MSK Complaints Flashcards
what are signs of MSK problem?
fever
weight loss
neurologic deficit
pain that awakens the px at night
urinary or bowel incontincence
what are the red flag diagnoses of MSK?
fracture
acute crystal-induced arthritis
septic arthritis
what should u find out in the px’s hx?
was there trauma experienced by the px?
did the px acquire any illness or infection?
what aer the ROS of rheuma?
fever, rash, myalgias, weakness, scalp changes or lesions
nail changes
what are rheumatic complaints?
- Cellulitis = Erythema around the knee
- swelling of joint in the px’s left knee
- swollen right knee w/o erythema
- warmth or effusion upon palpation
- tophic or uric acid deposits in px w/ chronic tophaceous gout
- osteoarthritis of the hands
- bony enlargement of the distal interphalangeal joints
- classic discoid rashes of lupus = scarring w/ central clearing
- petechial rashes in. a px w/ vasculitis
- coalescing vasculitic lesions
upon assessment of MSK complaints, what should u take note in anatomic localization?
- is it articular/non-articular?
- is the problem in the joint or around the joint?
Articular
1. if pain is deep or diffuse
2. pain or limited ROM (active & passive)
3. swelling
4. crepitation or grafting
Periarticular
1. painful on active but not passive ROM
2. point/focal tenderness in adjacent regions
to determine the chronology, what should u ask?
- onset (abrupt, indolent)
- evolution
* chronic = osetoarthritis,
* itnermittent = crystal arthritis
* migratory = rheumatic fever, gonococcal, or viral arthritis
* additive = RA, psoriatic arthritis - Duration
* acute (<6wks)
* chronic (>6wks)
how do you determie the nature of hte pathologic process?
- cardial signs of inflammation = erythema, swelling, warmth, pain
- systemic = faitgue (esp afternoon), fever, rash, weight loss
- lab = EST & CRP INC, Thrombocytosis, anemia/chronic disease, hypoalbuminemia
what phenomenon occurs when joints get stuck but it resolves on its own in 5-10mins
gel phenomenon
what should u determine in the extent of involvement of MSK complaints?
- Articular: monoarticular, oligoarticular (2-3 joints, Polyarticular: 4 or mroe)
- non-articular: focal or widespread
- Distibution: symmetrical/a, upper & lower ex, axial skeleton involvement (ankylosing spondylitis, sponfyloarthritis)
focal = epicondylitis. widespread = fibromyalgia
what are the most common conditions of MSK?
low back pain & trauma/fracture
low back pain can indicate what? how do u confirm its origin?
Fibromyalgia
<60 yrs -> repetitive strain (tendinitis, bursitis), gout (males only_, rheumatoid arthritis, psoriatic, reactive arthritis, infectious arthritis
> 60yrs = osteorhtiritis, Gout, pseudogout, polymyalgia rhematica, osetoporotic fractyre, septic arthritis (bacterial) –> Septic arthritis
wat are s/sxof De Quervains tenosynocitis?
- overuse syndrome assoc with pain on thumb & wrist motion
- swelling/pain for first dorsal movement
- (+) Finkelstein’s test
what are red flag conditions assoc w/ gout?
gout
septic arthritis
fracture
vascular ischemia
carpal tunnel syndrome
what is hte main complaint in acute monoarthritis?
acute inflammatory monoarthritis
- joint aspiration = best dx test
- synovial fluid analysis = infection or crystal yung source
