MSK Dx Flashcards
Worse pain in the AM
Pain lasts >45 min
Swelling, warmth, erythema
Inflammatory Arthritis
Worse pain at night
Pain lasts < 45 min
Swelling but less common than inflammatory
Bony hypertrophy
Non-inflammatory Artiritis
Typically symmetrical
Joint deformities if untreated
Ankylosis
Inflammation, joint pain, swelling, warnth, prolonged stiffness
Polyarticular disease w/ gradual onset
Hands mc involved- wrists, metacarpophalangeal (spares DIPJ)
Rheumatoid Arthritis
Skin and genital lesions
Eye and bowel inflammation
Association w/ preceding or ongoing infectious disorders
Inflam of axial joints
Asymmetrical oligoarthritis
Dactylitis
Enthesitis
Low back/inflam back pain usually at night and improves with exercise but NOT rest
Spondyloarthritis
SpA
MC affects DIPJ and PIPJ, hips and knees
Bony deformities
Bouchard’s nodes (PIPJ)
Heberden’s Nodes (DIPJ)
Squaring of thumb
Persistent use-related joint pain, morning stiffness ≤ 30 min
Osteoarthritis
DJD
Dull, aching pain over invovled area
Night pains “growing pains”
± fever, night sweats, weight loss
Tenderness to palpation of involved area, lim AROM of adj joint, limp, muscle atrophy, ± swelling, mass, deformity
± spontaneous fx
Pain from injury that doesn’t go away even after weeks
13-16 yo MC
Osteosarcome
Deep, dull, achy pain
MC in pelvis, ribs and hip
Pain at night
Chronic >1 yr
50-70 yo
Chondrosarcoma
Bone pain, tenderness on palpation, mass on exam
B sx (fever, night sweats, weight loss)
MC locations are pelvis, knee, prox humerus and femur disphysis
5-30 yo
Ewing Sarcoma
Dorsal surface of wrist at scapholunate joint
Joint instability, weakness, limited ROM
Normal overlying skin, compressible but firm movable mass
Transilluminates
May be adherent to bone, joint or tendon
Ganglion Cysts
What is the GS to diagnosis septic arthritis?
Arthrocentesis
MC affected bursa in adults
Olecranon
MC affected bursa in children
Prepatellar
GS to diagnose gout
Diagnostic Arthrocentesis
Monoarticular presentation (if pt comes in w/ monoarticular joint pain its septic arthritis until proven otherwise)
Abrupt swelling, warmth, and pain
Fever and chills
Antalgic gait (limp)
Guarding of limb
Extreme tenderness
Marked limitation in passive and active ROM
Septic Arthritis
Septic Arthritis etiology
S. aureus MC
Gonococcal
Infection of bone
Osteomyelitis
Osteomyelitis etiology
S. aureus
Tenosynovitis (inflammation of entire digit)
Dermatitis around palms and soles (pustules, hemorrhagic bullae)
Polyarthralgia starts in one joint and moves to another (migratory or additive)
GU sx
fevers/chills
Gonococcal Arthritis
Test of choice for gonococcal arthritis
(NAAT) of synovial fluid is preferred as more sensitive than culture
monoarticular or oligoarticular arthritis
Cold, large effusions Neurologic disease
Cutaneous involvement
Lyme Arthritis
Testing for Lyme arthritis
ELISA and confirm with Western blot due to high false ✚
Lyme IgM:1-2 wks
only 20- 40% ✚ at time of EM rash
Lyme IgG: 2-6 wks
Synovial fluid Lyme PCR
Most Lyme pts remain seropositive (including IgM) for yrs after successful tx with abx
Acute symmetric polyarthritis
Symmetric arthralgia or polyarthritis involving hands, wrists, knees, feet
Skin rash: lasts 2-4 days, face and trunk/limbs
Viral Arthritis
Septic Bursitis diagnostic test of choice
Aspiration and cx of bursitis = GS
Septic Bursitis etiology
s. aureus
MC site 1st MTP of foot= Podagra
Onset night or early morning
Pain, warmth, redness, swelling, fever (due to IL1), leukocytosis
Tenosynovial or bursal involvement
Acute Gout
Chronic Gout
Frequent attacks (≥2 per year)
Tophus
Erosive arthritis
CKD stage ≥2
Past urolithiasis (of any type)
Skeletal d/o characterized by compromised bone strength predisposing to inc risk of fx
Osteoporosis
Dx test of choice for Osteoporosis
Dual X-ray Absorptiometry (DXA) MC used
What pts should you use T score for?
used for dx of osteoporosis after menopause
What pts should you use Z score for?
used for dx of osteoporosis in children and YA
What fx requires greater force proximal humerus or humeral shaft?
humeral shaft
What should you look for on plain film if you suspect radial head fx
look for pulp findings (fat pad)
Anterior shoulder pain
Radiation down toward biceps
Tenderness over the bicipital groove
Biceps Tendinitis
Period of shoulder immobilization
Loss of passive ROM and active
Pain w/ active and passive ROM, progressive loss of ROM
Shoulder stiffness
Rest pain and night pain
Adhesive Capsulitis
“frozen shoulder syndrome”
Slowly progressive vague and diffuse shoulder pain
Pain is present at rest and exacerbated with activity
Progressive limitations on passive and active movement of shoulder (mostly due to pain)
Crepitus, ↓ ROM (w/ pain)
Glenohumeral Osteoarthritis
Galeazzi Fracture
fracture of the distal 1/3 of the radius with dislocation of the distal radioulnar joint
What is the mc type of metacarpal fx
Boxer’s Fracture
What is mc type of metatarsal fx
Jones Fracture
Jones Fracture
fx btwn the base and shaft of the fifth metatarsal bone
Starts w/ painless nodule over MCP joint in 1 or more fingers
Nodule expands in proximal direction to form cord along tendon (over course of several mo-yr)
Cord and nodule begin to limit finger extension → persistent flexion of finger toward palm
Duuytren’s Contracture
What is the most sensitive test for ACL tear?
Lachman’s
Shoulder pain worse w/ overhead activity, lifting arm above shoulder level
Located sup and lat aspect of shoulder over deltoid
May be acute/burning (bursitis) or intermittent and dull (tendinopathy)
↓ active ROM due to pain but should have full passive ROM
Impingement Syndrome
Rotator Cuff Syndrome or Rotator Cuff Disease
Pain in anterior lateral shoulder with radiation distally (but below elbow)
Weakness of the shoulder, especially with overhead movement
Night pain
Active ROM may show some weakness, esp with overhead reaching (above 90°)
Passive ROM is usually fine
Rotator Cuff Tears
What is MC involved ligament in low ankle sprains
Anterior Talofibular Ligament (ATFL)
c/o ”Walking on a Marble”
Pain & dysesthesias in the forefoot and
corresponding toes
Pain is described as sharp and burning
Toe numbness
Intermittent & episodic pain
Occasional night pain
MortonNeuroma
Dull/sharp pain when first ge tout of bed in the AM
Pain after standing following long periods without weight-bearing
Pain improves with
walking
Greater pain after exercise or activity
Pain worsening through the day
Plantarfasciitis
Pain worse after work or activities involving
repeated wrist extension and supination against resistance (think turning a screwdriver; painting a house; playing tennis)
Radiation of pain down posterior (dorsal) forearm
Pain reproduced with shaking hands,
opening/turning doorknob
Weakened grip, difficulty picking up heavy objects (bc tryin to avoid pain not bec inability)
ROM fully intact
Lateral Epicondylitis
tennis elbow
50-60 yo
symmetric weakness
trouble climbing stairs
Polymyositis
Pain after initial trauma but then dissipates
unless infected
Progressive formation of boggy swelling over
elbow
If infected → erythema, warmth, and pain
Olecranon Bursitis
muscle pain, weakness, dark urine
Rhabdomyolysis
Starts w/ painless nodule over MCP joint in 1 or more fingers
Nodule expands in proximal direction to form cord along tendon (over course of several mo-yr)
Cord and nodule begin to limit finger extension → persistent flexion of finger toward palm
Duuytren’s Contracture
What is the most sensitive test for ACL tear?
Lachman’s
> 3 months
Multifocal pain (above and below waist and on both sides of the body)
“tender points”
Cognitive problems/ Psychological distress
Fatigue, non-resorative sleep, arthralgias, cog dysfn, muscle spasm, parasthesias, depression/anxiety
Tension/migrain HA
Irritable bowel, restless legs, urinary infrequency, 1° dysmenorrhea/pelvic pain, temporomandibular pain, chem sensitivity
Fibromyalgia
Tests for ACL tear
✚Lachman’s Test *most sensitive
✚ Pivot Shift
✚Anterior drawer test (not very sensitive)
✚Swelling
MRI is most sensitive test
What is MC involved ligament in low ankle sprains
Anterior Talofibular Ligament (ATFL)
c/o ”Walking on a Marble”
Pain & dysesthesias in the forefoot and
corresponding toes
Pain is described as sharp and burning
Toe numbness
Intermittent & episodic pain
Occasional night pain
MortonNeuroma
Dull/sharp pain when first ge tout of bed in the AM
Pain after standing following long periods without weight-bearing
Pain improves with
walking
Greater pain after exercise or activity
Pain worsening through the day
Plantarfasciitis
5-15 yo and 45-65 yo
Symmetric muscle weakness
trouble climbing stairs
Gottrons papules Heliotrope rash V-sign Shawl sign Holster sign Mechanics hands Nailfold changes Subcutaneous calcification
Dermatomyositis
Motor disturbances are the earliest finding → triceps and hand intrinsic weakness
Clumnisess, can’t button shirt, dropping things, poor fine motor control
Spasticity in LE
Sensory sx can be minimal (can be stocking-glove dist)
Hyper-reflexive reflexes
Cord compression sx
Cervical Myelopathy
Insidious- progressive over mo-yrs
Asymmetric, distal AND proximal muscle weakness (forearms and flexor fingers)
PAINLESS weakness
Ant thighs mc involved > arms
Atrophy is prominent
Neuropathy
Inclusion Body Myositis
muscle pain, weakness, dark urine
Rhabdomyolysis
Pain/stiffness of shoulder and/or pelvic girdles
Morning stiffness 45 min
Weakness/stiffness when brushing hair
Pain may wake up pt early morning/night
May have swelling
Polymyalgia Rheumatica
Rapid decomp over mo
15% risk of blindness (mostly due to ischemic optic neuritis)
Jaw claudication is very specific
Constitutional sx
HA
Scalp tenderness
Abrupt field deficet (curtain coming down) - unilateral
Enlarged temporal arteries, absent temporal artery pulse, temporal artery tenderness
Giant Cell Arteritis
Temporal Arteritis
> 3 months
Multifocal pain (above and below waist and on both sides of the body)
“tender points”
Cognitive problems/ Psychological distress
Fatigue, non-resorative sleep, arthralgias, cog dysfn, muscle spasm, parasthesias, depression/anxiety
Tension/migrain HA
Irritable bowel, restless legs, urinary infrequency, 1° dysmenorrhea/pelvic pain, temporomandibular pain, chem sensitivity
Fibromyalgia
“My back hurts, and I peed my pants”
Urinary retention (or overflow incontinence)
Fecal incontinence
Saddle Anesthesia *mc sensory deficit (most sensitive)
Significant motor weakness
Sciatic pain – generally bilateral
Back pain
CaudaEquinaSyndrome
neck pain, sore deltoids, trouble holding up arm due to weakness, pain/sensory sx and sensory lat shoulder
C4-5 disc herniation
compress C5 root
neck pain, triceps, wrist drop (wrist extension), pain and sensory sx in upper arm 2nd-3rd fingers
C6-7 disc herniation (compress C7 root)
Arthralgias, fatigue
Dry eyes, dry mouth, neuro problems
Skin disorders- raynaud’s, cutaneous vasculitis
Nutritional malabsorption
Dry throat, dysphagia, liver abnormalities
Sjogrens Syndrome
Degenerative process that results in overall narrowing of spinal canal and neural foramen
Cervical Spondlyosis
Motor disturbances are the earliest finding → triceps and hand intrinsic weakness
Clumnisess, can’t button shirt, dropping things, poor fine motor control
Spasticity in LE
Sensory sx can be minimal (can be stocking-glove dist)
Hyper-reflexive reflexes
Cord compression sx
Cervical Myelopathy
pain post leg to hamstrings and to little toe side of the foot, motor weakness in plantar flexion, ↓ sensation in lat malleolus and lat foot
L5-S1 HLD (S1 nerve root
pain to post leg wrapping to shin below knee, motor weakness in tibialis anterior (foot drop), ↓ sensation in top of foot to big toe
L4-5 HLD *MC (effects L5 nerve root)
pain in ant thigh, motor weakness in quads, ↓ sensation in medial malleolus and medial foot
L3-4 HLD(effects L4 nerve root
bilat pain or discomfort in buttocks, worse w/ walking
Releived w/ rest of Δ in posture
Back pain
Used to be able to walk 2 mi now can walk 2 block before rest (rest on shopping cart/lean over)
Lumbar Spinal Stenosis
vertebral slip
Spondylolisthesis
“My back hurts, and I peed my pants”
Urinary retention (or overflow incontinence)
Fecal incontinence
Saddle Anesthesia *mc sensory deficit (most sensitive)
Significant motor weakness
Sciatic pain – generally bilateral
Back pain
CaudaEquinaSyndrome
Malar rash *spates nasolabial folds
Photosensitivity- rash in sun exposed areas
Oral or nasopharyngeal ulcers- usually painless
Arthritis- inflam, tenderness, swelling, non-erosive polyarthritis
SLE
Thickened skin
Edema, tight puffy fingers, disffuse swelling
Contractures, skin ulcers, dignital tip ulcers (assoc w/ Raynaud’s)
Symmetric polyarthralgias- stiffness of fingers, wrists, knees and ankles
Lip thinning, ↓ oral aperature
Scleroderma
Arthralgias, fatigue
Dry eyes, dry mouth, neuro problems
Skin disorders- raynaud’s, cutaneous vasculitis
Nutritional malabsorption
Dry throat, dysphagia, liver abnormalities
Sjogrens Syndrome
Classically involved lungs but can also involve other organs (skin, joints, brain, liver)
Acute polyarthritis (usually ankles)
Erythema nodosum
Eyes popping out
Sarcoidosis
Young pt w. Claudication or gangrene
Thromboangiitis Obliterans
