Module 5 Flashcards
1
Q
Confusion
A
not a disease process or disease state but rather a symptom. Confusion is an inability to think quickly or coherently
usually demonstrated by inappropriate reactions to environmental stimuli, may arise suddenly or gradually, and may be either temporary or irreversible. Stressful events, lack of sleep or food, or sensory deprivation may precipitate confusion. Age no reliable factor
2
Q
Dementia
A
is a decline in mental functioning, affecting memory, cognition, language, and personality
persistent or more severe confusion, with or without psychomotor hyperactivity characterized by a significant time span between symptom appearance and death
3
Q
Cognitive impairment
A
refers to a decline in at least one of the following cognitive domains: language, executive function, attention, perceptual-motor function, social cognition, learning, and memory. The disturbance must interfere with independence in everyday activities and not be better accounted for by another neurocognitive disorder
4
Q
Treatment of dementia- pharm
A
NMDA receptor agonist (memantine) and cholinesterase inhbitors (donepezil, rivastigmine)
most useful for moderate to severe AD, combo is more effective
5
Q
non pharm tx of dementia
A
cognitive rehab
exercise
occupational therapy
6
Q
recommended psychotic for dementia
A
risperidone, only used for 3 months
7
Q
delirium
A
acute, abrupt onset
confusion fluctuates throughout day
inattention
once the cause is corrected, should return to previous state of cognitive functioning
8
Q
metabolic disturbance/ confusion
A
fluid, electrolyte and acid base imbalance may b result of metabolic problems, which can produce confusion
dehydration
9
Q
infectious process/ confusion
A
confusion may be result of infectious process that can cause extensive tissue and organ impairment, ischemia produces cell injury
10
Q
Dizziness
A
is the sensation of unsteadiness or feeling off balance, faintness, light-headedness, and a feeling of movement within the head. Loss of consciousness rarely occurs, but the feeling of faintness encourages the patient to lie down, which may cause the feelings to disappear
brief episodes, result of inadequate blood flow and oxygen supply to brain
11
Q
Vertigo
A
is the false sensation of rotation or movement of the patient or the patient’s surroundings. Vertigo may result from an inner ear disease or a disturbance of the vestibular center or pathway in the central nervous system (CNS).
12
Q
Diagnoses of dizziness- 4 categories
A
peripheral vestibular disease
systemic disorders
CNS disorders
anxiety states
13
Q
Questions to ask regarding dizziness
A
duration
severity
nature of episodes
associated symptoms
14
Q
physical exam dizziness
A
exam ear (r/o cerumen)
whisper test
rinne and weber
thorough neuro assessment
Hallpike maneuver
15
Q
The Hallpike maneuver
A
is performed by rotating the patient’s head to one side and then lowering it slowly to 30 degrees below the bodyline. The patient should be observed for nystagmus during head rotation and vertical positioning.
In patients with benign vertigo, there may be rotational nystagmus and possible severe vertigo, which usually occurs in one direction. This resolves quickly and cannot be reproduced after two to three repetitions.
The clinician should suspect a central lesion when the vertical nystagmus is of a longer duration and continues with each repetition
16
Q
peripheral vestibular disease dizziness
A
Most often the problem is located in the labyrinth of the middle ear
dizziness, nausea and vomiting, diaphoresis, difficulty with balance, vertigo, tinnitus, fluctuating hearing loss, feelings of pressure in the ear, and diplopia
17
Q
tx vertigo
A
meclizine or promethazine most common- suppress vestibular end organ receptors, inhibit vagal response
take med x1 week, then taper down
18
Q
diamox
A
is used to decrease edema in the labyrinth
19
Q
vertigo exercise
A
instructed to reproduce the feelings of vertigo by placing the affected ear down, then assume a supine position and hold that position until the vertigo disappears. The vertigo may return when the patient sits up. The patient should repeat these maneuvers at least five times a day or until the vertigo no longer returns. Patients with persistent symptoms should be referred for assessment of nerve function.
20
Q
systemic disorder dizziness
A
aggravated by postural changes or exertion. Pallor, dyspnea, tachycardia, bounding pulse, weakness, hypotension, blurred vision, decreased breath sounds, headache, diaphoresis, and agitation suggest systemic problems
21
Q
percentage of HA without cause
A
90%
22
Q
types of primary headaches
A
tension-type headaches, migraines, and cluster headaches
23
Q
Tension-type headache
A
, also referred to as a muscle contraction headache, presents as a mild to moderate bilateral, nonpulsating, tightening pain that is not aggravated by routine physical activity. It is usually not accompanied by nausea and vomiting or photophobia.
24
Q
Migraine headache
A
may last for 4 to 72 hours and may or may not be precipitated by an aura. It is usually unilateral, of moderate to severe intensity with a pulsating quality, aggravated by routine physical activity, and accompanied by nausea, vomiting, and photophobia.
25
Cluster headache
usually occurs at night and may last from 15 to 180 minutes. There is usually severe unilateral orbital, supraorbital, and/or temporal pain that is accompanied on the same side of the face with sweating, lacrimation, nasal congestion, ptosis, rhinorrhea, eyelid edema, and/or conjunctival injection.
26
subtypes of migraine
with and without aura
27
aura
fully reversible neurologic symptoms: visual, motor, sensory, speech, brainstem, or retinal. The symptoms of an aura typically develop gradually and are usually followed by a headache. Auras are fully reversible and last 5 to 60 minutes
28
definition of migraine without aura (2 characteristics required)
unilateral location, pulsating quality, moderate to severe intensity, and exacerbation by physical activity. In addition, at least one of the following must be present: nausea or vomiting, photophobia, or phonophobia
29
chronic migraine definition
15 migraine days each month, for at least 3 months
30
women are _____x more likely to be affected by migraines
2-3
31
most common type of headache
tension, age peaks between 30-38
32
second mots common type of headache
migraine
African americans, non whites 2x likely to have migraines
33
foods that are known migraine triggers
sodium nitrate
alcohol
tyramine
phenylethylamine
caffeine
34
most painful type of headaches
cluster
35
temporal arteritis or GCA
Associated symptoms include scalp allodynia, jaw claudication, and concurrent polymyalgia rheumatica. Other symptoms are local swelling; tenderness and pulselessness of the temporal artery; and systemic symptoms of fever, anorexia, weight loss, and chills. Systemic markers of inflammation also are present. Prompt diagnosis is important since temporal arteritis can cause permanent vision loss if left untreated.
36
thunderclap headache
abrupt and severe, sudden onset headache that reaches maximal intensity in under 1 minute. This type of headache requires emergent evaluation since it is often caused by a subarachnoid hemorrhage
37
Arterial dissection,
characterized by cephalic pain or headache of sudden onset, often preceding transient ischemic attack (TIA) or stroke symptoms. Carotid or vertebral artery dissection causes acute unilateral neck pain that is sudden and often radiates to the ipsilateral face or eye. The headache is related to cervical manipulation, sustained exertion, or trauma. Recognition and proper treatment are important since arterial dissections can lead to stroke
38
Increased intracranial pressure
causes headaches that worsen with lying flat, bending over, or with the Valsalva maneuver. There may be an associated cranial nerve VI palsy, pulsatile tinnitus, or transient visual obscuration, including a graying out of vision, typically with position changes. Funduscopic examination reveals papilledema.
39
Encephalitis
is associated with a new-onset generalized headache, accompanied by confusion, altered level of consciousness, focal neurologic signs, or seizures. Signs of infection and meningismus may be present. Changes associated with these conditions can be detected with lumbar puncture (LP) and brain imaging
40
skull structures sensitive to pain
meninges, arteries, skull
41
Pain signals are transmitted from most structures in the head by branches of the
trigeminal nerve
42
It is thought that an abnormal reduction in serotonergic activity in the ________is a part of the hypersensitization in primary headache syndromes
thalamus
43
events of migraine
prodrome- hours to days before headache (drowsiness, depression, euphoria)
Unilateral headache- increased sensitivity
44
cluster headache duration
2-3 months, 1-2x/year
45
family hx-migraine
associated with 40% patients
46
typical migraine without aura
often unilateral
2-72 hours
pulsating
inhibiting daily activity
n/v, photo and phonophobia
47
typical migraine with aura
aura develops over minutes, lasts less than hour
visual symptoms most common
48
migraines and menses
migraines often occur after ovulation and before/during menstruation
49
for women who experience aura
use of any combined hormonal contraception is contraindicated= d/t 3x increase in risk of stroke
50
physical findings with subarachnoid hemorrhage
visual blurring
diploplia
fever
alteration of consciousness
nuchal rigidity
51
A symptom specific to temporal arteritis is
“claudication” of the muscles of mastication
52
A computed tomography (CT) scan or an magnetic resonance imaging (MRI) study is recommended if the patient’s headache
pattern is atypical, has changed in pattern or character, or is accompanied by seizures, personality changes, or an abnormal neurologic finding
53
labs for headache pt
CBC
CMP
UA
54
GCA labs
ESR strongly elevated
CRP elevated
biopsy of temporal artery is gold standard
55
HA red flags
* Progressive or fundamental change in headache that worsens over time
* Patient states, “This is the worst headache of my life!”
* New-onset headaches before the age of 5 or after age 50
* Persistent headache precipitated by a Valsalva maneuver, exertion, or sex
* Fever, acute glaucoma, hypertension, myalgias, weight loss, or scalp tenderness
* Neurologic signs and symptoms: confusion, altered level of consciousness, changes in memory, papilledema, sensory deficits, reflex asymmetry, or gait disturbances
* Headache with syncope or seizures
56
Tension type headache tx
NSAID, cool compresses, stress reduction
Not more than 2x/week
57
migraine tx- non pharm
ID and eliminate triggers
maintain strict sleep schedule
regular exercise
deep breathing, massage, hot/cold therapy
58
migraine tx- pharm
triptan , NSAID
59
cluster ha tx
SQ sumatriptan
intranasal zolmitriptan
O2
60
Paresthesia
is an abnormal sensation described as numbness or tingling, cramping, or pain without a known stimulus, felt along peripheral nerve pathways.
61
Paresis
is weakness
62
Tremors
are rhythmic involuntary muscle movements that result from alternate contraction and relaxation of opposing muscle groups. They are typically evident in patients with cerebellar or extrapyramidal disorders
63
resting tremor
occurs in a relaxed and supported extremity and ends with purposeful movement
64
intentional tremor
occurs when the patient attempts voluntary movement.
65
Musculoskeletal problems
most common cause of disability in workers
* Typically self limiting, however must r/o musculoskeletal emergencies
* Diagnosis dependent on patient’s self reporting symptoms
66
Categories of musculoskeletal complaints
o Acute or chronic
o Articular or nonarticular
o Inflammatory or non inflammatory
o Localized or systemic
67
articular complaints
involve synovium, synovial fluid, articular cartilage, intra articular ligaments, joint capsule
o Deep/diffuse pain, limited ROM on active and passive movement, swelling,crepitation, instability, locking, deformity
o Based on number of involved joints (monoarticular, periarticular, polyarticular)
68
non-articular complaints
involve extra articular ligaments, tendons, bursae, fascia, bone, nerve, skin
o Focal vs widespread
69
inflammatory muscle complaints
infectious or idiopathic
o Four signs of inflammation: erythema, warmth, pain swelling
70
non inflammatory musculoskeletal complaint
* Non inflammatory- r/t trauma, ineffective repair, neoplasm
71
when inspecting joint pain always compare
symmetry and sides
72
Pain over greater trochanter indicative of
hip trochanteric bursitis
73
hand numbness that awakens pt at night indicative of
carpal tunnel syndrome
74
Bony enlargement of distal interphalangeal joints indicative of
osteoarthritis
75
soft tissue swelling indicative of
rheumatoid arthritis
76
Two key portions of physical exam of musculoskeletal
ask pt to rise from chair without holding on
have pt walk
77
Lab tests for musculoskeletal complaints
CBC- r/o anemia, leukopenia
ESR, CRP
Rheumatoid factor
ANA
Lyme
Uric acid
78
Imaging for musculoskeletal complaints
Indicated when exam can’t localize structure causing symptoms, after significant trauma, loss of joint function, pain continues after conservative management, fracture or infection suspected, hx of malignancy
79
Acute Musculoskeletal Injury
* Acute pain of less than 6 weeks
* Damage to muscles, tendons, ligaments, nerves, bursae- most common are spasm, strain, sprain
80
Spasm
o - persistent, painful, reversible contracture of striated muscle
81
Strain
o - muscle injury caused by excessive tensile stress placed on muscle- results in stiffness, decreased function
“pulled muscle”, usually no redness/swelling, ROM may be limited
82
Sprain
o - stretching/tearing of ligaments when joint forced beyond normal anatomical range
often have hx of sudden fall/injury
o Redness/bruising over affected joint, active and passive ROM limited, pain when moving
83
1st degree sprain
* - stretching of ligamentous fibers
84
2nd degree sprain
* - tear of part of ligament, pain and swelling
85
3rd degree sprain
* - complete ligamentous separation
86
Acute muscle injury tx
* PRICE- protect, rest, ice, compress, elevate
* Most are self-limiting, improve within 2 weeks
* PT- heat and cold. Cold x48 hours, then heat
* Pain relief- NSAIDs. NO opoids
87
Muscle Cramps
* Sudden, involuntary, painful contractions of muscle that lasts several seconds- minutes
* Hyper-excitability of motor neurons supplying muscle
* In pregnancy and children- tend to be at rest, benign
* Leg pain/cramps in adults precipitated by exercise- peripheral vascular disease
88
Radiculopathy
* - caused by compression/injury of spinal nerve roots d/t spondylosis or disc hernation
o Weakness, numbness, tingling typically occur along distribution of affected nerve root
o Common: L3-L5, L5-S1
89
Brachial plexus injury-
severe burning upper arm/shoulder pain that radiates down arm, followed by weakness. Pt holds arm at affected side
90
Thoracic outlet syndrome
* - compression of brachial plexus and/or subclavian vessels as they exit narrow space between shoulder and first rib
o Women age 20-50 most common
91
Peripheral polyneuropathy
* - “stocking glove” paresthesia, diminished DTR. Diabetes is common cause
92
Myofascial Pain
* Type of muscle pain that is caused by development of “trigger points” within muscle
* Trigger point- area of local irritation that when activated causes referred pain
93
myofascial pain tx
ID and eliminate aggravating factors. Trigger point injections, dry needling, massage therapy, tizanidine
* Muscle relaxers- avoid with etoh, dry mouth
94
Neck pain
* Causes- generally structural in nature
* Risk factor- stress, sedentary occupation, improper biomechanics
* Watch for pain that begins gradually and improves with rest
* Evaluate ROM
* Spurlings maneuver to assess nerve root compression
* Palpate neck- check for tenderness, spams, lymphadenopathy
* Labs- EXR, RF or ANA if systemic
95
Spondylosis
* - degenerative changes, may cause osteophytes. Normal result of aging
96
Back Pain
* Causes: lumbar strain/sprain, nerve impingement, nerve compression, radic, fractures
* Fractures often result of trauma
* Inspect spine, lower extremities, gait. Palpate area of concern
* Inspect while standing, sitting with knees/hips at 90 degrees and lying in prone position
* Evaluate lower extremities for sensation. Can they walk on heels/toes?
* Straight leg test- pt supine, grab heel of leg and raise, assess for pain
97
Ankylosing spondylitis-
* inflammatory back pain in absence of RF with elevations in CRP
back pain/stiffness over several months, relief with exercise
98
Cauda equina
* - saddle numbness, loss of bowel/bladder. **Med emergency
99
Dissecting aortic aneurysm
* - sudden onset severe low back pain, not relieved with rest. **Med emergency
100
Gallstone back pain
* - pain after fatty meal, radiates around trunk to right scapula
101
herniated disc back pina
years of recurrent low back pain
102
infection back pain
pain even at rest, fever, diabetes
103
prostatitis back pain
constant low back pain, urinary hesitancy, change in sexual frequency
104
stenosis back pain
gradual onset, mimics intermittent claudication but pain is in butt, thigh or calf, pain relieved when sitting, leaning forward
105
Should pain
* Most commonly causes by local process
* Often caused by precipitating injury
* Instability often occurs in younger adults
* Inspection first for color, swelling, edema, symmetry. Then palpation. Then active/passive ROM
106
Apley scratch test
* - reach behind head and touch superior aspect of opposite scapula
107
shoulder pain with abduction
supraspinatus tendinitis, subacromial bursitis
108
shoulder pain with active motion
muscle and bursae involvment
109
shoulder pain with passive motion
involve tendons, bursae
110
acute anterior dislocation of shoulder
pain is severe, ROM limited
111
Frozen shoulder
o - global loss of passive and active ROM
112
elbow pain
* Normally because of overuse
* Most common lateral epicondylitis of humerus (tennis elbow)
o Associated with repeated extension of wrist and pronation/supination of forearm against resistance
o Pain in elbow that radiates to forearm, pain/weakness with gripping objects (coffee cup sign)
Rest, ice, NSAID, PT
113
Medial epicondylitis
* “golfers elbow”
* Result of overuse or strain of muscle group used in wrist flexion
* Tenderness/pain over medial epicondyle and exacerbated by wrist flexion
114
Allen’s test
* - compress radial and ulnar artery and arterial arch
115
Phalen’s maneuver-
* maintain forced flexion of the wrist for 1 min
116
Tinel’s sign
* - percuss median nerve at wrist, check for tingling
117
Finkelstein’s test-
* have pt touch thumb into palm and make a fist, check for pain
118
Hip pain
* Discomfort within or around hip, subject to stress from ambulation and weight bearing
* Pain in/around hip often felt in groin or the buttock, can be referred to thigh or knee
* Presence of stiffness- question degenerative disease
* Fracture of femoral head results in external rotation and flexion, shortened leg
* Check gait if possible, check passive ROM, assess femoral/pedal pulses, DTR
119
Knee pain
* Relatively weak joint, suspectable to many injuries
* Often result of overzealous exercise, fractures
120
Meniscal injury
* - often with twisting injury with foot planted on ground and locking, localized pain/tenderness
121
Ligamentous injury
* - acute pain, instability, swelling
122
Patellofemoral dysfunction
* - continuum of disorders including chrondomalacia patellae and patellofemoral arthralgia (overuse syndrome). Pain occurs when climbing stairs or standing after sitting
123
Bursitis/tendinitis
* - secondary to overuse, often bilateral. Pain worse with rising, at night
124
Bulge sign
* - pt supine, massage medial knee toward head, then stroke lateral aspect of knee toward medial aspect. Positive if flatulence occurs over medial aspect
125
McMurray test
* - flex knee, hold position while externally rotating foot, then extend knee
126
Anterior drawer test
* - stabilize tibia, grasp hindfoot and pull forward
127
Fairbank test
* - pt seat with quads relaxed, put knee in extension, displace patella laterally and flex knee to 30 degrees. Watch for pain, apprehension
128
Posterior impingement syndrome
* - seen in ballet dancers, pain/swelling of posterior ankle and worsens with plantar flexion
129
Achilles tendon rupture-
* pain, inability to walk normally. Side effect of fluoroquinolones
130
Thompson’s test
* - pt lies prone, bend knee so leg is vertical, squeeze calf, should create plantar flexion
131
Neuroma
o causes tenderness in 3rd and 4th intermetatarsal space with radiation into toes
132
Bunion (hallus vagus)
o - deformity of the first metatarsal joint with lateral drift of toe. Painful swelling
133
Midfoot problems
*
o Result of flat foot, likely to produce pain/stiffness in midfoot region, tenderness to palpation
134
plantar fasciitis
o - pain worse in morning, subcalcaneal pain that radiates to arch in foot when walking
135
Achilles tendinitis
o - pain at or proximal to insertion of tendon into calcaneus
136
“Whiplash”
describes an acceleration–deceleration of the neck with rapid flexion–extension and is a common sequela of motor vehicle accidents. Despite no apparent instability, these injuries may cause prolonged disability, probably related to a combination of relatively severe ligamentous/muscle injury with nonorganic overlay.
137
the most common cause of neck pain
Mechanical disorders of the cervical spine are
138
The highest prevalence (10%)of cervical pain is among
persons aged 45 to 64 years
139
occupations at risk of developing mechanical neck pain
Workers who do repetitive tasks with their upper extremities and prolonged sitting with their head in a flexed position are ; these include machine operators, carpenters, office workers, dentists, and keyboard operators
140
Cervical sprain
is a clinical condition describing a non-radiating discomfort or pain in the neck area associated with a concomitant loss of neck motion and stiffness
141
Whiplash injuries are most commonly caused by
rear-end motor vehicle collisions (MVCs) when the driver of a stationary car is struck from behind by another vehicle
142
cervical sprain subjective presentation
pain in middle to lower part of posterior neck
headache
pain that worsens with motion, spasm
if from MVC- does not appear until 12-14 hours after collison
143
cervical sprain objective presentation
decreased ROM in neck, poor quality of movement
negative Spurling sign
tenderness to palpation to cspine
144
Spurling’s sign
(radicular pain reproduced when the examiner exerts downward pressure on the vertex while tilting the head toward the symptomatic side)
145
when to order imaging cpsine sprain
neuro deficits
XR obtained in all instances
146
Cervical disc herniation presents with
associated radicular pain and neurologic findings.
147
Cervical spine tumor is accompanied by
a history of night pain and weight loss.
148
cervical spine infection is accompanied by
fever, sweats, and chills. Consider if the patient has a history of IV drug use.
149
Malingering is accompanied by
exaggerated symptomatology and evidence of secondary gain.
150
Cervical sprain tx
reassurance, decrease in activity
NSAIDs
muscle relaxers
PT
cervical traction
151
Spondylosis
(also called degenerative arthritis) is a blanket term for a group of chronic degenerative processes that affect the vertebrae and facet joints and cause pain, stiffness, and disability
152
Patho of cervical sponylosis
Changes in the intervertebral discs caused by aging include a loss of water and elasticity, which can make the disc vulnerable to injury and surrounding ligaments less able to support the surrounding structures
153
cervical spondylosis subjective presentation
neck stiffness, mild ache with activity
trouble turning neck
154
cervical spondylosis diagnostic test
MRI
155
if symptoms of cervical sponylosis are bilateral
consider disc herniation
156
Acute low back pain (ALBP) is pain that
persists for less than 6 weeks.
157
Chronic low back pain (CLBP) is defined as
pain lasting longer than 3 months; symptoms are typically recurrent and episodic but may be unremitting.
158
ALBP occurs most frequently in adults in between ages
20 and 50 years
159
CLBP typically is seen between
the third and sixth decades of life, or even older for women.
160
women report more LBP after
age 60, most likely due to osteoporosis; these women are at risk for vertebral compression fracture. In addition, a woman’s likelihood of experiencing LBP is increased after two or more pregnancies
161
There are two categories of risk factors that influence LBP
: occupational and patient related
162
occupations with associated increased risk of LBP
require hard labor and heavy exertion, exposure to prolonged vibration (riding)
pts who view occupations as boring
163
most frequent cause of lost workdays in the United States
LBP
164
low back pain subjective presentation
localized discomfort shortly after lumbar tissue mechanically stressed
difficulty standing erect, change position frequently
pain radiates into butt, posterior thigh
165
he hallmark symptom of CLBP
is recurrent LBP that often radiates to one or both buttocks
aggravated by activities
166
objective presentation of LBP
diffuse tenderness of low back
ROM reduced, elicits pain
167
LBP is a diagnosis of
exclusion
168
non pharm LBP tx
exercise
CBT
heat
massage
rest has little to no effect on resolution of LBP!!
169
LBP pharm tx
acetaminophen, NSAIDS, muscle relaxers
170
The first episode of back pain is usually
the briefest and least severe
171
The most common cause of radicular pain to the lower extremities is a
herniated lumbar intervertebral disc
172
Disc herniation occurs most commonly at the
L4 to L5 or L5 to S1 levels with subsequent irritation of the L5 and S1 nerve root.
173
hallmark sign of disc herniation
radicular symptoms
174
subjective clinical presentation lumbar spine disc herniation
insidious severe pain, exaggerated by sitting walking coughing
pain radiates down butt
unilateral radic
175
objective lumbar spine disc herniation presentation
patients list to one side when standing
reproduced back pain with supine straight leg raising limited to less than 45 degrees of leg elevation
176
lumbar spinal stenosis
most frequently results from enlarging osteophytes at facet joints
177
sign of lumbar stenosis
short term relief by leaning forward
178
lumbar spine stenosis tx
NSAIDs
B12
PT or exercise, biking
epidural steroid injection
179
Cauda equina syndrome incomplete (I)
perianal/saddle anesthesia without urinary incontinence or retention with CES-I
180
cauda equina retention (R)
fully developed urinary retention or incontinence with CES-R
181
vertebral fracture
cspine most common- c2, c5/6/7
associated with osteoporosis, injuries
midlevel back pain, associated with movement
XR, CT, MRI
182
vertebral fracture tx
pain relief- opioids, tramadol
maintain function- bedrest
prevention
quality of life
f/u in 1 week
183
Bursitis
, or inflammation of a bursa, is a common cause of painful musculoskeletal syndromes. Bursae are sacs filled with synovial fluid, located between muscles, tendons, and bony prominences.
more common in men, pts younger than 35
184
the most common cause of bursitis
Trauma in the form of repetitive motion injury is probably
185
bursitis clinical presentation- subjective
pain, swelling, warmth
if deep bursa- pain with activity or direct pressure
186
bursitis objective presentation
induration, erythema, effusion
187
bursitis management
XR
avoidance of activities, moist heat/ice to affected area every 4 hours x15 min
NSAID
steroid, oral or injection
188
Tendinitis
is the inflammation of a tendon, which usually occurs at its point of insertion into bone or at the point of muscular origin
189
tendinitis risk factors
overtraining with athletes
repetitive motion with job
vibration, cold environment
190
tendinitis subjective presentation
pain, swelling over localized area of tendon
pain worse with motion
squeaking or rubbing
191
tendinitis objective presentation
swelling minimal
pain worsens when stretches involved tendons
192
tendinitis tx
PRICE
compression
rest 1-2 days
PT
NSAIDs
steroid
193
most common cause of peripheral nerve compression
CTS
194
CTS
most common 40-60, affects females more than males
increased risk with occupations that require repeated flexion
195
CTS subjective & objective
aching sensation, nighttime awakening with pain/numbness in medial thumb and medial portion of 4th digit
thenar eminence atrophied
196
De Quervain's tenosynovitis
pain at base of thumb, more common in middle aged women
pt complains of pain while turning key
Finkelstein's test is confirmation test
197
ganglion cyst
caused by frequent strains and contusions, results in joint inflammation
asymptomatic
tx: aspiration, sx
198
trigger finger
can affect any digit, mostly affects middle or ring
snapping/locking, severe pain
tenderness in palm, palpable nodule sometimes
TX: local anesthetic, corticosteroid injection
199
Dupuytren's contracture
AKA viking disease
affects palmar tissue between skin and distal palm/fingers
Progressive condition, refer to ortho for tx
200
adhesive capsulitis
frozen shoulder
Risk factor: DM type 1
Tight, painful shoulder joint that has limited ROM
TX: moist heat, NSAIDs, PT
201
rotator cuff syndrome
lateral arm pain, radiating from shoulder to elbow, night pain, difficulty sleeping, atrophy
palpation elicits tenderness, crepitus
TX: resting, NSAIDs, stretching
202
calcific tendinitis
degenerative process accompanied by a local deposit of calcium that develops in the rotator cuff.
tender, severe localized pain
XR shows deposit
203
rotator cuff tear
occur spontaneously after age 50
lateral deltoid pain, weakness
empty can test-examiner places his or her fingers on the outstretched arm near the hand and applies pressure to assess if the patient can maintain position against resistance.
TX: icing, NSAIDs, PT, avoiding overhead activities
204
Greater trochanteric pain syndrome
is a combination of both gluteal (buttock) tendon injuries (tendinopathy) and bursitis (inflammation of the bursa) surrounding the hip joint.\
characterized by chronic, intermittent, aching pain over the lateral aspect of the hip, and some patients report numbness in the upper thigh. Pain will increase with movement, especially external rotation and abduction
TX: NSAID, steroid injection
205
most common fracture adult
hip fracture
externally rotated and shortened injured leg
