Common Musculoskeletal Complaints from Head to Toe Flashcards
Spurling/Foraminal compression test (4)
to confirm cervical radiculopathy
position patient with the neck extended and head rotated
apply downward pressure on the head
test is positive if pain radiates into the limb ipsilateral to the side to which the head is rotated
What are some of the most common causes of shoulder pain in primary case settings? (4)
Impingement syndrome 70%
Adhesive capsulitis 12%
A/C joint OA
Bicipital tendonitis
What is impingement syndrome?
Impingement syndrome describes a condition in which the tendons of the rotator cuff of the shoulder are pinched as they pass between the top of the upper arm (humerus) and the tip of the shoulder (acromion)
History in impingement syndrome (5)
- Any age, but risk increases with age
- Anterior or lateral shoulder pain
- Should not radiate below elbow
- Pain exacerbated by abduction and forward flexion
- Night pain common
Specific maneuvers to confirm impingement diagnosis (3)
Painful arc
Empty can
Neer’s
Supraspinatus Tendon Tear (6)
- Positive “Drop-Arm” Test
- Supraspinatous weakness
- External rotation weakness
- Impingement signs
- Greater than 60 years old + Empty Can, impingement signs (+ Neers) and over age 60 = 98% chance of having a tear!
What are some risk factors for adhesive capsulitis/frozen shoulder (4)
- Diabetes,Hypothyroidism,
- AVN of glenohumeral head
- Reflex Sympathetic Dystrophy (RSD)
- Immobility
Characteristics of adhesive capsulitis/frozen shoulder (6)
- Insidious onset of pain
- Pain in most planes of movement
- Pain in deltoid, but no tenderness to palpation
- Pain and limited active and passive ROM ( Need AP X-ray of glenohumeral joint to rule out glenohumeral arthritis
- Nightpain
- Pts need PT; consider injection or surgery in more
History in low back pain (8)
- Prior injuries
- Mechanism of current injury, if present
- Was it job-related … is litigation involved?
- Location of pain
- Any radiation of pain?
- Exacerbating/alleviatingfactors
- What has the patient tried in the way of activity or medications?
- History of cancer, recent fever, or weight loss
Some DDx for low back pain
- degenerative disk
- herniated disk
- spinal stenosis
- visceral disease (pelvic, renal, aortic aneurysm)
- neoplasia
- congenital disease
- traumatic fracture
- inflammatory Arthritis
Red flags for low back pain
- recent significant trauma, or mild trauma if older than 50
- unexplained weight loss
- unexplained fever or UTI
- IV use
- immunosuppression
- osteoporosis
- glucocorticoids
- old age
- motor or sensory deficit which is progressive
- duration longer than 6 weeks
- history of cancer
- saddle anestesia, bilateral sciatica, urination/defecation difficulties
Low back pain physical exam
Observe patient walking into room
Check vital signs
Do pulse and BP correlate with the amount of pain patient is reporting?
Inspect the back
Palpate/percuss
Evaluate muscle bulk in back, buttocks, and legs
Test for manual strength
Reflex testing
Rectal exam if bowel/bladder complaints
Tests for low back pain
Straight leg and crossed straight leg
Piriformis syndrome
Patrick’s test
FABERE sign
Do we obtain imaging studies in patients with non-specific low back pain?
Don’t Obtain Imaging Studies in Patients with Nonspecific Low Back Pain
“In patients with back pain that cannot be attributed to a specific disease or spinal abnormality following a history and physical
examination (eg, non-specific low back pain), imaging with plain radiography, computed tomography (CT) scan, or magnetic resonance imaging (MRI) does not improve patient outcomes.”
Common causes of chronic knee pain (3)
*Osteoarthritis/degenerative tears Patellofemoral syndrome
* Pes anserine bursitis
* Inflammatory causes (eg, rheumatoid arthritis)
