Final exam - Musculoskeletal Flashcards
Carpal tunnel syndrome
Inflammation of the Median Nerve
Symptoms of carpal tunnel syndrome
wrist achiness that radiates to the base of the thumb on the palm of the hand;
may be awakened at night with pain and numbness in the area
Treatment for carpal tunnel syndrome
Wrist splint and NSAIDS
Surgery
Shoulder pain in over 55s
More likely to have rotator cuff tears and degenerative arthritis.
Fractures and dislocations with falls more prevalent
Shoulder pain in under 30s
Glenohumeral dislocation
Shoulder pain in middle age
Impingement syndrome more likely
Differential diagnoses for shoulder pain
- fractures
- dislocations
- acute tendon rupture
- chronic or repetitive injuries (impingement syndromes, most rotator cuff tears and biceps tendon ruptures)
- degenerative conditions
- inflammatory conditions
- idiopathic conditions (glenohumeral and AC arthritis, frozen shoulder)
Dislocated shoulder
Dislocates due to excessive pressure on the joint.
Pain noted when shrugging shoulders
Shoulder pain - Musculoskeletal Differential Diagnoses
Adhesive capsulitis (frozen shoulder)
Rotator cuff syndrome
Impingement
Calcific tendinitis
Subacromial bursitis
Degenerative arthritis: glenohumeral, acromioclavicular
Shoulder pain - Trauma Differential Diagnoses
Fractures: humerus, clavicle, acromion
Acromioclavicular joint sprains
Rotator cuff tear
Dislocation: glenohumeral
Nerve injuries: compression
Shoulder pain - Neurovascular Differential Diagnoses
Reflex sympathetic dystrophy (shoulder–hand syndrome)
Thoracic outlet syndrome
Cervical root compression
Brachial plexus injury
Shoulder pain - Systemic Disease Differential Diagnoses
Inflammatory disease
Cancer
Herniated disc - Risk factors
- age-related degenerative changes (it is often difficult to distinguish between normal aging of the spine and pathological changes)
- cigarette smoking
- a narrowed lumbar vertebral canal
- obesity
- osteoporosis
- stress
- muscle tension.
Causes of herniated disc
Trauma (sudden or over time), frequent lifting without proper utilization of body mechanics, and vibration, such as driving and/or riding in a motor vehicle for prolonged periods of time.
What is the most common herniated disc?
L4-L5 (weakness in the great toe)
Evaluating a herniated disc - diagnostics
MRI should also be considered for patients with neurologic symptoms, specifically weakness, loss of deep tendon reflex, or bilateral symptoms.
Xray for patients with trauma
Evaluating herniated disc - physical exam
- Range of motion
- Sensory function
- Numbness/tingling
- Straight leg raise test
- patient unable to walk on toes or heels
Preventing recurrence of herniated disc
- smoking cessation
- weight reduction
- good posture and body mechanics
- adherence to an exercise regimen
Patellofemoral dysfunction
continuum of disorders due to overuse of the knee
Management of knee pain
NSAIDS and quadriceps strengthening exercises
How to evaluate for meniscus tears?
the McMurray test
Phalen’s test
involves flexing the wrist for 60 seconds, leads to painor paraesthesia in the median nerve
Anterior drawer test
used in initial clinical assessment of suspected rupture of the cruciate ligaments in the knee
Low back pain workup
Focus on HPI:
1.Mode of onset (abrupt or insidious?)
2.Characteristics
*Provoking factors
*Aggravating factors
*Relieving factors
3.Effects of activities
*Posture
*Coughing, sneezing, straining
*Exercise, exertion, rest
*Sleep
4.History
*Similar or different pains
*Course (progressive, decreasing, increasing, fluctuating, episodic?)
*Associated limb and/or neurologic symptoms (pain, paresthesias, numbness, weakness, atrophy, cramps, fasciculations?)
5.Associated symptoms
*Urinary problems (frequency, urgency, retention, incontinence?)
*Bowel problems (incontinence or constipation?)
6.Previous back pain history and treatment (medications, types of surgery, nonpharmacologic management, lifestyle and work modifications, litigation or compensation issues?)
Differential diagnoses for low back pain
- ovarian cyst
- ankylosing spondylitis
- infection
Lumbar spinal stenosis
- often radicular pain down the legs
- symptoms progress proximal to distal
- walking or prolonged standing causes pain and weakness in the legs and buttocks
- Patients report short term relief with leaning forward and often lean on counters when standing or grocery carts when shopping
Spinal fracture
- Can present as low back pain
-Consider red flags from the patient history that alerts you to a potential spinal fracture that may include a fall history, prolonged steroid use, osteopenia, osteoporosis
Cervical spondylosis
AKA degenerative arthritis
Blanket term for the chronic degenerative processes that affect the vertebrae and facet joints; causes pain, stiffness and disability
Cervical myelopathy
(compression-like a pinched nerve) symptoms would include radicular symptoms of the upper extremities and weakness.
In severe cases, leg weakness, gait disturbances, and loss of bowel and bladder control may occur.
Symptoms of nerve root involvement
Radiculopathy includes weakness, numbness, and tingling that typically occur along the distribution of the affected nerve root.
Paresthesia over the anterior thigh just above the knee indicates L4 involvement.
Vertebral Fractures
Osteoporosis is most commonly associated with vertebral fractures in susceptible individuals
Assessing for peripheral neuropathy
- medical history
- neuro exam
- sensation
- EEG, EMG (electrical condition)
- MRI/CT (nerve pinch)
- Deep tendon reflexes
Characterized by is “stocking-glove” or distal sensorimotor paresthesia, with diminished or variable deep tendon reflexes
First degree muscle strain
ligaments are stretched but not torn
Second degree muscle strain
most common; partial tearing of the ligament
Third degree muscle strain
most severe; ligament is torn completely
What can cause muscle strain
Strain-can be due to not warming up prior to exercise; Teachable moment when the patient presents with a strain is just to suggest stretching and warm-up exercises prior to the full exercise routine
How do you identify a strain?
Look for location; e.g. acute low back strain; low back pain that is not associated with sciatica;
Is aggravated by sitting, standing, and certain movements; alleviated with rest; pain locally on palpation and muscle spasms are felt.
How to treat strains
- NSAID
- low back strengthening exercises (type and intensity of the strengthening exercises depends on the patient’s pain tolerance). Be careful to not add insult to injury!
What is the most common presenting symptom for neck strain?
Pain. Associated complaints of headache, usually occipital, which may persist for months, is not unusual.
Signs and symptoms of ankle sprain
- injury
- swelling
- decreased ROM
- discoloration
