Bates-MSK Flashcards
rank of low back pain among reasons for clinical visits and rank for most common symptom of patients seeking care
5th highest reason
articular disease
involves swelling and tenderness of entire joint and limits both active and passive ROM
extra-articular disease
involves selected regions of the joint and types of movement
ligaments connect
bone to bone
list articular structures
joint capsule and articular cartilage, synovium and synovial fluid, intra-articular ligaments, juxta-articular bone
list extra-articular structures
periarticular ligaments, tendons, bursae, muscles, fascia, bone, nerve, overlying skin
tendons connect
muscle to bone
bursae
pouches of synovial fluid that cushion movement of tendons and muscles over bone or other joints
synovial joints
bones do not touch each other- joint articulations are freely moveable
cartilaginous joints
vertebral bodies
fibrous joints
- skull sutures
spheroidal (bone and socket)
- convex surface in concave cavity
hinge
- flat, planar
condylar
- convex or concave
fraction of adults with low back pain
2/3
what percentage of patients have idiopathic back pain
85%
think what for midline back pain
musculoligamentous injury, disc herniation, vertebral collapse, spinal cord metastases, epidural abscess
think what for off the midline pain
sacroiliitis, trochanteric bursitis, sciatica, hip arthritis
presentation of sciatica
radicular gluteal and posterior leg pain in S1 distribution that increases with cough or fever
presentation of spinal stenosis
leg pain that resolves with rest and/or lumbar forward flexion
presentation of cauda equina syndrome
bowel or bladder dysfunction (esp urinary retention and overflow incontinence)
red flags for serious underlying systemic disease
- age >50
probability of serious systemic disease in cases of LBP (low back pain) plus a red flat
10%
most common radicular pain in the neck region
spinal cord compression C7 followed by C6
usual cause of radicular pain in the neck
foraminal impingement from degenerative joint changes (not herniation)
pain in one joint suggests
trauma, monoarticular arthritis, tendinitis, bursitis
lateral hip pain near greater trochanter suggests
trochanteric bursitis
migratory pattern of spread seen when
rheumatic fever or gonococcal arthritis
progressive additive pattern with symmetric involvement
RA
presentation of acute septic arthritis or gout
severe pain of rapid onset in a red, swollen joint; maybe osteomyelitis in kids
fever, chills, warmth, redness seen in?
septic arthritis, gout, rhematic fever
gelling
stiffness and limited motion after inactivity in degenerative joint disease but usually lasts only a few minutes
stiffness lasting 30 minutes or more
RA
systemic findings common in these arthritides
RA, SLE, PMR
papules, pustules, vesicles on reddened bases, on distal extremities
conococcal arthritis
expanding erythematous patch early in illness
Lyme
hives
serum sickness, drug rxn
erosions or scale on the penis and crusted, scaling papules on soles and palms
Reiter’s syndrome- arthritis, uveiitis, urethritis
red, burning, itchy eyes
Reiter’s; Behcet’s syndrome
diarrhea, abdominal pain, cramping
arthritis with UC, regional enteritis, scleroderma
urethritis
reiter’s; gonococcal
percentage of americans who are lazy as shit and live sedentary lifestyles
20- 30%
vulnerable area of the lower back involved with lifting
L5-S1
what percentage of the population experiences low back pain in life
60-80%
leading cause of non-fatal injuries and account for rise in death rates after age 65
falls
general population vs. 65-74 y.o. population vs. 85+ population for death rates related to falls
5/100,000
fraction of patients who regain prior level of function and of those who require nursing home placement
1/3 each
how many americans have osteoporosis and how many are at increased risk
10 million
what percentage of patients with osteoporotic hip fractures die within 1 year
20%
osteopenia on the bone density scale
1.0-2.5 standard deviations below the mean for young adult white women
osteoporosis on bone density scale
2.5 or more standard deviations below the mean for young adult white women
who uses Z scores as a better measure
young people, because it allows comparison with those of similar, age, ht, wt
where is bone density measured
hip, femoral neck, Ward’s triangle, greater trochanter, total hip
what drop in bone density is assd with what increase in risk for fracture
10% drop in bone density is assd with a 20% increase in risk for fracture
statistics for those with osteoporosis vs osteopenic groups and fracture risk
relative risk is higher in those with osteoporosis but almost half of all fragility fractures occur in osteopenic group
risk factors for osteoporosis
- postmenopausal white women
treatment for osteoporosis
- calcium
subcutaneous nodules seen in
RA or rheumatic fever
effusions seen in
trauama
crepitus over inflamed joints
osteoarthritis
conditions where there is decreased ROM
arthritis, inflammation, fibrosis around joint, bony fixation (ankylosis)
palpable bogginess or doughiness of synovial membrane
synovitis; accompanied by effusion
osteomyelitis
arthritis, tendinitis, bursitis
DDx for nonarticular condition
- trauma/fracture
possibilities if chronic noninflammatory arthritis that does not involve DIP, CMC1, hip, or knee joints
- osteonecrosis
possibilities if chronic inflammatory arthritis involving 1-3 joints
- indolent infection
most active joint in the body
TMJ
what makes up the TMJ
fossa and articular tubercle of temporal bone and condyle of mandible
principle muscles that open the mouth
external pterygoids
muscles that close the mouth and their innervation
cranial nerve V
DDx for pain with chewing
TMJ
dynamic stablers of the shoulder
SITS
function of SItS muscles
move the humerus and depress and stabilize humeral head in glenoid fossa
statis stabilizers of shoulder
bone, labrum, articular capsule, glenohumeral ligaments
labrum
fibrocartilaginous ring that surrounds the glenoid and deepends its socker
articular capsule
formed by tendons of rotator cuff- adds to stability
Supraspinatus
- runs above glenohumeral joint; inserts on greater tubercle
infraspinatus and teres minor
-cross glenohumeral joint posteriorly; insert on greater tubercle
subscapularis
- originates on anterior surface of scapula and crosses joint anteriorly; inserts on lesser tubercle
axioscapular group
- attaches the trunk to the scapula
axiohumeral group
- attaches trunk to humerus
principal bursa of the shoulder
subacromial bursa- between acromion and head of humerus and overlying supraspinatus
when will subacromial bursa be painful if inflamed
abduction and rotation
shoulder muscles of flexion
anterior deltoid, pectoralis major, coracobrachialis, biceps brachii
shoulder muscles- extension
lat, teres major, posterior deltoid, triceps brachii
shoulder muscles- abduction
supraspinatus, middle deltoid, serratus anterior