2024/2025
1. 3 types of joints:
1. Synovial (freely movable, knee and shoulder)
2. Cartilaginous (slightly movable, vertebral bodies, symphysis pubis, sternomanubr-
ial joint)
3. Fibrous (immovable, skull sutures)
2. Types of synovial joints: 1. Ball and socket (shoulder/hip)
2. Hinge (wrist, interphalangeal joints of hands/foot)
3. Condylar (knee, temporomandibular joint)
3. Tips for assessing joint pain: 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. Clarify the attributes of each symptom including context, associations, etc.
5. Symptom analysis
4. Describe the following types of pain
Muscle
Nerve root
Nerve Sympathetic nerve
Bone
Fracture
Vascular: 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
5. Red flags for lower back pain: 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
6. Shoulder pain can be two nonmusculoskeletal reasons: Referred abdominal pain
Cardiac pain
7. Hawkins test
Indication
Movement
Positive: Subacromial impingement
90 degree arm, 90 degree elbow flexed
Forcibly internally rotate
Positive if pain, nerve burning
8. Empty can test
Indication
Movement
Positive: Impingement, rotater cuff tear
ARms elevated 90 degrees, then internally rotate 30 degrees (dumping out cans) Resist
abduction
Unable, positive
9. Apley's test
Indication
Movement
Positive: Rotator cuff tendonitis
REach overhead, reach behind as far as possible
10. Apprehension test
Indication
Movement
Positive: Arm at 90 degrees, shoulder at 90 degrees, abducted.
Externally rotate patient's arm, look for slipping, apprehension, resistance Anterior joint
instability
11. Lateral epichondylitis: tennis elbow
12. Medial epichondylitis: golfer's elbow