Module 7 Musculoskeletal Flashcards
What is the patho of neck pain?
• Strains and sprains caused by overuse, stretching or tearing
• If acute phase if no neurologic symptoms
– Strain or sprain
• Cervical radiculopathy can extend to arm
• Cervical myelopathy possible complication of cervical spondylosis
What risk factors are associated with neck pain?
- Older age
- Female
- Obesity
- Physically or psychologically strenuous work
- Sedentary lifestyle
- Acute trauma
What are differential diagnosis of neck pain?
- Infection
- Fracture
- Inflammatory disease
- Neoplasm
What history (subjective) should be reviewed with neck pain?
– OLDCARTS – Special attention to radiation of pain – loss of sensation – weakness
What should be checked in ROS (subjective) for neck pain?
– What do you need to rule out? – CV, GI, GU, respiratory, neuro, integumentary, psych – Chronic or acute pain – Radicular: > in the arm than neck
What are the red flags for neck pain?
• History of cancer • History of (or risk for) osteoporosis • Progressive neuro deficit • Greater than 6 weeks without improvement
What should be assessed on the physical exam for neck pain?
• Inspection – Gait and posture – structural abnormality • Palpation – pain over spinous processes – paraspinous muscles for pain or spasm • Motor system – ROM – flexion, extension, rotation – Strength • Neuro system: – Sensation by dermatome
What diagnostics can be done for neck pain?
• Imaging – X-ray – CT or MRI • Other – EMG • CBC, ESR, CRP
How can neck pain be treated?
• If a sprain or strain: -Conservative care -Heat, ice, and massage -Physical therapy for guided exercise • Pharmacology – NSAIDS, muscle relaxants • Activity – as tolerated • Lifestyle management: -Work on appropriate posture (decrease screen use!) -Avoid repetitive movement/lifting
What medications can be used for neck pain?
- NSAIDS, muscle relaxants
- May need short course (2-3 days) opioids
- Duloxetine (SNRI)
- Gabapentin
What patient education should be done for neck pain?
• Reassurance and support
• Explain the history of mechanical neck pain
• Preemptive exercise in conditioning
• Postural exercises
• Recommends of a lumbar support when sitting helps
the patient maintain proper head and neck alignment
• Warning signs and symptoms of serious complications
What complications are associated with neck pain?
- Sudden or progressive weakness
- Bowel or bladder changes
- Constitutional symptoms
What patients with neck pain should be referred?
- Abrupt-onset cervical myelopathy associated with gait disturbance
- Upper motor neuron signs
- Bowel and bladder incontinence
- Incapacitating neck pain refractory to conservative methods
- Trauma
- Fracture or instability of cervical spine
- Epidural steroids
- Surgery
What is the patho of low back pain?
• Mechanical – Injury – Deformity – Imbalance – Overuse • Systemic medical illness – Inflammatory infection – Neoplastic – Visceral sources
What are the risk factors of low back pain?
• Broad • Genetics • Smoking • Obesity • Older age >65 • Female • Physically or psychologically strenuous work • Sedentary lifestyle • Acute trauma
What are the differential diagnosis for low back pain?
• Diabetic amyotrophy • Vascular claudication • Sacroiliitis • Shingles with or without rash • Pancreatitis, intra-abdominal or gynecologic pathology • Renal colic • Priority dx – Spinal cord compression, fracture, inflammatory disease, neoplasm, infection
What subjective data may we see with low back pain?
• Pain disturbing sleep, work, and activities • Acute onset • Chronic in nature “I have had this for years.” • Exacerbated by prolonged activates – Pain mitigated by frequent position change • Lumbar radiculopathy – Leg and thigh pain – Neurologic symptoms • Numbness • Tingling • Weakness • Reflex changes
What should be done on a physical assessment for low back pain?
• Inspection – Gait and posture – structural abnormality • Palpation – pain over spinous processes – paraspinous muscles for pain or spasm • Motor system – ROM – flexion, extension, rotation and lateral bending – Strength • Neuro system: – DTRs – Sensation by dermatome • Special tests: – Straight leg raising – Abduction relief • Waddell signs
What diagnostics can be done for low back pain?
None
How can low back pain be managed?
Conservative care
• self-limited; 90% resolve in 1-6 wks.
• Ice, heat, TENS
• Pharmacology – NSAIDS, muscle relaxants
• Activity – as tolerated, bed rest no longer than 2
days; walking important.
• Do not advise patients with acute low back pain to remain at bed rest
• Lifestyle management:
• Weight loss
• physical activity, exercise X30 min per day to strengthen back and abdomen
• Good body mechanics
• Massage, yoga, acupuncture, spinal manipulation
What patient education should be reviewed with low back pain?
- Reassurance and support
- Typically benign
- Exercise is important
- Eliminate risk factors
What are the red flags associated with low back pain?
– New limb weakness
– Change in bowel and bladder
– Constitutional signs
What patient with back pain warrants immediate referral?
If significant neurologic weakness or cauda equina syndrome is occurring, the need an URGENT SURGEON referral
What is the patho of arthritis?
- Soft cartilage becomes overhydrated
- Collagen loses its stiffness
- Surface layers fibrillate, and cartilage loses thickness, developing surface crevices, thus losing integrity
- Whole-joint disease
What are risk factors associated with arthritis?
- Female
- Middle-aged
- Obesity
- Prior trauma
- Repetitive activities
- Metabolic disorders
- Neurologic diseases
- Hematologic conditions
What are differentials associated with arthritis?
– Fracture
– Avascular necrosis
– Infectious arthritis
– Lyme disease
What subjective data is associated with arthritis?
- Insidious, progressive pain or stiffness
- Pain upon arising, with duration <1 hour
- Favoring one side
- Pain after prolonged activity and relieved by rest
- Difficulty with weight bearing activities
- Neuropathy and radiculopathy may develop if the cervical or lumbar spins is involved
What objective data is associated with arthritis?
- Trendelenburg gait noted
- Deformity of an extremity
- Pain on palpation
- Atrophic quadriceps muscles to affected side
- Heberden nodes (distal interphalangeal joints)
- Bouchard nodes (proximal interphalangeal joints)
What diagnostics can be done with arthritis?
• Additional – Joint aspirate for crystal/white blood cells • Imaging – X-ray
How can arthritis be managed?
• Acetaminophen • Consider Tramadol (nonopioid) • NSAIDS – Consider H2 Blocker or proton pump inhibitor to protect the gut • Exercise • Weight management • Acupuncture
What patient education should be reviewed for arthritis?
• Progressive disease • Lifestyle modifications – Weight management – Low-moderate intensity exercise • Assistive devices
What complications are associated with arthritis?
• Pain • Immobility • Medication side effects • Failure of prosthetic components • Infection or microfractures of damaged joints
When should a patient be referred with arthritis?
Suspected fracture
How is fibromyalgia defined?
• Are characterized by symptoms of: – widespread musculoskeletal pain – Fatigue – Nonrestorative sleep – Depression – Headaches – Gastrointestinal complaints • Defined as having more than three months of musculoskeletal pain present above and below the waist bilaterally, associated with pain on palpation of specific tender points
What is the patho of fibromyalgia?
• Pain getting in the periphery is processed in the spinal cord and transmit it to the brain. For unclear reasons the pain becomes louder at the level of the spinal cord and brain, a condition called central
sensitization
• Follows physical or mental trauma, viral illness, and stress
