MSK disorders

Question 1

Thought process for MSK questions

Answer 1

is the patient otherwise well - likely limited to bones/joints –> osteoarthritis or osteoporosis

does the patient have systemic symptoms (fever, involuntary weight loss, anemia of chronic disease, rash, joint swelling) – ortho s/s of systemic disease – RA, SLE, polymyalgia rhematica

Question 2

Gout etiology

Answer 2

uric acid overproduction - ~10%
urate under-excretion ~90% of people w/ gout – renal insufficiency, etoh abuse, use of loop or thiazide diuretics, ASA, purine-rich foods (organ meats, sardines, anchovies, spinach, oatmeal)

Question 3

What does McMurray’s test look for

Answer 3

meniscal tear - click felt over the knee

Question 4

What does the talar tilt test assess for

Answer 4

ankle instability

Question 5

What does spurlings test look for

Answer 5

cervical nerve root compression

Question 6

What is Tinel’s sign

Answer 6

Tinel’s sign is a tingling or “pins and needles” feeling you get when your healthcare provider taps your skin over a nerve.

• indicates carpal tunnel syndrome

Question 7

What is Lachman test, and what does it tell you

Answer 7

The Lachman test is a passive accessory movement test of the knee performed to identify the integrity of the anterior cruciate ligament (ACL)

Question 8

What is the straight-leg raising test, and what does t tell you

Answer 8

lumbar nerve root compression

Question 9

What is the drop arm test, and what does it tell you

Answer 9

drop arm test is used to assess for full thickness rotator cuff tears, particularly of the supraspinatus.

– assesses integrity of the rotator cuff

Question 10

What is the Finkelsteins test, and what does it tell you?

Answer 10

Finkelstein maneuver is a helpful test to diagnose De Quervain’s Tendonitis

Question 11

Polymyalgia rheumatica (PMR) - etiology, clinical presentation & diagnosis, intervention

Answer 11

etiology - inflammation of unknown origin that affects muscles & joints, age usually >50

s/s - often include the shoulder (often 1st symptom), neck, upper arms, lower back, hips, and thighs. symptoms usually come quickly (days-weeks), worsen in the AM and improve throughout the day

PMR,CRP,ESR typically elevated – indicate inflammation imaging can detect inflammation

intervention - low dose corticosteroid (10-15mg prednisone) for 2-3 weeks or until s/s resolve – taper dose. treatment can last 2-3 years

Question 12

lumbar spinal stenosis assessment & intervention

Answer 12

clinical presentation - age >50, standing discomfort w/ improvement with bending forward nearly universal, pseudoclaudication (leg pain that worsens with activity and improves w/ rest), bilateral LE numbness & weakness

no diagnostics needed

for s/s >1mo consider MRI, EMG, or nerve conduction velocity

Question 13

osgood-schlatter disease etiology, clinical presentation & diagnosis, and intervention

Answer 13

etiology - patellar swelling & pain in adolescents who participate in sports involving running & jumping. repeated stress – inflammation below patellar tendon

presentation & diagnosis - pain, swelling, and tenderness in one or both knees (mild - debilitating pain) XR can be used for diagnosis

intervention - NSAIDS, PT, strength exercises for quads

pain will resove at completion of growth spurt

Question 14

prepatellar bursitis etiology, clinical presentation & diagnosis, and intervention

Answer 14

etiology - thickening of synovial tissue + excess fluids within the bursa – swelling & pain. c/b joint overuse, trauma, infection, arthritis

presentation & diagnosis - abrupt onset of knee pain w/ focal tenderness & swelling, ROM can be full or limited by pain. Diagnosis made by Hx and PE

intervention - bursal aspiration (1st line tx), minimize offending activity, ice, NSAIDS, if no improvement for 4-8 weeks - corticosteroid injection

Question 15

Meniscal tear etiology, clinical presentation & diagnosis, and intervention

Answer 15

etiology - disruption of the meniscus, often found in athletes d/t the twist-type of injury to the knee

presentation & diagnosis - effusion w/ knee tightness & stiffness. larger tears - locked knee, popping sound, or gives out. MRI can be used to identify the extent of injury. McMurray test and Apley grinding test are specific for meniscal tear

intervention - rest, elevation, ice, and analgesia are initial treatment options. aspiration can be considered if no improvement after 2-4 weeks. athroscopy for debridement if no improvement after 4-6 weeks or earlier if joint locking and effusion are problematic

Question 16

reactive arthritis etiology, clinical presentation & diagnosis, and intervention

Answer 16

etiology - painful inflammatory arthritis, typially seen days or weeks after an episode of acute bacterial diarrhea or STD infection

presentation & diagnosis - pain and/or swelling of the knees, ankles, heels, toes or fingers, persistent low back pain. conjunctivitis and urinary problems

diagnosis - blood test to check for infection and inflammation (ESR AND CRP). test for chlamydia trachomatis

intervention - anti-inflammatory drugs (NSAIDS, corticosteroids or TNF blockers), antimicrobial therapy

can’t see, can’t pee, can’t climb a tree

Question 17

Lumbar-sacral strain etiology, clinical presentation & diagnosis, and intervention

Answer 17

the most common reason for low back pain

etiology - spasm, irritation of LS spine-supporting muscles

characteristics - spasm, ache, stiffness, position, activity and rest impact pain

PE: tenderness, spasm, LS curve straightening, decreased LS flexion, neuro exam is WNL

intervention - analgesia, physical conditioning, limiting physical activity, heat/ice, muscle relaxers

Question 18

lumbar radiculopathy etiology, clinical presentation & diagnosis, and intervention

Answer 18

etiology - irritation or damage of neural structures (disks), L4-L5, L5-S1 = most common

discomfort characteristics - sharp, burning, electric shock sensation. worse when increased spinal fluid pressure (sneeze, cough, straining, sharp)

PE - signs of LS strain, altered neuro exam including abnormal straight leg raise, sensory loss, and altered DTRs

intervention - conservative tx as with LS, specialty referral if indicated for rapidly evolving defect, persistent neuro defect w/o resolution after 4-6 weeks

Question 19

normal BMD

Answer 19

-1.0 and above

Question 20

low bone mass (osteopenia) BMD

Answer 20

-1 to - 2.5

Question 21

osteoporosis BMD

Answer 21

below -2.5

Question 22

who should undergo BMD testing

Answer 22

W > 65y/o
M > 70 y/o
post menopausal women, or women transitioning into menopause and men 50-69 with high risk for fracture

Question 23

risk factors for osteoporosis

Answer 23

life story (physical activity, low Ca++, etoh abuse)
genetic factors (CF, gaucher’s disease)
hypogonadal states
endocrine disorders (DM, adrenal insufficiency)
GI disorders (celiac, ibd)
heme disorders (Multiple myeloma, leukemia)
Rhem and autoimmune disorders (RA and lupus)
CNS disorders (epilepsy, multiple sclerosis)
misc (aids/HIV, HF)
long term corticosteroid use, some anticonvulsants, and thyroid hormones

Question 24

nondairy options for Ca++ replacmeent

Answer 24

spinach
sardines
tofu
nuts (almonds)

Question 25

osteoarthritis assessment, diagnosis, and treatment

Answer 25

assessment - pain, tenderness, and stiffness (more prominent in the AM), decreased ROM, crepitus, and effusion may be present

diagnosis - XR - narrowing of the joint space, changes in the bone, presence of bone spurs

treatment - conservative (strength training), procedural (corticosteroid injection), surgical (arthroscopy)