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Primary > Diagnosis and Management of Musculoskeletal Disorders > Flashcards

Diagnosis and Management of Musculoskeletal Disorders Flashcards

1
Q

____ _____ _____:
An injury that occurs in non-osseous structures of the musculoskeletal system, such as muscles, bursa, ligaments (the fibrous connective tissue that connects bone to bone), tendons (the fibrous connective tissue that connects muscle to bone) or cartilage (dense connective tissue with no blood supply)

A

Soft Tissue Injuries

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2
Q

Classification of Injuries

  1. Abrasions
  2. ________
  3. Hematomas
  4. Lacerations/tears
  5. ______
  6. Sprains
A

2) Contusions

5) Strains

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3
Q 
Management 
1.  \_\_\_\_\_\_ (\_\_\_) 
   of the injured part
2. Immobilization may be necessary; dependent on location, severity, and type of injury 
a.    Casts
b.    Splints
c.    Immobilizers
d.    Slings
A
  1. R-I-C-E (i.e., rest, ice, compression, elevation)
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4
Q 
Sprain treatment:
Pharmacologic Interventions
1. NSAIDs for mild to moderately severe 
   injuries:
• a) Ibuprofen: \_\_\_\_ mg TID to QID
• b) \_\_\_\_\_\_ : 250 to 500 mg every day in 
       divided doses
• c) COX-2 inhibitor: \_\_\_\_ (Celebrex)
2. Muscle relaxants: \_\_\_\_\_\_ (Skelaxin) 
    800 mg BID or TID 
3. Narcotics for short term use:
•   a) \_\_\_\_\_\_ (Ultram): Narcotic-like
•   b) Hydrocodone + acetaminophen 
         (Vicodin, Lortab, Lorcet) • 
     c) Acetaminophen + codeine (Tylenol # 
         3)
•   d) \_\_\_\_\_\_\_\_\_\_\_ (Percocet, 
         Tylox)
4. Referral
A
  1. a) 400 to 800 mg
    b) Naproxen
    c) Celecoxib
  2. Metaxalone
  3. a) Tramadol
    d) Oxycodone/acetaminophen
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5
Q

Due to mechanical, inflammatory and/ or degenerative problems

A

Knee Injury/ Pain

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6
Q

Cause/ Incidence of knee injury:

  1. __________
  2. Exercise
  3. Medial meniscus tears are 10 x more common than lateral tears
A
  1. Trauma
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7
Q

Signs and symptoms of knee injury:

  1. “Locking”: Usually indicative of meniscal tear or loss bodies
  2. ” ____ _____”
  3. Swelling
  4. Crepitus
A
  1. Giving way
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8
Q

_____ ____: An audible/ palpable click when the knee is raised slowly with one foot externally rotated (knee is flexed and then quickly straightened); NP’s hand rests on the joint line; the test is positive for medial meniscal injuries

A

McMurray’s test

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9
Q

____ ____: Drawer test to assess for anterior/ posterior cruciate ligament tear

a) Most sensitive and easy to perform test on a swollen, painful knee
b) Place knee in 20 to 30-degree flexion, grasp leg with one hand with anterior force to the proximal tibia (stresses the ACL/PCL) while the oppositive hand stabilized the thigh; graded 1+ to 3+ grade of displacement (i.e. a positive test)

A

Lachman’s test

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10
Q

____ ___ __: Flex knee 90 degrees with the patient prone; but pressure on the heel with one hand while rotating the lower leg internally and externally; pain or click is positive for medial or later collateral ligament damage and; or meniscus injury

A

Apley’s grind test

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11
Q 
Laboratory/ diagnostics for knee injury:
1. Lab examination only indicate if arthritis is 
    suspected
2. \_\_\_\_ \_\_\_ \_\_\_\_: AP and lateral 
3. MRI
A
  1. X-ray of knees
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12
Q

Management of Knee injury:

a) _______/ rest (RICE)
b) NSAIDs
c) ROM
d) Aspirate effusions as needed
e) Consultation/ referral

A

a) Immobilization

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13
Q

Stretched, partially tom or completely ruptured ligaments

A

Ankle Sprain

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14
Q

Causes/Incidence

  1. A ____ ankle sprain is the most frequent sports-related injury
  2. Most commonly involve the anterior _______ and fibulocalcaneal ligaments
A
  1. lateral

2. talofibular

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15
Q

Signs/Symptoms
(Classified on a scale from 1 to 3):

Grade ___: Mild, localized tenderness, normal ROM, no disability

A

1

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16
Q

Signs/Symptoms
(Classified on a scale from 1 to 3):

Grade ___: Impossible to ambulate; resists any motion of feet; “egg-shaped” swelling within 2 hours of injury

A

3

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17
Q

Signs/Symptoms
(Classified on a scale from 1 to 3):

Grade ___: Moderate/severe pain with weight-bearing; difficulty walking, swelling and ecchymosis; pain immediately after injury

A

2

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18
Q

Diagnostics: Ankle Sprain

  1. _____ to rule out fractures
  2. MRI
A
  1. X-rays
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19
Q

Management: Ankle Sprain

  1. R-I-C -E
  2. No ____ _____
  3. High-dose NSAIDs
  4. Refer Grade 3 sprains for possible casting
    as needed
A
  1. weight beating
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20
Q

Caused by overuse of muscle tendons, often occurring with repetitive movement, resulting in inflammation

A

Muscle Strain

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21
Q

Signs/Symptoms: Muscle Strain

  1. Pain during ROM
  2. _____
  3. Ecchymosis
A
  1. Edema
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22
Q

Management: Muscle Strain

  1. R-I-C-E
  2. Assistive devices as needed
  3. _______
  4. NSAIDs
  5. Prevention education
A
  1. Analgesics
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23
Q

Inflammation of a bursa (closed sac lined with a synovial-like membrane in an area subject to friction or pressure)

A

Bursitis

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24
Q

Causes/ Incidence: Bursitis

  1. _______
  2. Sepsis/ infection in a joint space
A
  1. Trauma
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25
Q

Most common locations: Bursitis

a) Olecranon
b) Subdeltoid
c) Ischial
d) _______

A

Prepatellar

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26
Q

Signs and symptoms: Bursitis

a) Pain: especially with movement
b) _________
c) Tenderness
d) Erythema

A

b) Swelling

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27
Q

Diagnostics: Bursitis

1) _______ with gram stain and C and S
2) WBC (elevation suggestive of a bacterial infection)
3) Plain x-ray to rule out other bone/joint conditions

A

1) Aspiration

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28
Q

Management: Bursitis

1) _______
2) R-I-C-E
3) Applying heat x 30 minutes TID or QID
4) Aspirin or NSAIDs (e.g. Naproxen 250 mg BID or TID)
5) Steroid injections into the bursa
6) If septic: Aspiration or I and D with parenteral antibiotics

A

1) Splinting

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29
Q

Pathology:

Degenerative joint disease with slow destruction of the articular cartilage

A

Osteoarthritis (OA)

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30
Q

Systemic autoimmune disease causing

inflammation of connective tissue •

A

Rheumatoid Arthritis (RA)

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31
Q

Inflammation: Asymmetrical this is a form of arthritis

A

Osteoarthritis (OA)

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32
Q

Inflammation: Symmetrical this is a form of arthritis

A

Rheumatoid Arthritis (RA)

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33
Q

Age for ____ arthritis is: 53-64 years (85% reported)

A

Osteoarthritis (OA)

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34
Q

Age for ____ arthritis is:35-50 years (80% reported) •

A

Rheumatoid Arthritis (RA)

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35
Q

Men & women equally affected by ____ arthritis?

A

Osteoarthritis (OA)

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36
Q

Women more common (3:1) affected by _____ arthritis?

A

Rheumatoid Arthritis (RA)

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37
Q

Joints with ____ arthritis:

1) Weight-bearing (knees, hip) + fingers, hands, wrists
2) Swelling & edema, but no redness or “heat” complaints to joints •
3) Heberden’s nodes- distal interphalangeal joints (DIPs) •
4) Bouchard’s nodes- proximal interphalangeal joints (PIPs)

A

Osteoarthritis (OA)

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38
Q

Stiffness/pain: ____ arthritis

Better in the morning- worse as file day progresses; aggravated by activity, relieved by rest

A

Osteoarthritis (OA)

39
Q

Other findings: _____ arthritis

1) Genetic predisposition likely •
2. Increased incidence of with age •
3) Obesity is, an exacerbating factor •
4) Angular deformities of affected joints •
5) Limited ROM
6) Crepitus possible
7) Hallux rigidus (arthritis of big toe)

A

Osteoarthritis (OA)

40
Q

Diagnostics: _____ arthritis

1) Synovial aspirate normal, clear/yellow

A

Osteoarthritis (OA)

41
Q

X-ray findings: _____ arthritis

1) Narrowing of the joint space •
2) Osteophytes •
3) Jutxa-articular sclerosis •
4) Subchondral bone

A

Osteoarthritis (OA)

42
Q

Management: ____ arthritis

1) ASA
2) _________
3) NSAIDS •
a) Ibuprofen •
b) Naproxen
4) COX-2 inhibitors celecoxib (Celebrex)

A

2) Acetaminophen •

43
Q 
Supportive Care: \_\_\_\_ arthritis 
a) Weightloss
b) Use canes on the opposite side •
c) Ice (improve ROM) •
d) Moist heat (decrease muscle spasms and 
    relieve stiffness)
e) Physical therapy
f) Refer for joint replacement•
A

Osteoarthritis

44
Q

Joints: ____ arthritis
a) Proximal interphalangeal joint (PIPs), •
b) Metacarpophalangeadjoints (MCPs) •
c) Wrists
d) Swelling & edema with redness and “heat”
complaints to joints

A

Rheumatoid Arthritis (RA)

45
Q

_____ arthritis associated with stiffness/ pain:

a) Worse in the morning- better as the day progresses

A

Rheumatoid Arthritis (RA)

46
Q

Other findings: ______ arthritis

a) Autoimnmne- multifactorial etiology •
b) Fatigue
c) Weakness
d) Malaise
e) Anorexia
f) Well loss
g) Gout

A

Rheumatoid Arthritis (RA)

47
Q

Labs: ______ arthritis

a) ESR usually elevated •
b) ANA(+) in 1/5 patients

A

Rheumatoid Arthritis (RA)

48
Q 
\_\_\_\_\_ \_\_\_\_ (\_\_\_) 
Synovial aspirate with inflammatory changes and WBCs
A

Rheumatoid Arthritis (RA)

49
Q

X-ray findings: Rheumatoid arthritis (RA)

a) ____ ____
b) Progressive cortical thinning •
c) Osteopenia
d) Joint space narrowing

A

a) Joint swelling

50
Q 
Management: Rheumatoid Arthritis (RA) 
1) High dose salicylates
2) \_\_\_\_\_\_
3) Disease-modifying antirheumatic drugs (DMARDs)
       a) Corticosteroids
•     b) Methotrexate
•     c) Antinmlafials (hydroxychloroquine) • 
       d) Gold salts injections
A

2) NSAIDs

51
Q

Supportive Care: Rheumatoid Arthritis (RA)

a) Early rheumatologist referral •
b) Rest
c) ____ ____
d) Surgery

A

c) Physical therapy •

52
Q

____ ____ _____:

Median nerve compression of the wrist beneath the transverse carpal ligament

A

Carpal Tunnel Syndrome

53
Q

Causes/Incidence: Carpal Tunnel Syndrome

  1. Idiopathic; associated with repeated wrist
  2. 2 to 5 × more prevalent in women.
  3. Frequently affects the _____ hand
A

dominant

54
Q

Signs and symptoms: Carpal Tunnel Syndrome

1) Numbness, tingling, “burning” along the median nerve
2) ______ pain
3) Pain exacerbated with dorsiflexion of the wrist

A

2) Nocturnal pain

55
Q

Tapping overt he median nerve on the flexor surface of the wrist produces a tingling sensation radiating from the wrist to the hand

A

Positive Tinel’s sigma:

56
Q

Reproduction of symptoms after 1 minute of wrist flexion

A

Positive Phalan’s test

57
Q

Pressure with the examiner’s thumb over the patient’s carpal tunnel for 30 seconds elicits symptoms

A

Carpal compression test

58
Q

Diagnostics of Carpal Tunnel Syndrome:

  1. ________ to document motor involvement
  2. Routine x-rays to rule out other disorders/complications
A
  1. Electromyography
59
Q 
Management of Carpal Tunnel Syndrome:
1. Elevation
2. Occupational splinting or bracing
3. NSAIDs
4. Injection of carpal tunnel with 
       \_\_\_\_\_\_\_\_\_\_\_\_\_
5. Referral for surgical intervention
A
  1. corticosteroids
60
Q

Any pain perceived by the patient as originating from the lumbosacral region of the spinal column; may be localized or radiate to the leg and/or feet

A

Low Back Pain (LBP)

61
Q 
Causes/Incidence of low back pain:
1. The leading cause of \_\_\_\_ \_\_\_\_ in 
    America
2. Second only to headache as a leading 
    cause of pain
3. Common causes:
     a. Mechanical strain
     b. 0besity
     c. Poor body mechanics
     d. Trauma
     e. Repetitive twisting, bending or lifting
     f. Herniated lumbar disks
     g. Lumbar spinal stenosis
     h. Other
A
  1. lost workdays
62
Q

Sings and symptoms for ____ ___ pain:

a) Pain in the low back region; may have a radiating pain
b) Numbness along a specific dermatome
c) Bowel, bladder or sexual dysfunction
d) Decreased muscle strength or actual atrophy of muscle
e) Decreased or absent reflexes
f) Ataxic gait: Limp (twisted to one side and bent forward)
g) decreased position sense (i.e., proprioception)

A

low back

63
Q

____ test (radiating pain in the dermatome of cervical radiculopathy)

A

Spurling

64
Q

Possible positive ____ ____ ___ test: Radiating or sciatic pain reproduced when the patient’s legs are elevated off the exam table

A

straight leg raise

65
Q

_____ _____ _____ ____: Screen for sacroiliac joint dysfunction. Place hands on each of the anterior superior iliac spines and attempt to “ open an close” the pelvic. The test is positive if the patient feels pain in either or both sacroiliac joints.

A

Positive pelvic rock test

66
Q

_____ disk pathology:

a) Quadriceps muscles weak and/or atrophic
b) Pain radiating into medial malleolus; numbness along the same path, especially medial aspect of the knee
c) Diminished or absent patellar reflexes

A

L3- L4

67
Q

Assessment for determining L3-L4 Disk:

Have patient ____ and rise

A

squat

68
Q

_______ disc patho:

a) The weakness of the dorsiflexion mechanism of the great toe and foot
b) Pain radiation into lateral calf; numbness of dorsum of the foot and lateral calf

A

L4-L5

69
Q

Screening test for L4-L5 disk pathology is?

Have a patient walk on ____ of feet

A

heels

70
Q

_____ Disk Pathology:

a) The weakness of plantar flexion of great toe and foot
b) Pain along buttocks, lateral leg and lateral malleolus; numbness to the lateral aspect of the foot and in posterior calf
c) Diminished or absent Achilles reflex

A

L5-S1

71
Q

Screening exam to assess L5-S1:

Have a patient walk on _____

A

toes

72
Q

Diagnostics for spine include?

a) ______: A/P lateral films of the spine
b) CT or ____

A

a) X-ray

b) MRI

73
Q

Management of spine injury include:

1) Functional bracing with orthotic devices
2) ____; Limit activities that increase pain
3) Physical therapy
4) Alternat hear/ ice therapy
5) ____ loss
6) Education in proper body mechanics
7) Ultrasound/ transcutaneous electric nerve stimulator (TENS)
8) NSAIDs (e.g. Ibuprofen _____ mg three times a day for four times a day)
9. Psychosocial assessment with stress management strategies
10. Refer

A

2) Rest
5) Weight
8) 400 to 800 mg

74
Q

A benign neuroma causing a compression neuropathy of an intermetatarsal plantar nerve, most commonly of the 3rd or 4th intermetatarsal spaces

A

Morton’s Neuroma

75
Q

Incidence/Causes: Morton’s Neuroma

  1. Usually injury of the nerve from high-heeled shoes; especially shoes that have narrow toe boxes which place extra pressure on the toes and balls of the feet.
  2. High ____ _____
  3. Flatfeet, bunions, and hammertoes may contribute to the problem
A
  1. impact activities
76
Q

Signs/Symptoms: Morton’s Neuroma

  1. A feeling as though “standing on a _____,” in the shoe
  2. Shooting pain affecting the contiguous halves of two toes
  3. Tingling or numbness in the toes
A
  1. pebble
77
Q

Laboratory/Diagnostics: Morton’s Neuroma

  1. _______
  2. MRI for lesions
A
  1. Ultrasound
78
Q

Management: Morton’s Neuroma

  1. Orthotics and _________ injections
  2. Referral for cryogenic neuroablation or neurectomy
A
  1. corticosteroid
79
Q

Inflammation of plantar fascia, the thick tissue on the bottom of the foot that connects the heel bone to the toes and creates the arch of the foot

A

Plantar Fasciitis

80
Q

Incidence/Causes: Plantar Fasciitis

  1. Foot arch pain/problems
  2. Obesity, sudden weight gain
  3. Particularly common in runners
  4. More common in men aged _______
A
  1. 40 to 70
81
Q

Rupture of the growth plate at the tibial tuberosity as a result of stress on the patellar tendon; also known as “tibial tubercle apophyseal traction injury”

A

Osgood-Schlatter Disease

82
Q

Signs/Symptoms: Osgood-Schlatter Disease
1. Painful limp with pain below the ____ _____
2. Can occur in one or both legs
3. Pain is exacerbated with running, jumping, and
climbing stairs
4. Swelling ranges from mild to very severe

A
  1. knee cap
83
Q

Diagnostics: Osgood-Schlatter Disease

  1. Physical exam
  2. _____ to rule out other conditions
A
  1. X-rays
84
Q

Management: Osgood-Schlatter Disease

  1. _______
  2. NSAIDs or acetaminophen
  3. In rare cases, refer for ______
A
  1. R-I-C-E

3. surgery

85
Q

Inflammation of the cartilage that connects a rib to the sternum

A

Costochondritis

86
Q

Incidence/Causes: Costochondritis

  1. Most cause ______
  2. Those that are known include:
    a. Injury, such as a blow to the chest
    b. Physical strain
    c. Upper respiratory illness
    d. _______
    e. Fibromyalgia
A
  1. unknown

2. d. Infection

87
Q

An inflammatory disorder involving pain and stiffness in the shoulder and usually, the hip

A

Polymyalgia Rheumatica

88
Q

Incidence/Causes: Polymyalgia Rheumatica

  1. Etiology is unknown
  2. Almost always occurs in people over ____ years old
  3. May be associated with temporal arteritis
A
  1. 50 years old
89
Q

Signs/Symptoms: Polymyalgia Rheumatica

  1. Stiffness in neck, shoulders, and hips
  2. ____ of range of motion in affected areas
  3. Fatigue, anemia, and mild fever
A
  1. Loss
90
Q

Diagnostics: Polymyalgia Rheumatica

  1. ____ ____ ___ (___)
  2. X-rays as needed to rule out other conditions
A
  1. Erythrocyte sedimentation rate (ESR)
91
Q

Management: Polymyalgia Rheumatica

  1. _______
  2. Symptomatic management
A
  1. Corticosteroids
92
Q

Musculoskeletal: Gerontology Considerations
1. Physiologic changes
a. Sarcopenia (decreased muscle mass and strength)
occurs
b. Loss of lean body mass
c. Lean body mass replaced by fat
d. Redistribution of fat occurs
e. Low ____ ____develops
f. Intervertebral disc degeneration
g. Changes in stature with kyphosis, hei~at reduction.
h. Decreased total body water
i. Increased percent adipose tissue (until age 60, then
decreased)
j. Degeneration of cartilaginous: tissues
k. Fibrosis decreased joint elasticity

A

e. bone mass

93
Q

Possible findings/results: Gerontology Considerations
a. For _____: Increased risk of disability, falls, and
unstable gait
b. Increased percentage of body fat
c. Height reduction from intervertebral disc: degeneration
d. Osteoporosis
e. ___________
f. LimitedROM
g. Joint instability

A

a. sarcopenia

e. Osteoarthritis

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