MSK Flashcards
What is the arm squeeze test for?
To differentiate cervical radiculopathy vs shoulder pathologies
-Postitive test = pain with mid arm squeeze is > 3 vs minimal pain at AC joint and subacromial area
When do you start uric lowering medications?
2020 American College of Rheumatology Guideline for the Management of Gout strongly recommends starting urate-lowering therapy for patients with hyperuricemia who have >2 gout flares annually, ≥1 tophus, or radiographic evidence of joint damage attributable to gout
What is complex regional pain syndrome? (also known as reflex sympathetic dystrophy, shoulder-hand syndrome, and causalgia).
a broad term describing excess and prolonged pain and inflammation that follows an injury to an arm or leg
What are the symptoms of complex regional pain syndrome?
pain, usually described as burning or deep and aggravated by movement. It does not follow a dermatomal distribution. Pain can be worsened by non-noxious stimuli (allodynia). The pain is usually accompanied by local edema and vasomotor changes. Early in the course, the skin is often erythematous and warm. Later, it may appear cyanotic, or mottled with livedo reticularis. Skin may become shiny and thin, and nails become brittle.
What medication can help in CRPS early in its course?
prednisone (short course)
What is the best treatment for pseudoclaudication syndrome/lumbar spinal stenosis?
Surgical laminectomy is currently the only well-validated treatment for lumbar spinal stenosis. It was more effective than conservative management in a trial that followed patients for 4 years (number needed to treat: 5)
What medication may help with posit polio fatigue and pain?
There is low-quality evidence that lamotrigine (50–100 mg/d) is effective in decreasing pain and fatigue, and thus decreasing activity limitations.
However, follow-up was limited to 4 weeks, and long-term effects and outcomes remain unclear. Still, lamotrigine appears to be the only medication that may reduce activity limitations in patients with postpolio syndrome
Initial work-up for peripheral neuropathy
Blood glucose level, serum level of vitamin B12 with methylmalonic acid (with or without homocysteine), and serum protein electrophoresis offer the highest yield for identifying a treatable cause of distal peripheral neuropathy. (Option A)
Serum protein electrophoresis may reveal a monoclonal gammopathy, monoclonal gammopathy of undetermined significance, or multiple myeloma that could cause distal peripheral neuropathy. Increased methylmalonic acid and homocysteine levels would identify vitamin B12 deficiency as the cause of peripheral neuropathy; the increased levels may indicate deficiency even when vitamin B12 level is normal. Increased levels of methylmalonic acid are more specific than increased homocysteine levels for vitamin B12 deficiency.
Has impaired glucose tolerance in the absence of diabetes been associated with peripheral neuropathy?
yes
