MSK1-Table 1 Flashcards
what are some important observations in msk?
gait, carrying angle, pain, function, atrophy, asymmetry, deformity, footwear, color.
why is medication important? Esp steroids?
osteoporosis
what about sexual hx?
gonorrhea reactive arthritis
if your patient has a score of 3 on motor examination they can…?
active full ROM against gravity (no resistance)
what is HLA-B27 antigen used for?
spondylomyopathy
are x-rays useful in OA or RA?
OA in early dg and dz progression
what should you order if you suspect spondyloarthropathy?
sacroiliac films!
most common cause of neck pain?
mechanical!
where does trapiezus pain refer to?
temporal lobe, jaw, mastoid,
SCM pain may refer where and cause what automonic dysfunction?
above the eye, back of head, top of head. Auditory, corryza, lactorrhea, lactimation.
scalene pain moves where?
shoulder, upper arm, chest
when is the soonest time you can do an EMG/NCV nerve conduction study after neck injury?
1 month post onset
where are your C5, C6, C7, C8, T1, T2 dermatomes???
C5 shoulder, 6-top forearm/thumb/1st digit. 7- middle digit/hand, 8-4th and 5th digits/wrist, T1- forearm to elbow, T2-upper arm
what view is needed on x-ray to see C-7?
swimmer’s view
what kind of curve should be seen on cervical x-ray?
lordotic
when do you order an MRI for degenerative disc disease?
neuro compromise is apparent
what are the main tx options for neck pain?
PT, NSAIDs, muscle relaxants, trigger point (trapezius)
pt has chronic arm and shoulder pain with unknown cause, and weakness/wasting of hand muscles, plus sensory disturbance of palmar 5th digit?
thoracic outlet syndrome (TOS)
Dg? Tx?
cervical x-ray and electrodiagnostics. EMG w/ slow conduction. Tx surgical resection of band.
what nerve roots are compressed in TOS
C8 or T1
where does sciatica occur?
buttock, posterior thigh, posterolateral leg including malleolus, dorsum and sole
where do discs bulge?
posterior lateral
what test do you use for low back pain w/radiation?
straight leg raise
u/l LBP and buttock pain worse with standing in one position?
SI joint. Do compression test! Dg/tx- injection
elderly pt with low back pain that increases with walking and is relieved by leaning forward?
spinal stenosis
what are red flag sx for low back pain?
Fever, Wt. loss, morning stiffness, hx. of IV drug/steroid abuse, trauma, hx. of CA, saddle anesthesia, bowel/bladder function loss, major motor weakness
when do you get an MRI in LBP?
cord, neural tumor, stenosis, disc infections
colitis pain may refer where?
low back!
where does the sciatic nerve refer pain to?
posterior calf.
what should you measure in a back pain w/u?
leg length!
what degrees are considered positive for sciatica in SLR?
30-70 degrees elict pain
what else should you check for in back pain w/u?
fever, breast mass, pleural effusion, prostate dz, skin abscess, lipoma.
elevated ESR may raise suspicion for?
malignancy or inflamm condition (polymyalgia)
post menopausal female w/ back pain should get what?
DXA w/ VFA view for compression fx
what are your leg dermatomes?
refer to slide 70. L5 heal, S1 outer leg/5th digit, S5- anus/inner thigh, L-4 knee, big toe. L5 and S1 important.
what is spondylolisthesis?
vertebra slips onto bone below it
how many signs do you need for Waddel’s? what does it test?
3 or more. Suggestive malingering. Tenderness, simulation, distraction, regional disturbances, overreaction.
what are red flags for emergency investigation of back pain?
loss of bowel or bladder, saddle anesthesia, loss sphincter tone, sensory level on neuro exam, B/L leg pain w/ B/L neuro deficit.
what should you encourage your mechanical chronic low back pn pt do to?
exercise, keep moving, lose wt.
medical mngmt of LBP?
NSAIDs: Ibuprofen 600mg TID . Flexeril 5-10mg TID. Tx depression.
how do you dg disc herniation?
MRI w/ focal and neuro sx.
what curvature is significant in scoliosis?
greater than 15 degrees. Commonly right thoracic T7 or T8.
what degree do you refer? When do you x-ray?
refer over 20. x-ray q3-4 mo in 15-20 degrees.
leg pain, numbness, saddle anesthesia and/or paralysis, with loss of bowel or bladder?
cauda equina. Sg emergency
what is the difference in perarticular vs articular disorder?
articular- limited ROM w/active and passive; swelling. Periarticular- pain with active ROM only, tender to adjacent structure, pain w/ specific movement.
what is bursistis associated with?
rotator cuff tendinitis
tx of bursitis?
NSAID, rest, occ steroid inj.
where is the most common location of tendinitis?
supraspinatus
dull aching, worse at night, interferes w/ sleep, severe w/ abduction and overhead reach, tender lateral humeral head?
supraspinatus tendinitis. Tx: NSAID, PT, steroid inj, surg decompression.
painful ROM esp resisted supination?
bicipital tendinitis.
inflammation at lateral epicondyle, possible weak hand extension, pt types a lot.
lateral epicondylitis- tennis elbow. Tx- counterforce tennis elbow brace.
Taut band, tender spot, referred pn, motor dysfunction and autonomic phenomena…
trigger point (MTrPs)
what are the 3 components in Motor Endplate Hypothesis?
- motor componenet (contraction knot). 2. sensory (allodynia and hyperalgesia). 3. autonomic (lacrimation, coryxa, salivation, dizzy)
MTrPs is the result of…
mechanical, chemical and neuro dyf in mscle and CNS. Chronicity-> recruit additional mscle and sensory regions resulting in hyperalgesia, allodynia and widespread stimulus.
tx?
get blood to it, diet, posture, vitamins.
Local or regional pain syndrome (usually aching and poorly localized) with spasm, tightness, referral along well established pattern, with possible autonomic symptoms and articular dysfunction.
myofascial pain
what is main dg for myofascial pain?
palpation! Tight band!
where should you NEVER inject on neck?
high and right= vertebral artery
what is the goal of dry needling or 0.5% lidocaine?
elicit LTR spinal reflex to contract fibers in taut band. Then vapocoolant spray, stretch and heat.
what is never indicated in myofascial pain?
opiods!
what are some important observations in msk?
gait, carrying angle, pain, function, atrophy, asymmetry, deformity, footwear, color.
why is medication important? Esp steroids?
osteoporosis
