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Stack #13598

musculoskeletal (H&P exam)

Hallux Rigidus arthritis of the big toe
plantar heel pain most common hindfoot problem
pump bump superficial irritation of the posterior heel
sever's disease 5-7 y/o w/ heel pain from starting new sport
plantar fascitis tearing pain in the morning when 1st step out of bed
plantar fascistis tx with injection or surgery as last option
morton's neuroma swelling of small nerve bwt 3/4th toes
tarsal tunnel syndrome pain @ medial aspect of foot, worse as day goes on
inversion sprain most common ankle sprain
bony tenderness when you should order a radiograph for an ankle injury
sesamoid palpation under 1st toe
palapation of peroneal tendons outside at base of 5th metatarsal
tarsal tunnel syndrome sx worse w/ progression of day & pain shoots up foot
Dx stress fracture palpate metatarsal and push up from bottom
dx hallux rigidus reduced dorsiflexion or plantar flexion of great toe
sesamoid fracture pain under 1st metatarsal from a jump/fall
resisted inversion tests strength of posterior tibial tendon
resisted eversion test strength of peroneal muscles
L1 intact patient can push toe down against resistance
L5 intact can resist against toe dorsifelxion
ATF tears first on ankle inverison
anterior drawer test to show anterior instability of talus in ankle mortise
Thompson test sign for Achilles tendon rupture
achilles tendinitis feels like kicked in the calf
excessive pronation of the foot mechanism for posterior tibial tendinitis
posterior tibial tendinitis pain/tenderness just posterior to medial malleolus
Low back pain affects 60-80% of population at some time
breast, lung, renal, adrenal, thyroid, prostate cancers most often metastisize to bone
mylopathy or paralysis most signficant adverse outcome of spinal stenosis
cauda equina pt chg's bowel or bladder function
menigomyelocele outpuching of a nerve
causes of <10 y/o back pain leukemia, congen kyphosis, menigomyelocele
cause of teens back problems spondylolisthesis, kyphosis
cause of middle aged back problems disc injury, C-spine and L-spine herniations
cause of older peoples back problems degen, herniation, instability, tumors
low back pain in children uncommon & always warrants evaluation
nerve entrapment sx: bilateral shoulder pain
whiplash from MVA neck pain & transient numbness in the arm
entrapment of C4-C5 pain radiates to lateral shoulder
entrapment of C5-C6 pain/numness of thumb & radial aspect of forearm
entrapment of C6-C7 pain/numbness in triceps, index finger and long finger
herniated cervical disc most comfortable with hand of symptomatic arm on their head
intrinsic should problems most comfortable with arms at thier sides
SI joint or Buttock common radiation point for low back pain
trochanteric bursitis in women often mimicks sciatica
neurofibromatosis genetic disorder where tumors grow on nerve roots
spinal trauma all must have radiographic exam done
spondylolysis defect of the pars articularis
dx spondylolysis scotty dog wearing a collar
sx of spondylolysis sx worse with extension
mechanism for spondylolisthesis suddent twisting/lifting motion
sx of spondylolisthesis flexion bothers them more
dx spondylolisthesis can palpate step-off deformity
first physical sign of spondylolisthesis tightness in hamstrings
low back sprain feel twinge in back with twisting motion
#1 test for chronic low back pain physical exam
lumbar radiculopathy abrupt onset of pain, prefers to stand up for comfort
sciatica LBP w/ some degree of neurogenic dysfxn in the leg
problem w/ L4 quad weakness & decreased knee jerk reflex
problem w/ L5 foot drop b/c affects tibialis anterior
problem w/ S1 can't toe walk/achilles reflex lost
flip sign pt jerks back when leg raised due to pain
what does flip sign test herniation
femoral stretch test pt prone, then hip extension to ID pain
L5-S1 disc herniation damage to S1 nerve root
L4-L5 disc herniation damage to L5 nerve root
spinal stenosis narrowing of spinal canal
lateral recess stenosis impingement on tract where nerve root exits central canal
foramina stenosis impingement where indiv. nerve roots exit out to the body
central stenosis impingment where spinal cord and cauda equina are located
vascular claudication gets worse w/ activity & not relieved by rest
neurogenic claudication worse w/ activity but relieved by rest
improves spinal stenosis flexion of lumbar spine
romberg test eyes closed & feet together to see if pt can balance
scoliosis rotational deformity >10 degrees
forward bending most sensitive test for scoliosis
cobb angle 1st and last degree of curvature in spine
brace treatment curve >30-40 degree range o
surgery to fuse vertebra curve >50 degrees
facet arthropathy pain w/ twisting/extension w/o radiation, just localized
cause of myelopathy spinal stenosis compressing cord leads to degeneration
signs of myelopathy difficulty walking, generalized weakness, poor balance
rheumatic disorder of back ankylosing spondylitis
ankylosing spondylitis presentation stiff in AM, fatigue, young male
dx bone tumors bone scan if x-ray normal but high suspscion
HLA B27 is assoc. with this disease ankylosing spondylitis
shoulder shrug C4
deltoid muscle C5
biceps muscle C6
triceps muscle C7
finger flexors C8
finger abd/adduction T1
lateral arm sensation C5 (sensation testing)
lateral fforearm sensation C6 (sensation testing)
3rd dinger sensation C7 (sensation testing)
4th/5th finger sensation C8 (sensation testing)
medial arm sensation T1 (sensation testing)
distraction test relieves pain due to narrowing
compression test tests neural foramern, facet joints, muscle spasm
valsalva test test for herniated disc/tumor
tibialis anterior muscle testing L4 nerve root-muscle
extensor hallicus longus muscle testing L5 nerve root-muscle
peroneus longus & brevis muscle testing S1 nerve root-muscle
patellar relfex (DTRs) L4 nerve root -reflex
achilles tendon relfex (DTRs) S1 nerve root-reflex
medial leg & foot sensation L4 nerve root-sensation
lateral leg & dorsum of foot sensation L5 nerve root-sensation
lateral foot sensation S1 nerve root-sensation
#1` test for disc herniation straight leg raising test
malingerer test Hoover test
what does + SLR test indicate sciatica
+ hoover test no downward pressure thru heel
kernig test passive forward flex neck w/ pt supine
screen for meningitis kernig test
Created by: chrismcdev