Approach to the MSK pt - Exam 1 Flashcards
______ is often the most important factor in diagnosing musculoskeletal problems
history
What does an articular symptom classification entail? What will the pt complain of?
includes the synovium, synovial fluid, articular cartilage, intra-articular ligaments, joint capsule, and juxta-articular bone
Deep, diffuse pain, limited active and passive ROM, instability, “locking,” deformity
What does an nonarticular symptom classification entail? What will the pt likely complain of?
supportive extra-articular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin
Usually not painful in passive ROM, focal tenderness that can radiate, but not typically associated with swelling, crepitus, instability, or deformity of the joint itself
What will inflammatory symptom classification entail? give some examples of common dz that fall under this category?
cardinal symptoms include erythema, warmth, pain and/or swelling
infections, gout, RA, SLE, rheamatic fever, reactive arthritis
What will non-inflammatory symptom classification entail? what are some examples of common dz that fall under this category?
Pain without synovial swelling or warmth, absence of inflammatory or systemic features, daytime, intermittent gel phenomena rather than prolonged morning stiffness, and normal (for age) or negative laboratory investigations
Degeneration (OA), pain amplification (fibromyalgia), trauma (rotator cuff tear), repetitive use (bursitis), benign neoplasm (pigmented villonodular synovitis)
What are important to note about the “Inspection” part of the MSK exam?
Swelling
Erythema
Atrophy
Deformity
Scars/skin
SEADS
have the pt point to the area of maximal pain/tenderness
need to look at both sides of the body, everyone’s anatomy is different
Before you palpate, you should ask your pt to?????
point to area that hurts the most!
locate point of maximal tenderness
_______ is used to measure ROM. What are 3 different types of ROM?
goniometer
active, passive and active-assistive
What joints are good to use the goniometer on? Which ones are LESS USEFUL? why?
good:
Elbow
Wrist
Digits
Knee
Ankle
Great toe
BAD:
hip
shoulder
Overlying soft tissue structures don’t allow for as much precision
What are the different grades of manual muscle testing?
When would you need to assess neurovascular status?
in a trauma pt
What are the dermatomes from the lecture in class? mytomes?
consider memorizing this if you have time
When assessing a long bone xray, what other xray views are neccessary?
include joint above and below
What are indications for an xray?
History of trauma
Deformity of a bone or joint
Inability to use the joint or extremity
Unexplained pain and localized tenderness to a bone or joint
Abnormal asymmetry or mass
Evaluation of foreign bodies
What imaging modality has the highest bony detaile?
CT
What are the indications for a CT? What is the weight limit for a CT?
Pre-operative planning
Complex or intraarticular fracture patterns
Evaluation of bone tumors
Bone and joint aspirations/infections
450lbs
What are the advantages of an MRI? MRI are beneficial for evaluation of ______, ______ and _____
Advantage of soft-tissue detail
think: muscles, tendons, menisci and discs
tumors, osteonecrosis and stress fractures
What are the indications for an MRI?
Spinal column pathology
Tendon and ligament injuries
Meniscal and cartilaginous injuries
Stress and occult fractures
Osteomyelitis/-necrosis
Soft tissue and bony tumors
What are the indications for an US?
Joint effusions
Tendinopathy
Ligament pathology
Soft-tissue masses
Infantile hip dysplasia
What is an scintigraphy? What does it examine?
bone scan
Examines blood flow and metabolic activity of bone to assess bone formation/destruction
What are the indications for scintigraphy?
Infection of the bones/joints said good for joint infections in lecture
Fractures
Metastatic bone disease
Tumors
Metabolic bone disease
Bone death
What is a myelography? When is it used?
Involves injection of a contrast medium into the spinal subarachnoid space followed by continuous x-rays (fluoroscopy)
Indicated to detect pathology of the spinal cord: Level of injury, infection, tumor, cysts or herniated disk
good for pt who cannot undergo MRI
What is an arthrography? What joints are used most commonly?
Imaging (often CT/MRI/fluoroscopy) of a joint following the injection of contrast medium. Provides a clear image of the soft tissue borders of the joint
aka good for checking on joint spaces, if a tear is present the dye will leak out of the joint space
hip and knee
What is a PET scan? When is it indicated?
Imaging test that uses a radioactive glucose tracer to look for disease in the body
Indicated to identify metastatic malignant lesions
When is an arthrocentesis indicated? What is the goal?
Indicated in patients who have an effusion or signs suggesting inflammation or infection within the joint
to determine the source of the effusion, pulling fluid off the joint and sending it off for cultures
**Draw the synovial fluid analysis chart on how to interpret a synovial fluid analysis
What is the indication for a muscle biopsy?
Indicated in muscle weakness and low muscle tone to distinguish between myopathies and neuropathies
What are some common lab studies ordered for MSK complaints? What are the indications for each?
Would order ______ if there is a moderate suspicion of RA
serum rheumatoid factor
______ is ordered when clinical suspicion is high for ankylosing spondylitis (young adults 20-30 years old M > F)
HLA-B27
What is ankylosing spondylitis?
Ankylosing spondylitis (AS) is a chronic autoimmune disease that causes inflammation in the spine and other areas of the body
What are some indications for an EMERGENCY referral?
neurovascular injury
open/unstable fractures
unreduced joint dislocation
septic arthritis
What 3 lab markers will be increased in septic arthritis?
increased WBC, CRP and ESR
What are indications for an URGENT referral? within 7 days
Closed and stable fractures
Reduced joint dislocation
“Locked” joint
Tumor
What are indications for an EARLY referral?
Motor weakness
Constitutional symptoms (not due to other conditions)
Multiple joint involvement
What are the indications for a ROUTINE referral?
Failure of conservative treatment and
Persistent symptoms >3 months
Persistent numbness and tingling in an extremity
