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msk Flashcards

1
Q

Sjögren’s syndrome
classic triad

associated with?

A

Classic triad–xerophthalmia (dry eyes, conjunctivitis), xerostomia (dry mouth, dysphagia), arthritis

Associated with rheumatoid arthritis
predominantly in females

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2
Q

SLE diagnostics

A

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

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3
Q

ottawa foot rules: when to xray 4

A
  • 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
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4
Q

ottawa ankle rules: when to xray 4

A
  • 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
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5
Q

cyclobenzaprine

other meds for back pain - 1-4th line

A

flexeril - for back spasm

1st line - tyl
2nd line - NSAIDs
3rd line - amitrip/ Nortriptyline*
*fewer adverse effects
4th line - weak opioid
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6
Q 
1Lateral Femoral Cutaneous Nerve Syndrome 
2Snapping Hip
3Hip Strains
4Thigh Strains
5Stress Fracture of Femoral Neck
6Trochanteric Bursitis
A

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

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7
Q

most common causes of lateral hip pain

use what tests 2

tx

A

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)

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8
Q

most common ligament tear

dx 3

tx

A

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

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9
Q

meniscus tear test 2

knee contussions

A

thessaley and mcmurray

fall on knee, bruised knee

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10
Q

Diagnostics: Ottawa Knee Rule - 5

A

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.

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11
Q

Iliotibial BAND SYNDROME

A

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

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12
Q

itis vs osis

A

acute inflammation vs chronic = pathology of chronic degeneration /structural changes

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13
Q

popliteal cyst associated with ?

if rupture, can present like what?

A

degenerative meniscal tears and systemic inflammatory conditions

present like dvt

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14
Q

thompson test?

May elicit a “clicking” sound (Mulder’s Sign) test?

A

squeeze calves to check for achilles tendon rupture

mortons neuroma

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15
Q

where is talus fracture

A

by midfoot area, where you dorsiflex

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16
Q

when to refer for metatarsel fractures

A

Multiple metatarsal fractures
Metatarsal fracture with more than 4 mm displacement
Displaced fractures to 1st or 5th metatarsal bone
Possible compartment syndrome

17
Q

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 -

A

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

18
Q

Most common complaint of the elbow

aka

how to test

A

Lateral Epicondylitis

tennis elbow

extended and resist

19
Q

tx of epichondylitis

age range?

Olecranon Bursitis - pain where

A 
Self limiting (6 –24 months)
Common in middle aged women and men (35-55 yrs)

Pain with elbow flexion – often extends with no discomfort

20
Q

special test for elbow 5

A

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

21
Q

how many spinal bones

A

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
22
Q

cervical Radiculopathy what is it

where it innovates

dx
tx

A

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

23
Q

Spondylolisthesis

occurs most often where?

dx

tx

A

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

24
Q

education and tx for acute lower backpain

A

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

25
Q

Lumbar Spinal Stenosis – aka

A

“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

26
Q

lumbar herniated disk

A

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

27
Q

Cauda Equina Syndrome s/s

tx

A

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!

28
Q

obvious sign of AC joint injury

dx

tx

A

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

29
Q

rotator cuff dx

special test

A

u/s better

special test, lift off, lag test

30
Q

Ludington’s test

dx
tx

A

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

31
Q

most common cause of shoulder pain

special test

A

Impingement syndrome

special
Neer and Hawkins tests
Neer test can help diagnose the extent of impingement

32
Q

Frozen shoulder def

tx? how long it last?

worse when?

differentiate from normal pain?

A

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

33
Q

Thoracic Outlet Syndrome (TOS)

dx

tx

A

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

34
Q

vein TOS at risk for?

A

edema, DVT

35
Q

if bites of hands, suture?

if risk of infection, use?

if bite on face?

A

no suture on hands, risk of infection

amoxclave 875, or polysporin or mulcirpin, fucidin cream

face, to ER

36
Q

joint pain involved in lumbar spine

spared in

A

ankylospondylitis, lumbar stenosis from herniation

spared in RA

37
Q

Ocular symptoms may be present:
uveitis
conjunctivitis

A

uveitis with ankylosing spondylitis

conjunctivitis with reactive arthritis.

38
Q

FDA approved drug for pain in OA and FM

Schirmer Test for?

A

duloxetine

for sjorgrm syndrome, dry eyes test

pc3 (8 decks)

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