MSK

Question 1

4 patterns of mechanical back pain

Answer 1

pattern 1 = buttocks/back dominant, constant, worse with flexion (and maybe extension) = disc

pattern 2 = buttocks/back, intermittent, worse with extension only = facet

pattern 3 = leg dominant, constant, all mvt hurts = compressed nerve

pattern 4 = leg dominant, intermittent, walking or standing hurts = spinal stenosis (neurogenic claudication)

Question 2

cervical radiculopathies

Answer 2

• C1&C2: control the head, may cause headaches
• C3&C4: regulate diaphragm, C4 can radiate pain to the lower neck and shoulders
• C5: If impinged or irritated, shoulder pain and weakness can affect the top of upper arms
• C6: If impinged or irritated, weakness can affect the biceps and wrists. Pain, tingling and numbness can radiate through arm to thumb
• C7: Compression here causes weakness of the back and upper arm or pain that can radiate down the back of the arm and into middle finger.
C8: compression here causes weakness with the handgrip as well as numbness and tingling down the arm to the little finger.

Question 3

get an x-ray for non-traumatic neck pain for:

Answer 3

> 50 years and new Sx
Concern of infection
Unexplained Sx of weight loss, fever/chills
Neuro Sx that continue to progress
Concern or history of malignancy
Uncomplicated subacute neck pain with or without arm pain
Persistent neck pain (> 12 weeks) with or without arm pain

Question 4

criteria for MRI for neck pain

Answer 4

> 6 weeks… or NIFTI

Question 5

what are the ottawa ankle rules?

Answer 5

• can’t bear weight at scene and in ER (4 steps)
• tender supra maleolus 6 cm (posterior)
• tender base 5th metatarsal
• tender navicular bone

Question 6

what are the ottawa knee rules?

Answer 6

• age > 55
• can’t bend to 90
• tender fibular head
• isolated tender patella
• can’t walk (at scene + ER)

Question 7

what vitamin can you take for carpal tunnel?

Answer 7

vitamin B6

Question 8

how often can you repeat CS for CT ? why?

Answer 8

6 mo, avoid necrosis

Question 9

epicondylitis (what muscles, where)

Answer 9

lateral = tennis (extensor carpi radialis brevis) 
medial = golf (pronator teres, flexor carpi radialis)

Question 10

de quervain’s = what muscles involved

Answer 10

tenosynovitis

distal tendons of abductor pollicis longus (APL) and extensor pollicis brevis (EPB)

Question 11

stages of SIS

Answer 11

shoulder impingement syndrome

1) edema and hemorrhage
2) firbosis and tendinitis
3) rotator cuff tear, biceps tendon rupture, bony change

*note athletes that throw ball have unique posterior SIS

Question 12

positive tests for SIS

Answer 12

painful arc (160-180 degrees). painful arc on passive and active ROM
positive neer (passive forward flexion?) hand forwards and up over head) 
hawkins kennedy 
may have weak drop arm and external rotation

Question 13

FAI

Answer 13

FABER and FADIR (especially the latter)
pain w/ sitting w/ hips flexed at 90 for a long time
clicking, locking

Question 14

plantar fasciitis

Answer 14

most common cause heel pain 
night symptoms, first thing in AM and after activity
overuse
stretching!! rolling! splints 
may have heel spur x-ray normal 
flat foot 
obese 
MRI = order if thickening or suspect fracture

Question 15

worksafe reporting

Answer 15

within 3 days, then Q 4 weeks