Questions and Answers
What is the primary function of articular cartilage in a joint?
To act as a cushion for the underlying bone
Which of the following structures is NOT an articular structure?
Tendons
What is the purpose of synovial fluid in a joint?
To provide nutrition to the adjacent articular cartilage
What is the term for the pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures?
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What is an important question to ask when taking a musculoskeletal health history?
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What is the primary function of the vertebral body in the spine?
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What is the primary goal of characterizing pain using the OLD CARTS method?
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Which of the following structures serves as a site of muscle attachment?
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What is the most likely diagnosis for a patient with a worsening stiff, painful neck and lateral deviation of the head towards the shoulder?
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What is the cutoff point for distinguishing between acute and chronic pain?
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What type of joint pain is characterized by worsening pain with rest?
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What is the primary function of the intervertebral disk?
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What is the purpose of the Look, Feel, and Move technique in joint examination?
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Which of the following maneuvers would confirm a likely diagnosis of winged scapula?
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What is the name of the device used to measure joint range of motion?
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During a musculoskeletal examination, the clinician instructs the patient to look over one shoulder, and then the other shoulder. This action assesses the movement of which muscle?
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What is the purpose of the Spurling test in spine examination?
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What is the primary function of the vertebral arch?
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Which of the following conditions is characterized by increased flexion of the thoracic vertebrae?
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What is the recommended screening age for osteoporosis in women according to the USPSTF?
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What is the primary function of the spinous process?
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What is the T score range for osteopenia?
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What is the primary muscle being assessed when the patient is asked to flex the neck during an active range of motion evaluation?
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What is the primary action of the scalene muscle?
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What structure in the spine supports the body's weight?
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Study Notes
Joint Anatomy
- Articular structures: joint capsule, articular cartilage, synovium, synovial fluid, intra-articular ligaments, and juxta-articular bone
- Articular cartilage: composed of collagen matrix, charged ions, and water, allowing it to change shape in response to pressure or load, acting as a cushion for underlying bone
- Synovial fluid: provides nutrition to adjacent relatively avascular articular cartilage
- Extra-articular structures: periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin
- Ligaments: rope-like bundles of collagen fibrils connecting bone to bone
- Tendons: collagen fibers connecting muscle to bone
- Bursae: pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures
Types of Joints
- Not specified in the text, but there are different types of joints (e.g. synovial, cartilaginous, fibrous)
Musculoskeletal Health History
- Ask about pain: location, characteristics (using OLD CARTS), and mechanism of injury
- Goal: determine if the pain is articular (joint) or extra-articular (outside joint), acute or chronic, inflammatory or non-inflammatory, and localized or diffuse
Common Causes of Joint Pain by Age
- Not specified in the text, but different age groups may have different common causes of joint pain
Spine Pain Questions
- Ask about location, radiation into shoulders/legs, arm or leg weakness, and bladder or bowel dysfunction
- Red Flags for Low Back Pain: not specified in the text, but important to identify any signs of serious underlying conditions
Techniques of Exam
- Three broad sections: Look (visual), Feel (palpation), Move (evaluation of joint movement)
- Inspect: look for deformity, asymmetry, swelling, scars, inflammation, or muscle atrophy
- Palpate: feel surface landmarks, crepitus
- Range of Motion: move actively by patient then by examiner
- Special Maneuvers: if indicated
Measuring Joint Range of Motion
- Use a goniometer to measure joint range of motion
- Helps determine how much range of motion is present or not present and can show improvement over time
Joint Exams
- Temporomandibular Joint Exam: not specified in the text
- Shoulder Joint Exam: includes inspection, palpation, range of motion, and special maneuvers
- Shoulder Joint Range of Motion: not specified in the text
- Shoulder Special Tests: not specified in the text
- Elbow Examination: not specified in the text
- Wrist/Hand Examination: includes Finkelstein's Test, De Quervain Tenosynovitis, Carpal Tunnel Syndrome, Tinel and Phalen Signs, Allen Test, and Arterial Blood Supply to Hand
Osteoarthritis vs Rheumatoid Arthritis
- Not specified in the text, but important to differentiate between these two conditions
Spine Examination
- Neck Pain Assessment and Causes: not specified in the text
- Low Back Pain Assessment and Causes: not specified in the text
- Spine Special Tests: includes Spurling Test
Health Promotion
- USPSTF grade B recommendation on osteoporosis screening for women 65 and older or younger women with higher fracture risk
- Osteoporosis: T score < -2.5, osteopenia: T score between -1 and -2.5
- Risk factors for Osteoporosis: not specified in the text
- Osteoporosis Screening: not specified in the text
- Osteoporosis Prevention: not specified in the text
- Calcium and Vitamin D Recommendations: not specified in the text
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