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