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
