MSK Flashcards
Navicular/ Scaphoid bone fracture presentation/ PE/ Xray
hx of falling forward with hyperextension if the wrist. wrist pain is below the thumb area. may report difficulty gripping objects
PE: tenderness to palpation of the anatomic snuff box. pain with resisted pronation
Xray: may NOT show fracture as it take 14-21 days to show callus formation
MRI: is the most sensitive dx in < 24 hours
Navicular/ Scaphoid bone fracture TX for non and displaced
refer to hand speclaist
non: thumb spica case
displaced: surgery w/ screws
Colles fracture
distal radius fracture w/ radius tilting upward. MOST common wrist fracture
will need sugery if displaced
What are the emergent cases of LBP
progressive loss of bladder resulting in retention or incontinence ( caude equina)
progressive numbness in pelvic area (saddle anesthesia)
Impending rupture of AAA (severe abd pain w/ low BP in elderly smokers)
night pain, fever, sweat, wgt loss ( cancer)
Osteoporosis ( check if on steroids)
Osteomyletisis
Classic presentation of mechanical LBP
dull pain that persist for weeks, NO nuero sympt
Sciatica
Impingement of L4-L5 nerve root causing ( type of radiculopathy). Sharp pain located midline and runs down leg to top of foot. May have weakness
what does the SLR check for?
sciatica pain
lumbrosacral ner root irritiation
SLR is a passive move
LBP tx
Pt education
NSAIDS
XRAYs not reccomended unless hx of trauma or red flag
MRI w/ people with nuero defs
No blood work
for muscle spasms - can use muscle relaxant (flexeril or Skelaxin) or valium
Ankylosing Spondylitis what/presentation/PE/ complications / TX
Progressive seronegative arthitis (HLA B 27 pos)
Chronic inflammation of the spine
Men from puberty to 40’s
young male, w/ progressive back pain w/ stiffness (most of spine), may have generalized fever, fatigue
PE: lumbar spine loss of lateral flexsion ( early finding)*
comp: anterior uveitis, cauda equina, increase in CRP and ESR
TX first line: high dose NSAIDS ( indomethacin)
When to use cold therapy?
first 48 hours to decrease swelling
isometric exercises
spares joint, helps build muscle ( resistance bands)
aerobic exercises
swimming, walking , biking
when to get MRI?
for soft tissue injuries such as cartilage, tendons
what is EMG?
electomyogram to evaluate nerve function
When can you get joint injections?
3/4 times per year. No in same joint more than once every 3 months.
watch out for : tendon rupture, infection, bleeding, DM, cushing syndrome
McMurray test
M = Meniscus assess for a “click” - also assess for joint line for tenderness on palpation
Anterior Drawer test
ACL test + = if laxity/glide when tibia is pulled forward ( anteriorly)
Posterior Drawer test
PCL test + = if laxity/glide when tibia is pulled backwards (posteriorly)
lachman test
Most sensitive test for ACL
+ = excessive motion of the knee = laxity
Valgus stress test
MCL test + = laxity when medial stress applied ot the knee
putting stress on the actual medial ligament ( abduction)
Vargus stress test
LCL : + = laxity when lateral or vargus stress applied to the knee
Rotator Cuff tendinitis / shoulder impingement / supraspinatus tendinitis is most common in who?
common in young athletes ( swimmer, tennis, baseball) and middle-aged
supraspinatus tendinitis what/ presentation/ tx
inflammation of rotator cuff
gradual or acute onset of pain w/ over head movements (hyperextension). Pain in front of shoulder (anteriorly) and radiates to the side of arm. Lifting and reaching cause pain.
TX: Nsaids, PT, avoid over head activity during acute phase
MRI is gold standard
Lateral epicondylitis presentation, risk, tx
tennis elbow : overuse of forearm muscles ( flexors/extensors)
people at risk : painting, using screwdriver, tennis player
gradual onset of pain on the outside of the elbow that sometimes radiates to forearm. Pain worsens with twisting and grasping movements ( shaking hands, opening jars)
tx: RICE, can use tennis elbow strap
refractory cases ; cortisone injection
Medial Epcondyitis presentation, risk, complication, pe
golf elbow/ baseball pitcher complains of aching pain over the inside part of the elbow
PE: tenderness to palpation over the inner aspect of the elbow
Risk : golfing, baseball, bowling, weight-lifters
complication: ulnar nerve neuropathy
DeQuervain Tenosynovitis / Tendonitis : what/s/s, PE, TX, test
inflammation of the tendon sheath causing entrapment of the thumb tendons
s/s: wrist pain over the thumb side, pain with grasping
PE: tenderness/swelling over the thumb tendon
TX: wear a wrist splint 4-6 weeks, NSAIDs
+ Finklestein test ( fingers over thumb w/ ulnar deviation) = pain
Carpal Tunnel Syndrome : what, presentation, tests, late sign, tx
Compression of the median nerve due to ( repetitive motion, hypothyriodism, preg) on palmer side
gradual onset of parathesias on the thumb, index, middle, half of ring finger
nocturnal awakening
+ Flick sign = shaking hand for releif
+ Phalen = full wrist flexion for 60 sec
+ tinels = tap anterior wrist briskly x 60 sec
Late sign : atrophy of the thenar eminence
TX: modify/limit motion
night splint
NSAIDS
Classic presentation of Morton Neuroma and what
scarring of the common digital nerve ( ganglion) due to chronic pressure from wearing hight heels and tight-fitting shoes
complains of pebble-like mass and pain in the interspace area
+ Mulder sign
Plantar Fasciitis
inflammation of pantar facia due to over use
stretching to help
complains of severe pain in am, on the heel of foot
Chondromalacia Patella
Patellopfemoral syndrome
damage to the cartilage behind knee cap
OA / DJD
most common joint dx in world
affects weight bearing joints
morning stiffness for less than 30 min
pain worse with cold weather, prolonged or overuse joint
PE: joint crepitus, joint deformity, swelling
Will have Herberdeen’s DIP nodes and Bouchards
TX : tylenol ASA #1 then NSAIDS
Herberdeen nodes
DIP - only seen in OA/DJD
Bouchard nodes
PIP - seen in both RA and OA
TX for OA
- rest/ restriction of weight bearing on affected joint
- Tylenol
- if inflammation = NSAIDS
- hight risk stomach ulcers = COX 2 ( celebrex)
- if severe glucocosteroid intraarticular
RA : what, late signs, signs, presentation, Pe, labs
systemic autoimmune dx
symmetrical arthitis that involves multiple joint
will NOT effect HIPS
Late sign: swan-neck deformity, boutonniere deformity ( on PIP)
will see bouchards nodes
presentation: middle aged women complains of new onset of swollen, painful and stiff joints especially on hand and wrist. Joint stiffness for hours in am. Pain NOT relieved by rest. Maay have low grade fever, normocytic anemia
PE: multiple joints, swollen, red, tender to palpation. IF rheumatoid nodules = chronic dx
Labs: + RH, ANA +, normocytic anemia,ESR and CRP +
Imaging: xrays
Complications : uveitis , vasculitis , need eye exam
TX : NSAIDS or ASA
What are examples of DMARDS ( disease modifying agent for Rheumatoid disease)
Methotrexate and sulfaslazine
Plaquinil
Prednisone ( systemic)
Biologics TNF
Humera, Enebrel = PPD adn CBC
adverse : lymphoma
Fibrimyalgia
Soft tissue pain
chronic condition (last more than 3 months)
generalize MSK pain with fatigue, cognitive imparment
Need 11 out of 18 tender point to dx
occuring everywhere
Gout what, presentation, joint, DX criteria
deposit of urate acid crytals ( monosodium urate ) on distal joints and tendons
middle age male with acute exacerbation of gout. pain ful ankle. knee wrist. recent increase alcohol intake, seafood, or meat. Serum uric acid level is increased
MTP joint of great toe swollen, red, hot, painful
Intake: alcohol, red meat, seafood, diurtics
DX: elevated uric level and clinical findings
untx gout: joint destruction and kidney damage
Tophi
small white nodules filled with urates ( in ears and joints)
Podagra
the classic red/swollen/painful toe of gout
Gout management: acute
acute : provide pain relief.
if pt is on allopurinol continue and add pain med
start pain med ASAP w/ 12 hours of onset = indomethacin, naproxen, motrin
Low-dose colchine can shorten episode
Colchicine dose
inital 1.2 mg followed by .6 mg in one hour
drink lots of water
Gout Maintinance
use 4-6 wks after attac
check CBC prior to starting allopurinol
Probenecid
Marfan’s syndrome
genetic disorder affects connective tissue production
concern about aortic anuresym / dissection
Medial Tibia Stress Syndrome
(shins splints) can lead to stress fracture
F>M
complains of pain on the inner edge of the tibia.
TX:
- stop activity for weeks
- cold packs first 24-48 hours
- NSAIDs
- Once pain is gone Wait 2 weeks before resuming activity
- stretch
- if suspect a fracture get bone scan and MRI
