Physical Exam Principles
Spine
Shoulder
Lower Extremity
Elbow, Wrist, Hands
Anatomy
100
what is the least common sign of inflammation?
redness
100
What is the abnormal lab marker for ankylosing spondylitis?
HLB-27
Discuss: bamboo spine -> fusion
100
how would you palpate the subacromial bursa?
passively extend the humerus and lift the elbow posteriorly
100
What gait abnormality can be described as lack of knee flexion or foot dorsiflexion?
circumduction
Discuss: wide-based, painful, and trendelenburg gait
100
Adduction force is applied at the distal forearm to test the radial collateral ligament.
What test is this?
Varus stress test
100
Where is the sciatic nerve palpated?
In between the greater trochanter and ischial tuberosity (within the sciatic notch)
Hip would be flexed and pt laying on the opposite side.
200
What is the stretching or tearing of ligaments that are attached to bone?
Sprains
Discuss: What are strains?
200
What test would be done for cervical radiculopathy?
Spurling test
Discuss: Lumbar radiculopathy?
200
What is this:
calcium salts in the supraspinatus that ellicit acute pain in 30-60 year old women.
Calcific Tendonitis
Discuss: Bicipital tendonitis
200
You perform a test on a pt for minor effusion to the knee joint, what test would you perform?
Bulge sign
Discuss: What is the major effusion tests (2)?
200
a 70 year old man presents with swelling and inflammation superficial to the olecranon process. He is complaining of fever and pressure at the site of injury.
What are we thinking?
olecranon bursitis
200
Where does the subscapularis muscle insert?
lesser tuberacle
all the other rotator cuff muscles insert on the greater
300
What is an oligoarticular joint injury?
injury involving 2-4 joints
Discuss: one joint =
five or more joints=
300
Pt presents with pain and numbness in the buttocks and legs when walking but that is relieved when bending over. What is the most likely condition?
Lumbar Stenosis
"shopping cart sign"
300
Which test assesses overall shoulder rotation?
Apley Scratch test
if pain is elicited -> impingement tests
300
What tests are performed to assess a potential ACL injury?
Anterior drawer sign and Lachman test
Discuss: what about PCL test?
medial and lateral meniscus tests?
300
Compare tennis elbow vs golfers elbow. What are the medical terms.
lateral epicondylitis = tennis, repetitive EXTENsion of the wrist or pronation-supinations of forearm
medial epicondylitis = golfers, repetitive wrist FLEXion
300
We can collect stem cells in bone marrow transplants and bone grafts from this anatomical location
Iliac Crest
Also found at L4 - a spot for epidurals, spinal taps
400
If the pt presents with MSK inflammation with fever and chills - what should we be thinking? (according to the slides)
septic arthritis/ crystalline arthritis
400
A 60 yr old female has pain with side bending and extending the lower back (not responding to pain management), MRI shows a loss of disc space height. What is the most likely condition?
Facet Joint Arthritis
400
Which test / impingement maneuver would you perform to assess the supraspinatus for tendinitis?
Painful arc, Hawkins, Drop-arm, Empty can
400
A 30 yr old female complains of achy diffuse knee pain after running. She is experiencing knee pain and popping when walking down the stairs.
What is the Dx?
Chondromalacia Patella
400
pt presents with numbness, tingling, and pain within the median forearm and ring finger after a prolonged period of elbow flexion. What is your dx?
Cubital tunnel syndrome
400
How is leg length discrepancy measured?
from the ASIS to the medial malleolus
500
Name 2 conditions with symmetric joint involvement
RA, SLE, Ankylosing spondylitis
Bonus: what are the asymmetric conditions?
500
PT presents with pain that is worse in AM, has pain when bending forward, and decreased patellar DTR. What are we thinking?
Degenerative Disc Disease
Discuss: How is this different from Degenerative Joint Disease?
500
Pt presents with a positive drop arm test and a shoulder shrugging effort with limited abduction. What does this suggest?
A complete tear within rotator cuff
Discuss: Partial tear s/s
500
Pt presents with an autoimmune condition that has caused clawed toes and tenderness on the ball of the foot. What would be your leading Dx?
Rheumatoid arthritis
500
a clinician is instructing a patient to hold their wrists together in flexion (backs of the hands) for 60 seconds.
What is the test and what is a positive sign?
Phalens test - + sign= numbness and tingling in the median nerve distribution within 60 seconds
Discuss: Tinels Sign
500
which muscles supinate the arm? which muscles pronate the arm?
supinate = biceps brachii and supinator
pronate = pronator teres and pronator quadratus
600
What are some inflammatory causes of MSK conditions?
Infectious (Neisseria gonorrhoeae, TB), Gout, Immune related (SLE, RA), reactive, idiopathic
600
Pt has cervical radiculopathy because of foramina narrowing at C7. Upon palpation the spinous processes were tender, pain described as burning and stabbing. Loss of sensation in the pinky is reported. What could be the cause?
Herniated Disc
Discuss: how does the presentation differ from spinal stenosis?
600
What is the difference between the painful arc test and the neer impingement sign test?
both pain provocation tests
Painful arc = testing impingement of the supraspinatus tendon and subacromial bursa beneath the acromion. + between 60-120
Neer impingement sign = trying to impinge subacromial structure with humeral head, compressing the greater tuberosity against the acromion. Any pain is a positive test for subacromial impingement and rotator cuff tendonitis
600
What kind of stress is this?
What is the order of injury (the ligaments)?
Valgus
mcl -> acl -> medial meniscus
600
a 50 year old diabetic man presents to urgent care with a lump in his hand and the inability to extend his ring finger. When prompted, the hand could not be placed flat.
What is your dx?
Dupuytren contracture
600
what four muscles insert at the tibial tuberosity (via patella)?
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
700
How can you tell the difference between articular joint pain vs non-articular joint pain
Articular joint pain - Decreased active AND passive ROM. Deep aching stiffness in the morning, diffuse (can't pinpoint). includes swelling, warmth, erythema, crepitus, or instability. EX: Rheumatoid arthritis, osteoarthritis, gout, septic arthritis
Non-articular pain - Passive ROM remains intact. Easier to locate/point to. Tenderness restricted to one side of the joint, no generalized swelling. EX: Tendinitis, bursitis, myofascial pain, injury to ligaments
700
Upon physical exam pt has + Hoffman's sign and hyperreflexia, clonus and neck and leg stiffness. Pt complains of an acute onset of balance and coordination problems.
What are your differentials?
Cauda Equina Syndrome
Discuss: hallmark buzzwords of CES
700
What differentiates between Adhesive capsulitis and bursitis clinically (s/s) ?
Adhesive Capsulitis: dull diffuse pain, progressive restrictive ROM, fibrosis of GH joint
Bursitis: pain may be gradual or sudden. Often seen with injury, infection, or rheumatic condition. may lead to adhesive capsulitis
700
How could you differentiate between polymyalgia rheumatica and osteoarthritis in a clinical vignette?
PMR = inflammatory
improvement with movement
tx - low dose corticosteroids
OA = degenerative
improvement with rest
tx - exercise, wt loss, meds, surgery
700
What is a condition that presents as inflammation of the flexor tendon sheaths that occurs from the distal phalanx to the mtp joint?
What are the most common infectious agents?
Acute Tenosynovitis
Staphylococcus, Streptococcus, Gonorrhea, Candida, Albicans
700
what muscles are within the deep group of anterior forearm (flexor/ pronator compartment) ?
FPL - flexor pollicis longus
FDP - flexor digitorum profundus
PQ - pronator quadratus