Exam 3: Musculoskeletal Flashcards
Adduction
the movement of a limb or other part toward the midline of the body or toward another part.
abduction
the movement of a limb or other part away from the midline of the body, or from another part
Flexion
the action of bending or the condition of being bent, especially the bending of a limb or joint.
Extension
It occurs when muscles contract and bones move the joint from a bent position to a straight position. It is a posterior movement for joints that move backward or forward, such as the neck
Pronation
person shifts their weight from the heel to the forefoot, it is termed pronation
Suppination
weight is placed on the outside of the foot while walking or running
3 major bones of ankle
Tibia, fibula, talus
Weight bearing bone of ankle
Talus
Sprain
Ligament injury (bone to bone) Occurs due to abnormal rotation such as a sudden change in direction or a misstep on an uneven surface
Clinical presentation of ankle sprain
Swollen and painful joint, ecchymosis and decreased ROM. weight bearing causes pain
Immediate swelling or ecchymosis is suspicious for
Fracture
Treatment of sprain
RICE
Rest, ice, compression elevation
NSAIDs
Passive and active exercises
Achilles tendon
Responsible for flexion and extension of the ankle
Clinical presentation of achilles tendinopathy
Intermittent symptoms, pain that subsides during exercise but increases while at rest
Can be local at heel or along th elength of tendon
Severe pain climbing stairs
Abnormal gait
Haglund deformity
Bony prominence at the heel
Achilles tendinopathy
Gold standard for achilles tendinopathy
MRI
Tx of achilles tendinopathy
Cessation of sports, tendon rest, NSAIDs, ice massage
May take 8 weeks to heal
Achilles tendon rupture
Sudden event; feel like you were shot in the calf; sudden weakness in the ankle and inability to rise up on toes; pain not common
PE of achilles tendon rupture
Visible and palpable gap overlying the tendon where the rupture occurred
Thompson test
Achilles tendon is in tact if th efoot plantar flexes when the calf is squeezed
Tx of achilles tendon rupture
Long leg cast with foot in plantar-flexed position for 6 weeks or surgical repair
Plantar fasciitis
Pain in the bottom of the foot and along the arch and in the heel
Due to high impact running/jumping or shoes with inadequate support
Pain with weight bearing first thing in the morning and point tenderness
Morton neuroma
Result of perineural fibrosis of the plantar nerve at the point where the medial and lateral branches of the plantar nerve converge
Usually due to high heeled shoes
severe pain and burning in the region of the third web space; barefoot and foot massages relieves discomfort; elevation of foot aggravates
Tx of morton neuroma
Wide toe shoes, NSAIDs, separation of toes with pad
Sarcoma
Malignant tumor of mesenchymal or neuroectodermal origin
Most common malignant tumor that originates in bone
Multiple myeloma
Pain management for bone tumors
Biphosphanates
Gabapentin, amitriptyline, benzos
Bursa
Sac lined with synovial fluid, which provides lubrication and facilitates smooth movement between tissues of an extremity
Clinical features of bursitis
Pain at motion and rest, regional loss of ROM, visible swelling, tenderness to palpation
Shoulder bursitis
Anterior/lateral shoulder pain exacerbated by overhead activities
Deep aching interrupts sleep
Tenderness below the acromion
Signs for shoulder bursitis
NEER and Hawkins
Olecranon bursitis
Elbow
Visible posterior elbow swelling
1/3 cases are septic–antibiotics should cover S Aureus
Ballottement test
For knee effusion
Valgus stress
Force on medial elbow from throwing or axial compression
Golf
Varus stress
Force on lateral elbow
Tennis
Tx of fibromyalgia
Amitriptyline, cyclobenzaprine, SSRI, gabapentin, trazadone, zolpidem, lidocaine IM
4 stages of gout
Asymptomatic hyperuricemia
Acute gouty flare
Intercritical gout
Chronic tophaceous gout
Most common inflammatory arthritis in adults
gout
Predominant cause of hyperuricemia
Undersecretion of urate by the kidneys
Definitive dx of gout achieved by
Needle aspiration of inflamed joint
Tx of acute gout flare
NSAIDs, colchicine, steroids
higher doses of NSAIDs in first 24-48 hours
Urate lowering therapy
Start 6-8 weeks after acute flare has resolved
Start at low dose and increase slowly every 4-6 weeks
Allopurinol, prebencid, pegloticase
Tinnel sign
For carpal tunnel syndrome
Push down on radial nerve
Phalen test
For carpal tunnel syndrome
Back of hands pressed together
What should always be ruled out for hip pain caused by trauma
Avascular necrosis
Primary fx of hip
locomotion and weight bearing