NR511 Final Musculoskeletal
ACL strength test (lachman test) - correct answer-1. Resists translocation of tibia foward
(anteriorly)
2. Knee in slight flexion
3. Grasps at ankle behind calf
4. Pull tibia forward
5. Positive: Drawer sign (tibia slides out anteriorly)
6. Check right and left!! To compare, range of normal is wide.
Acromioclavicular (A/C) Sprains Causes - correct answer-1. Direct trauma
2. Excessive pushing/pulling of the upper extremity
3. Fall while the arm is abducted
4. Indirect trauma
5. Classified into 6 grades
Acromioclavicular (A/C) Sprains history - correct answer-1. young males
2. Patients will often report pain on adduction or abduction past 90 degrees.
Acromioclavicular (A/C) Sprains Imaging - correct answer-1. X-rays can be performed to
assess A/C distance. 2. 2. Normal acromioclavicular distance 1-3 mm (distance shrinks with
age)
3. Compare X-ray with uninjured side.
Acromioclavicular (A/C) Sprains physical - correct answer-1. Point tenderness over A/C joint
2. Swelling
3. Possible deformities
Acromioclavicular (A/C) Sprains Treatment - correct answer-1. Types I & II injuries are
treated non-operatively with 1-3 weeks of NSAIDs and sling.
2. Type III injuries controversially trend toward non-operative management.
3. Types IV, V, & VI injuries: surgery
Acute musculoskeletal injuries - correct answer-1. Less than 6 weeks
2. Spasm
3. Strain
4. Sprain
Acute pain - correct answer-1. Less than 3 mos
2. Sharp, throbbing, burning
3. Intense at first and slows down
4. Edema at first
5. Disappears with healing
6. Localized
7. Result of something specific
,Adhesive Capsulitis diagnosis - correct answer-1. AP & axillary x-rays of the shoulder:
smooth, concentric joint surfaces with intact cartilage space and rule out other pathology
(osteophytes, calcification, tumors)
2. If xray normal: CT, MRI, and arthrography rarely indicated (done by orthopedics)
Adhesive Capsulitis History - correct answer-1. Tight, painful shoulder joint with idiopathic
loss of both active and passive ROM.
2. Risk Factors: 40-60 years old, diabetes (especially Type I)
3. Without predisposing factors possible underlying organic or neoplastic disease.
4. Underlying conditions include: Parkinson's, stroke, tumors and cervical disk herniation
5. Recuperation can take 6 months to 24 months.
6. Decreasing discomfort associated with increasing improvement in function.
Adhesive Capsulitis Physical - correct answer-1. Loss of active and passive ROM
2. Pain and tenderness with motion at deltoid insertion
3. May also have diffuse tenderness over the shoulder
Adhesive Capsulitis Treatment - correct answer-1. Moist heat
2. Non-narcotic analgesics
3. Physical therapy to restore function (long recovery time is possible)
4. No improvement after 6-12 weeks: refer to orthopedics
Allen's test - correct answer-1. Purpose: patency of radial and ulnar arteries and arterial arch
2. Compress radial artery at wrist
3. Have pt rapidly open and close hand several times.
4. Have pt open hand (hand should be pale/white)
5. Release pressure from artery
6. Hand should flush, indicating patency
Ankle sprain Diagnostics - correct answer-1. Anterior drawer test
2. Varus stress test
3. Radiograph tests (a. ankle pain and tenderness over posterior 6cm or tip of post. or lat.
malleolus, b. midfoot pain and tenderness over navicular or base of fifth metatarsal, c.
midfoot or ankle pain and unable to take four steps immediately and in ER.)
Ankle sprain findings - correct answer-1. Swelling, deformity
2. Discoloration
3. Palpate for tenderness
4. Compare ROM with unaffected foot
5. Crepitus is sign of fracture
Ankle sprain risk factors - correct answer-1. 1/2 occur in athletics
2. Men 19-24
3. Women greater than 30
4. Overall equal men to women
Ankle sprain treatment - correct answer-1. PRICE
2. Ice (or ice immersion) immediately after and every few hours for first 48 hrs.
, 3. Elastic bandage/splint to stabilize ankle against inversion and eversion stress.
4. Limited activity until pain and swelling subside
5. NSAIDs
6. Ankle strengthening for prevention
Apley scratch test - correct answer-Shoulder ROM test
1. Abduction and external rotation: pt reach behind head and touch superior aspect of
opposite scapula
2. Adduction and Internal rotation: pt reach behind back and touch the inferior aspect of the
opposite scapula.
Apprehension sign - correct answer-1. Purpose: Tests patellar instability
2. Seated with quads relaxed, knee in extension
3. Displace patella laterally and then flex knee 30 degrees.
4. Instability: this maneuver displaces patella to abnormal position on lateral femoral condyle,
causes pain and apprehension
Articular pain - correct answer-1. Deep or diffuse pain
2. Limited ROM (active and passive)
3. Swelling
4. Crepidation
5. instability
6. locking
debility
Avascular Necrosis - correct answer-1. Abrupt hip pain followed by progressive, intermittent
episodes.
2. Worse: motion and activity, nighttime
3. Limp, limited abduction and inernal rotation
4. MRI and ortho referral required
5. Complication of hip trauma (or unrelated)
Boutonniere deformity - correct answer-1. Rupture of central portion of extensor tendon at its
insertion into the middle phalanx.
2. Finger is held partially flexed at PIP joint and extended or hyperextended at DIP joint.
3. Contractures possible
4. Commonly seen in RA
Bulge test - correct answer-1. Apply lateral pressure to area adjacent to patella
2. Medial bulge will appear if fluid is in knee.
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