Mosby 21 Flashcards
Ankylosing Spondylitits
What is it?
Results?
Steps
Population
X-ray
Presentation
Chronic degenerative inflammatory arthritis primarily affecting the spine and sacroiliac joints
Fusion and deformity
Synovitis -> Bone destruction -> Fusion
Male 20-40yo
Bamboo spine
Uveitis (blurry vision/potential blindness)
Aortitis (aortic aneursym/aortic root dilation)
Decreased chest expansion
Lumbosacral Radiculopathy (Herniated Disk)
Cause
Population
Most coomon roots
Subjective
Objective
Test
Degeneration and tears in annulus fibrosis
30-50yo men
L4, L5, S1
When lifting heavey objectButtock ben and posterior thigh, relieved by lying down
Paraspinal muscle sensitivity, difficulty walking in heel/toes
Straight leg test
Lumbar Stenosis
Cause
Subjective
Objective
Hypertrophy of ligamentum flavum and facets joints resulting in narrowing of the spinal canal
Pain with walking especially downhill (relieved by uphill), pain often in buttons and legs
Focla weakness and sensory loss, neurological usually normal in early stages
Carpal Tunnel Syndrome
Cause
Association
Subjective
Objective
Compression of medial nerve
TAPRHOD , gout, acromegaly, hypothyroid, and pregnancy
Numbness, tingling, burning in 3 1/2 digits often worse at night (rotation can make it worse, may radiate to arms)
+Tinel +Phalen
Gout
Cause
Subjective
Location
Objective
Elevation of serum uric acid level, monosodium urate crystal deposition in tissues
Warm/hot swolleng joints, limited ROM
Great phalanx
Sking over the join may be shiny/purple/red and swollen
Lyme Disease
Cause
Subjective
Objective
Treatment
Tick bite –
Borrelia burgdorferi
fatigue, anorexia, headache, joints
Erythema migrans rash, neurological symptoms bell’s palsy, meningitis, encephalitis)
Doxycycline
Temporo Mandibular
Joint Syndrome
Cause
Subjective
Objective
Painful jaw movement often caused by congenital anomalies, malocclussion, trauma, arthritis, and other joint diseases.
unilateral facial pain that may worsen with joint movement. May refer to any point on the face/neck
muscle spasm, clicking, popping, crepitus in the affected joint
Osteomyelitis
Cause
Subjective
Objective
Treatment
Bone infection; open wounds, necrosis
dull pain develops and progresses over days to weeks
Looks limp or decreased movement in infants/children
fever, diabetetes/vascular disease
Debrideent, amputation
Paget Disease (of Bone)
Population
Cause
Subjective
Objective
>45 yo
Ill Bone turnover
increasing hat size, vertigo, headaches, deafness (CNVIII) or involvement of the ossicles
bowed tibias, misshapen pelvis, prominent forehead (Look for a history of frequent fractures due to poor bone formation)
Fibromyalgia
What is it
Population
Subjective
painful, nonarticular condition that leads to diffuse musculoskeletal discomfort
Women +40yo
widespread pain and aching, persistent fatigue, generalized morning stiffness, may also have headaches, sleep problems, and dysmenorrhea, may change with weather (?)
multiple tender points (>11) at nine bilateral sites
Osteo Arthiritis vs. Rheymatoid Arthritis
Onset
Duration
Progression during day
PE
LABS
Many years / gradual or suddent
<30min / >30min
Stays similar / gets worse
OA PE: reduced ROM, joint mal-alignment; joint crepitus
RA PE: synovitis; symmetrical joint; joint destruction;
OA LAB: osteophytes, space narrowing, clear fluid
RA PE: ESR; CCP
Fracture
What is it
Subjective
Objective
Partia. or complete break
Acute trauma more often in people with disorders e.g. OI
Deformity, edema, pain, loss of function, parasthesias
Tenosynovitis
Cause
Subjective
Objective
inflammation of the synovium-lined sheath around a tendon (repetitive action in occupational or sports activties)
Pain with movements at joints
Point tenderness if common, pain with movements, limitation of ROM
Rotator Cuff Tear
what is it
subjective
objective
tests
Treatment
Microtrauma and tering of rotator cuff muscles (most often supraspinatus) - repeatred lifting and compression under acromiom, also acutre from outstreched arm
pain in shoulder, can awake at night
Inability to maintain lateral arm raise against resistance, tenderness over AC joint, crepitus, weakness
Neer (hold scapula)
Hawkins test (flex rotate)
Empty Can test (thumb down pressure)
Surgery or supportive depending on patient
Ankle Injury
Test
Rules of this test
Importance
Absolute criteria exclusion
Ottwawa Ankle
Malleolar zone + one of the following
Pain in distal fibula
Pain in distal tibia
Inability to bear weight
High sensitivity
age <18, intoxication, multiple painful injuries, pregnancy, head injury, and neurologic deficit
Knee Injuries
Cause
Subjective
ACL/PCL tears vs. Meniscous tear
Injuries
Hyperextension / Pop
ACL/PCL swell faster
Knee Injuries
tests
Anterior/Posterior Drawer Test - ACL/PCL
Lachman Test - ACL
McMurray Test - Medial lateral meniscus
PEDIATRIC Clubfoot
Cause
Subjective
Objective
Fixed congenital defect of the ankles and foot
Demormity at birth
Inversion of the foot at ankle and plantar flexion
PEDIATRIC Legg-Calvé-Perthes
Cause
Population
Subjective
DDx from Slipped capital femoral epiphysis (SCFE)
Objective
Decreased blood supply to femoral head, avacular aseptic necrosis
Boys 3-11 yo
Pain referred to knee, groin, or medial thigh
Limph that may be painless or antalgic (shortened extremity/painful limp); loss of internal rotation, abduction, and decreased ROM; muscle weakness
PEDIATRIC Osgood-Schlatter Disease
What is it
Association
Population
Subjective
Objective
Inflammation of anterior aspect of tibial tubercle
Inflammation of anterior patellar tendom
9-15 boys (and self limited)
Liming and pain over tibial tubercle that worsens with activity
Knee swelling aggrevated by strenous activity esp. using quad muscles
PEDIATRIC Slipped Capital Femoral Epiphysis (SCFE)
What is it
Population
Subjective
Objective
Disorder in which the capital femoral epiphysis slips over the neck of the femur
8-16 boys overweight
Kneee and limping
Taller, obsese, reduced internal hip rotation, XRAY with slippage of head
PEDIATRIC Muscular dystrophy
Cause
Types
Subjective
Objective
Dysrophin gene causing muscular degeneration. Progressive symmetric symptoms or pseudohypertrophy. Skel and Cardiac muscle affected.
Becker / Duchenne
Clumsiness, difficulty standing, frequent falls
Positive Gower, muscle atrophy, waddling gait
Barlow-Ortolani Maneuvers
Purpose
Symptom for dislocation sublaxation
Exam for newborns to assess hip dislocation or subluxation
palpable clunk
Scoliosis
What is it
Shapes of vertebra
Cause
Population
Sujbective
Objective
Deformity lateral rotation of thoracic spine
Anterior concave and posterior convex
Unknown
Girls during early adolescene
Back discomfort, leg length discrepancy
Unevern shoulder, hip, spine, chest
