MSK Flashcards
Physical exam findings indicative of disc pathology/herniation
Diminished/absent Achilles- L5-S1 = weak plantar flexion
’ ‘ Patellar- L3-L4; weak quads so assess squat/stand,
Trouble holding up great toe while walking on heels- L4-L5 = weak dorsiflexion
Straight leg raise to assess for pain r/t sciatica
Apley’s Grind Test
Medial or lateral ligament damage,
McMurrays test = meniscal injury, audible/palpable clicking
Sprain Classifications
Grade I: point tenderness, full ROM
Grade II: moderate to severe pain c weight bearing
Grade III: egg shaped swelling & NWB
Medial epicondylitis
Lateral ‘ ‘
Tendonopathy
Golfers elbow, strain to medial aspect, pain is medial/inner aspect of elbow
Tennis elbow, strain to lateral aspect, pain on outside or lateral elbow
Inflammation & micro tears
Meds to prevent GOUT FLARE
S/s of gout
Risk factors
Allopurinol (xanthine oxidase inhibitor)
Colchicine
Febuxostat (xanthine oxidase inhibitor)
Probenecid (increases excretion of uric acid in urine)
RFs: obesity, LDA, higher beer consumption, M>W,
Cauda Equina Syndrome
Lumbar Nerve Root Compression/sciatica
Medical emergency due to compression of spinal nerve roots
New onset bowel bladder complaints think Cauda Equina
Pain radiates along the sciatic nerve down the leg from lower back
Osteoarthritis
Herberden’s (DIP) & Bouchard’s (PIP) nodes may both be swollen in OA
Tx: NSAIDs (acetaminophen & aspirin), corticosteroids,
M=W are affected, not symmetrical inflammation,
X-ray +for joint space narrowing early in disease process (unlike RA)
Rheumatoid arthritis
Bouchard’s nodes (PIP), metacarpophalangeal joints & wrists may be swollen in RA
Tx: DMARDs (methotrexate), corticosteroids,
W>M, symmetrical inflammation, 35- 50yo, redness over joints, WBCs in aspirated synovial fluid, elevated sed rate,
bursitis
Caused by joint overuse
S/s: pain c movement, swelling & tenderness
Tx: RICE (as c strains), reduce pain/inflammation (NSAIDS), heat/ice, steroid injections (if deep tissue bursitis)
Trochanter bursitis =Common in runners
Olecranon bursitis= pain behind elbow
Retrocalcaneal busitis =pain behind ankle, worse with climbing stairs, common in hikers
Ligaments
Vs
Tendons
Ligaments attach bone to bone
*hold structure together, stabilize
Tendons attach muscle to bone or other soft tissue structures
*help to move bone or structure
Muscle strain
Vs
Joint strain
S/s: acute onset of pain, limited ROM, swelling, stiffness, bruising, spasms
S/s joint strain: #1 sports injury,
Lateral ankle sprain is #1 sports injury
Carpal tunnel syndrome
Tx: NSAIDs, corticosteroids, splint/brace,
Goal: decrease inflammation around compressed nerves
Rotator cuff injury
Drop arm test
Ligament tear/damage
Lachmans test (pressure placed against tibia while knee is flexed) indicative of AP cruciate ligament tear
Tx for herniated disc
NSAIDS, ice/heat, brace, transcutaneous electric nerve stimulation, PT
Gout
S/s
Diagnosis: cultures of synovial fluid or blood
If gout suspected serum uric acid levels can guide tx
Tx = NSAIDS
- low dose colchicine may be used if NSAIDS are contraindicated (kidney disease, active PUD or NSAID intolerance)
- if both NSAIDS and colchicine are contraindicated PO or parenteral glucocorticoids may be used
Prevention: allopurinol, febuxostat (xanthine oxidase inhibitors), probenecid (increases uric acid excretion in the urine)
Wait 2-3w after flare to start using urate lowering agents
Lumbosacral strain
S/s decreased or painful ROM especially with flexion
neuro exam should be intact. S/s numbness, weakness or incontinentinence indicative of disc prolapse, spinal canal stenosis or nerve root impingement
Radiculopathy
S/s low back pain with nerve involvement such as referred pain down buttock to ankle
Radiculopathy L1-L3 s/s referred pain down front of thigh to knee
Antinuclear antibody test
Is the primary test used to evaluate for auto immune disorder
