Module 9: Musculoskeletal (a) Flashcards
1
Q
Osteoarthritis (OA)
-Info/Stats
A
- Most common type of arthritis — accounts for 30% of primary care visits
—Most COMMON musculoskeletal problem of adults >45 yrs
—Most COMMON cause of disability in elderly — OA of the knee is leading cause of chronic disability in US - Also called Degenerative Joint Disease
2
Q
Osteoarthritis (OA)
-Patho
A
- Changes in cartilage cellular matrix — earliest manifestations of OA are superficial erosions of the cartilage
—Loss of articular cartilage
—Thickening of sub-chondral bone
—Development of osteophytes
3
Q
Osteoarthritis (OA)
-Contributing Factors
A
- Aging
- Genetic Factors
- Obesity
- Muscle weakness
- Trauma
4
Q
Osteoarthritis (OA)
-Clinical Presentation
A
- Joint pain — deep aching pain aggravated by motion & weight bearing — Worse at night s/p vigorous activity
- Joint Stiffness — esp after inactivity — morning stiffness usually <30 minutes
- Joint Enlargement — Osteophyte formation
- Crepitus on movement w/ joint
- Later stages — Pain on motion and at rest; limitation of motion; mal-alignment; body protuberances from spurs
NO SYSTEMIC SYMPTOMS
5
Q
Osteoarthritis (OA)
-Joint Involvement
A
- Knees and Hips
- Hands — Distal inter phalange all joint (DIP) & Proximal inter phalange all joint (PIP)
- Spine
6
Q
Osteoarthritis (OA)
-Major Radiographic Features
A
- Joint space narrowing
- Osteophyte formation
- Subchondral bone cysts — periarticular ossicles
- Subchondral sclerosis
7
Q
Osteoarthritis (OA)
-Management
A
- Control Pain
- Maximize functional independence — encourage movement
- Minimize disability
- Preserve quality of life
- Non-Pharm
- Weight loss, proper body mechanics
- Warm, moist heat or Ice
- PT — Good for quad development for knee pain - Pharm
- Acetaminophen & NSAIDS
- Capsaicin cream (Topical)
8
Q
Osteoarthritis (OA)
-When to Refer?
A
- Severe, disabling OA
- Mal-alignment
- Instability
- Bone spurs
Follow up Q3-6 months
9
Q
Rheumatoid Arthritis
-Info/Stats
A
- Autoimmune disorder — immunologically mediated chronic inflammatory disease
- Higher incidence in females
- Peaks at 20-30 yrs and has familiar component
10
Q
Rheumatoid Arthritis (RA) -Presentation
A
- Synovitis and destructive arthritis of the diarthroidal joints — fingers (MCP, PIP), wrist, shoulders, knees
2Affected joints are painful to pressure (tender), swollen, and partially immobile
11
Q
Rheumatoid Arthritis (RA) -Extra-articular involvement
A
- Cardiovascular system
- Pulmonary visceral pleura
- Sclera
- Spleen
12
Q
Rheumatoid Arthritis (RA) -S/S
A
- Peripheral Symmetric poly arthritis & Morning stiffness > 1 hr ***
- Pain, tenderness, warmth, swelling
- Fatigue, depression, malaise, anorexia
- Chest pain w/ deep inspiration
- Low grade fever
- Painful eyes
13
Q
Rheumatoid Arthritis (RA) -Diagnostic Tips?
A
- Persistent symmetric** poly-arthritis
- Presence of systemic features
- Presence of rheumatoid nodules
- Exclusion of other systemic disorders (Ex: Lupus)
14
Q
Rheumatoid Arthritis (RA) -American Rheumatism Association Diagnostic Criteria
A
- Morning stiffness for >6 wks
- Arthritis involving 3 or more joints for > 6 wks
- Arthritis of hand joints >6 wks
- Rheumatoid nodules
15
Q
Rheumatoid Arthritis (RA) -Treatment
A
- Non-Pharm — Rest, splints, regular supervised exercise (PT, OT), Support groups, community resources
- Pharm
- NSAIDS, methotrexate, low dose corticosteroids, antimalarials, sulfasalazine, Gold Salts
- Rheumatologist REFERRAL
16
Q
Gout
-Info/Stats
A
- Metabolic disorder influenced by dietary factors — Overeating, obesity, ETOH abuse, Hyperlipidemia & insulin resistance syndrome
- Male to female ration 9:1
- Peak age of 1st attack — Males 50 yrs; females 60 yrs
17
Q
Gout
-Primary & Secondary?
A
- Develops when uric acid crystals collect in synovial fluid
- PRIMARY Gout — Inborn error in production or excretion of uric acid
- SECONDARY Gout — d/t other factors/disorders that cause hyperuricemia through over production of uric acid or decreased excretion of uric acid
18
Q
Gout
-Risk Factors for Acute Gout Attack
A
- Family Hx
- Obesity
- Lead exposure
- Purine rich diet
- Diuretics
- Recent Surgery
- ETOH abuse
- Chronic renal disease
- Rapid weight loss
- Infection or Trauma
19
Q
Gout
-Purine Rich foods?
A
- Organ meats and other meats
- Anchovies
- Sardines
- Meat extracts — gravy, broth, bouillon
High intake of low fat dairy products can reduce risk of gout
20
Q
Gout
-S/S
A
- Sudden onset of intense pain
- Usually monoarticular
- Inflammation increases within hours & lasts a few days to weeks
- Erythema
- Peak w/in 24-36 hrs
- MOST COMMON affected joint — 1st metatarsophalangeal joint 90%** (Big Toe) — other joints as well
21
Q
Gout
-Treatment
A
- Non-Pharm
— ETOH in moderation
—Diet if there is an association w/ symptoms
—2 L water per day - Pharm
- DOC is — Indocin (Indomethacin)**
- Alternative Drug — is naproxen or ibuprofen
-Chronic Gout
—Colchicine or Allopurinol
22
Q
Gout
-Drug of Choice?
A
- Indocin (Indomethacin)
23
Q
Gout
-Alternative Drugs
A
- Naproxen or Ibuprofen
24
Q
Gout
-Chronic Gout Drugs
A
- Colchicine
2. Allopurinol
25
Gout
| -Patient Education
1. Lifestyle modification — weight reduction if obese; Reduce ETOH
2. Medications — start w/ first sign of attack
3. Ice pack may be helpful w/ NSAID use
4. Follow-up PRN on individual basis
26
Costochondritis
| -Info/Stats
1. Inflammation of the costochondral junction
2. Most common cause of non-cardiac chest pain
3. Pain is reproducible/increased w/ palpation
27
Costochondritis
| -Presentation
1. Sharp, dull, or gnawing pain; fleeting or intermittent
2. 2nd to 5th upper costal cartilage spaces
3. Increased pain w/ movement, deep breathing or coughing
4. May have Hx of URI, heavy lifting, or hard exercise
5. NO objective PE findings other than localized tenderness
6. Pain is reproducible
- Diagnosis is made solely on ability to reproduce pain by palpation of tender area**
28
Carpel Tunnel Syndrome
| -Info/Stats
1. Median nerve compression neuropathy
2. Genetic predisposition
3. Females > males
4. Bilateral or unilateral
29
Carpal Tunnel Syndrome
| -Presentation
1. Most cases are idiopathic — Some may be seen w/ RA, connective tissue dz, pregnancy, fracture of carpal tunnel bones, acromegaly, hypothyroidism, and DM
2. Repetitive hand/wrist use and workplace factors in the development of CTS is controversial
30
Carpal Tunnel Syndrome
| -Physical Exam Signs
1. Tinel’s Sign — tap palmer surface of the wrist — Positive = tingling sharp sensation following along medial nerve
2. Phalen’s maneuver — Press back of hands together
LOOK UP in BOOK**
31
Carpal Tunnel Syndrome
| -Treatment
1. Splinting is 1st line therapy — Especially when sleeping; IDEALLY 24 hrs, 7days/wk for 6 wks
2. NSAIDS
32
Tendinitis (Tenosynovitis)
| -Info/Stats
1. Common cause of localized soft tissue pain
2. Seen w/ occupations that require REPETITIVE wrist and thumb movements
3. Pain noted on ulnar deviation under stress
- Caused by OVER USE & Direct or microtraumatic INJURY
4. Refer to Orthopedist if unresolved in 2 wks
33
Ganglion Cyst
| -Info/Stats
1. Develops on or in a tendon sheath
2. Thick, gel-like material leaks from the joint into weakened tendon sheath and forms a cyst sac
3. Cause — Frequent strains and contusions
4. Common sites — dorsum of wrist over radiocarpal joint or volar surface of wrist
5. May be Asymptomatic or associated w/ dull aching pain and weakness
6. Treatment includes ASPIRATION or SURGICAL removal
—Refer to General Surgery
