NR509 Musculoskeletal GUARANTEED PASS
synovial joints - (ANSWER)freely movable joints
ex. knee, shoulder
cartilaginous joints - (ANSWER)allow only slight movement and consist of bones connected
entirely by cartilage
ex. vertebral bodies of the spine, symphysis pubis
Fibrous joints - (ANSWER)Immovable
ex: skull sutures
Synovial Joint Anatomy - (ANSWER)Articular cartilage lines the bone surface, changes in shape
in response to pressure or load
Synovial cavity - cushions joint movement
Synovial membrane -secretes synovial fluid
synovial fluid - lubrication and nutrition to articular cartilage
Joint capsule strengthened and sometimes continuous with ligaments
types of synovial joints - (ANSWER)Spheroidal (ball & socket) - wide ROM ex shoulder hip
Hinge - flat/planar (flex, extend) ex foot, elbow, knee, TMJ
Condylar - Metacarpals and metatarsals
Bursae - (ANSWER)flattened fibrous sacs lined w/synovial membrane, contains synovial fluid;
common where things rub together (skin to bone or tendons/muscles on bone, ligaments, tendons
or other muscles)
Articular structures include: - (ANSWER)joint capsule, articular cartilage, synovium, synovial
fluid, intra-articular ligaments, juxta-articular bone
Extraarticular structures include - (ANSWER)periarticular ligaments, tendons, bursae, muscle,
fascia, non-articular bone, nerves, and overlying skin
Pathology of articular structures typically involves - (ANSWER)swelling, tenderness, crepitus,
instability, 'locking' or deformity and limits BOTH active & passive ROM
Pathology involving extra-articular structures ... - (ANSWER)Rarely causes intraarticular joint
swelling, instability or joint deformity, typically involves 'point or focal tenderness' in regions
adjacent to joint articular structures
ONLY ACTIVE ROM LIMITED, passive intact
Considerations for monoarticular pain - (ANSWER)Injury, monoarticular arthritis
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, OR
extraarticular causes such as tendinitis, bursitis or soft tissue injury
Considerations for oligoarticular (pauciarticular pain) - (ANSWER)consider infection from
gonorrhea or rheumatic fever, connective tissue disease and OA
Polyarthritis possible causes - (ANSWER)Viral, inflammatory from RA, SLE, or psoriasis
inflammatory joint disorders - Rest vs activity - (ANSWER)Rest tends to worsen the pain, where
as activity tends to improve the pain
Ex. RA, psoriatic arthritis, SLE, goat, ankylosing spondylitis
mechanical joint disorders - Rest vs activity - (ANSWER)Activity tends to increase the pain and
stiffness, and rest improves symptoms
Ex: OA, low back disorders, tendinitis
Extra-articular pain occurs in ... - (ANSWER)inflammation of bursae (bursitis), tendons
(tendinitis), or tendon sheaths (tenosynovitis) as well as in sprains from stretching or tearing of
ligaments.
Differentials for LBP on the midline - (ANSWER)musculoligamentous injury, disc herniation,
degenerative disc disease (DDD), degenerative disease of the facet joints of spine, vertebral
fracture or collapse; and rarely, spinal cord metastases or epidural abscess
Differentials for LBP off of the midline - (ANSWER)muscle strain, myofascial pain (trigger
points), sacroiliitis, greater trochanteric pain syndrome, and hip arthritis
also consider renal conditions like pyelonephritis or stones
cauda equina syndrome - (ANSWER)Due to S2-S4 midline disc herniation or tumor if there is
bowel or bladder dysfunction, especially with saddle anesthesia or perineal numbness.
serious condition where the terminal portion of the spinal cord is compressed. If left untreated, it
can lead to permanent loss of bowel/bladder function as well as lower extremity paralysis.
Immediate imaging and surgical intervention needed
Red flags for LBP from underlying systemic disease - (ANSWER)Age <20 or >50
H/o cancer
unexplained weight loss, fever, or decline in general health
pain lasting > 1 mo or not responding to tx
pain at night or present at rest
h/o IV drug use, addiction, or immunosuppression
presence of active infection or HIV infection
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synovial joints - (ANSWER)freely movable joints
ex. knee, shoulder
cartilaginous joints - (ANSWER)allow only slight movement and consist of bones connected
entirely by cartilage
ex. vertebral bodies of the spine, symphysis pubis
Fibrous joints - (ANSWER)Immovable
ex: skull sutures
Synovial Joint Anatomy - (ANSWER)Articular cartilage lines the bone surface, changes in shape
in response to pressure or load
Synovial cavity - cushions joint movement
Synovial membrane -secretes synovial fluid
synovial fluid - lubrication and nutrition to articular cartilage
Joint capsule strengthened and sometimes continuous with ligaments
types of synovial joints - (ANSWER)Spheroidal (ball & socket) - wide ROM ex shoulder hip
Hinge - flat/planar (flex, extend) ex foot, elbow, knee, TMJ
Condylar - Metacarpals and metatarsals
Bursae - (ANSWER)flattened fibrous sacs lined w/synovial membrane, contains synovial fluid;
common where things rub together (skin to bone or tendons/muscles on bone, ligaments, tendons
or other muscles)
Articular structures include: - (ANSWER)joint capsule, articular cartilage, synovium, synovial
fluid, intra-articular ligaments, juxta-articular bone
Extraarticular structures include - (ANSWER)periarticular ligaments, tendons, bursae, muscle,
fascia, non-articular bone, nerves, and overlying skin
Pathology of articular structures typically involves - (ANSWER)swelling, tenderness, crepitus,
instability, 'locking' or deformity and limits BOTH active & passive ROM
Pathology involving extra-articular structures ... - (ANSWER)Rarely causes intraarticular joint
swelling, instability or joint deformity, typically involves 'point or focal tenderness' in regions
adjacent to joint articular structures
ONLY ACTIVE ROM LIMITED, passive intact
Considerations for monoarticular pain - (ANSWER)Injury, monoarticular arthritis
Page 1 of 12
, OR
extraarticular causes such as tendinitis, bursitis or soft tissue injury
Considerations for oligoarticular (pauciarticular pain) - (ANSWER)consider infection from
gonorrhea or rheumatic fever, connective tissue disease and OA
Polyarthritis possible causes - (ANSWER)Viral, inflammatory from RA, SLE, or psoriasis
inflammatory joint disorders - Rest vs activity - (ANSWER)Rest tends to worsen the pain, where
as activity tends to improve the pain
Ex. RA, psoriatic arthritis, SLE, goat, ankylosing spondylitis
mechanical joint disorders - Rest vs activity - (ANSWER)Activity tends to increase the pain and
stiffness, and rest improves symptoms
Ex: OA, low back disorders, tendinitis
Extra-articular pain occurs in ... - (ANSWER)inflammation of bursae (bursitis), tendons
(tendinitis), or tendon sheaths (tenosynovitis) as well as in sprains from stretching or tearing of
ligaments.
Differentials for LBP on the midline - (ANSWER)musculoligamentous injury, disc herniation,
degenerative disc disease (DDD), degenerative disease of the facet joints of spine, vertebral
fracture or collapse; and rarely, spinal cord metastases or epidural abscess
Differentials for LBP off of the midline - (ANSWER)muscle strain, myofascial pain (trigger
points), sacroiliitis, greater trochanteric pain syndrome, and hip arthritis
also consider renal conditions like pyelonephritis or stones
cauda equina syndrome - (ANSWER)Due to S2-S4 midline disc herniation or tumor if there is
bowel or bladder dysfunction, especially with saddle anesthesia or perineal numbness.
serious condition where the terminal portion of the spinal cord is compressed. If left untreated, it
can lead to permanent loss of bowel/bladder function as well as lower extremity paralysis.
Immediate imaging and surgical intervention needed
Red flags for LBP from underlying systemic disease - (ANSWER)Age <20 or >50
H/o cancer
unexplained weight loss, fever, or decline in general health
pain lasting > 1 mo or not responding to tx
pain at night or present at rest
h/o IV drug use, addiction, or immunosuppression
presence of active infection or HIV infection
Page 2 of 12
