msk Flashcards
Sjögren’s syndrome
classic triad
associated with?
Classic triad–xerophthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia), arthritis
Associated with rheumatoid arthritis
predominantly in females
SLE diagnostics
Lab tests detect presence of:
1. Antinuclear antibodies (ANA)––sensitive, but not specific for SLE
2. Antibodies to double-stranded DNA
(anti-dsDNA)––very specific, poor prognosis
3. Anti-Smith antibodies (anti-Sm)–– very specific, but not prognostic
4. Antihistone antibodies––drug-induced lupus
ottawa foot rules: when to xray 4
- pain to mid foot zone (around navicular), and bone tenderness to
- base of 5th metatarsal
- navicular (around midfoot)
- inability to weight bear both immediately and in clinic (unable to take 4 steps independently, even with limping
ottawa ankle rules: when to xray 4
- pain to malleolar zone (top of midfoot where you bend/dorsiflex) and bone tenderness to
- posterior edge of lateral malleolus 6cm
- posterior edge of medial malleolus 6cm
- inability to weight bear both immediately and in clinic (unable to take 4 steps independently, even with limping
cyclobenzaprine
other meds for back pain - 1-4th line
flexeril - for back spasm
1st line - tyl 2nd line - NSAIDs 3rd line - amitrip/ Nortriptyline* *fewer adverse effects 4th line - weak opioid
1Lateral Femoral Cutaneous Nerve Syndrome 2Snapping Hip 3Hip Strains 4Thigh Strains 5Stress Fracture of Femoral Neck 6Trochanteric Bursitis
1 usually a self limiting, benign disease with spontaneous remission. > 90% of patients respond to conservative measures. weight loss (if necessary), remove source of compression, can use neuropathic pain medications such as Gabapentin if ongoing symptoms (> 1-2 months
2 PT to improve function gluteus maximus, gluteus medius and iliopsoas, home exercise program
3 activity modification, home exercise program. If pain persists > 3-4 weeks, send for formal rehabilitation program.
4 clinical dx, NSAIDs PRN for pain, home exercise program
5 need xray, Non weight bearing + REFERRAL to orthopedic surgeon
6 most common causes of lateral hip pain
most common causes of lateral hip pain
use what tests 2
tx
Trochanteric Bursitis
faber test - leg into a 4
trendelenberg
tx Usually a self-limiting disease, goals are to relieve symptoms and prevent disability (improve within 1-2 years). Non-opioid analgesia, heat, posture, stretching and strengthening exercises. For persistent symptoms -glucocorticoid injections. Surgery (no resolution or tears)
most common ligament tear
dx 3
tx
ACL, PCL
dx - clinical with drawer test etc
Xray – rule out #
MRI – definitive diagnosis
tx all needs RICE, early mobilization and rehab
ACL sx, pcl non sx
PCL knee brace- usually no need for sx unless other ligaments involved
meniscus tear test 2
knee contussions
thessaley and mcmurray
fall on knee, bruised knee
Diagnostics: Ottawa Knee Rule - 5
1patient age (>55 years old) or presence of local 2tenderness (at the patella ONLY) or
3tenderness at the head of fibula or
4inability to flex to 90 degrees or
5inability to bear weight immediately or walk more than four steps immediately after injury.
Iliotibial BAND SYNDROME
overuse injury of the lateral knee that occurs primarily in runners
usually pain by the knee joint although band runs from joint to greater trochanter
conservative tx
itis vs osis
acute inflammation vs chronic = pathology of chronic degeneration /structural changes
popliteal cyst associated with ?
if rupture, can present like what?
degenerative meniscal tears and systemic inflammatory conditions
present like dvt
thompson test?
May elicit a “clicking” sound (Mulder’s Sign) test?
squeeze calves to check for achilles tendon rupture
mortons neuroma
where is talus fracture
by midfoot area, where you dorsiflex
when to refer for metatarsel fractures
Multiple metatarsal fractures
Metatarsal fracture with more than 4 mm displacement
Displaced fractures to 1st or 5th metatarsal bone
Possible compartment syndrome
Achilles tendon rupture -
Ottawa or Low Risk Pediatric Ankle rules -
3 M’s of Morton’s Neuroma -
Plantar Fasciitis -
Calcaneus and Talus fractures -
Metatarsal Fractures -
Phalanges Fracture -
Achilles tendon rupture - needs an urgent orthopedic consult
Ottawa or Low Risk Pediatric Ankle rules - a useful ankle injury assessment tool
3 M’s of Morton’s Neuroma - Occurs in metatarsal space, feels like a marble and + Mulder’s.
Plantar Fasciitis - most common cause of heel pain, does not need imaging
Calcaneus and Talus fractures - require further physical assessment
Metatarsal Fractures - pay special attention to 1st, 5th and metatarsal head fractures
Phalanges Fracture - Refer if displaced or open fractures
Toe Deformities - Maximize choice of shoes and toe pads, and prevent skin injury
Most common complaint of the elbow
aka
how to test
Lateral Epicondylitis
tennis elbow
extended and resist
tx of epichondylitis
age range?
Olecranon Bursitis - pain where
Self limiting (6 –24 months) Common in middle aged women and men (35-55 yrs)
Pain with elbow flexion – often extends with no discomfort
special test for elbow 5
Special Test:
2 Medial Epicondylitis (golfers elbow): forced wrist flexion – valgus
3 Lateral Epicondylitis (tennis elbow): forced wrist extension – varus - long finger test
4 Hand grip (nerve compression, epicondylitis)
5 tinel or bend elbow, extend wrist (test for ulnar compression)
Long finger test – forearm pronation while resisting extension of D3
how many spinal bones
there are 7 cervical vertebrae with 8 cervical spinal nerves; C1 is ring-shaped (called the atlas) connects directly to the skull
- 12 thoracic vertebrae (main function to hold the rib cage)
- 5 lumbar vertebrae (function is to bear the weight of the body)
- 5 sacral vertebrae which are fused together (connect to the hip bones)
- coccyx region – four fused bones provide attachment for ligaments and muscles of the pelvic floor
cervical Radiculopathy what is it
where it innovates
dx
tx
degenerative changes, cause compression on cervical nerve
Pain radiating to paraspinal and scapular regions: suprascapular pain (C5-C6); interscapular (C7); scapular (C8)
dx clinical
tx conservative 2-8 weeks
Spondylolisthesis
occurs most often where?
dx
tx
spine slip, slippage of one vertebra over another vertebra directly below it
Most often occurs in the lower spine (lumbosacral area)
Most common cause of spondylolisthesis in patients over 50 years of age
Most common at the L4-5-s1 level - cause low back pain
Higher incidence in women and African-American population
dx - xray
tx conservative, refer if neuro def, or coccyx numbness
education and tx for acute lower backpain
Patient education is key!
Pain will resolve in 4-6 weeks, but recurrences are often common
Advise to stay active; return to work and ADLs ASAP; AVOID bedrest
No diagnostic testing/imaging involved unless they do not improve as expected (incidental findings are often seen which lead to other unnecessary interventions)
Pharmacological Tx:
1st line: Trial of short-term (2-4 wks) of NSAIDs, tylenol
2nd line: short course of muscle relaxants (e.g. robaxacet, cyclobenzaprine)
Pts who have refractory/severe pain – could consider short course Tramadol or opioids (<3 days)
Non-pharmacological Tx:
Superficial heat, massage, acupuncture, exercise
Refer those who are at high risk of developing chronic low back pain early to PT
Lumbar Spinal Stenosis – aka
“neurogenic claudication” - from herniations or narrowed dsck space
slow onset
Pts may also wake at night with back and/or leg pain after a few hrs of sleep
Pain/ claudication to the low back, gluteal region, and lower extremities (often bilateral) that is worsened by prolonged standing, walking, or other activities that cause spinal extension
X-ray – often shows narrowed disc space, bone spurs (osteophytes), or osteoarthritis
conservative tx - herniation can reabsorb with time
refer post 6 weeks if pain persist
lumbar herniated disk
acute onset of pain, can cause sciatica
If L5 impingement pt. cannot walk on the heels
If S1 impingement -> pt. cannot walk on the toes
Cauda Equina Syndrome s/s
tx
Severe low back pain that radiates down the legs bilaterally
Saddle anaesthesia* (reduction in sensation over the buttocks, upper posterior thighs, and perineum)
Tingling/numbness/pins & needles to the lower limbs bilaterally
Leg weakness – ataxia/stumbling gait or a footdrop that is often symmetric
Urinary retention, and/or bowel or bladder incontinence
Sexual dysfunction
Diagnostics:
MRI
CT if pt. cannot undergo MRI
Labs to rule out infection – CBC, CRP, ESR
Treatment:
Medical/Surgical emergency!
obvious sign of AC joint injury
dx
tx
bump over AC joint
dx with xray
tx
Grade I, II and III, patients are expected to return to normal activity within 6 to 12 weeks
Grade I and II - conservative management (rest, ice, immobilization, analgesics, physiotherapy) that uses pain as a guide to exercise progression
rotator cuff dx
special test
u/s better
special test, lift off, lag test
Ludington’s test
dx
tx
for bicep tendon rupture
both hands behind back, get pt to flex, you feel for them
dx US
conservative if no functional issues, if sx, need to be within two weeks
distal rupture needs referral
most common cause of shoulder pain
special test
Impingement syndrome
special
Neer and Hawkins tests
Neer test can help diagnose the extent of impingement
Frozen shoulder def
tx? how long it last?
worse when?
differentiate from normal pain?
inflammation of the shoulder causes the development of adhesions and fibrosis of the joint causing stiffness and decreased ROM.
Although self-limiting, the pathophysiology of a frozen shoulder can run over many, many years!
unilateral, severe and nagging pain that is worse at night
differentiate decreased ROM due to frozen shoulder vs. pain, perform passive ROM and look for a firm, painful and premature end to the movement.
normal strenght and reflex
Thoracic Outlet Syndrome (TOS)
dx
tx
Compression of blood vessels or nerves between the first rib and clavicle, brachial plexus nerve, vein or artery
common in women, pregnancy
some ppl have extra cervical rib
Diagnosis: nerve plexus
Often clinical. EMG studies can be done and imaging to r/o other diagnosis
Most often EMG studies are -ve
Elevated arm stress test
Brachial plexus nerve block - looking for relief of s/s
Tx:
Conservatively w/ PT and weight loss
Physiotherapists need to specialize in TOS
Medical therapy: steroid or botox injection
NSAIDs, muscle relaxants, gabapentin/lyrica, SNRIs/TCAs
Thoracic outlet decompression surgery to remove the source of compression
vein TOS at risk for?
edema, DVT
if bites of hands, suture?
if risk of infection, use?
if bite on face?
no suture on hands, risk of infection
amoxclave 875, or polysporin or mulcirpin, fucidin cream
face, to ER
joint pain involved in lumbar spine
spared in
ankylospondylitis, lumbar stenosis from herniation
spared in RA
Ocular symptoms may be present:
uveitis
conjunctivitis
uveitis with ankylosing spondylitis
conjunctivitis with reactive arthritis.
FDA approved drug for pain in OA and FM
Schirmer Test for?
duloxetine
for sjorgrm syndrome, dry eyes test
