we palpate in a shoulder examination?
- palpate sternoclavicular, acromioclavicular, glenohumeral joints, and clavicle - feel joint temperature - any tenderness in surrounding muscles
30
What movements do we assess in a shoulder examination?
- shoulder flexion/extension - shoulder abduction/adduction - shoulder internal/external rotation - (note: hands on head with elbows back tests shoulder flexion, abduction, and external rotation) - (note: hands behind back on thoracic area tests shoulder extension, adduction, and internal rotation)
31
What does loss of passive shoulder extension and abduction?
- adhesive capsulitis (frozen shoulder) - note: frozen shoulder is an unknown disease (thought to be inflammation of the synovium within the shoulder joint which causes stiffness)
32
What does scapular winging indicate in a shoulder examination?
- scapula winging is a common sign of serratus anterior dysfunction, caused by damage to the long thoracic nerve
33
Serratus anterior and long thoracic nerve diagram...
34
What 4 muscles make up the rotator cuff?
- supraspinatus - infraspinatus - teres minor - subscapularis
35
What is the 'painful arc' in a shoulder examination?
- shoulder abduction (between 60 and 120 degrees) - pain indicates supraspinatus impingement
36
How do you test the rotator cuff muscles?
- supraspinatus: empty can test (Jobe's test) - subscapularis: resisted internal rotation - infraspinatus / teres minor: resisted external rotation
37
What does the scarf test in shoulder examination test?
- acromioclavicular joint injury
38
The elbow consists of two articulations, one provides elbow flexion/extension, the other allows wrist rotation of the wrist through 180 degrees, what are they?
- first is between humerus, radius, and ulna - second is the superior radioulnar joint
39
What are you looking for in an elbow examination?
- scars, swelling, erythema, muscle wasting - rheumatoid nodules, psoriatic plaques, olecranon bursitis
40
What are you feeling in an elbow examination?
- olecranon process, radial head, ulnar head - medial epicondyle tenderness: golfer's elbow - lateral epicondyle tenderness: tennis elbow
41
What movements are assessed in an elbow examination?
- elbow flexion/extension - pronation/supination (palm down, palm up respectively) - note: also check for hyperextension
42
How do you test for tennis elbow and golfer's elbow?
- resisted wrist extension pain: tennis elbow - resisted wrist flexion pain: golfer's elbow - (note; tenderness over lateral epicondyle is tennis elbow, tenderness over medial epicondyle is golfer's elbow)
43
What are you looking for in a hand/wrist examination?
- skin: psoriasis, nodules, scleroderma (skin tightening) - nails: pitting, onycholysis (psoriatic changes), splinter haemorrhages in vasculitis - joints: deformity/swelling, OA (DIP/PIP joints affected), RA (PIP/MCP joints affected) - muscles: thenar wasting (suggests carpal tunnel syndrome), hypothenar wasting (suggests cubital tunnel syndrome), dorsal interossei wasting (seen in RA)
44
What do we assess in the feel aspect of a wrist/hand examination?
- palpate wrist joint, MCP, PIP, DIP joints - MCP squeeze - palpate anatomical snuff box - check sensation of radial, median, and ulnar nerve distributions
45
What movements do we assess in a hand/wrist examination?
- wrist flexion/extension (prayer sign and opposite respectively) - finger flexion/extension (ask patient to make a fist) - finger abduction/adduction
46
How do you put tension on the radial, median, and ulnar nerves to test function?
- radial: wrist/finger extension against resistance - median: thumb abduction against resistance - ulnar: finger abduction against resistance
47
What special tests are performed in a hand/wrist examination?
- Tinel's test: tap on wrist over carpal tunnel - Phalen's test: hold wrist flexion for 60 seconds - assess power grip - assess pincer grip - assess picking up a small object
48
What peripheral pulses can you palpate in the upper limb?
- radial pulse - ulnar pulse
49
What peripheral pulses can you palpate in the lower limb?
- dorsalis pedis - posterior tibial
50
What is the terrible triad?
- ACL (anterior cruciate ligament) - MCL (medial collateral ligament) - meniscus
51
Does being hypermobile affect knee replacement surgery?
- yes - often the surgery will make the joint more stable but will cause more pain for the patient
52
What does localised weakness suggest and what does generalised weakness suggest?
- localised: peripheral nerve lesion - generalised: systemic cause
53
What muscle is responsible for hip flexion?
- iliopsoas
54
what muscle is responsible for knee flexion?
- quadriceps
55
What muscle is responsible for ankle dorsiflexion?
- tibialis anterior
56
What muscle is responsible for great toe extension?
- extensor hallucis longus
57
What is a common way for true hip pain to present in a patient?
- true hip pain is often felt in the groin and may radiate to the knee on movement
58
Depuytren's contracture...
- thickening of the connective tissue in the hand (often forming nodules)
59
What is De Quervain's tenosynovitis?
- De Quervain syndrome is mucoid degeneration of two tendons that control movement of the thumb and their tendon sheath - this results in pain and tenderness on the lateral (radial) aspect of the wrist
60
What is Finklestein's test?
- test for De Quervain's tenosynovitis - examiner ulnar deviates the hand/wrist and pain will be felt on the radial side of the hand/wrist
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