MUSCULOSKELETAL, DERM, EYE,
PEDIATRIC & AGING REVIEW
1. Bone, Muscle & Joints
● Compact bone: Dense, strong outer layer; long-bone shafts.
● Trabecular bone: Spongy; vertebrae/epiphyses; more vulnerable to osteoporosis.
● Osteoblasts: Build bone.
● Osteoclasts: Resorb/break down bone.
● Osteocytes: Maintain/sense bone stress.
● PTH: ↑ Ca²⁺ through bone resorption.
● Calcitonin: ↓ Ca²⁺ by inhibiting osteoclasts.
● Vitamin D: ↑ Ca absorption/mineralization.
● Muscle: Myofibrils contain actin + myosin; contraction requires Ca²⁺ + ATP.
● Type I: Slow/endurance. Type II: Fast/power.
● Synarthrosis: Immovable. Amphiarthrosis: Slight movement. Diarthrosis: Freely
movable/synovial.
2. Musculoskeletal Special Tests
Shoulder
● Apprehension: Anterior instability.
● Relocation: Relief with posterior pressure → anterior instability.
● Neer/Hawkins: Shoulder impingement.
● Drop-arm: Supraspinatus/rotator cuff tear.
Hip/Leg
● Straight-leg raise/Lasegue: L5-S1 radiculopathy/sciatica; pain 30–70°.
● FABER/Patrick: Hip or SI pathology.
● Limited painful internal/external rotation: Hip/femoral neck fracture.
● Chair-rise: Proximal muscle weakness.
● Froment: Ulnar nerve palsy.
● Windlass: Plantar fasciitis.
Knee
● Anterior drawer: ACL.
, ● Posterior drawer: PCL.
● Valgus stress: MCL.
● Varus stress: LCL.
● McMurray: Meniscal tear.
3. Lower-Extremity Reflexes/Motor
● Patellar: L2–L4/femoral → knee extension.
● Achilles: S1–S2 → plantarflexion.
● Babinski: Adult toe extension/fanning = UMN lesion.
● Dorsiflexion: L4-L5/tibialis anterior.
● Plantarflexion: S1/gastrocnemius-soleus.
4. Fracture Types
● Complete: Entire bone fractured.
● Comminuted: ≥3 fragments.
● Compression: Bone collapses; common in osteoporosis.
● Transverse: Horizontal break.
● Greenstick: Incomplete; common in children.
● Spiral: Twisting injury; consider abuse in children.
● Avulsion: Tendon/ligament pulls off bone fragment.
5. Common Fractures
● Smith: Distal radius + volar displacement; fall on flexed wrist; garden-spade deformity.
● Colles: Distal radius + dorsal displacement; FOOSH; dinner-fork deformity.
● Clavicle: Usually middle third; fall/direct blow; deformity; X-ray.
● Hip: Groin pain, inability to bear weight; shortened + externally rotated leg; X-ray →
MRI if occult.
● Femur: Severe thigh pain/deformity; high-energy trauma; risk fat embolism; X-ray;
surgical fixation.
6. Musculoskeletal Disorders
● Lyme: Borrelia/tick; erythema migrans → neurologic/cardiac symptoms → arthritis;
ELISA/confirmatory testing; doxycycline.
● Carpal tunnel: Median nerve compression; thumb–middle finger numbness, worse at
night; Phalen/Tinel; splint → injection/surgery.
● DDD: Disc degeneration/herniation; back pain/radiculopathy; MRI; PT/NSAIDs.
● Osteomalacia: Vit D deficiency → poor mineralization; bone pain; ↓Vit D/Ca/phosphate,
↑ALP.
PEDIATRIC & AGING REVIEW
1. Bone, Muscle & Joints
● Compact bone: Dense, strong outer layer; long-bone shafts.
● Trabecular bone: Spongy; vertebrae/epiphyses; more vulnerable to osteoporosis.
● Osteoblasts: Build bone.
● Osteoclasts: Resorb/break down bone.
● Osteocytes: Maintain/sense bone stress.
● PTH: ↑ Ca²⁺ through bone resorption.
● Calcitonin: ↓ Ca²⁺ by inhibiting osteoclasts.
● Vitamin D: ↑ Ca absorption/mineralization.
● Muscle: Myofibrils contain actin + myosin; contraction requires Ca²⁺ + ATP.
● Type I: Slow/endurance. Type II: Fast/power.
● Synarthrosis: Immovable. Amphiarthrosis: Slight movement. Diarthrosis: Freely
movable/synovial.
2. Musculoskeletal Special Tests
Shoulder
● Apprehension: Anterior instability.
● Relocation: Relief with posterior pressure → anterior instability.
● Neer/Hawkins: Shoulder impingement.
● Drop-arm: Supraspinatus/rotator cuff tear.
Hip/Leg
● Straight-leg raise/Lasegue: L5-S1 radiculopathy/sciatica; pain 30–70°.
● FABER/Patrick: Hip or SI pathology.
● Limited painful internal/external rotation: Hip/femoral neck fracture.
● Chair-rise: Proximal muscle weakness.
● Froment: Ulnar nerve palsy.
● Windlass: Plantar fasciitis.
Knee
● Anterior drawer: ACL.
, ● Posterior drawer: PCL.
● Valgus stress: MCL.
● Varus stress: LCL.
● McMurray: Meniscal tear.
3. Lower-Extremity Reflexes/Motor
● Patellar: L2–L4/femoral → knee extension.
● Achilles: S1–S2 → plantarflexion.
● Babinski: Adult toe extension/fanning = UMN lesion.
● Dorsiflexion: L4-L5/tibialis anterior.
● Plantarflexion: S1/gastrocnemius-soleus.
4. Fracture Types
● Complete: Entire bone fractured.
● Comminuted: ≥3 fragments.
● Compression: Bone collapses; common in osteoporosis.
● Transverse: Horizontal break.
● Greenstick: Incomplete; common in children.
● Spiral: Twisting injury; consider abuse in children.
● Avulsion: Tendon/ligament pulls off bone fragment.
5. Common Fractures
● Smith: Distal radius + volar displacement; fall on flexed wrist; garden-spade deformity.
● Colles: Distal radius + dorsal displacement; FOOSH; dinner-fork deformity.
● Clavicle: Usually middle third; fall/direct blow; deformity; X-ray.
● Hip: Groin pain, inability to bear weight; shortened + externally rotated leg; X-ray →
MRI if occult.
● Femur: Severe thigh pain/deformity; high-energy trauma; risk fat embolism; X-ray;
surgical fixation.
6. Musculoskeletal Disorders
● Lyme: Borrelia/tick; erythema migrans → neurologic/cardiac symptoms → arthritis;
ELISA/confirmatory testing; doxycycline.
● Carpal tunnel: Median nerve compression; thumb–middle finger numbness, worse at
night; Phalen/Tinel; splint → injection/surgery.
● DDD: Disc degeneration/herniation; back pain/radiculopathy; MRI; PT/NSAIDs.
● Osteomalacia: Vit D deficiency → poor mineralization; bone pain; ↓Vit D/Ca/phosphate,
↑ALP.
