MSK geriatrics Flashcards
in what population is scoliosis most common
girls
FHx
more sensitive screening test for scoliosis
Adams forward bend test
XR scoliosis
Cobb’s angle >/= 10 degrees
tx scoliosis
Cobb angle < 25 - observe
surgery if > 40
can do bracing otherwise to stop progression
kyphosis vs lordosis
kyphosis - humpback
lordosis - swayback
normal curvatures of the spine
cervical - lordosis
thoracic - kyphosis
lumbar - lordosis
risks for ankylosis spondylitis
young males 15-30
HLA-b27
sx ankylosis spondylitis
low back pain and neck pain
decreased ROM in the night and morning, not improved with rest
improves with exercise and activity
dactylitis - uniform swelling of the fingers and toes (sausage digits)
may have anterior uveitis
!!!
dx ankylosis spondylitis
increased ESR, HLAB27 positivity
XR - bamboo spine - straightening of spine; loss of lordotic lumbar curvature + fusing of vertebrae
tx ankylosis spondylitis
NSAIDs first line
anti-TNF drugs if no response after 2 weeks
at what level is herniated disc MC
L5-S1
sx herniated disc
RADICULAR BACK PAIN!!!
POSITIVE SLR, crossover
dx herniated disc
XR
MRI
tx herniated disc
conservative
injections
laminectomy vs discectomy
MCC cauda equina
massive lumbar disc herniation
sx cauda equina
back pain
leg pain
saddle anesthesia
urinary or bowel dysfunction
DECREASED ANAL SPHINCTER TONE
dx cauda equina
MRI!!!!
tx cauda equina
emergency decompression
dx spinal stenosis
MRI preferred
which hip fractures are associated with AVN
fractures of the femoral head and neck
PE hip fracture
shortened, abducted, externally rotated (opposite for dislocation)
dx hip fracture
XR - traction-internal rotation AP hip
first line for osteoporosis
1200 Ca+
800 Vit D
DEXA screening
65 F or older
what is poly myalgia rheumatica associated with
giant cell arteritis
sx polymyalgia rheumatica
pain and stiffness in the proximal joints and muscles - shoulder and hip girdles!!!
worse after inactivity (worse in the AM > 45 min)
PE polymyalgia rheumatica
normal muscle strength
may have decreased ROM
dx polymyalgia rheumatica
clinical
increased ESR and CRP
tx polymyalgia rheumatica
low dose steroids is associated with rapid response!!!
what is polymyositis
muscle inflammation due to CD8+ lymphocytes
sx polymyositis
progressive symmetric proximal muscle weakness (shoulder, hips)
decreased muscle strength!!
dx polymyositis
elevated muscle enzymes - CK, aldolase, AST, ALT, LDH
Anti-jo-1
anti-signal recognition protein
muscle biopsy - definitive
tx polymyositis
high dose steroids
sx RA
joint pain, stiffness, swelling
worse inn the morning with morning stiffness > 1 hour after initiating movement
improves later in the day
wrist, MCP, PIP
PE RA
symmetric inflamed joints - warm, erythematous, soft “boggy”
ulnar deviation
dx RA
RF - best initial
anti-CCP most specific
XR - symmetric joint narrowing, osteopenia, bone and joint erosions
C1-2 subluxation
tx RA
DMARDs (methotrexate, leflunomide) + NSAIDs or steroids (for sx)
most important modifiable RF for OA
obesity
sx OA
usage-related joint pain, stiffness, restriction of movement
evening joint stiffness - worse throughout the day; morning stiffness is short in duration
PE OA
asymmetric joint space narrowing
marginal osteophytes
tx OA
acetaminophen, NSAIDs, steroids
