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level: Musculoskeletal System

Questions and Answers List

level questions: Musculoskeletal System

Question	Answer
Fibrous: sutures of the skull Cartilaginous: between vertebrae and pubic symphysis Synovial: 6 types	Type of joints and where they are found
Elbow and knee Flexion and extension	Hinge joint
Rotation of bone around one another Atlas and axis	Pivot joint
Shoulder and hip joints	Ball and socket
Carpal-metacarpal joint at base of thumb Circumduction!	Saddle joint
Movement of 2 articulating surfaces not dissociable Wrist, Metacarpal-phalanges and metatarsals-phalanges, knee, temporomandibular	Condyloid
Intercarpal joints	Gliding
1. Articular / extra-articular 2. Acute (<6 weeks) or chronic (> 6 weeks) 3. Inflammatory or non inflammatory 4. Localized (monoarticular) or diffuse (polyarticular)	What 4 terms should you characterize the patient's complaint regarding the musculoskeletal system?
Joint capsule Articular cartilage Synovium Synovial fluid Intra-articular ligaments Juxta-articular bone	What are the articular structures
Provides nutrition to the adjacent relatively avascular articular cartilage Cushion	What is the function of the synovial fluid
Limits both active and passive range of motion due to either stiffness or pain. Typically involves some of the following: 1. swelling and tenderness of the entire joint 2. crepitus 3. instability 4. "locking" 5. deformity	Articular disease
1. Periarticular ligaments (collagen fibrils, bone-bone) 2. tendons (collagen fibers muscle-bone) 3. bursae (pouches of synovial fluid, cushion movements of tendons and muscles over bone) 4. muscle 5. fascia 6. bone 7. nerve 8. overlying skin	Extra-articular structures
Typically involves 1. point or focal tenderness in regions adjacent to articular structures 2. limits active range of motion (sprains) Rarely causes swelling, instability or joint deformity	Extra-articular disease
Found in cartilaginous joints at the center of each fibrocartilaginous discs separating the bony surfaces Serves as a cushion or shock absorber between bony surfaces	Nucleus pulposus
Knee: prepatellar bursa Soulder: subacromial bursa	Where can you find bursae?
pain in a muscle or group of muscles	Myalgia
pain in the joint, but no evidence of arthritis	arthralgia
interleukins TNF	What factors are involved in inflammatory joint pain?
prostaglandins chemokines GF	What factors are involved in noninflammatory joint pain?
1. swelling 2. warmth 3. redness (least common sign) 4. pain (fever and chills in some types of arthritis)	What are the 4 cardinal features of inflammation?
abnormal loss of bony tissue resulting in fragile porous bones attributable to a lack of calcium; most common in postmenopausal women T score <-2.5	Osteoporosis
NEXUS Canadian C-spine rule	What criteria are used to assess for cervical spine injury?
Midline: disc herniation, vertebral collapse, spinal cord metastases Off the midline: muscle strain, renal stones Gluteus or posterior leg: sciatica (s1) increases with Valsalva and cough Bladder/bowl dysfunction: cauda equina syndrome (s2-4)	Location of low back pain and their possible cause
age <20 or >50 History of cancer Unexplained weight loss, fever or decline in general health Pain lasting >1 month Pain at night or present at rest IV drugs, addiction or immunosuppression	red flags for low back pain
Psychosocial factors e.g. anxiety, depression, work stress	What are the "yellow flags" of low back pain?
Postmenopausal status in women Age >50 Low BMI Low dietary calcium intake Vitamin D deficiency Tobacco and excessive alcohol use Immobilization (inadequate physical activity)	Risk factors for osteoporosis
A previous low-impact fracture from standing height or lower	What is the greatest risk factor for subsequent fractures?
Active: by the patient Passive: by the examiner	What are active and passive movements?
audible or palpable crunching during movement of tendons or ligaments over bone or areas of cartilage loss. Occurs in joints without pain but is significant when associated with symptoms	Crepitus
chronic inflammation of synovial membranes with secondary erosion Symmetrically additive pain pattern spread (progresses to other joints while persisting in initial joints) Tender and warm (not red)	rheumatoid arthritis
1. Gonococcal arthritis 2. Rheumatic fever	If patient complains of migratory pain pattern in the musculoskeletal system, what is this indicative of?
1. Vertebral fraction 2. Hip 3. distal radial (forearm)	Most common fractures in elderly?
a clinical sign found in patients with infection of a flexor tendon sheath in the hand affected finger is in slight flexion it is painful to palpate or percuss affected finger pain with passive extension fusiform swelling over affected tendon can cause rapid loss of function of affected finger	kanavel's sign
Gait Arms Legs Spine	GALS
Capable of movement SITS muscles of rotator cuff 1. supraspinatus 2. infraspinaturs 3. teres minor 4. subscapularis	Dynamic stabilizers of the shoulder girdle
Incapable of movement labrum, articular capsule and glenohumeral ligament	Static stabilizers of shoulder girdle
1. glenohumeral joint: ball and socket 2. sternoclavicular joint: 3. acromioclavicular joint	Joints of the shoulder
an abnormal lateral curve to the vertebral column may cause elevation of one shoulder	scoliosis
A mechanical neck pain Aching paracervical pain and stiffness, often occurs the day after injury Musculoligamentous sprain/strain from forced hyperflexion Decreased neck range of mtion	Whiplash
shooting pain below the knee, accompanies low back pain (often with associated paresthesia and weakness) Cause: disc herniation, intervertebral disc	sciatica
metastatic malignancy to the spine from cancer of prostate/breast/lung/thyroid/kidney Loss of normal lumbar lordosis	nocturnal back pain unrelieved by rest