MSK Flashcards
A sprain is a:
Ligamentous injury
A strain is a:
Musculotendonois injury
A tendon connects:
Muscle to bone
A ligament connects:
Bone to bone
This type of sprain is when a ligament is minimally torn, stable joint.
Grade I
This type of sprain is when you have a partial tear and greater instability.
Grade II
This type of sprain is a complete tear with complete instability.
Grade III
This is a stretching or tearing of muscle or tendon.
Strain
This is the inflammation, irritation, and swelling of a tendon.
Tendinitis
What are the most common symptoms associated with tendonitis?
Pain, tenderness, and increase in pain with movement
Types of neck pain:
Strain
Torticollis
Degenerative disc disease
Cervical disc disease
This stems from overuse, whiplash (usually mechanical injury).
Cervical strain
Neck pain is considered chronic if it lasts:
Over 3 months
This is contraction or spasm of neck muscles causing head to be lifted and tilted to one side; usually accompanied by rotation of chin upward.
Torticollis
Causes of Torticollis?
Unknown (possibly infection) unless congenital (wryneck)
Treatment for Torticollis?
PT
Pain control with anti-inflammatories
Muscle relaxants
Possible neck brace if prolonged (prescribed by orthopedic)
Treatment of cervical disc disease?
Anti-inflammatories
ROM exercises
If the patient raises arm above head with cervical disc disease what may happen?
Pain may be alleviated as it alleviates stress and pull on herniated disc.
If neck pain is neurological, or pain persists or worsens after conservative treatment (4-6 weeks), what should you do?
Order an MRI or CT- CT scans are used more for acute injury, in ERs, or if patient has metal in their body.
How does an acute cervical strain present?
Sharp neck pain with radiation to the head, shoulder, or hand.
How does chronic cervical pain present?
Burning or aching, with or without radiation to the arm or hand.
With this test you compress downward on the head to reproduce radicular symptoms if herniated disc is present. Pain does not go down the spine to the lower back; it will go out if there is a herniated disc present.
Compression test
This test you abduct and externally rotate shoulder while turning head toward are being tested. Check pulse at the same time for thoracic outlet problem.
Adson’s test
What does adson’s test look at?
C5-T1
A positive test if there is a marked decrease or disappearance of radial pulse = thoracic outlet problem.
Biceps reflex (C5) looks at:
Biceps and deltoid
Radial reflex (c6) looks at:
Biceps and wrist extensors
Triceps reflex (c7) looks at:
Triceps, wrist flexors, and finger extensors
C8 has no reflex but can be assessed by:
Abduction and adduction of fingers
T1 has to reflex and looks at:
Interossei muscles
This assessed nerve root irritation or spinal cord compromise:
EMG
After onset of radicular pain how long for EMG to show anything?
6-8 weeks after onset
Odontoid X-ray view looks at?
C1 and C2; the atlas and axis of spine
What nerve involvement presents similarly to carpal tunnel?
C6
When to refer to PT with neck pain?
If no improvement within 3 days.
When to refer for neck pain?
Cervical fracture
Neurosurgical or orthopedic consult if patient has intractable pain with neuro deficit: weakness, numbness, tingling
After 4-6 weeks, no relief from treatment
Pain is worst at rest with what type of back pain?
Nonmechanical spinal disorders: infection, malignancy
This is stretching or tearing of the tendons, muscles, and ligaments of the lower back often caused by improper lifting.
Lumbosacral strain
With a lumbosacral strain lost people will recover spontaneously in 4 weeks but pain is often?
Aggravated by standing and flexion
Alleviated with rest and standing
In young to middle-aged adults, herniated disc can resolve in:
4-6 weeks with PT and rest
What is the most common herniated disc?
L5-S1
Acute injury where lower spine is compressed and person loses bladder and bowel control, and strength in legs. Immediate surgical emergency!
Cauda Equina
This is slippage of one vertebrae on top of another with tears in ligaments that hold spine straight.
Spondylolisthesis
Spondylolithesis is most common in what age group with what on neurological exam?
Under 25
Neuro exam: tight hamstrings
Hyperextension with spondylolithesis often:
Reproduces pain
What would X-ray show with spondylolithesis?
Slippage or nonalignment of vertebrae
This is a painful, progressive problem that is compression or narrowing of the spinal cord or root canal.
Spinal stenosis
Spinal stenosis is most common in what age group?
Elderly
The pain with spinal stenosis is:
Gradual Back/buttocks pain Numbness/tingling with walking Relieved with sitting, leaning forward Aggravated by walking Unremitting because spinal canal is becoming narrow
Valsalva maneuver and radicular pain could indicate:
Disc herniation
Patrick’s maneuver aids in evaluating:
Hip and sacroiliac disease
Acute low back pain will resolve in:
6-12 weeks regardless of treatment
This is radiculopathy along the sciatic nerve with shooting pain down the leg; may be from an injury or herniated disc.
Sciatica
4-6/10 low back pain use these for pain management:
Tylenol (limit to 4000mg/day)
Vicodin at bedtime
7/10 pain with lower back treat with:
Duragesic patch
What is mainstay of low back pain treatment?
PT
What bursae in the hip typically does not get inflamed or cause bursitis?
Gluteus bursae
This bursitis is most common in the hip with pain over the lateral aspect of the hip; when touched it hurts and can be inflamed or red from overuse, direct trauma, or occurring on its own.
Greater trochanter bursitis
This hip bursitis has pain in the groin with radiation to anterior thigh. L1 nerve also comes around to this area so must differentiate between bursa and the back.
Iliopsoas bursitis
This type of hip bursitis causes pain over the ischial tuberosity with radiation to the posterior thigh to the knee.
Ischiogluteal bursitis
When do you get an X-ray with hip pain?
If suspicious of bony involvement, dislocation, or a growth.
Always get a standing x-ray with the hip to get an accurate dimension of joint
Management of hip pain:
NSAIDs, Tylenol, lidocaine patches, and capsaicin cream.
Heat, rom, ice; joint rest as needed
Low impact exercise
PT
When do you get an MRI with hip pain?
If AVN is suspected
When to refer to orthopedic surgeon with hip pain?
If no improvement, pain worsens with conservative treatment after 4-6 weeks
This is a loss of blood supply to the bone on the hip, primarily the femoral head that can be caused by prolonged steroid therapy, direct trauma, protease inhibitors, sickle cell anemia, chemo, and lupus,
AVN
This is softening and breakdown of articular cartilage of the patella (underside); bone rubbing on bone.
Chondromalacia
This is a surgical emergency; always X-ray with point tenderness or direct trauma to patella.
Patellar fracture
This is compression that forces twisting and shearing; often confused with meniscal tear, but over time it doesn’t improve.
Tibial plateau fracture
This is caused by twisting or rotary forces, usually applied to a flexed knee joint (common in degeneration when menisci dry out).
Meniscal tear
This occurs when foot is planted, knee is flexed, and individual suddenly changes direction (common in soccer and basketball).
ACL tear
This is caused by callus stress or external force with knee flexed (football or basketball).
MCL tear
Locking of the knee may suggest what?
Meniscal tear
What tests for meniscal tear?
Duck walk
Apley’s maneuver tests for:
Meniscus tear is causes pain
Lachman’s maneuver tests for?
ACL with significant forward excursion
Anterior drawer tests for?
ACL tear with a forward jerk showing the contours of the upper tibia
Posterior drawer tests for?
PCL tear with tibial movement backward
Medial laxity test (varus) tests for?
LCL
Lateral laxity test (Valgus) tests for?
MCL
Mcmurray tests for?
Meniscal tears
Ottawa rules for knees:
Order X-ray if: Older than 55 with injury or knee pain Direct patellar point tenderness Tenderness at head of fibula Inability to flex 90-degrees Inability to walk/bear weight immediately
Sunrise view of knee X-ray gives better view:
Underneath patella to uncover any fracture
Management of knee pain:
NSAIDs
Rest, ice compression
Evaluate for PT
When to get an MRI for knee pain?
Knee is locked, pain is too much, or patient cannot stand up
When to refer for knee pain?
Neurovascular compromise
Suspected fractures
Dislocation of patella
Grade 2 or 3 sprains ( with laxity and bruising)
Suspected ACL injury
Torn meniscus
If no improvement after 2-4 weeks of conservative treatment
What test is used to assess for Achilles’ tendon rupture?
Thompson rest
Inversion sprains of the ankle are most common and involve:
Talofibular and calcaneofibular ligaments
PT is recommended for what grade of ankle sprains?
2 or 3
Ottawa rules for ankles:
X-ray the ankle if:
Pain near the malleoli, or bony tenderness at the posterior tip of either malleolus
Inability to bear weight
Severe injury
X-ray foot if:
Pain in the mid foot
Inability to bear weight
Bony tenderness at the base of the 5th metatarsal
When to refer for ankle sprains?
Eversion sprain Grade 3 sprain No improvement after 2-3 weeks or instability present Neurovascular compromise Tendon rupture or subluxation
Most common tear in the rotator cuff?
Supraspinatus
Anterior shoulder pain (with or without trauma) that does not radiate below the elbows and worsens when arm is lifted overhead?
Consider rotator cuff tendonitis
A patient will complain of a heaviness and numbness or arm with:
Tear and instability
What does the empty can test look for?
Rotator cuff tear (supraspinatus)
What does the Neer’s test look at?
Pain indicates subacromial impingement or rotator cuff tendonitis
What does apprehension test look at?
Pain or feeling of subluxation indicate glenohumeral instability.
What does scratch test look for?
Pain suggests rotator cuff disorder or adhesive capusulitis
What does the painful arc look at?
Pain from 60-120 suggests subacromial impingement or rotator cuff tendonitis
When to get an X-ray with shoulder pain?
If suspected fracture or dislocation
When to get an MRI with shoulder pain?
If rotator cuff tear, adhesive capsulitis, or chronic tendonitis is suspected
Management of mild shoulder impingement:
Rest without immobilization (sling 24-48 hours) Ice NSAIDs Avoid triggering activities PT and home exercise
When to refer with shoulder pain?
No response in 4 weeks Nocturnal pain Pain with activity and rest Shoulder instability Large or partial tears on MRI Neurovascular compromise
Tennis elbow is;
Lateral epicondylitis
Golfers elbow is:
Medial epicondylitis
Increased pain with pronation of arm indicates:
Lateral epicondylitis
Increased pain with supination of arm indicates:
Medial epicondylitis
Treatment of elbow pain:
Ice NSAIDs Rest Splint PT May need referral for local steroids if no improvement
This is entrapment neuropathy involving the median nerve strain the wrist.
Carpal tunnel syndrome
Carpal tunnel most common in:
Females ages 30-60
Carpal tunnel clinical findings:
Nocturnal pain Positive tinels Positive phalen (hold for 60 seconds) Thenar atrophy Weak pincer grasp
When is EMG/NCS indicated in carpal tunnel?
If no improvement after 6-8 weeks
Carpal tunnel management:
Determine repetitive trauma and eliminate it
NSAIDs
Low dose steroids (20 mg prednisolone 14 days)
Control of underlying medical disorders
Refer to hand specialist is symptoms severe ( burning pain, atrophy)
Splints/braces
This causes pain over radial base of thumb and positive finklestein test?
De Quervain’s
De Quervain’s management:
Ice
Spica or gutter splint
Ortho referral no improvement in over 2 weeks
This is one of the most common overuse injuries of the knee and it refers to knee pain that is localized to the anterior portion of the knee.
Patellofemoral pain syndrome
Also called runners knee and anterior knee pain
What is patellofemoral pain syndrome thought to result from?
Abnormal tracking of the patella resulting from weak quads, poor flexibility, patellar hyper mobility, a tight iliotibial band, an atomic malalignment, or overuse.
Presentation of patellofemoral pain syndrome?
Knee pain often bilateral and largely limited to the anterior portion of the knee, around and behind the patella. Exacerbated by sports, squatting, kneeling, climbing stairs, or hills.
Management of patellofemoral pain syndrome?
Limit flexion of knee
NSAIDs
Immobilization May be beneficial.
Cornerstone- rehab to strengthen muscles supporting the knee.
Straight leg raise is used to test for damage to?
L5-S1
What test is performed by placing the patient supine and raising a straight leg to approximately 70-90 degrees of hip flexion?
Straight leg raise
What is a positive straight leg raise indicative of?
If the patient experiences pain or paresthesias at any point in 20-70 degrees of hip flexion, the test is positive and indicates that a nerve root impingement from a herniated disk is likely contributing, refereed to as sciatica.
