Exam 3- Muskoloskeletal, PVD, GI, Breast Flashcards
How do you diagnose Osgood- Schlatter disease?
-NONE usually needed based off of the symptoms!
-x-ray of the proximal tibia and knee…. shows calcified thickening & prominence of the tibial tuberosity
- x-ray shows soft tissue swelling
-x-ray shows heterotopic ossification anterior to the tibial tubercle
Osgood-Schlatter Disease
(Apophysitis of the Tibial Tuberosity)
Layer disease shows fragmented apophysis
Bone scan is NOT a good choice b/c of increased natural uptake with age
Description of Osgood-Schlatter Disease
What is it?
Traction apophysitis
Repeated contraction of the quadriceps through the patellar tendon on the immature skeletal tibial tubercle
Etiology of Osgood- Schlatter Disease
Rapid bone growth increased traction is placed on the insertion of the patellar tendon at the tibial tubercle
Due to tightening quadricep tendons
Results in inflammation & micro trauma to the apophysis
Incidence of Osgood-Schlatter disease
- common cause of knee pain in boys 13-15
-girls 11-13
-boys affected more often than girls - higher in athletes
Bilateral involved in 30% of cases
Risk factors of osgood-schlatter disease
- periods of rapid growth
- repetitive jumping
-sport activities
Assessment findings of osgood-schlatter disease
-painful swelling & erythema of the tibial tubercle at the insertion of the patellar tendon
- worse with activity
- activity like: squatting, kneeling, running, jumping, crouching
- pain relieved with rest
- pain worsens with contraction of the quadriceps against resistance
- prolonged sitting with knees flexed
- notable tibial tuberosity
- unilateral or bilateral
Differential diagnosis
-Fracture of the tibial plateau or proximal tibia
-Avulsion of the quadriceps tendon or tibial tubercle
- patellofemoral syndrome
-bursitis synovitis
-neoplasm of the proximal tibia
-infection
Management of osgood-schlatter disease
(Apophysitis if the tibial tuberosity)
-rest avoidance of activities that increase or swelling
- ice during acute phase every 2-4 hours every 20 mins
-quadriceps strengthening & stretching
-application of ice after athletic activity
-educate that participation in activities is reasonable as pain is minimal
-protective knee pads or supports
-unresolved or severe pain may be treated with a knee immilizer or a cast
-PT consult for stretching and strength
-cross training in low impact activities
-return to activities as pain resolves
Pharm management of Osgood-Schlatter Disease
Analgesic- acetaminophen and ibuprofen
Phalans sign
Fingers pointed down
Phalan Sign
Tests for Carpal Tunnel Syndrome
Aching
Tingling
Numbness
In 2nd, 3rd, and 4th volar fingers
This is a positive phalen sign
Phalen Sign
A patient flexes wrists for 60 secs… after this the patient experiences aching numbness and tingling what is this called?
And what does this indicate
Positive phalen sign
Carpal tunnel syndrome
Tinel s sign
Tinels sign
Tinels sign
Tap lightly over medium nerve at volar wrist
This tests for carpal tunnel syndrome
Positive tinel sign is
Aching, tingling and numbness in 2nd, 3rd, 4th fingers
What are the risk factors for osteoporosis?
Major public health threat and common US health problem
10% of adults over 50 y/o have osteoporosis at the femoral neck and lumbar spine
16% of women
4% of men
——- of all postmenopausal women sustain a osteoporosis related fracture during their lifetime
Half
From —— 25% develop vertebral deformities
Osteoporosis
—— -affects 15% of hip fractures
Which increase pain, disability, loss of independence, increased mortality
Osteoporosis
A woman that is 65 years old, low BMI, does not drink milk (low calcium), deficient in Vit D, smokes, does not exercise, and history of fragility fracture
What is this woman at risk for?
Osteoporosis
Clinical conditions at risk for osteoporosis?
Thyrotocicosis
Celiac
IBD
Cirrhosis
Chronic renal disease
Organ transplant
DM
HIV
Hypogonadism
Multiple myeloma
Anorexia
RA
Autoimmune disorders
Meds that increase risk for osteoporosis
-inhaled corticosteroids high dose
- anticoagulants (long term use)
- aromatase inhibitors for breast cancer
- methotrexate
-anti-seizure meds
-immunsuppression agents
-proton pump inhibitors (long term use)
-androgen deprivation therapy for prostate cancer
Straight leg raise
Cross straight leg test
Crossed straight leg test
Know difference between cross straight leg test and straight leg test
What is the difference between OA and RA?
Difference between OA and RA
How do you assess for scoliosis?
Make sure child bends forward with the knees straight (Adams bend test)
Check for any asymmetry in positioning or grant
If you detect for scoliosis use a scoliometer
What is scoliosis?
Diagnosis is made when layers curvature is 10 degrees or greater
Scoliosis
—— is the appearance of a lateral curvature WiTHOUT structural changes in the vertebral column
Functional scoliosis
—— is a true deformity of the vertebrae rather than a postural problem
Structural scoliosis
Etiology of scoliosis
-idiopathic
-80% of. Childhood scoliosis
-ex exclusion with unknown cause
Infant idiopathic scoliosis: 0-3
Juvenile idio scolio: 3-10
Adolescent idio scolio: > 10 years
Degenerative scoliosis
Result of degeneration disease of the spine, degenerative disc, ligaments, laxity,facet arthopathy
Congenital
Due to spinal congenital deformity & abnormal formation of the vertebrae…may not be noted for several years after birth
Neuromuscular
May stem from the myopathic cause (muscular dystrophy) upper motor neuron disorder, lower motor neuron disorder
Scoliosis
Related to infection, tumor, connective tissue, metabolic disease, disease syndromes, dysplasia’s
Scioliosis
3% of the population.
Infantile idiopathic scoliosis
- more in boys than girls
- curve is typical to the left
- 90% resolve spontaneously
Juvenile idiopathic scoliosis
Girls more than boys
10-20%
Curve to the right
Progresses slowly during adolescence
More likely to develop into a severe deformity
Adolescent idiopathic scoliosis
Girls higher curvature
Most likely need surgery
Most common type
Degenerative scoliosis
68% of people >60
Congenital sciolosis
Other organ system present in 60% of patients
Neuromuscular sciolosis
90% with Duchenne muscular dystrophy (boys)
20% with cerebral palsy (children)
-60% with myelodysplasia
What are the risk factors for scoliosis?
- Unequal leg length
- spinal column anomalies
-cerebral palsy - neurofibromatosis
- Marfan syndrome
- poliomyelitis
-muscular dystrophy
-friedreich’s ataxia - Charcot Marie tooth disease
- family history of scoliosis
Assessment findings:
Screen for adolescent idiopathic sciolosis
-screen girls 10-12 years old
- only screen boys once btw 13-14
- get history identify causes other than idiopathic scoliosis
- onset lateral curvature of the spine
- 25% of teens experience pain
Assessment of sciolosis
Unequal shoulder heights, scapula prominences & heights, waist angles, rib prominences with forward glue ion (Adams forward bending test)
- neuro test for intraspinal lesion
Functional sciolosis disappears when child is placed in Adams position bend forward at the waist
Structural sciolosis is accentuated
Differential dx for sciolosis
- neurofibromatosis
-cerebral palsy - juvenile idiopathic scoliosis
- Ms
- Rett syndrome
- osteomyelitis of vertebral body (TB)
- tumor
Dx studies of sciolosis
- Lateral X-ray of spine
- Degree of curve and structural deformity
- Skeletal maturity
- MRI to r/o tumor
- CT tumor or congenital abnormality
Possible complications of sciolosis
- Deformity
- Decreased Physical acititiy
- Cardio and resp impairement
- Psychological anger or low self esteem
PV
Techniques of PV Exam
A patient presents with exercise induced pain that is absent at rest, the patient stops walking and pain gets better within 10 mins what does the patient have?
Intermittent claudication
What disease is associated with intermittent claudication?
Peripheral arterial disease (PAD)
Systematic leg ischemia with exertion
Neurogenic leg pain is different from intermittent claudication because
It is reduced by leaning forward to stretch spinal cord
And not relieved by rest like intermittent claudication
What questions would you ask in the review of systems with PV for intermittent claudication
1 have you had pain or cramping in your legs when you exercise?
2. How far can you walk without stopping to rest
What symptoms in the review is systems are important for pAD?
No sx’s or a range of sx’s
Aching, cramping, numbness, fatigue
A patient has calf swelling, hyperpigmentation, edema and cyanosis when legs are dependent especially are sx’s of?
DVT
Venous status ulcers are different than DVT because the patient has
Red legs instead of white (DVT)
Swelling (DVT & cellulitis)
Tenderness
Cellulitis- infection—- red
Symptoms of Raymond phenomenon
Cold induced digits ischemic change
Cyanosis (white) than red rubor
PVD vs chronic venous insufficiency
