The Musculoskeletal Examination in the Elderly. PPC 1-30-2007 10:00 Block 3- 2006 R Williams, MD. Objectives. Review the adult musculoskeletal examination Classify the common musculoskeletal conditions and risks inherent with aging
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PPC 1-30-2007 10:00
Block 3- 2006
R Williams, MD
Knee Effusion with obscured landmarks
Knee Effusion Causes
Ballottable Patella Sign
Knee Bulge Sign
Previous surgical scars
Knee resting position
Quadriceps muscle atrophy
Evaluate Vastus Medialis Obliquus specifically
Atrophy often on side of ligamentous injury
Tenderness to Palpation
Normal Range of Motion
Flexion: 135 degrees
Extension: 0 to 10 degrees above horizontal plane
Quadriceps Femoris Muscle Angle (Q Angle)
Patella tracking with quadriceps contraction
Evaluate for smoothness of motion and crepitationKnee exam
Evaluates for Patella Subluxation
Anterior Cruciate Ligament (ACL) Stability Tests
Lachman Test (most sensitive)
Knee Anterior Drawer Test
Pivot Shift Test (MacIntosh Test)
Posterior Cruciate Ligament (PCL) Tests
Knee Posterior Drawer Test
PCL Sulcus Test
PCL Sag Test
Collateral ligament evaluation
Knee Valgus Stress Test (Medial collateral ligament)
Knee Varus Stress Test (Lateral collateral ligament)
Apley's Compression Test and Apley's Distraction Test
Balanced weight on each leg
Genu Varum or Genu Valgum deformity
Patella baja or patella alta deformity
Hip, Knee, and ankle alignmentKnee exam
A joint capsule is a watertight sac that surrounds a joint. In the shoulder, the joint capsule is formed by a group of ligaments that connect the humerus to the glenoid.. These are the glenohumeral ligaments (GHL) Another ligament links the coracoid to the acromion - coracoacromial ligament (CAL). This ligament can thicken and cause Impingement Syndrome Ligaments attach the clavicle to the acromion in the AC joint. Two ligaments connect the clavicle to the scapula by attaching to the coracoid process, a bony ridge on the scapula - coracoclavicular ligaments (CCL) Ligaments of the Shoulder Complex:
1. Rise from sitting position
2. Walk 10 feet
3. Turn around
4. Return to chair and sit down
Patient takes <20 seconds to complete test=Adequate for independent transfers and mobility
Patient requires >30 seconds to complete test= Suggests higher dependence and risk of falls
MCP inguinal ligament--a possible site of nerve compression
Note the involvement of the DIP (Distal Interphalangeal) followed by PIP (Proximal Interphalangeal) and relative sparing of the MCP (Metacarpal Phalangeal) joints.
Swelling, tenderness, and crepitus on movement of the joint are typical. Osteophytes may lead to a "squared" appearance of the thumb base. In contrast to Heberden's nodes, which usually do not interfere significantly with function, thumb base OA frequently causes loss of motion and strength. Pain with pinch leads to adduction of the thumb and contracture of the first web space, often resulting in compensatory hyperextension of the first metacarpophalangeal joint and swan-neck deformity of the thumb.
OA of the base of the thumb
OA of the knee may involve the medial or lateral femorotibial compartment and/or the patellofemoral compartment.
Palpation may reveal bony hypertrophy (osteophytes) and tenderness.
Effusions, if present, are generally small.
Joint movement commonly elicits bony crepitus.
OA in the medial compartment may result in a varus (bow-leg) deformity; in the lateral compartment it may produce a valgus (knock-knee) deformity.
A positive "shrug" sign (pain when the patella is compressed manually against the femur during quadriceps contraction) may be a sign of patellofemoral OA.
Risk factors: low calcium intake, smoking, alcoholism, certain medications.
Both men and women lose predominantly cancellous (vertebral) bone.