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NPTE Study Practice > MSK Patho UE > Flashcards

MSK Patho UE Flashcards

1
Q

DJD/OA are characterized by

A
  • Degeneration of articular cartilage with hypertrophy of subchondral bone & joint capsule of weight bearing joints
  • Most common form of arthritis affecting men more than women before age 50 and women more than men after age 50
  • Slowly progressive condition
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2
Q

Signs and symptoms of DJD/OA

A
  • Pain
  • Swelling
  • Loss of ROM
  • Bony deformity
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3
Q

Radiographic findings indicating OA

A
  • Diminished joint space
  • Decreased height of articular cartilage
  • Presence of osteophytes
  • Subchondral cysts
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4
Q

Primary medications used for management of DJD/OA

A
  • Oral analgesics
  • NSAIDs
  • Corticosteroid injections
  • Viscosupplementation or intra-articular injections of the knee with a form of hyaluronic acid can be used
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5
Q

Pathology of Ankylosing spondylitis

A
  • Progressive inflammatory disorder of unknown etiology that initially affects axial skeleton
  • HLA-B27 biomarker indicating disease
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6
Q

Timeline of symptoms for Ankylosing spondylitis

A
  • Mid to LBP for ≥3 months before the 4th decade of life
  • Morning stiffness and sacroiliitis
  • Results in kyphotic deformity of cervical/thoracic spine & decreased lumbar lordosis
  • Men affected 3x more than women
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7
Q

Medications used for management of Ankylosing spondylitis

A
  • NSAIDs to reduce inflammation & pain
  • Corticosteroids to suppress immune system to control various sx
  • Cytotoxic drugs (drugs that block cell growth) for those that don’t respond well to other treatments
  • Tumor necrosis factor (TNF) inhibitors to improve some sx
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8
Q

Pathology of Gout

A
  • Genetic disorder of purine metabolism
  • Characterized by elevated serum uric acid (hyperuricemia)
  • Uric acid changes into crystals & deposits into peripheral joints & other tissues
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9
Q

What joints is Gout most frequently observed

A
  • Knee
  • Great toe
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10
Q

Medications for management of Gout

A
  • NSAIDs
  • COX-2 inhibitors
  • Colchicine
  • Corticosteroids
  • Adrenocorticotropic hormone (ATCH)
  • Allopurinol
  • Probenecid
  • Sulfinpyrazone
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11
Q

Pathology of Psoriatic arthritis

A
  • Chronic, erosive inflammatory disorder of unknown etiology, associated with psoriasis
  • Both sexes affected equally
  • Erosive degeneration typically of the digits and axial skeleton joints
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12
Q

Medications for management of Psoriatic arthritis

A
  • Acetaminophen for pain
  • NSAIDs
  • Corticosteroids
  • DMARDs (disease modifying anti rheumatic drugs) to slow progression
  • Biological response modifiers (BRM) like Enbrel
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13
Q

Pathology of RA

A
  • Chronic systemic autoimmune disorder of unknown etiology thought to have a genetic basis
  • Pts produce antibodies to their own immunoglobulins (RF and ACPA)
  • Characterized by periods of exacerbation and remission
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14
Q

Who does RA affect

A
  • Women affect 2-4x more than men
  • Age of onset ~40-60
  • Onset may be gradual or abrupt
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15
Q

How is RA characterized

A
  • Bilateral and symmetrical synovial joint involvement
  • Most common joints include hands, feet, and cervical spine
  • Systemic features may include weight loss, fever, and extreme fatigue
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16
Q

Diagnostic testing for RA

A
  • Radiographs
  • Increased white blood cell count
  • Increased erythrocyte sedimentation rate
  • Elevated rheumatoid factor
  • Hemoglobin and hematocrit will show anemia
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17
Q

Medications for management of RA

A
  • Golds and DMARDs in early stages
  • NSAIDs and immunosuppressive agents
  • Corticosteroids for acute flare-ups or long term management
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18
Q

Pathology of osteoporosis

A
  • Metabolic disease that depletes bone mineral density/mass, predisposing individual to fracture
  • Affects women 10x more than men
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19
Q

Common fracture site for osteoporosis

A
  • Thoracic and lumbar spine
  • Femoral neck
  • Proximal humerus
  • Proximal tibia
  • Pelvis
  • Distal radius
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20
Q

What is primary/postemenopausal versus senile osteoporosis

A
  • Primary: directly related to a decrease in estrogen production
  • Senile: occurs due to a decrease in bone cell activity secondary to genetics or acquired abnormalities
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21
Q

Medications for management of osteoporosis

A
  • Calcium
  • Vitamin D
  • Estrogen
  • Calcitonin
  • Biophosphonates
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22
Q

Pathology of osteomalacia

A
  • Decalcification of bones due to vitamin D deficiency
  • Sx: severe pain, fractures, weakness, deformities
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23
Q

Medications for management of osteomalacia

A
  • Calcium
  • Vitamin D
  • Vitamin D injections in the form of calciferol (vitamin D2)
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24
Q

Diagnostic tests for osteomalacia

A
  • Radiographs
  • Urinalysis and blood tests
  • Bone scan
  • Bone biopsy if warranted
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25
Q

Pathology of osteomyelitis

A
  • Inflammatory response within bone caused by an infection
  • Usually caused by Staphylococcus aureus
  • More common in children and immunosuppressed adults
  • More common in men than women
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26
Q

Treatment for osteomyelitis

A
  • Antibiotics
  • Proper nutrition
  • Surgery if infection spreads to joints
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27
Q

Pathology of myofascial pain syndrome

A
  • Characterized by “trigger point” which is a focal point of irritability found within a muscle
  • Trigger point can be identified as a taut, palpable band within the muscle
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28
Q

Difference between an active versus latent trigger point

A
  • Active: tender to palpate & have a characteristic referral pattern of pain when provoked
  • Latent: palpable taut bands that are not tender to palpate but can be converted into an active trigger point
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29
Q

Medical intervention for trigger points

A
  • Dry needling
  • Analgesic injection
  • Can be combined with a corticosteroid
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30
Q

Pathology of tendonosis/tendonopathy

A
  • Dysfunction caused by an imbalance between tendon loading and recovery which leads to tendon failure an a microscopic and eventually macroscopic level
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31
Q

Histological characteristics of tendonosis/tendonopathy

A
  • Hypercellularity
  • Hypervascularity
  • No indication of inflammatory infiltrates
  • Poor organization and loosening of collagen fibrils
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32
Q

Pathology of bursitis

A
  • Inflammation of bursa secondary to overuse, trauma, gout, or infection
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33
Q

Signs and symptoms of bursitis

A
  • Pain with rest
  • PROM and AROM are limited due to pain but not in a capsular pattern
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34
Q

Medications for management of bursitis

A
  • Acetaminophen
  • NSAIDs
  • Steroid injections
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35
Q

Pathology for muscle strains

A
  • Inflammatory response within a muscle following a traumatic event that caused microtearing of the musculotendinous fibers
  • Pain and tenderness within that muscle
  • Pain with active contraction and passive stretch of the muscle
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36
Q

Pathology of myositis ossificans

A
  • Painful condition of abnormal calcification within a muscle belly
  • Usually precipitated by direct trauma that results in hematoma and calcification of the muscle
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37
Q

What are the most frequent locations for myositis ossificans

A
  • Quadriceps
  • Brachialis
  • Biceps brachii
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38
Q

When is surgery warranted for management of myositis ossificans

A
  • Only in pts with non-hereditary form
  • Only after maturation of the lesion (6-24 months)
  • Indicated when lesion mechanically interferes with joint movement or impinge on nerves
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39
Q

Pathology of complex regional pain syndrome (CRPS)

A
  • Etiology unknown but thought to be related to trauma or precipitating event
  • Results in dysfunction of sympathetic nervous system to include pain, circulation, and vasomotor disturbances
40
Q

What are the 2 types of CRPS

A
  • CRPS I: frequently triggered by tissue injury; no underlying nerve injury
  • CRPS II: experience the same symptoms but their cases are clearly associated with a nerve injury
41
Q

Medical interventions for CRPS

A
  • Sympathetic nerve block
  • Surgical sympathectomy
  • Spinal cord stimulation
  • Intrathecal drug pumps
42
Q

Medications for management of CRPS

A
  • Topical analgesics
  • Antidepressants
  • Corticosteroids
  • Opioids
43
Q

Long term changes associated with CRPS

A
  • Muscle wasting
  • Trophic skin changes
  • Decreased bone density
  • Decreased proprioception
  • Loss of muscle strength from disuse
  • Joint contractures
44
Q

Pathology of Paget’s disease (osteitis deformans)

A
  • Etiology unknown but thought to be linked to a type of viral infection along with environmental factors
  • Consider a metabolic bone disease involving abnormal osteoclastic and osteoblastic activity
  • Results in spinal stenosis, facet arthropathy, & possible spinal fracture
45
Q

Medications for management of Paget’s disease

A
  • Acetaminophen for pain control
  • Calcitonin & etidronate disodium to limit osteoclast activity
46
Q

Pathology of torticollis

A
  • Spasm and/or tightness of SCM muscle with varied etiology
  • Dysfunction observed is sidebending toward & rotation way from the affected SCM
47
Q

What position do anterior-inferior GHJ dislocations occurs in

A
  • Occurs when abducted upper extremity if forcefully ER causing tearing of inferior glenohumeral ligament, anterior capsule, and possibly the glenoid labrum
48
Q

What position do posterior GHJ dislocations occur in

A
  • Rare and occur with horizontal adduction and IR of the GHJ
49
Q

What is a Hills-Sachs lesion

A
  • Compression fracture of the posterior humeral head
  • Associated with an anterior-inferior dislocation of the humerus
50
Q

What is a Bankart lesion

A
  • Avulsion of the anterior-inferior capsule and glenoid labrum
  • Associated with an anterior-inferior dislocation of the humerus
51
Q

Presentation of an axillary nerve injury due to GHJ dislocation

A
  • Exam will demonstrate numbness and tingling in the lateral deltoid and weakness in shoulder abduction
  • Inability to abduct arm with neutral rotation
52
Q

Signs and symptoms of possible spinal accessory nerve involvement in the shoulder

A
  • Inability to abduct arm beyond 90º
  • Pain in shoulder on abduction
53
Q

Signs and symptoms of possible long thoracic nerve involvement in the shoulder

A
  • Pain on flexing fully extended arm
  • Inability to flex fully extended arm
  • Winging starts at 90º forward flexion
54
Q

Signs and symptoms of possible suprascapular nerve involvement in the shoulder

A
  • Increased pain on forward shoulder flexion
  • Shoulder weakness (partial loss of humeral control)
  • Pain increases with scapular abduction
  • Pain increases with cervical rotation to opposite side
55
Q

Characteristics of atraumatic shoulder instability

A
  • Global hypermobility
  • Throwing athletes
  • Characterized by popping/clicking in the joint
56
Q

Signs and symptoms of a glenoid labrum tear

A
  • Should pain that cannot be localized to a specific point
  • Pain is made worse by overhead activities or when the arm is held behind the back
  • Weakness
  • Instability in the shoulder
  • Pain on resisted flexion of the biceps (bending the elbow against resistance)
  • Tenderness over the front of the shoulder
57
Q

Physical therapy guidelines following a glenoid labrum surgery

A
  • Avoid apprehension position (90/90º abduction/ER) for 12 wks post-op
  • Shoulder is usually kept in a sling for 3-4 wks
  • After 6 wks more sports specific training can be done although full fitness may take 3-4 months
58
Q

Common areas of compression for TOS (thoracic outlet syndrome)

A
  • Superior thoracic outlet
  • Scalene triangle
  • Between clavicle and first rib
  • Between pectorals minor and thoracic wall
59
Q

Special tests useful in making a TOS diagnosis

A
  • Adson’s test (anatomical position of arm with head ipsi turn)
  • Roos test (90-90 with pumping fists)
  • Wright test (90-90 position no head turn)
  • Costoclavicular test (depress/retract shoulder in neutral0
60
Q

MOI for AC/SC joint disorders

A
  • Fall onto shoulder with upper extremity adducted or a collision with another individual during a sporting event
61
Q

Tendons of rotator cuff are susceptible to tendonitis and tears due to relatively

A
  • Poor blood supply near insertion of muscles
62
Q

Common symptoms of rotator cuff disorders

A
  • Pain (night pain is common)
  • Weakness
  • Loss of shoulder ROM (active > passive)
63
Q

Common MOIs for rotator cuff disorders

A
  • Compression/impingement: mechanical impingement of distal attachment of rotator cuff on the anterior acromion and/or coracoacromial ligament with repetitive overhead activity
  • Tensile overload: repetitive resistance to horizontal adduction, IR, anterior translation, & distraction
  • Macrotrauma (RTC tear): forces generated by trauma exceed tendon tensile strength
64
Q

Characteristics of internal (posterior) shoulder impingement

A
  • Characterized by an irritation between the rotator cuff and greater tuberosity or posterior glenoid and labrum
  • Often seen in athletes performing overhead activities
  • Pain commonly noted in posterior shoudler
65
Q

MOI and population typically affected by proximal humeral fractures

A
  • Humeral neck fracture: occur with a FOOSH (fall on outstretched hand) among older osteoporotic women; generally does NOT require immobilization/surgical repair since it is a fairly stable fx
  • Greater tuberosity fracture: more common in middle aged and elder adults; usually related to a fall onto the shoulder & does NOT require immobilization for healing
66
Q

Pathology of adhesive capsulitis (frozen shoulder)

A
  • Characterized by restriction in shoulder motion as a result of inflammation & fibrosis of the shoulder capsule usually due to disuse following injury or repetitive microtrauma
  • Commonly seen in association with DM and thyroid disease
67
Q

Loss of motion in non-capsular pattern (extension > flexion) of the elbow can be the result of

A
  • A loose body in the joint
  • Ligamentous sprain
  • Complex region pain syndrome (CRPS)
68
Q

Pathology of lateral epicondylalgia/epicondylitis (tennis elbow)

A
  • Most often a chronic degenerative condition of the the extensor carpi radiialis brevis tendon (ECRB) at its proximal attachment at the lateral epicondyle
  • Gradual onset usually the result of sports or occupations requiring repetitive wrist extension or strong grip with wrist extended resulting in overload of the ECRB
69
Q

Pathology of medial epicondylitis/epicondylalgia (golfer’s elbow)

A
  • Usually a degenerative condition of the pronator teres & flexor carpi radialis tendons at their attachment to the medial epicondyle
  • Occurs with overuse sports (pitching, golf swings, swimming) or occupations requiring a strong hand grip & excessive pronation of the forearm
70
Q

Pathology of osteochondritis dissecans

A
  • Affects central/lateral aspect of capitellum/radial head
  • Osteochondral bone fragment becomes detached from articular surface forming a loose body in joint
  • Caused by repetitive compressive forces between radial head and humeral capitellum
  • Occurs in 12-15 year olds
71
Q

Pathology of Panner’s disease

A
  • Localized AVN of capitellum leading to loss of subchondral bone with fissuring & softening of articular surfaces of radiocapitellar joint
  • Etiology unknown but occurs in children age 10 or younger
72
Q

Clinical signs of a UCL injury

A
  • Pain along medial elbow at distal insertion of ligament
  • Paresthesias in some cases reported in ulnar nerve distribution with positive Tingel’s sign
73
Q

Possible causes of ulnar nerve entrapment

A
  • Direct trauma at the cubital tunnel
  • Traction due to laxity at medial aspect of elbow
  • Compression due to thickened retinaculum or hypertrophy of flexor carpi ulnaris muscle
  • Recurrent subluxation
  • DJD that affects the cubital tunnel
74
Q

Possible causes of median nerve entrapment

A
  • Occurs within pronator teres muscle and under superficial head of flexor digitorum superficialis with repetitive gripping activities
75
Q

Clinical signs of median nerve entrapment

A
  • Aching pain with weakness of forearm muscles
  • Positive Tinel’s sign with paresthesias in median nerve distribution
76
Q

Possible causes of radial nerve entrapment

A
  • Entrapment of distal branches (posterior interosseous nerve) occurs within radial tunnel (radial tunnel syndrome) as result of overhead activities & throwing
77
Q

Clinical signs of radial nerve entrapment

A
  • Lateral elbow pain that can be confused with lateral epicondylitis/epicondylopathy
  • Pain over supinator muscle
  • Paresthesias in a radial nerve distribution
  • Tinel’s sign may be positive
78
Q

Clinical signs of an elbow dislocation

A
  • Rapid swelling
  • Severe pain at the elbow
  • Deformity with the olecranon pushed posteriorly
79
Q

What structures are impacted by a posterior/posterior-lateral dislocation of the elbow

A
  • Occurs as a result of elbow hyperextension from a fall on the outstretched hand
  • Can cause avulsion fractures of medial epicondyle secondary to traction pull of medial collateral ligament
80
Q

Pathology of carpal tunnel syndrome

A
  • Compression of median nerve at the carpal tunnel of the wrist due to inflammation of the flexor tendons and/or median nerve
  • Commonly occurs as result of repetitive motions/gripping with pregnancy, DM, & RA
81
Q

Common clinical findings of carpal tunnel syndrome

A
  • Exacerbation of burning, tingling, pins and needles, and numbness into median nerve distribution at night
  • Positive Tinel’s sign and/or Phalen’s test
  • long term compression causes atrophy & weakness of thenar muscles & lateral 2 lumbricals
82
Q

Pathology of de Quervain’s tenosynovitis

A
  • Inflammation/degeneration of extensor pollicis brevis & abductor pollicis longus tendons at 1st dorsal compartment
  • Results from repetitive microtrauma or as a complication of swelling during pregnancy
83
Q

Clinical signs of de Quervain’s tenosynovitis

A
  • Pain at anatomical snuffbox
  • Swelling
  • Decreased grip & pinch strength
  • Positive Finkelstein’s test (which places tendons on a stretch)
84
Q

MOI of a Colles’ fracture

A
  • FOOSH
  • Fracture is immobilized for 5-8 wks
  • Complication of median nerve compression can occur with excessive edema
  • Characteristic “dinner fork” deformity of wrist/hand results from dorsal/posterior displacement of distal fragment of radius with a radial shift of wrist/hand
85
Q

Possible complications with a Colles fracture

A
  • Loss of motion
  • Decreased grip strength
  • CRPS
  • Carpal tunnel syndrome
86
Q

What is a Smith’s fracture

A
  • Similar to Colles fracture except distal fragment of radius dislocates in a volar direction causing characteristic “garden spade” deformity
87
Q

Possible complications with a scaphoid fracture

A
  • High incidence of AVN of the proximal fragment of the scaphoid secondary to poor vascular supply
  • Carpals are immobilized for 4-8 wks
88
Q

Pathology of Dupuytren’s contracture

A
  • Observed as banding on palm & digit flexion contractures resulting from contracture of palmar fascia that adheres to skin
  • Affects men more than women
  • Contracture usually affects MCP & PIP joints of 4th/5th digits in nondiabetic individuals & affects 3rd/4th digits most often in individuals with DM
89
Q

Pathology of Boutonnière deformity

A
  • Results from rupture of central tendinous slip of extensor hood
  • Observed deformity is MCP and DIP extension with PIP flexion
  • Commonly occurs following trauma or in RA with degeneration of the central extensor tendon
90
Q

Pathology of Swan neck deformity

A
  • Results from contracture of intrinsic muscles with dorsal subluxation of lateral extensor tendons
  • Observed deformity is MCP & DIP flexion with PIP extension
  • Commonly occurs following trauma or with RA following degeneration of lateral extensor tendons
91
Q

Pathology of Ape hand deformity

A
  • Observed as thenar muscle wasting with 1st digit moving dorsally until it is in line with 2nd digit
  • Results from median nerve dysfunction
92
Q

Pathology of Mallet finger

A
  • Rupture or avulsion of extensor tendon at its insertion into distal phalanx of digit
  • Observed deformity is DIP flexion
  • Usually occurs from trauma forcing distal phalanx into a flexed position
93
Q

Pathology of Jersey finger (flexor digitorum profundus tendon rupture/avulsion)

A
  • MOI forced hyperextension of DIP with maximal finger flexion contraction
  • Ring finger involved in 75% of cases
  • May rupture directly from insertion, avulse from bone, or rupture at musculotendinous junction
  • Key exam finding of inability to produce isolated DIP flexion
94
Q

Pathology of Gamekeeper’s thumb

A
  • Sprain/rupture of ulnar collateral ligament of MCP of 1st digit
  • Results in medial instability of thumb
  • Frequently occurs during a fall while skiing when increasing forces ar replaced on thumb through ski pole
  • Immobilized for 6 wks
95
Q

Pathology of a Boxer’s fracture

A
  • Fracture of neck of 5th metacarpal
  • Frequently sustained during a fight or from punching a wall in anger or frustration
  • Casted for 2-4 wks

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