MSK/rheumatologic Flashcards
What is polymyalgia rheumatica?
Polymyalgia rheumatica (PMR) is an inflammatory rheumatic condition characterized clinically by aching and morning stiffness in the shoulders, hip girdle, and neck. It can be associated with giant cell (temporal) arteritis (GCA), and the two disorders may represent different manifestations of a shared disease process. Usually responds well to steroids.
What treatment is best for a midshaft tibial stress fracture (e.g. from running)?
A pneumatic stirrup leg brace
What is the typical presentation and treatment of plantar faciitis?
Pain usually around medial calcaneal tuberosity. Pain is worse first thing in the morning or after sitting for long periods of time. No need for x-ray usually.
Treatment may not be needed as most cases resolve on their own. NSAIDs, icing, and over-the-counter shoe inserts may be beneficial. Expensive custom inserts should not be considered unless first line therapies fail.
What is the first-line treatment for Achilles tendinopathy?
Eccentric exercise should be the first-line treatment for chronic midsubstance Achilles tendinopathy.
What drugs are indicated for prevention of osteoporotic hip fractures?
Only zoledronic acid, risedronate, and alendronate have been confirmed in sufficiently powered studies to prevent hip fracture. Ibandronate, raloxifene, denosumab, and etidronate have been shown to reduce new vertebral fractures, but are not proven to prevent hip fracture.
What are the screening recommendations for osteoporosis in men and women?
All women ≥65 (SOR A) and all men ≥70 (SOR C) should be screened for osteoporosis. For men and women age 50–69, the presence of factors associated with low bone density would merit screening. Risk factors include low body weight, previous fracture, a family history of osteoporosis with fracture, a history of falls, physical inactivity, low vitamin D or calcium intake, and the use of certain medications or the presence of certain medical conditions.
What does pain and swelling posterior to the medial malleolus, that is worse with weight bearing and inversion of the foot, with pain elicited with plantar flexion against resistance in a woman over 40 who is unable to perform a single-leg heel raise suggest?
Tendinopathy of the posterior tibial tendon (patients often cannot recall an injury)
What is the treatment for tendinopathy of the posterior tibial tendon?
Immobilization in a cast boot for 2-3 weeks. An injury can, over time, elongate the midfoot and hindfoot ligaments, causing a painful flatfoot deformity.
What is the FADIR test and what does it test for?
Flexion, ADduction and internal rotation. Test for hip impingement.
What is the FABER test?
Flexion, ABduction, and external rotation. Used to differentiate between hip and lumbar pain - positive test suggests hip pain (e.g. OA).
How is the diagnosis of polymyalgia rheumatica made?
Bilateral hip or shoulder pain for at least a month, with an ESR of > or =40
What therapies have the best evidence for being effective in the treatment of chronic back pain?
Treatment options that have the best evidence for effectiveness include analgesics (acetaminophen, tramadol, NSAIDs), multidisciplinary rehabilitation, and acupuncture (all SOR A). Other treatments likely to be beneficial include herbal medications, tricyclics, antidepressants, exercise therapy, behavior therapy, massage, spinal therapy, opioids, and short-term muscle relaxants (all SOR B). There is conflicting data regarding the effectiveness of back school, low-level laser therapy, lumbar supports, viniyoga, antiepileptic medications, prolotherapy, short-wave diathermy, traction, transcutaneous electrical nerve stimulation, ultrasound, and epidural corticosteroid injections (all SOR C).
How soon should surgery for rotator cuff tears be done after the initial injury?
Within 6 weeks, before muscle atrophy occurs
What imaging study is best for assessing early osteomyelitis?
MRI
What is the best medical management for fibromyalgia?
An antidepressant such as amitriptyline or duloxetine. Tramadol may be used for pain management.
What are the Ottawa ankle and foot rules?
According to these guidelines, an ankle radiograph series is required only if there is pain in the malleolar zone and bone tenderness of either the distal 6 cm of the posterior edge or the tip of either the lateral malleolus or the medial malleolus. Inability to bear weight for four steps, both immediately after the injury and in the emergency department, is also an indication for ankle radiographs. Foot radiographs are required only if there is pain in the midfoot zone and bone tenderness at the base of the 5th metatarsal or the navicular, or if the patient is unable to bear weight both immediately after the injury and in the emergency department.
Patients with what rheumatologic condition have the highest risk for cancer?
In one study, 32% of patients with dermatomyositis had cancer. The risk of cancer was highest at the time of diagnosis, but remained high into the third year after diagnosis. The cancer types most commonly found were ovarian, pulmonary, pancreatic, gastric, and colorectal, as well as non-Hodgkin’s lymphoma. Among patients with polymyositis, 15% developed cancer.
