Module 6 Flashcards
differentiate between acute, chronic and emergent low back pain
acute: mechanical, usually treated within 4-6 years, could be from trauma, injury, sitting for prolonged periods
chronic: spinal stenosis, DDD, herniated discs, narrowing or claudication
emergency low back pain:
cauda equina syndrome
wt loss with back pain, pain at night or at rest, pain >6 weeks
Value of diagnostics for low back pain
clinical presentation is key
only use diagnostics to assess and evaluate symptoms that are suspected
xrays can be trialed with no improvement in 4-6 weeks
MRI to assess for discs, tissues, bone structures (used to assess recurrent, persistent or neurological related back pains)
CT scans - neurological pain
labs ie) CRP
Treatment of low back pain with radicular compenent
radicular component = radiating leg pain or tingling dud to neural compression
NSAIDS, gabapentin or tricyclic antidepressants can be used for neuropathic pain
classifications of sprains
sprain- stretching and or tearing of the ligament that connects bone to bone
grade 1 - partial tear with no instability; pain and edema (no intervention)
grade 2- partaien tear with some instability, illicited by stress maneuvers, functional impairment, ecchymosis, discomfort of pain with weight bearing (immobolize area)
grade 3 - complete opening of joint due to stress; loss of ligaemtne intergrt, weakness to muscle (requires surgical intervention)
Review diagnosis and management of carpal tunnel syndrome
carpal tunnel-compression of medial nerve in the wrsit
intermittent wrist pain, numbness and tingling that radiats from palm to index, middle and ring fginer, inability to hold things and will drop tings
dx: tenderness, motor strength, Electrodiagnostic studies and nerve conduction studies , phalen and tinels test
management: wrist splint, NSAIDS, ice, phsyical therapy, surgery
Describe the evaluation and management of a patient with fibromyalgia.
physical and history exam
lab values are usually normal
management tricyclic drugs SSRIs, gapapentin, NSAIDS
CBT, exercise, alternative therapies
multidisciplinary approach is most effectve
Review evaluation and management of patients with fractures and sprains.
sprains: swelling, discomfort and pain with movement
fractures: pin point pain
radiographs are beneficial in use for fractures
trauma, immediate pain, limited range of motion or decreased strength is used for x ray students
management:
RICE, NSAIDS, splints, ortho referral
Describe evidence-based preventive care in patients regarding osteoporosis.
adequate diet in protein. calories calcium and vitamin D
discontinuation of corticosteroids
smking cessation and decreased alcholo intake
excerceises (walking, resistance exercise)
safety prevention ie ) falls, canes, walkers
decrase use of mediacations that can cause falls
Describe the differential diagnoses associated with osteomyelitis
a. Metastatic cancer of the bone or osteosarcoma
b. Old or new trauma
c. Non-infected union
Describe the pathophysiology of scleroderma,
o Autoimmune disorder characterized by inappropriate overproduction of collagen in the connective tissues; as if the body were trying to heal an injury but there isn’t one.
o Interferes with functioning of vital organs.
o Can be life threatening.
o Chronic disease that can flare or go into remission
o Early signs include Raynaud’s symptoms and finger stiffening/puffiness
Sjoregren’s syndrome
o Autoimmune disorder characterized by two classic symptoms of dry eyes and dry mouth. Usually occurring in women over 40 o Other symptoms include: o Joint pain, swelling and stiffness o Swollen salivary glands — particularly the set located behind your jaw and in front of your ears o Skin rashes or dry skin o Vaginal dryness o Persistent dry cough o Prolonged fatigue
Rhabomyolysis
o Potentially life threatening condition caused by the breakdown of skeletal muscle, usually as a result of metabolic starvation, crush injuries, alcoholism, electric shock or overexertion
o Skeletal muscle fibers break down due to leakage of calcium which disrupts the interaction of actin and myosin, leading to destruction of the muscle fiber. and the protein contents such as myoglobin leak into the bloodstream
o The first sign of rhabdo is usually tea-colored urine, followed by fatigue and fever
o Cardiac arrhythmias due to hyperkalemia from electrolyte leakage, as well as acute renal failure are some of the major complications of this condition.
Paget’s disease
o Suspected to be caused by a mix of environmental or genetic factors
o Causes the bone to generate new bone faster than normal
o Most people may not have any symptoms, if they do its usually bone pain
o The rapidly produced bone is softer and more brittle than normal, typically occurs in pelvis, skull, spine and legs
o May result in deformities and fractures
presentation of osteoporosis, evaluation, treatment and management
increased bone fragility and susceptibility to fracture
asymptomatic usually, kyphosis, scoliosis and height loss could be signs
evaluation includes lab work,. radiaographs. bone density tests, T score <2.5 is indicative of osteoposis
management: lifestyle first, vitamin d, calcium, wieght bearing exercise, smoking cessation
biphosphonates are used in first line treatment
presentation of osteoarthritis, evaluation, treatment and maangement
progressive degenerative joint disease
increasing thickness and sclerosising of the joint
monoarticular or polyarticular and is asymmetrical
common type of arthritis
progressive pain or stiffnes to one or more joints
exacerabted by activity and releived with rest
grinding, swelling, loss of motion
nerupathy common in lumbar spine
early stages: may not be evidence in radiaographs
can trial xray, or MRI
management acetaminophen, NSAIDS, corticoinjections
alternative therapies, slow progressive, lose weight and avoid repetitive stress or trauma
