Types of synovial joints - ANS 1. Ball and socket/shoulder/hip
2. Hinge/wrist, interphalangeal joints of hands/foot
3. Condylar/knee, temporomandibular joint
Tips to evaluate joint pain - ANS 1. Point to the pain
2. Clarify onset, mechanism of injury, activity
3. Articular or extraarticular, acute or chronic, inflammatory or noninflammatory,
localized monoarticular or diffuse polyarticular
4. Describe each symptom- circumstances, associated factors, etc.
5. Symptom interpretation
Symptom Interpretation
Describe the following types of pain
Muscle
Nerve root
Nerve
Sympathetic nerve
Bone
Fracture
Vascular - ANSWER Muscle: dull, cramping, aching
,Nerve root: sharp shooting
nerve: sharp, lightening like
Sympathetic: burning, pressure like, stinging
Bone: deep nagging, dull
Fracture: sharp, severe, intolerable
Vascular: throbbing, diffuse
Red flags for lower back pain - ANSWER Age <20 or >50
History of cancer
Unexplained weight loss, fever, or general decline in health
Pain lasting >1mo, unresponsive to treatment
Pain worse at night or present at rest
history of IVDA, addiction, immunosuppression
Presence of active infection or HIV
Long term steroid therapy
Saddle anesthesia
Bladder or bowel incontinence
Neurological deficits
Lower extremity weakness
Shoulder pain can be two nonmusculoskeletal reasons - ANSWER Referred abdominal
pain
Cardiac pain
Hawkins test
Indication
Movement
, Positive - ANSWER Subacromial impingement
90 degree arm, 90 degree elbow flexed
Forcibly internally rotate
Positive if pain, nerve burning
Empty can test
Indication
Movement
Positive - ANSWER Impingement, rotater cuff tear
ARms elevated 90 degrees, then internally rotate 30 degrees (dumping out cans)
Resist abduction
Unable, positive
Apley's test
Indication
Movement
Positive - ANSWER Rotator cuff tendonitis
REach overhead, reach behind as far as possible
Apprehension test
Indication
Movement
Positive - ANSWER Arm at 90 degrees, shoulder at 90 degrees, abducted.
Externally rotate patient's arm, look for slipping, apprehension, resistance
Anterior joint instability
Lateral epichondylitis - ANSWER tennis elbow
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