Adult - Musculoskeletal Flashcards
connecting bone to bone
ligament
connecting muscle to bone
tendon
dense connective tissue with no blood supply
cartilage
contusion
bruise
hematoma
bruise you can feel
strain has to do with -
muscle and associated tendon
sprain has to do with -
joint
Non-pharm management for acute musculoskeletal injury
RICE
rest - ice - compression - elevation
Pharm management of acute musculoskeletal injury
3 to 4 rule -
3 to 4 ibuprofen
3 to 4 times a day
3 to 4 days
What lab should be checked before high dose NSAID?
BUN and especially creatinine
celecoxib (Celebrex)
class?
caution?
COX-2
not used much
cousin Vioxx caused valve problems
What is naproxen typically used for?
more chronic pain
metaxalone (Skelaxin)
class?
muscle relaxant
Ultram
what is generic?
class?
tramadol
narcotic
Vicodin / Lortab / Lorcet
what is generic?
class?
hydrocodone + acetaminophen
narcotic
Tylenol #3
what is generic?
class?
acetaminophen + codeine
narcotic
Percocet / Tylox
what is generic?
class?
acetaminophen + oxycodone
narcotic
Typical meniscal tear presentation?
“locking”
immediate and significant swelling after injury (grapefruit within 30 minutes)
McMurray’s test
patient recumbent, audible/palpable click when, with foot externally rotated, knee is flexed and then extended with one hand on the joint line
+ for medial meniscal tear
MMM - mcmurray - medial meniscal
Lachman’s test
otherwise known as drawer test
knee at 20-30` put anterior force to proximal tibia
graded 1+ to 3+
assessing anterior and posterior cruciate ligament (ACL-PCL)
LL - lachman - ligament
Apley’s grind test
patient PRONE
knee 90` rotate lower leg internally and externally
pain or click = + for medial or lateral collateral ligament
damage and/or meniscal injury
Which type of arthritis can be assessed with bloodwork?
rheumatoid
Diagnostics for knee pain -
bloodwork only if RA is suspected
Xray to evaluate joint
MRI only if really needed and after Xray
Ankle sprain involves what type of structure?
ligaments - stretched, partially torn, or completely ruptured
How are ankle sprains classified?
Grade 1 - 2 - 3
What level of mobility impairment is present with each of the grades of ankle sprain?
grade 1 - no impairment
grade 2 - difficulty walking
grade 3 - impossible to ambulate
Diagnostics for ankle sprain
consider X-ray to rule out fracture
MRI if unresolved in a few days and after X-ray
What is a common cause of muscle strain?
repetitive movement resulting in inflammation
Signs and symptoms of muscle strain
pain during ROM
edema
ecchymosis
Definition of bursitis
inflammation of the small fluid filled cushion in a joint
Olecranon bursitis affects the –
elbow
Subdeltoid/subacromial bursitis affects the –
shoulder
Ischial bursitis affects the –
ischial tuberosity at the base of the pelvis
Prepatellar bursitis affects the –
front of the knee cap
What is the characteristic pain found with bursitis?
pain with MOVEMENT
What diagnostics are considered if infection is a concern with bursitis?
o aspiration - with gram stain and C & S
o WBC
What is the management of bursitis?
o splinting o RICE o heat x 30 min TID o NSAIDS o steroid injection
What is the total number of steroid injections, for all sites total, that a patient should have? Why?
3 total per year
o can break down joint surface
o can trigger Addisonian crisis
