Lecture two (UPPER)-EXAM 3 Flashcards
Musculoskeletal diseases
- Musculoskeletal diseases affect how many people?
- What is the estimated cost?
- World-wide, WHO reports the most common and debilitating to be what?
- What is the percentage of all ambulatroy care visits?
- What identity plays a role in prevalence of specific issues?
Health Maintenance & Screening
How many people have Osteoporosis & Osteopenia?
over 40% of adults age ≥ 50 in US have osteopenia( why we have fractures – 40 million people/17 million are male
Osteoporosis & Osteopenia:
* What is the risk?
* What are current recommendation for bone density screening?
- Risk factors include; age>50, low BMI, tobacco, ETOH, low physical activity, 1st degree relative with dx, certain pharmaceuticals
- Current recommendation for bone density screening – all women over 65, and post menopausal women under 65, men over 70 or younger men who have increased risk for low bone mass.
What is the prevalence of osteoporosis age and race/ethnicity?
- 10.3% of adults over age 50 years have osteoporosis at the femoral neck or lumbar spine
- 15.4% of women and 4.3% of men highest
- Race/ethnicity: Mexican-American (13.4%) and Non-Hispanic white (10.2%) adults have the highest prevalence
- Non-Hispanic blacks (4.9%) have the lowest
Morbidity & Mortality:
* How many women sustain an osteoporsis related fracture during their lifetime?
* How many fx’s a year in US from osteoporosis?
* How many hospitalizations and nursing home admissions?
* Half of patients become what? 20-30% do what?
* Mean over 60 have what type of risk?
* Fall are the leading cause of what?
* Accounted for how much of total medical costs in 2015?
What is wolff’s law?
For every change in the external force on the bone there is a change in the internal architecture
What are the Current Exercise Guidelines?
* Moderate-intensity?
* Vigorous-intesity?
* Muscle-strengthening activities of moderate or greater intensity?
* Older adults should do what?
- 150-300 minutes weekly of moderate-intensity
- 75 -150 minutes of vigorous-intensity
- Muscle-strengthening activities of moderate or greater intensity, use a weight correct for 8-12 reps, involve all major muscle groups on 2 or more days a week
- Older adults should do multicomponent physical activity that includes balance training for fall prevention. (Tai chi)
What is the fall risk test?
Timed Get Up and Go Test – from armchair, 3 meters and back in 24 seconds or less
* Rise up from chair and walk meter out and back in 24 seconds
Define this:
- “Gelling” phenomenon:
- 4 Cardinal features of inflammation:
- “Gelling” phenomenon – decreased active and passive ROM and stiffness upon awakening (this is a sign of articular pain)
- 4 Cardinal features of inflammation – swelling, warmth, redness in combination with pain
What are the consitiutional symptoms?
- High fever or chills – begin acute work up
- Chronic systemic disease – constitutional symptoms are common in inflammatory conditions.
- Joint pain may provide important clues to diagnosis
What does lupus often presents?
joint pain, typically symmetric, with erythema, most often seen in knees, fingers, hands and wrists
inflammation disease
What are examples of diagnostic indicators of Systemic Disease that may present as MSK complaints (7)?
- Malar Rash - Lupus
- Scaly plaques, pitting of nails – Psoriatic arthritis
- Red based papules, pustules, vesicles on distal extremities – Gonococcal arthritis
- Target/Bulls eye patch – Lyme disease
- Mental status change, facial or other weakness, sensory changes, radicular pain - Lyme disease with central nervous system involvement
- Clubbing of fingernails – Hypertrophic Osteoarthropathy
- Reactive arthritis (often with urethritis and/or uveitis) - Erosions or scaling on the penis and crusted scaling papules on the soles and palms
- What is the sign of lupus?
- What is the sign of psoriatic arthritis?
- What is the sign of gonococcal arthritis?
- Malar Rash - Lupus
- Scaly plaques, pitting of nails – Psoriatic arthritis
- Red based papules, pustules, vesicles on distal extremities – Gonococcal arthritis
- What is the sign of lyme disease?
- What is the sign of Lyme disease with central nervous system involvement?
- Target/Bulls eye patch – Lyme disease
- Mental status change, facial or other weakness, sensory changes, radicular pain - Lyme disease with central nervous system involvement
- What is the sign of hypertrophic osteoarthropathy?
- What is the sign of reactive arthritis?
- Clubbing of fingernails – Hypertrophic Osteoarthropathy
- Reactive arthritis (often with urethritis and/or uveitis) - Erosions or scaling on the penis and crusted scaling papules on the soles and palms
What is this? What is the risk group?
- It is gonococcal arthritis- Unilateral
- Risk: young, sexual activity
What is this?
Lupus
What is this?
Psoriatic plaques
What is this?
Target/bullseye lesion of Lyme Disease
You need to be careful with neck pain, therefore you need to ask what? (4)
- Radiation of pain to upper extremity (cervical radiculopathy)
- Bilateral weakness in both upper and lower extremities and urinary frequency is cervical myelopathy until proven otherwise. -> Need to ask about bladder
- In children – must document that nuchal rigidity nor systemic complaints exist (Meningitis)-> MUST DO chain to neck test
- Acute onset/episodic with associated achy arm or jaw pain in middle aged female – consider Cardiac etiology
- What is a sign of cerival radiculopathy?
- What is sign of cervical myelopathy?
- Radiation of pain to upper extremity (cervical radiculopathy)
- Bilateral weaknees in both upper and lower extremities and urinary frequency is cervical myelopathy until proven otherwise.
What did you need to document with children that present with neck pain?
must document that nuchal rigidity nor systemic complaints exist (Meningitis)
When do you consider cardiac etiology?
Acute onset/episodic with associated achy arm or jaw pain in middle aged female
What is myelopathy?
What is radiculopathy?
- Mye: brain and spinal cord, covered by myelin sheath-> usually inflammation
- Rad: Nerve Roots out -> usually MVA or herniated disc
Spinal nerves:
* Each spinal nerve formed from what?
* What are the posterior and anterior branches?
- Each spinal nerve is formed from anterior and posterior roots on the spinal cord.
- The posterior branches are afferent (sensEory) nerves; the anterior branches are efferent (motor) nerves
What is neuropraxia?
temporary loss of nerve function
What are the fibrous joints? And what do they do?
Fibrous – Absorbs shock with little or no movement
* Suture – irregularly grooved articulating bone. Sutures of the skull
* Syndesmoses – ligament or fibrous membrane between bones. Allow limited movement. Inferior tibiofibular joint, interosseus membrane between the radius and ulna
- What are cartilaginous joint types? Primary and secondary?
Cartilaginous – united by hyaline cartilage or fibrocartilage
* Primary: sternocostal joints and epiphyseal plates while open
* Secondary: intervening pad, plate, or fibrocartilage as in the pubic symphysis and intervertebral joints
What are synovial joints?
Freely moveable as in the shoulder and knee
What covers with synovial joint? What happens if their is damage?
Articular cartilage/hyaline cartilage (vs. fibrocartilage i.e. labrum, menisci, disc)
* Glassy smooth covering on ends of long bones reduces friction, spongy cushion, absorbing compression, no nerve or blood supply, nutrition from synovial fluid
* Damage = arthritis
Where is the joint cavity in the synovial joint and what is it filled with?
- Lined with synovial membrane
- Filled with synovial fluid
The joint capsule of the synovial joint is continuous with waht?
Continuous with the periosteum
Bursa:
* What is it?
* What does it reduce?
* Where is it?
* Can have what? (2)
- Synovial fluid-filled sacs
- Reduce friction between tendons and bones (subacromial, pes anserine bursae) or
- Between bone and skin (prepatellar bursa, olecranon bursa)
- Can have explosive synovial swelling
- Can have septic bursa
Act as an lubricant
Not dangerous until infected
What is a sprain, strain, hemarthrosis?
- Sprain – tearing or rupture of ligamentous tissue
- Strain – tearing or rupture of musculotendinous tissue
- Hemarthrosis – blood in a joint
What is contusion, edema, exostosis?
- Contusion – bruise
- Edema – swelling
- Exostosis – extra bone growth (hypertropic bone)
ROS guidelines for upper extremity (4)
What is osteophyte, apophysistis, osteoarthritis, RA?
- Osteophyte – exostosis along joint margin
- Apophysitis – inflammation where a tendon attaches to bone
- Osteoarthritis – inflammatory condition at a joint
- Rheumatoid arthritis – systemic disease-causing arthritis
What are the key features of complaint characterization?
What do you need to know for the history of MSK
What is the different between pain in small and large joints?
pain in small joints (hands/feet) stays local and typically indicates an accurate approximation of location of injury or disease, pain in larger joints, long bones may often be referred pain
* Example: Hip pain is often felt in the groin or at times down leg to knee, pain at the knee may predominate in the young
What should you inspect for the MSK upper?
- Visually inspect anterior shoulder and posterior shoulder/scapula, elbow, wrists, hands, fingers
- You are looking for swelling, deformity, muscle atrophy, fasciculations, unusual contours and abnormal positioning
What do you need to verbalize for inspection?
You are verbalizing “I am looking for swelling, deformity, atrophy, unusual contours, fasciculations or abnormal positioning””
What are the rotator cuff muscles and their actions?
What do you need to note about inspection? (7)
What is the right and left picture?
Palpation:
* What are you palpating?
* What are you looking for?
* What do you verbalize?
* Assessment of tenderness?
* Fracture assessment?
How do you do shoulder palpation?
What are all the ranges of motions for arm?
What tests do you do for rotator cuff, tendinitis/tendonosus?
What tests do you do for rotator cuff tears?
- Rotator Cuff Tendinitis/Tendonosus (Impingement Syndrome) – Empty Can, Neer, Hawkins, Painful Arc
- Rotator Cuff Tears – Drop Arm, Lift-Off (Belly Press)
- What do you do for adhesive capsulitis?
- What is the test for Acromioclavicular Arthritis/Sprain?
- Adhesive Capsulitis (Frozen Shoulder)
- Acromioclavicular Arthritis/Sprain – Crossover/AC Compression
What is the painful arc?
Indicative of Impingement
What is the neer and hawkins kennedy test for impingement?
Impingement/Strength Tests: Empty Can for what muscle?
Supraspinatus
What is another test (not empty can) for supraspinatus? What is the test for subscapularis?
What test is for a infraspinatus and strength test?
What is the AC joint crossover test?
What do you palpate on the elbow?
- Palpate lateral and medial epicondyles
- Palpate olecranon/bursa
What are the 4 different elbow ranges of motion?
- Flexion – bend elbow
- Extension – straighten elbow
- Supination – palms up
- Pronation – palms down
What do you need to palpate and compress of the wrists and hands?
- Palpate joint space at distal radius and distal ulna
- Palpate radial styloid
- Palpate anatomical “snuffbox”
- Compress metacarpophalangeal joint
- Palpate carpometacarpal joint of thumb
- Palpate PIPS and DIPs medial/lateral
What are the range of motions for wrist and fingers?
What are the thumb motions?
What is the difference of OA and RA?
- Heberden Nodes-DIPs (OA)
- Bouchard Nodes- PIPs (RA)
What are the tests for carpal tunnel syndrome?
