HAPE Exam 4 Lower MSK 2024 complete
update A+ graded
Synovial Joint - Extent of Movement and Examples - Freely movable (diarthrotic)
Ex = hinge, pivot, saddle, etc; specific ex = knee, shoulder
Cartilaginous Joint - Extent of Movement and Examples - Slightly movable
(amphiarthrotic); found at midline's
Ex = vertebral bodies, symphysis of pubis, sternomanubrial joint
Fibrous Joint - Extent of Movement and Examples - Immovable (synarthrotic)
Ex = skull sutures
Joints connect what to what - Bone to bone
Ligaments connect? Tendons connect? - Ligaments attach bone to bone
Tendons attach muscle to bone
Main parts of synovial joint - Internal parts (Articular structures)
-Articular cartilage covering ends of each bone within the joint
-Synovial cavity: space separating each bone within the joints
-Synovial membrane: lines synovial cavity and secretes synovial fluid into the synovial
cavity
-Fibrous joint capsule: capsule surrounding the entire outer part of joint, also helping
connect bones
External portions (Extra-articular structures of joint)
-ligament: further helps connect bone to bone
Articular shape, movement, and example of spheroidal, ball & socket joint - Articular
shape: convex surface in concave cavity
Movement (multiaxial): flexion, extension, abduction, adduction, rotation, circumduction
Examples: hip, shoulder
,Articular shape, movement, and example of hinge joint - Articular shape: flat, planar
Movement (uniaxial): motion in one plane; flexion & extension
Examples: interphalangeal joint of hand and foot, elbow
Articular shape, movement, and example of condylar joint - Articular shape: convex or
concave
Movement (biaxial): movement of two articulating surfaces, not dissociable
Examples: metacarpophalangeal joint, TMJ, condylar
Surface of cartilaginous joints are covered with _________________________. Some
examples are - Surfaces of cartilaginous joints are covered with hyaline cartilage. Some
examples are intervertebral joints and pubic symphysis
Fibrous joints definition and example - -intervening layers of fibrous tissue or cartilage
that hold two bones tight together so much that the bones are almost touching
-not movable (synarthrotic)
-ex = cranial sutures
Bursae are disc shaped synovial sacs that facilitate joint movement. Bursae allow
adjacent muscles to glide over one another during movement, thus reducing friction.
Bursae can lie between (1) ____ and _____ or (2) ____ and ____ - (1) betw skin and
convex surface of bone or joint
(2) in betw areas where tendons or muscles rub against bone, ligaments, or other
tendons and muscles
An example of a bursa that lies between the convex surface of a bone or joint and the
outer lying skin is - prepatellar bursae betw patellar bone and skin
An example of bursa betw areas where (a) tendons or muscles rub against (b) bone,
ligaments, or other tendons and muscles is... - the subacromial bursa
Articular vs. Extra-articular Structures. Difference and example - Articular refers to items
within the joint itself
While extra-articular refers to structures outside the joint, that facilitate connection or
movement, thus helping the articular structures within the joint to work properly
Articular structures: synovial cavity, synovial membrane / fluid, articular cartilage, fibrous
joint capsule, intra-articular ligaments, juxta articular bone
Extra-articular structures: periarticular ligaments (bone to bone), tendons (muscle to
bone), bursae
Terminology for...
pain in 1 joint, 2-4 joints, 4+ joints - 1 joint: monoarticular
2-4 joints: oligoarticular or pauciarticular (Gr and La prefix for few)
4+: polyarticular
4 cardinal features of inflammation - swelling, warmth, redness, pain
, Stiffness - perceived tightness
Symptoms associated with inflammation and limitation in movement - fever, rash,
fatigue, weight loss, weakness
Process, pattern of spread, pain, onset, swelling, warmth, morning stiffness, and
general symptoms of rheumatoid arthritis vs osteoarthritis - Process: RA is autoimmune;
OA is degenerative
Pattern of spread: RA is multiple joints; OA isolated to one joint
Pain: RA pain at rest bc autoimmune so all the time; OA is relieved with rest bc resting
the degenerative joint
Onset: RA is weeks to months bc abnormal immune response doesnt take long to
develop; OA onset is years bc slow degenerative
Swelling: RA includes subcutaneous nodules, most likely accumulation of WBCs; OA is
boney enlargement
Warm Feeling: RA often feels warm prob due to inflammation from auto-immune
response; OA is rarely warm bc its just a degenerated bone
Morning stiffness: RA > 30 minutes; OA < 30 minutes
General symptoms: RA = weakness, fatigue, fever, prob just feel sick again bc auto-
immune; OA besides bone related pain
MSK Physical Exam: Overview of Steps - Inspect, Palpate, Range of Motion, Special
Tests, Evaluate neurologic and vascular integrity such as pulses, sensation, and
strength
MSK Physical Exam: What do you inspect for? - Deformity, swelling or effusion, scars,
inflammation, muscle atrophy, using contralateral side for comparison
MSK Physical Exam: What do you palpate for? - localized tenderness or fluid collection
MSK Physical Exam: Active vs Passive ROM - Active: patient performs
Passive: provider does movements for pt and notes effect
Remember its active and passive from the patient's POV
MSK Special Tests differ for each joint, which means the provider must think about the
anatomy of each joint while performing the tests. Special tests specifically look for
__________________________________ - joint stability and integrity of ligaments and
tendons
Gait Evaluation. Describe difference between stance phase and swing phase. - Stance
"stand" phase: foot is planted, bearing body weight; hip abductors are required to
stabilize pelvis during stance phase; stance is 60% of normal gait
Swing phase: foot moving forward, non weight bearing (40% of normal gait cycle)
Stance phase includes these 4 parts - heel strike, foot flat, midstance, push off
update A+ graded
Synovial Joint - Extent of Movement and Examples - Freely movable (diarthrotic)
Ex = hinge, pivot, saddle, etc; specific ex = knee, shoulder
Cartilaginous Joint - Extent of Movement and Examples - Slightly movable
(amphiarthrotic); found at midline's
Ex = vertebral bodies, symphysis of pubis, sternomanubrial joint
Fibrous Joint - Extent of Movement and Examples - Immovable (synarthrotic)
Ex = skull sutures
Joints connect what to what - Bone to bone
Ligaments connect? Tendons connect? - Ligaments attach bone to bone
Tendons attach muscle to bone
Main parts of synovial joint - Internal parts (Articular structures)
-Articular cartilage covering ends of each bone within the joint
-Synovial cavity: space separating each bone within the joints
-Synovial membrane: lines synovial cavity and secretes synovial fluid into the synovial
cavity
-Fibrous joint capsule: capsule surrounding the entire outer part of joint, also helping
connect bones
External portions (Extra-articular structures of joint)
-ligament: further helps connect bone to bone
Articular shape, movement, and example of spheroidal, ball & socket joint - Articular
shape: convex surface in concave cavity
Movement (multiaxial): flexion, extension, abduction, adduction, rotation, circumduction
Examples: hip, shoulder
,Articular shape, movement, and example of hinge joint - Articular shape: flat, planar
Movement (uniaxial): motion in one plane; flexion & extension
Examples: interphalangeal joint of hand and foot, elbow
Articular shape, movement, and example of condylar joint - Articular shape: convex or
concave
Movement (biaxial): movement of two articulating surfaces, not dissociable
Examples: metacarpophalangeal joint, TMJ, condylar
Surface of cartilaginous joints are covered with _________________________. Some
examples are - Surfaces of cartilaginous joints are covered with hyaline cartilage. Some
examples are intervertebral joints and pubic symphysis
Fibrous joints definition and example - -intervening layers of fibrous tissue or cartilage
that hold two bones tight together so much that the bones are almost touching
-not movable (synarthrotic)
-ex = cranial sutures
Bursae are disc shaped synovial sacs that facilitate joint movement. Bursae allow
adjacent muscles to glide over one another during movement, thus reducing friction.
Bursae can lie between (1) ____ and _____ or (2) ____ and ____ - (1) betw skin and
convex surface of bone or joint
(2) in betw areas where tendons or muscles rub against bone, ligaments, or other
tendons and muscles
An example of a bursa that lies between the convex surface of a bone or joint and the
outer lying skin is - prepatellar bursae betw patellar bone and skin
An example of bursa betw areas where (a) tendons or muscles rub against (b) bone,
ligaments, or other tendons and muscles is... - the subacromial bursa
Articular vs. Extra-articular Structures. Difference and example - Articular refers to items
within the joint itself
While extra-articular refers to structures outside the joint, that facilitate connection or
movement, thus helping the articular structures within the joint to work properly
Articular structures: synovial cavity, synovial membrane / fluid, articular cartilage, fibrous
joint capsule, intra-articular ligaments, juxta articular bone
Extra-articular structures: periarticular ligaments (bone to bone), tendons (muscle to
bone), bursae
Terminology for...
pain in 1 joint, 2-4 joints, 4+ joints - 1 joint: monoarticular
2-4 joints: oligoarticular or pauciarticular (Gr and La prefix for few)
4+: polyarticular
4 cardinal features of inflammation - swelling, warmth, redness, pain
, Stiffness - perceived tightness
Symptoms associated with inflammation and limitation in movement - fever, rash,
fatigue, weight loss, weakness
Process, pattern of spread, pain, onset, swelling, warmth, morning stiffness, and
general symptoms of rheumatoid arthritis vs osteoarthritis - Process: RA is autoimmune;
OA is degenerative
Pattern of spread: RA is multiple joints; OA isolated to one joint
Pain: RA pain at rest bc autoimmune so all the time; OA is relieved with rest bc resting
the degenerative joint
Onset: RA is weeks to months bc abnormal immune response doesnt take long to
develop; OA onset is years bc slow degenerative
Swelling: RA includes subcutaneous nodules, most likely accumulation of WBCs; OA is
boney enlargement
Warm Feeling: RA often feels warm prob due to inflammation from auto-immune
response; OA is rarely warm bc its just a degenerated bone
Morning stiffness: RA > 30 minutes; OA < 30 minutes
General symptoms: RA = weakness, fatigue, fever, prob just feel sick again bc auto-
immune; OA besides bone related pain
MSK Physical Exam: Overview of Steps - Inspect, Palpate, Range of Motion, Special
Tests, Evaluate neurologic and vascular integrity such as pulses, sensation, and
strength
MSK Physical Exam: What do you inspect for? - Deformity, swelling or effusion, scars,
inflammation, muscle atrophy, using contralateral side for comparison
MSK Physical Exam: What do you palpate for? - localized tenderness or fluid collection
MSK Physical Exam: Active vs Passive ROM - Active: patient performs
Passive: provider does movements for pt and notes effect
Remember its active and passive from the patient's POV
MSK Special Tests differ for each joint, which means the provider must think about the
anatomy of each joint while performing the tests. Special tests specifically look for
__________________________________ - joint stability and integrity of ligaments and
tendons
Gait Evaluation. Describe difference between stance phase and swing phase. - Stance
"stand" phase: foot is planted, bearing body weight; hip abductors are required to
stabilize pelvis during stance phase; stance is 60% of normal gait
Swing phase: foot moving forward, non weight bearing (40% of normal gait cycle)
Stance phase includes these 4 parts - heel strike, foot flat, midstance, push off
