MSK/Rheum (Exam 3) Flashcards
What condition involves bone overgrowth/bone abnormality during bone development that changes function of hip joint?
FAI (Femoroacetabular Impingement)
What condition AND specific subtype has acetabular involvement; extra bone extends over normal rim of acetabulum?
FAI (Femoroacetabular Impingement)
- Pincer
What condition AND specific subtype has femoral head involvement; femoral head not round so does not run smoothly inside acetabulum
FAI (Femoroacetabular Impingement)
- Cam
What condition involves pain aggravated with turning, twisting, prolonged standing/squatting?
FAI (Femoroacetabular Impingement)
What is the best physical exam test for evaluating FAI (Femoroacetabular Impingement)? What other test may be considered?
FADIR is best test
- Also FABER
What condition involves dull or sharp groin pain that may radiate; catching, clicking that may cause pain?
Labral Tear of hip
What is the best radiology test for a Labral Tear of hip?
MR Arthrogram is best test
What LE condition is most common in dancers?
Snapping Hip Syndrome
What LE condition involves tendon sliding over bone at top of femur (involves IT band and greater trochanter)?
EXternal Snapping Hip Syndrome
What LE condition involves tendon sliding over bone structures anteriorly (involves iliopsoas tendon over femoral head)
INternal Snapping Hip Syndrome
What LE condition involves snapping/popping sensation worse with activity (painless or painful); pseudosubluxation?
Snapping Hip Syndrome
With Snapping Hip Syndrome, what is often possible on physical exam?
Snapping often reproducible by patient
What PE exam is used to test internal Snapping Hip Syndrome? What PE exam is used to test external Snapping Hip Syndrome?
- Internal: FABER
- External: passive internal and external rotation of hip
What condition involves PAIN, lateral hip pain with localized pain to greater trochanter?
Greater Trochanter Pain Syndrome
What is the most common cause of lateral hip pain in adults?
Greater Trochanter Pain Syndrome
What LE condition can present with positive Trendelenburg Test on physical exam?
Greater Trochanter Pain Syndrome
With what LE condition are steroid injections VERY effective?
Greater Trochanter Pain Syndrome
What is the Unhappy Triad? What is another name for this?
Unhappy Triad = Triad of O’Donoghue
- MCL, ACL and medial meniscus
What LE condition has an MOI that most commonly involves knee flexion + foot planted AND lateral impact causing valgus stress?
Medial Collateral Ligament (MCL) Sprain
What is the least common knee ligament injury?
Lateral Collateral Ligament (LCL) Sprain
What type of physical exam is performed for an MCL or LCL sprain?
Varus (medial force applied) or valgus (lateral force applied)
What is the most common knee ligament injury?
Anterior Cruciate Ligament (ACL) Injury
What injury are 50% of Anterior Cruciate Ligament (ACL) Injury associated with?
50% associated with meniscus injury
Which type of knee ligament injury requires contact on MOI? Which one classically does not require contact?
- Medial Collateral Ligament (MCL) Sprain: contact required
- Anterior Cruciate Ligament (ACL) Injury: NON-contact
What LE condition involves feeling/hearing “pop” → immediate pain and swelling with feeling of instability?
Anterior Cruciate Ligament (ACL) Injury
What three physical exam tests are performed for an Anterior Cruciate Ligament (ACL) Injury?
Lachman test
- Also Anterior Drawer, and Pivot Shift
Most LE injuries involve supportive care as treatment. Which injury is an exception that often requires surgery?
Anterior Cruciate Ligament (ACL) Injury
What MOI is most common with a Posterior Cruciate Ligament (PCL) Injury?
Most likely MVA trauma injury
What type of knee ligament injury is least likely to be injured in athletics?
Posterior Cruciate Ligament (PCL) Injury
Which meniscus is more susceptible to injury?
Medial
What LE condition involves joint line pain; “locking” or “catching” of knee?
Medial Meniscus Injury
What physical exam test is performed to test for a Medial Meniscus Injury? Describe this.
McMurray Test
- Medial: hand on medial meniscus and other on foot, ext. rotate foot and apply valgus stress at knee
What physical exam test is performed to test for a Lateral Meniscus Injury? Describe this.
McMurray Test
- Lateral: hand on lateral meniscus and other on foot, int. rotate foot and apply varus stress at knee
What are the three grades of knee sprains? Describe each, AND the recommended treatment for each.
- Grade I (mild stretch): supportive (RICE, weight-bearing as tolerated)
- Grade II (partial tear): supportive +/- surgery (RICE, brace immobilization, PT, possible surgery)
- Grade III (complete tear): surgery (then supportive with crutches, brace, PT)
What LE conditions involves deep knee pain anteriorly?
Patellofemoral Pain Syndrome (Runner’s Knee)
What is the most common knee complaint in primary care medicine?
Patellofemoral Pain Syndrome (Runner’s Knee)
What LE condition involves positive theater sign/long car ride sign; often see crepitus, popping, feeling of instability?
Patellofemoral Pain Syndrome (Runner’s Knee)
What two physical exam tests are performed to test for Patellofemoral Pain Syndrome (Runner’s Knee)?
Patellar Glide
- Also Apprehension Test
What LE condition involves accumulation of fluid in popliteal fossa behind knee?
Baker’s Cyst (Popliteal Cyst)
What LE condition is often asymptomatic, or found incidentally; potential pain with prolonged standing or activity?
Baker’s Cyst (Popliteal Cyst)
What LE condition often occurs after skeletal maturity in adulthood?
Patellar Tendonitis (Jumper’s Knee)
What population is Patellar Tendonitis (Jumper’s Knee) most common in?
Athletes
What treatment is not recommended for Patellar Tendonitis (Jumper’s Knee)?
Steroid injection NOT recommended
What LE condition involves : progressive localized pain to lateral thigh?
Iliotibial Band Syndrome (ITBS)
What population is Iliotibial Band Syndrome (ITBS) most common in?
Overuse injury more common in runners/cyclists
What LE condition has a physical exam finding significant for localized tenderness that is reproducible with ROM/compression?
Iliotibial Band Syndrome (ITBS)
What are the three subtypes of Knee Bursitis?
- Prepatellar
- Pes anserinus
- Suprapatellar
For which LE condition should you consider aspirating to rule out infection? What treatment should not be done if there is infection?
Knee Bursitis
- Do NOT perform injections if infected
What LE condition involves idiopathic osteonecrosis of subchondral bone? What is the most common location for this to occur?
Osteochondritis Dissecans (OCD) - Most common in the knee joint
If Osteochondritis Dissecans (OCD) is in the elbow, what is the most likely location?
Capitellum (laterally)
If Osteochondritis Dissecans (OCD) is in the knee, what is the most likely location?
Lateral portion of medial femoral condyle from repetitive actions
What age range is most commonly affected by Osteochondritis Dissecans (OCD)?
10-20 years old
What LE condition involves ague symptoms like progressive, deep, poorly localized pain; decreased ROM in elbow but not knee; can include popping, clicking, catching with advanced disease, may have intermittent swelling?
Osteochondritis Dissecans (OCD)
What type of radiology is recommended for Osteochondritis Dissecans (OCD)? What would be seen on imaging?
X-ray
- Would show flattening of articular surface (crater)
What five conditions should be considered if a patient presents with ANTERIOR knee pain?
- Injury of quadriceps/patellar tendons
- Patellofemoral pain syndrome
- Knee bursitis
- Patellar fracture/dislocation
- Osgood-Schlatter disease
What three conditions should be considered if a patient presents with MEDIAL knee pain?
- MCL injury
- Medial meniscus injury
- Pes anserine bursitis
What three conditions should be considered if a patient presents with LATERAL knee pain?
- LCL injury
- IT band syndrome
- Lateral meniscus
What two conditions should be considered if a patient presents with POSTERIOR knee pain?
- Baker’s Cyst
- DVT
Which ankle location is most commonly injured? What specific ligament complex is injured most?
Lateral most commonly injured
- Lateral Ligament Complex (anterior talofibular ligament, calcaneofibular ligament (CFL) and posterior talofibular ligament)
What are the three types of ankle sprains (think location)? What is the MOI for each?
- Lateral: inversion injury
- Medial: eversion injury
- Syndesmotic: rotational injury
What is the physical exam test performed for a lateral ankle sprain?
Anterior Drawer Test
What is the physical exam test performed for a syndesmotic ankle sprain?
Squeeze Test
What is the most important treatment for ankle sprain?
PT
What LE condition is due to increased activity and involves burning pain worse with activity?
Achilles Tendinopathy
What LE condition often involves a sensation of violent “hit or pop” due to sudden pivot or rapid acceleration?
Achilles Tendon Rupture
What Achilles Tendon injury is common in pediatrics?
Calcaneal Apophysitis (Sever’s Disease)
What is the physical exam test performed for an Achilles Tendon Rupture? Describe this.
Thompson Test (+ if squeeze calf of affected Achilles Tendon with no movement of foot)
If an Achilles Tendon Rupture is suspected, what position should the foot be kept in (think for splinting)?
Keeping foot in continued plantar flexed position
What LE condition involves pain with onset of walking (first step in the morning)?
Plantar Fasciitis
What is one of the most common causes of foot pain?
Plantar Fasciitis
With Plantar Fasciitis, what should be ruled out? How do you rule it out (think exams)?
Rule out S1 radiculopathy (weakness with great toe dorsiflexion) with SLR and Achilles DTR
What is an inflammatory arthritis involving hyperuricemia?
Gout
What level is considered hyperuricemia (think exceeds what value)?
Serum uric acid level exceeds 6.8 mg/dL
With Gout, what does uric acid accumulate into?
Uric acid accumulates into monosodium urate (MSU) crystals
What is uric acid? What types of food is it found in?
Uric acid: breakdown product of purine metabolism
- Found in red meat, seafood
What are the two population groups for Gout (think reasons for getting gout)? Which is more common? Describe each
- Underexcretors (90%): more common; due to kidney disease or fluid abnormalities
- Overproducers: due to high cell turnover
What are four non-modifiable risk factors associated with Gout?
- Male
- Older
- Pacific Islanders
- Genetic variants
What are eight modifiable risk factors associated with Gout?
- Obesity
- HTN
- Hyperlipidemia
- CKD
- Type II DM
- Diet
- EtOH
- Certain medications
What is white chalky material consisting of dense concentrations of MSU crystals? What condition are they associated with?
Tophi
- Seen with chronic Gout
What conditions involves rapid onset of severe pain at night?
Acute Gout Flare
What condition is often recurrent, monoarticular, affecting the 1st MTP joint? What is this location site specifically called?
Acute Gout Flare
- 1st MTP joint = “Podagra”
What condition is triggered by acute increase OR decrease in uric acid levels? What two types of medications might cause this?
Acute Gout Flare
- Thiazide loop diuretics
- Urate-lowering medications
What condition shows bony erosions like “punched out” or “rat bite erosions”? What stage of the disease does this occur?
Advanced disease of Gout
What diagnostic test will provide a definitive diagnosis for Gout OR Pseudogout?
Arthrocentesis/synovial fluid analysis
What condition would show + for MSU crystals that are needle-shaped and negatively birefringent on polarized light microscopy?
Gout
What are the three recommended treatments for Acute Gout Flare OR Pseudogout?
- NSAIDs (Indomethacin or Naproxen)
- Steroids
- Colchicine
What is ULT (Urate-Lowering Therapy)? How does it work, and what condition is it used to treat?
ULT treat Gout
- Lowers serum uric acid levels to avoid future attacks by preventing new crystal formation and dissolving those already formed
What prophylactic treatment should be considered when starting ULTs?
Adding NSAIDs or Colchicine
What are Xanthine Oxidase Inhibitors (XOIs) an example of, and what condition do they treat?
XOIs are a type of ULT
- Used to treat Gout
What population group of Gout do XOIs work for?
Underexcretors AND overproducers
What is the DOC for XOIs to treat Gout? What type of dosing should be considered? What are possible side effects of this DOC?
Allopurinol
- Consider renal dosing (low and slow)
- Side effect: SJS
What population group of Gout do Uricosuric Agents work for?
Underexcretors only
When should ULTs NOT be considered for the treatment of Gout? When is the appropriate time to use ULTs?
Acute Gout Flare
- Wait 2 weeks
Why is long-term management of ULTs important?
Non-optimal sUA levels can increase risk for premature mortality
What two metabolic/endocrine disorders are often associated with Pseudogout?
- Hemochromatosis
- Hyperparathyroidism
What are three possible causes/triggers of Acute Pseudogout?
- Trauma
- Surgery
- Severe medical illness
What condition involves severe acute joint inflammation with possible associated systemic findings?
Pseudogout
If an x-ray is performed for Pseudogout, what would be seen on imaging?
Chondrocalcinosis, or “cartilage calcification”
What condition would show + for CPP crystals that are rhomboid-shaped and positively birefringent on polarized light microscopy?
Pseudogout
What are the two subtypes of Axial Spondyloarthritis?
- Ankylosing Spondylitis
- Non-radiographic axial SpA
What are the four subtypes of Peripheral Spondyloarthritis?
- Reactive arthritis
- Psoriatic arthritis
- Arthritis associated with IBD
- Peripheral SpA without any associated illness aka “undifferentiated SpA”
What group of diseases involve a strong association with HLA-B27?
Spondyloarthropathies (SpA)
What group of diseases are generally seronegative (rheumatoid factor (RF) is negative)?
Spondyloarthropathies (SpA)
What subtype of SpA involves inflammation/swelling of LEs, asymmetrical; affects 1-3 joints (oligoarthritis)?
Peripheral SpA
What condition involves inflammation/swelling of entheses, particularly at Achilles tendon?
Enthesitis (“heel pain”)
What subtype of SpA involves acute, non-septic inflammatory arthritis that is asymmetrical oligoarthritis?
Reactive Arthritis (ReA)
Which subtype of SpA is triggered by preceding GI or GU/STD infection 1-4 weeks prior?
Reactive Arthritis (ReA)
What subtype of SpA involves “can’t see, can’t pee, can’t climb a tree”? What does each mean symptomatically?
Reactive Arthritis (ReA)
- “Can’t see”: conjunctivitis, uveitis
- “Can’t pee”: urethritis
- “Can’t climb a tree”: peripheral and/or axial symptoms of peripheral arthritis
What subtype of SpA involves conjunctivitis/uveitis, urethritis and peripheral arthritis?
Reactive Arthritis (ReA) - “Can’t see, can’t pee, can’t climb a tree”
What is the initial treatment for Reactive Arthritis (ReA)? If this doesn’t work, what type of medication should be considered?
NSAIDs with rheumatology referral
- DMARDs can be started
What subtype of SpA involves chronic inflammatory disease of axial skeleton, particularly SI joints and spine?
Ankylosing Spondylitis (AS)
What subtype of SpA involves a STRONG hereditary component?
Ankylosing Spondylitis (AS)
What subtype of SpA involves inflammatory back pain and progressive stiffness of spine?
Ankylosing Spondylitis (AS)
What subtype of SpA progresses proximally?
Ankylosing Spondylitis (AS) - SI joints to outer fibers of annulus fibrosus
What subtype of SpA shows “bamboo spine” appearance with late disease on imaging?
Ankylosing Spondylitis (AS)
What subtype of SpA involves enthesitis with chronic inflammation → structural damage that is attempted to be repaired by new bone formation (ossification) → leads to fusion
Ankylosing Spondylitis (AS)
What subtype of SpA involves limited spine mobility and chest expansion on physical exam?
Ankylosing Spondylitis (AS)
What is the initial treatment for Ankylosing Spondylitis (AS)?
First line is NSAIDs (Indomethacin or Naproxen)
When considering referral to rheumatology, what are the two required requirements for SpA, as well as the list of seven other conditions that 1+ must be present?
Lol sorry this question sucks ass
Patients with >3 months back pain + age onset <45 years + 1 or more of these…
- Positive family history of SpA
- Inflammatory back pain
- HLA-B27 positivity
- Sacroiliitis on imaging
- Extraarticular manifestations
- Good response with NSAIDs
- Elevated acute phase reactants
What condition is a chronic multi-organ autoimmune disorder?
Systemic Lupus Erythematosus (SLE)
What general symptom is often associated with Systemic Lupus Erythematosus (SLE)?
Fatigue
What four skin symptoms are often associated with Systemic Lupus Erythematosus (SLE)?
- Malar rash (“butterfly rash”)
- Discoid
- Painless oral/nasal ulcers
- Raynaud Phenomenon
What cardiac symptom is often associated with Systemic Lupus Erythematosus (SLE)?
At increased risk for MI due to accelerated atherosclerosis
What two renal symptoms are often associated with Systemic Lupus Erythematosus (SLE)?
Nephritis with proteinuria
What condition involves joint pain/joint effusions that tend to be migratory, polyarticular and symmetrical?
Systemic Lupus Erythematosus (SLE)
What condition involves positive ANA (with titer and staining – homogenous and speckled) + subtypes (positive anti-dsDNA, anti-Sm and antiphospholipid antibodies)?
Systemic Lupus Erythematosus (SLE)
What is the first line pharmacologic treatement for Systemic Lupus Erythematosus (SLE)? What referral MUST be made before starting this medication, and why?
Antimalarials (Plaquenil)
- Regular ophthalmology follow-up for Plaquenil and possible retinal toxicity
What three co-morbid disease worsen prognosis for Systemic Lupus Erythematosus (SLE)?
- Active renal disease/infection
- Active CNS disease/infection
- CV disease
What three medications can caused Drug-Induced Lupus?
- Isoniazid
- Procainamide
- Hydralazine
What condition has similar symptoms to Systemic Lupus Erythematosus (SLE)?
Drug-Induced Lupus
What condition involves positive antihistone antibody test; negative anti-dsDNA and anti-Sm antibody?
Drug-Induced Lupus
What condition involves progressive, symmetric proximal muscle weakness most often in deltoids and hip flexors?
Polymyositis
What other systems may be affected by Polymyositis, and which is most important to consider/why?
Lungs: cough/SOB due to interstitial lung disease
- Also Raynaud Phenomenon, esophageal disease, cardiac disease, myocarditis and skin
What is Dermatomyositis?
Polymyositis + cutaneous eruptions
What condition involves increased risk of occult malignancy?
Dermatomyositis
What is an erythematous/violaceous rash on upper eyelids? What condition is it associated with?
Heliotrope rash
- Associated with Dermatomyositis
What is an erythematous/violaceous papules on dorsal aspect of MCP, PIP and DIP joints? What condition is it associated with?
Gottron’s papules
- Associated with Dermatomyositis
What is redness at top of shoulders called? What condition is it associated with?
Shawl sign
- Associated with Dermatomyositis
What two conditions show elevated CK and aldolase on labs?
- Polymyositis
- Dermatomyositis
What is the first line treatment for both Polymyositis and Dermatomyositis?
Steroids
What condition involves systemic, chronic autoimmune inflammatory disorder of exocrine glands/extraglandular features?
Sjögren’s Syndrome
What condition involves “sicca complex”? What are the two symptoms of this complex?
Sjögren’s Syndrome
- Xerophthalmia (dry eyes)
- Xerostomia (dry mouth)
What condition will have a positive Schirmer Test?
Sjögren’s Syndrome
What condition involves +ANA with positive Anti-Ro/SSA and Anti-La/SSB?
Sjögren’s Syndrome
What three specialty referrals are recommended for follow up with Sjögren’s Syndrome?
- Dentist
- Ophthalmologist
- Rheumatologist
What condition involves inflammation of muscular arteries resulting in thrombosis, ischemia, infarct?
Polyarteritis Nodosa (PAN)
What population is more commonly affected by Polyarteritis Nodosa (PAN)?
Most common in males
What condition involves leukocytoclastic vasculitis mostly in LE?
Polyarteritis Nodosa (PAN)
What other two diseases are often associated with Polyarteritis Nodosa (PAN)?
- Renal disease
- HTN
What condition has a negative ANCA (antineutrophil cytoplasmic antibodies)?
Polyarteritis Nodosa (PAN)
What is the first line treatment for Polyarteritis Nodosa (PAN)?
Steroids +/- immunosuppressants
What rare condition involves autoimmune disorder causing diffuse fibrosis (thickening/tightening) of skin/internal organs?
Systemic Sclerosis (SSc)
What are the two subtypes of Systemic Sclerosis (SSc)?
- Limited Cutaneous SSc
- Diffuse Cutaneous SSc
What condition involves CREST? What does each letter stand for (aka what are the symptoms)?
Limited Cutaneous SSc
- Calcinosis
- Raynaud syndrome
- Esophageal dysfunction
- Sclerodactyly
- Telangiectasias
What condition has a +ANA; positive ACA (anti-centromere antibodies)?
Limited Cutaneous SSc
Does Limited Cutaneous SSc or Diffuse Cutaneous SSc have a better prognosis?
Limited Cutaneous SSc has a better prognosis
What condition involves CREST + trunk and proximal extremities involved?
Diffuse Cutaneous SSc
What condition has a +ANA; positive Anti-Scl-70 (Antitopoisomerase I antibodies); or positive Anti-RNA Polymerase III antibody?
Diffuse Cutaneous SSc
What is the recommended treatment for Raynaud Phenomenon?
Nifedipine
What is the most common inflammatory arthritis?
Rheumatoid Arthritis (RA)
What condition involves primarily synovial joints with possible extraarticular manifestations?
Rheumatoid Arthritis (RA)
What condition involves synovial hypertrophy and chronic joint inflammation?
Rheumatoid Arthritis (RA)
What condition progresses from periphery to proximal symmetrical pain, stiffness, with swelling of many joints?
Rheumatoid Arthritis (RA)
What condition affects the MCP and PIP joints but NOT the DIP joints?
Rheumatoid Arthritis (RA)
Typically, the axial skeleton is spared with Rheumatoid Arthritis (RA), except for which level?
Cervical spine with advanced disease
What two conditions involve LONG morning stiffness more than 1 hour?
- Rheumatoid Arthritis (RA)
- Polymyalgia Rheumatica (PMR)
What two conditions are WORSE WITH REST, better with activity?
- Rheumatoid Arthritis (RA)
- Polymyalgia Rheumatica (PMR)
What type of arthritis involves accelerated cardiovascular disease?
Rheumatoid Arthritis (RA)
What is Felty’s Syndrome, and what condition is it associated with?
Felty’s Syndrome: triad of RA, splenomegaly and neutropenia
- Associated with Rheumatoid Arthritis (RA)
What condition has soft, warm, tender joints on physical exam?
Rheumatoid Arthritis (RA)
What condition has that “boggy” and fluctuant joints on physical exam?
Rheumatoid Arthritis (RA)
What condition has “trigger” finger from flexor tendon tenosynovitis on physical exam?
Rheumatoid Arthritis (RA)
What condition has “ulnar drift” on physical exam?
Rheumatoid Arthritis (RA)
What condition has swan-neck and boutonniere deformities on physical exam?
Rheumatoid Arthritis (RA)
What condition is associated with carpal tunnel syndrome and ulnar nerve compression on physical exam?
Rheumatoid Arthritis (RA)
What condition presents with rheumatoid nodules on physical exam?
Rheumatoid Arthritis (RA)
What condition has hammer toes; hallux valgus (bunions) on physical exam?
Rheumatoid Arthritis (RA)
What condition has associated Baker’s cyst with effusion and limited knee ROM on physical exam?
Rheumatoid Arthritis (RA)
What condition involves joint instability at C1-C2? What can this progress to?
Rheumatoid Arthritis (RA) - Can progress to cervical myelopathy
What is the preferred radiology test for Rheumatoid Arthritis (RA)? What might be seen on imaging?
X-ray preferred
- Evidence of soft tissue swelling around joint, bony erosions
What condition has positive RF AND positive Anti-CCP (Anti-Cyclic Citrullinated Peptide) antibodies?
Rheumatoid Arthritis (RA)
What test can show as seronegative for Rheumatoid Arthritis (RA), but should still be referred if suspected?
RF may be seronegative
What is the first line treatment for Rheumatoid Arthritis (RA)?
DMARDs + NSAIDs/steroids
How do DMARDs work (2)?
- Slow/halt disease progression
- Preserve joint function
What are the two risks associated with DMARDs?
- Infection
- Malignancy
What are four non-pharmacologic treatments for Rheumatoid Arthritis (RA), and what is the primary goal?
Preserve ADLs
- Rest/exercise/PT/OT
- Nutrition/diet
- Psychosocial help
- Stop smoking
What is a major risk factor associated with Rheumatoid Arthritis (RA)?
SMOKING
What is the most common form of general arthritis?
Osteoarthritis (OA)
What condition involves joint pain and functional impairment, leading to disability?
Osteoarthritis (OA)
What condition involves synovitis + bony changes (osteophytes) + soft tissue involvement?
Osteoarthritis (OA)
What arthritic condition involves cartilage loss and which tissues are involved?
Osteoarthritis (OA)
- ALL joint tissues involved
What condition involves any joint changes trigger proinflammatory mediators?
Osteoarthritis (OA)
What condition involves single OR multiple joints; asymmetrical pain of hands WITH DIPs?
Osteoarthritis (OA)
What condition affects the 1st CMC joint of wrist and 1st MTP joints of feet?
Osteoarthritis (OA)
Which arthritic condition does NOT involve extraarticular manifestations?
Osteoarthritis (OA)
What arthritic condition involves the knees, hips, cervical and lumbar spine?
Osteoarthritis (OA)
What condition has SHORT morning stiffness less than 30 minutes?
Osteoarthritis (OA)
What condition has hard, bony joints on physical exam?
Osteoarthritis (OA)
What condition has Heberden’s nodes and Bouchard’s nodes on physical exam? What joint does each type of node affect?
Osteoarthritis (OA)
- Heberden’s nodes: DIP joints
- Bouchard’s nodes: PIP joints
What condition has the 1st CMC “squared off” on physical exam?
Osteoarthritis (OA)
What condition has UNIlateral hip pain with decreased ROM and hip/groin pain? What body part might show referred pain?
Osteoarthritis (OA)
- Referred pain to knee possible
What type of radiology is recommended for Osteoarthritis (OA), AND HOW should it be obtained? What would be seen on imaging?
X-rays WITH weight bearing
- Shows joint space narrowing and osteophyte formation
How is Osteoarthritis (OA) diagnosed?
Clinical
- Labs often normal
What are the four recommended treatments for Osteoarthritis (OA) ?
- NSAIDs/Tylenol
- Tramadol
- Steroid injections
- SNRIs
What two conditions are often associated with Osteoarthritis (OA)?
- Depression
- Sleep issues
What age group is most affected by Polymyalgia Rheumatica (PMR)?
50+ years
What condition involves discrete bilateral, proximal aching and stiffness (affects shoulders, neck, pelvis)?
Polymyalgia Rheumatica (PMR)
What condition has symptoms due to synovitis, tenosynovitis and bursitis?
Polymyalgia Rheumatica (PMR)
What condition has limited ROM with subjective weakness but normal muscle strength on physical exam?
Polymyalgia Rheumatica (PMR)
What condition has VERY elevated ESR/CRP? What is the level numerically?
Polymyalgia Rheumatica (PMR) - >40 mm/hr
What is the recommended treatment for Polymyalgia Rheumatica (PMR)?
STEROIDS
- ALWAYS WORK!
Which condition uses steroids as the first line treatment AND they always work? What is the recommended dose/course?
Polymyalgia Rheumatica (PMR) - Begin at 10-20 mg/day and slowly taper over 1 year
What condition is very common, chronic WIDESPREAD musculoskeletal pain?
Fibromyalgia (FM)
What condition often occurs in conjunction with RA and SLE?
Fibromyalgia (FM)
What condition is considered a disorder of central pain processing?
Fibromyalgia (FM)
What condition has a strong genetic component and must be present for >3 months?
Fibromyalgia (FM)
What condition has vague symptoms of widespread muscle pain with associated fatigue, poor sleep, depression/anxiety and psych/cognitive issues?
Fibromyalgia (FM)
What condition has vague symptoms with associated headaches and IBS?
Fibromyalgia (FM)
What condition has widespread soft tissue tenderness but NO soft tissue swelling or redness on physical exam?
Fibromyalgia (FM)
What is the first line treatment for Fibromyalgia (FM)? What other two medications may be considered?
Tricyclic antidepressants
- Also SNRIs or anticonvulsants
What non-pharmacologic treatment is recommended for Fibromyalgia (FM)?
Exercise (aquatic therapy)
What type of approach is VITAL to treating Fibromyalgia (FM)?
Interprofessional team approach (PCP, rheum, pain management, psych, sleep specialist)
What two actions do the SIT muscles perform?
External rotation and abduction
What action does the Subscapularis perform?
Internal rotation
What group of injuries involves pain over anterior and lateral aspects of shoulder with radiation to deltoid?
Rotator Cuff Injuries
What are Drop Arm and Empty Can testing for?
Weakness
What are Neer’s Impingement and Hawkins testing for?
Pain
Which RC injury involves chronic degeneration with age?
Tendinosis
Which RC injury involves gradual onset of inflammation with repetitive, everyday activities?
Tendonitis
Which RC injury involves degeneration, impingement, overload? How does this initially present, and how does it progress?
Chronic RC Tear
- Partial tear of Supraspinatus initially → Progresses to complete tear with SITS + Biceps tendon
Which RC injury involves acute shoulder pain with neg. radiographs; often due to FOOSH?
Acute RC Tear
What condition has gradual onset of deep achy pain with subacromial point tenderness?
Tendonitis/Impingement
What two tests will be positive when testing for Tendonitis/Impingement on physical exam?
+ Neer’s and Hawkins’s
- PAIN
What is the recommended treatment for Tendonitis/Impingement?
Analgesics
- Pain WILL improve
What condition involves accumulation of impingement + degeneration; with risk factor being male and over age 40?
Chronic RC Tear
What condition has pain that progresses with eventual associated weakness that does NOT relate to the pain?
Chronic RC Tear
What two tests will be positive when testing for Chronic RC Tear on physical exam?
+ Drop Arm, Empty Can
- WEAKNESS
What treatment will not work for a Chronic RC Tear?
Analgesics will have NO affect
What are the three conditions that differentiate between tendinopathy and an RC tear?
TEAR IF…
- Lidocaine injection test: inject lido, but weakness persists on Neer’s test with pain removal
- Elevation of humeral head over 1 cm on x-ray
- MRI proves tear is present
What type of radiography can be used to test for labral pathology?
MRI arthrography for labral pathology
What are the three primary goals to treating an RC tear?
- Recover lost strength
- Improve function (remove pain)
- Treat concurrent tendonitis
Typically, supportive care is used to treat an RC tear but if symptoms persist, what two treatments can be considered?
- Steroid injections (3-4 per year)
- Surgery (arthroscopic repair, joint arthroplasty (replacement))
What condition is very similar to RC tendonitis and involves subacromial point tenderness with normal ROM and strength?
Shoulder Impingement Syndrome
What three tests will be positive when testing for Shoulder Impingement Syndrome on physical exam?
+ Painful Arc (pain)
- Also, + Neer’s and Hawkins’s (pain)
What type of tests will often be negative with Shoulder Impingement Syndrome?
All radiology is often normal
- Can consider an MRI to rule out RC tear
What is the recommended treatment for Shoulder Impingement Syndrome?
PT referral
What condition involves shoulder pain acutely and clicking/catching chronically?
Labral Tear
What is a Bankart lesion, and what condition is it associated with? Is it acute or chronic?
Bankart lesion: acute inferior tear of rim associated with shoulder dislocation – acute
- Associated with Labral Tear
What is a SLAP tear, and what condition is it associated with? Is it acute or chronic?
SLAP tear: Superior Labral Anterior Posterior (anterior to posterior tear) – chronic
- Associated with Labral Tear
What is the MOI for a Labral Tear (think acute AND chronic)?
- Acute (FOOSH, sudden pull)
- Chronic (repetitive overuse like throwing athletes, laborer)
What three tests will be positive when testing for a Labral Tear on physical exam?
+ Anterior Glide Test, Speed’s Test and O’Brien’s Test
What type of radiography is recommended for a Labral Tear? What is another type of diagnostic test that can be definitive?
- MRA
- Arthroscopy is also definitive diagnosis
What condition involves shoulder stiffness with limited ROM unilaterally?
Adhesive Capsulitis (Frozen Shoulder)
What is a potential risk factor that providers should consider when using slings?
Extended sling use can lead to Adhesive Capsulitis (Frozen Shoulder)
What condition involves reduced ROM in 2+ planes passive AND active (due to mechanical restriction, not pain)?
Adhesive Capsulitis (Frozen Shoulder)
What test will be positive when testing for Adhesive Capsulitis (Frozen Shoulder) on physical exam?
+ Apley Scratch Test with comparison
What is the recommended treatment for Adhesive Capsulitis (Frozen Shoulder)?
PT referral
- Will NOT improve without treatment
What condition has AC joint tenderness worse with downward traction?
Acromioclavicular (AC) Injury
What are the three grades of shoulder sprain? Describe each, and describe what imaging might show.
- Sprain (Grade 1): stretch, but no ligament separation = normal imaging
- Sprain with partial separation (Grade 2): AC ligament torn but coracoclavicular ligaments intact; slight offset seen on imaging
- Sprain with complete separation (Grade 3): AC ligament torn AND coracoclavicular ligaments torn; dramatic offset seen on imaging
What is the MOI for an Acromioclavicular (AC) Injury?
Fall onto tip of shoulder with arm tucked to side
What test will be positive when testing for Acromioclavicular (AC) Injury on physical exam?
+ Cross-Over Test
What is the recommended treatment for Acromioclavicular (AC) Injury?
Immobilization for 3-4 weeks, also supportive care
- Surgery if grade 3+
What type of Clavicle Fracture is most common? What is second most common?
Middle 1/3
- Then distal 1/3 then proximal 1/3
What type of Clavicle Fracture is most dangerous and why?
Proximal 1/3 because of possible involvement of internal organs
What condition shows patient apprehension and guarding, may see tenting of skin on physical exam?
Clavicle Fracture
If a Clavicle Fracture is middle 1/3 and non-displaced, what is the recommended treatment?
Supportive (muscle relaxants) and Sling/Swathe vs. Figure 8 Harness
If a Clavicle Fracture is distal or proximal 1/3 and/or displaced, what is the recommended treatment?
Surgery (ortho referral)
What condition is often associated with RC tendonitis or impingement syndrome?
Subacromial Bursitis
What condition may be caused by systemic disease like RA, gout, sepsis?
Subacromial Bursitis
What condition involves point tenderness over bicipital groove?
Biceps Tendonitis
What is the common cause for Biceps Tendonitis?
Due to repetitive lifting
What two tests will be positive for Biceps Tendonitis on physical exam? Which one tests for the “popping” noise?
+ Yergason’s Test (for “popping” noise), also Speed’s Test
What condition is associated with “Popeye Deformity”?
Biceps tendon rupture
What are the two primary goals when treating Biceps Tendonitis?
- Prevent recurrence
- Prevent rupture
When is surgery indicated for Biceps Tendonitis?
Young and/or laborer/athlete
What condition includes “golfer’s elbow” and “tennis elbow”? At what location does each occur on the elbow?
Elbow Epicondylitis
- Medial = golfer’s elbow
- Lateral = tennis elbow
What two muscle groups (actions) should be tested with Medial Epicondylitis (golfer’s elbow)?
- Wrist flexors
- Pronators
What two muscle groups (actions) should be tested with Lateral Epicondylitis (tennis elbow)?
- Wrist extensors
- Supinators
What is the treatment for ACUTE Elbow Epicondylitis (4)?
- Sling
- Wrist brace
- Ice
- NSAIDs
What is the treatment for PREVENTATIVE Elbow Epicondylitis (3)?
- Forearm strap
- Correct technique
- Minimize aggravating activities
What is the treatment for RECURRENT Elbow Epicondylitis (2)?
- Steroid injections
- Surgery
What is the primary recommended treatment for Olecranon Bursitis?
Aspiration
- Can be clinical and diagnostic
What condition involves ulnar n. compression?
Cubital Tunnel Syndrome
What condition involves ulnar n. neuropathy; decreased grip strength? How does ulnar n. neuropathy present (distribution)?
Cubital Tunnel Syndrome
- Ulnar n. distribution: 4th, 5th digits
What is the recommended diagnostic test for Cubital Tunnel Syndrome?
EMG/NCS
What condition can be caused by a congenitally smaller tunnel or occupational problem?
Carpal Tunnel Syndrome
What condition involves median n. compression?
Carpal Tunnel Syndrome
What condition involves median n. neuropathy; decreased grip strength? How does median n. neuropathy present (distribution)?
Carpal Tunnel Syndrome
- Median n. distribution: 1st, 2nd, 3rd, 1/2 4th digits
What condition involves symptoms worse at night → sleep disturbances; initially presents as dull ache that progresses to burning pain/paresthesias?
Carpal Tunnel Syndrome
What two tests will be position on physical exam with Carpal Tunnel Syndrome? What other finding will be seen with this condition?
- Tinel’s
- Phalen’s
Also, decreased grip strength
What is the recommended diagnostic test for Carpal Tunnel Syndrome?
EMG/NCS
If Carpal Tunnel Syndrome presents acutely, what is the recommended treatment?
Surgery (carpal tunnel release)
What condition involves collection of synovial fluid within wrist joint or tendon sheath?
Ganglion Cyst
What condition involves a soft mobile mass that fluctuates in size, often with activity?
Ganglion Cyst
What condition involves inflammation of 1st dorsal compartment?
De Quervain’s Tenosynovitis
What condition involves pain, swelling along dorsal radial wrist; pain worse with gripping?
De Quervain’s Tenosynovitis
What test will be positive with De Quervain’s Tenosynovitis on physical exam?
Finkelstein’s
What condition is classically seen in males, northern European descent, >40-50 years? What are three other possible associated risk factors?
Dupuytren’s Contracture
- EtOH use
- Tobacco use
- DM
What condition involves nodules → irreversible contractures?
Dupuytren’s Contracture
What condition is often painless because due to gradual, NON-retractable fibrosis?
Dupuytren’s Contracture
What test will be positive with Dupuytren’s Contracture on physical exam?
Hueston Table Top test
What condition involves nodules → catching/locking sensation?
Trigger Thumb/Finger (Stenosing Flexor Tenosynovitis)
What condition is progressively painful because due to inflammation of A1 pulley?
Trigger Thumb/Finger (Stenosing Flexor Tenosynovitis)
What four factors are considered concerning for bone tumor or lesions?
- Indistinct margins
- Abnormal periosteal reaction (formation of new bone in response to injury/other stimuli)
- Soft tissue mass/invasion
- Rapid growth
Generally, what is the recommended treatment for a benign bone tumor/lesion if it is NOT aggressive?
Observe with serial scans
Generally, what is the recommended treatment for a benign bone tumor/lesion if it IS aggressive?
Ortho/neurosurgery referral
+/- surgery
What bone lesion/tumor condition is also called a “simple bone cyst” and is fluid-filled?
Unicameral Bone Cyst (UBC)
What bone lesion/tumor condition is NOT aggressive and often seen in long bones of younger patients?
Unicameral Bone Cyst (UBC)
What bone tumor/lesion condition can improve spontaneously by adulthood?
Unicameral Bone Cyst (UBC)
What bone lesion/tumor condition involves blood-filled cyst that is AGGRESSIVE/rapid growth? Where two locations of the body are these often seen?
Aneurysmal Bone Cyst (ABC)
- Spine and extremities
What bone lesion/tumor condition involves MES, and what does this stand for?
Non-Ossifying Fibroma (NOF)
- MES: metaphyseal, eccentric, sclerotic borders
What bone lesion/tumor condition is AGGRESSIVE; involves metaphyseal/epiphyseal?
Giant Cell Tumor (GCT)
What two symptoms are associated with Giant Cell Tumor (GCT)?
Localized pain and possible weakness
Which type of benign bone lesion/tumor condition has a high recurrence rate?
Giant Cell Tumor (GCT)
What bone lesion/tumor condition involves severe night pain; NSAIDs relieve pain?
Osteoid Osteoma
What bone lesion/tumor condition contains nidus center of growing cells that release prostaglandins, surrounded by thickened bone?
Osteoid Osteoma
What is the most common benign bone tumor?
Osteochondroma (Exostosis)
What bone lesion/tumor condition involves a fixed, non-mobile mass that can be painful with activity?
Osteochondroma (Exostosis)
What is ALWAYS the recommended treatment for a malignant bone lesion/tumor?
REFER TO ORTHO OR NEUROSURGERY
What is the most common bone tumor in children?
Osteosarcoma
Which two primary bone lesion/tumor conditions can be symptomatic OR present with pain/swelling?
- Osteosarcoma
- Ewing’s Sarcoma
What is a primary bone tumor of cartilage-producing cells (epiphysis); occurs in hips, shoulder, pelvis?
Chondrosarcoma
What is the most common primary bone tumor? What part of the bone is associated with this condition?
Multiple Myeloma
- Malignant bone marrow
What condition involves entire skeleton; can be associated with radiation, pesticide exposure, HIV/immunocompromised?
Multiple Myeloma
What does Multiple Myeloma appear like on imaging?
Punched out appearance (lytic lesions)
What type of proteins will be seen on UA for Multiple Myeloma?
Bence-Jones proteins
What five primary cancers are most associated with Metastatic Bone Cancer?
Lead Kettle aka PB-KTL
- Prostate
- Breast
- Kidney
- Thyroid
- Lung
What finding is always seen on imaging with Metastatic Bone Cancer?
Pathologic fracture
What three primary cancers present with osteolytic bone destruction on imaging for Metastatic Bone Cancer?
KTL
- Kidney CA
- Thyroid CA
- Lung CA
Which primary cancer presents with osteoblastic formation on imaging for Metastatic Bone Cancer?
Prostate CA
Which primary cancer presents with mixed (osteolytic bone destruction and osteoblastic formation) on imaging for Metastatic Bone Cancer?
Breast CA
Which two benign bone lesion/tumor conditions are aggressive?
- Aneurysmal Bone Cyst (ABC)
- Giant Cell Tumor (GCT)
Which two benign bone lesion/tumor conditions have metaphyseal involvement?
- Non-Ossifying Fibroma (NOF)
- Giant Cell Tumor (GCT)
What three risk factors are often associated with back pain?
- Pregnancy
- Poor core strength
- Obesity
What are the two most significant indication for lumbar spine imaging? What are six other important reasons?
This card sucks lol
Pain at night or pain at rest
- Fall from height >3 meters,
- Fall in age >60 years/frail
- MVA ejection
- Trauma
- Neuro deficit
- History of cancer with back pain
Why would you order a CT to evaluate the spine? Why would you order an MRI to evaluate the spine?
- CT: bony (fracture)
- MRI: soft tissue structures, nerve compression
What does an EMG test for?
muscle
What does a NCS test for?
nerve
Where are Upper Motor Neurons located? Are they more associated with myelopathy or radiculopathy?
Brainstem
- Myelopathy
Where are Lower Motor Neurons located? Are they more associated with myelopathy or radiculopathy?
Spinal cord
- Radiculopathy
What is the primary cause for myelopathy? What part of the nervous system is affected?
Caused by spinal stenosis
- Affects spinal cord
What is the primary cause for radiculopathy? What part of the nervous system is affected?
Caused by neuroforaminal narrowing
- Affects nerve roots
Is myelopathy or radiculopathy more associated with weakness/loss of sensation, increased muscle tone (spasticity), hyperreflexia, Babinski sign, clonus, Lhermitte’s sign?
Myelopathy
Is myelopathy or radiculopathy more associated with hypotonia, hyporeflexia, weakness/loss of sensation, muscle atrophy, fasciculations?
Radiculopathy
Differentiate between strain and sprain (think associated tissue).
- Strain = ligaments
- Sprain = muscles, tendons
What type of spinal condition is associated with whiplash?
Cervical Strain/Sprain
What condition involves neck pain at any point skull base to cervical/thoracic junction; pain worse with motion; +/- spasms, normal neuro exam?
Cervical Strain/Sprain
What spinal condition involves the NEXUS criteria? What is this criteria?
Cervical Strain/Sprain
NEXUS Criteria (ALL must be met; if all 5 are present, imaging is not necessary before exam)
- Absence of posterior midline tenderness
- Normal level of alertness
- No evidence of intoxication/substance use
- No abnormal neurologic findings
- No other painful distracting injuries
Under what three conditions is NEXUS criteria NOT considered (aka imaging is done first always)?
- Direct blow to neck
- Trauma
- Adults >60 years
What spinal condition typically resolves in 4-6 weeks spontaneously, and does NOT recommend manipulation as treatment?
Cervical Strain/Sprain
What condition involves axial back pain +/- buttock radiation; spasms with TTP in low back or SI; limited low back flexion; neuro exam normal?
Lumbar Strain/Sprain
For what condition is bedrest NOT recommended?
Lumbar Sprain/Strain
What are Waddell’s signs (4)? What do they pertain to?
Used to identify secondary gain motivation
- Simulation sign
- Distraction sign
- Reported regional sensory/motor disturbance (no dermatomal pattern)
- Overreaction
What condition involves “spinal arthritis” with osteophytes?
Spondylosis
What condition involves decreased cervical spine ROM; occipital headaches; chronic neck pain +/- muscle spasms?
Cervical Spondylosis
What test will be positive on physical exam with Cervical Spondylosis?
Spurling test
What condition involves LBP radiating to one/both buttocks; pain relieved with lying downs, with often axial back pain; normal motor/sensory/DTRs; +/- decreased ROM?
Lumbar Spondylosis
What spinal condition involves anterior displacement of vertebra often due to uni/bilateral fracture of pars interarticularis?
Spondylolisthesis
What condition involves neck pain that radiates to shoulders, pain with ROM; occipital headaches
Cervical Spondylolisthesis
What lumbar spinal condition often involves often L3-4 or L4-5?
Lumbar Spondylolisthesis
What spinal condition involves flat back; +/- step-off deformity on physical exam?
Spondylolisthesis
What spinal condition involves unilateral or bilateral fracture of pars interarticularis (“scotty dog fracture”)?
Spondylolysis
Differentiate between spondylolysis and spondylolisthesis.
Spondylolysis: fracture at pars interarticularis (“scotty dog fracture”)
Spondylolisthesis: anterior displacement of vertebra often due to uni/bilateral fracture of pars interarticularis
What condition involves unilateral radicular pain/paresthesias that follow dermatome; weakness; reduced grip strength?
Cervical Radiculopathy
At what spinal level is Cervical Radiculopathy most common?
C6-7
What is considered an aggravating factor for radiculopathy?
Activity
At what two spinal levels are Lumbar Radiculopathy most common?
- L4-L5
- L5-S1
What levels of the lumbar spine have a dermatomal distribution of anterior thigh pain?
L1-4
What levels of the lumbar spine have a dermatomal distribution of pain can radiate down leg into foot?
L4 and below
What level of the cervical spine has a dermatomal distribution of lateral arm, thumb?
C6
What level of the cervical spine has a dermatomal distribution of 2nd and 3rd fingers?
C7
What level of the cervical spine has a dermatomal distribution of 4th and 5th fingers?
C8
What is the first line imaging recommended for radiculopathy?
MRI
What two tests will be positive on physical exam if L1-4 radiculopathy is present?
+ SLR
+ reverse SLR
What is the recommended treatment for radiculopathy if radicular symptoms but no progressive neuro deficits?
Supportive (NSAIDs, steroids, PT)
What is the recommended treatment for radiculopathy if no improvement/worsening radicular symptoms OR concerns for myelopathy?
Surgery
What is the recommended treatment for radiculopathy if radicular symptoms, severe pain OR worsening neuro deficits
Epidural injections
What is the most common cause of acquired Spinal Stenosis?
Spondylosis
What is the most common cause of myelopathy in elderly?
Cervical Spinal Stenosis
What is the most common cause of neurogenic leg pain in elderly?
Lumbar Spinal Stenosis
What condition involves progressive bilateral leg pain worse with standing and/or walking (neurogenic claudication)
Lumbar Spinal Stenosis
Can radicular pain present without back pain?
YES IT CAN
With what condition might you expect to see diminished DTRs, wide-based gait on physical exam?
Lumbar Spinal Stenosis
How can you differentiate neurogenic claudication from vascular leg pain?
Neurogenic: relieved with walking flexed with cart (“shopping cart sign”), NOT relieved with standing erect, relieved within minutes of sitting/lying down
Vascular: NOT relieved with “shopping cart sign”, relieved with standing erect, relieved IMMEDIATELY with sitting/lying down
What is the recommended diagnostic testing for both Cervical and Lumbar Spinal Stenosis (2)?
MRI with EMG/NCS
What specific treatment is recommended for the elderly with Lumbar Spinal Stenosis?
Water exercise
What condition involves perineal sensory loss at S2-4 (“saddle anesthesia”); bladder or bowel incontinence?
Cauda Equina Syndrome
What spinal condition did we learn about that is an EMERGENCY (@Hannah)?
Cauda Equina Syndrome
What is the recommended empirical treatment for Cauda Equina Syndrome?
Dexamethasone 10 mg IV
What is the recommended diagnostic testing for Cauda Equina Syndrome?
Emergent MRI with contrast or CT myelogram
What four conditions are considered red flags for back pain MALIGNANCY?
- Unexplained weight loss
- Failure of pain to improve with treatment; chronic
- Pain at night +/- sleep disturbances
- History of cancer
What five conditions are considered red flags for back pain INFECTION?
- Pain at rest
- Spinal pain with fever
- Immunocompromised
- IV drug user
- Recent history of infection (UTI, pneumonia, cellulitis
What condition involves pain that can be associated with chest pain (dermatomal “band-like” pain)?
Thoracic Spine Pain
What condition involves compression of upper extremity neurovascular bundle above first rib/behind clavicle?
Thoracic Outlet Syndrome
What are the three types of Thoracic Outlet Syndrome? Which is most common?
- Neurogenic (nTOS)
- Arterial (aTOS)
- Venous (vTOS)
What is the most common cause for Neurogenic (nTOS) Thoracic Outlet Syndrome?
Brachial plexus compression in scalene triangle
What is the most common cause for Arterial (aTOS) Thoracic Outlet Syndrome?
Subclavian artery compression due to cervical rib anomaly
What is the hallmark symptom/sign associated with Venous (vTOS) Thoracic Outlet Syndrome?
Swelling of extremity
Which type of Thoracic Outlet Syndrome involves thromboembolism in hand/arm with ischemia causing pain/paresthesias, pallor?
Arterial (aTOS)
Which type of Thoracic Outlet Syndrome involves progressive unilateral hand/arm/shoulder with weakness and paresthesias (reproducible/may not be in a specific distribution)?
Neurogenic (nTOS)
What two diagnostic tests are recommended for Neurogenic (nTOS) Thoracic Outlet Syndrome?
- Electrodiagnostic testing
- + brachial plexus block
What is the recommended diagnostic testing for both aTOS and vTOS?
US
For which type of Thoracic Outlet Syndrome is catheter directed thrombolysis recommended as treatment?
vTOS
For which type of Thoracic Outlet Syndrome is surgical embolectomy recommended as treatment?
aTOS
What is the recommended treatment for all types of Thoracic Outlet Syndrome if severe or failed treatment?
Decompressive surgery
