Muscoloskeletal Flashcards
Lab Studies
A. ESR, C-reactive protein - inflammation
- ESR: how much do the erythrocytes settle in an hour, 20 ??
- doesn’t tell us very much, just inflammation, however can be good for specific diseases
B. RF, ANA - autoimmune connective tissue disorders
- Rheumatoid Factor, Anti-nuclear antibodies
C. CK, AST - peripheral muscle disorders
- Creatine Kinase - muscle enzyme, always a little in blood stream — when muscles start to breakdown, they release a lot of CK into the bloodstream
- long term diagnosis of MI - when cardiac muscles die, they release a specific form of CK
Imaging
A. x-rays - always done first in evaluating musculoskeletal disorders
- dense bone on the outside, web in the inside
B. CT scans
- nice definition of tissues,
- exposure to significant amount of radiation
C. MRI
- Magnetic resonance imaging, picking up all tissues (magnetic), more information, less risk than CAT scan
D. ultrasound - soft tissue masses
- sound waves bouncing off tissues - diagnostic ultrasound, not therapeutic ultrasound
E. arthrography - joints
- dye injected into joint, take pictures (contrast media)
F. bone and marrow scans - bony disorders
- injected radioactivity, where is it being re-uptaken?
Other diagnostic
A. joint aspiration - pull out synovial fluid from joint, culture
1. synovial fluid evaluation
B. arthroscopy - putting a scope in, taking a look
C. thermography - taking temperature of the area, picture, often not found very useful
D. electromyography - electrical change associated with muscle contraction
- Is the muscle contracting normally? Can rule out muscle problem, mostly. Nerve?
E. nerve conduction velocity - conduction of impulse along a nerve - for differentiation of muscle disorders - see how long it takes from getting from point A to point B
F. muscle and bone biopsy
Emergencies
A. not many true emergencies in musculoskeletal system
1. acute bacterial arthritis
- Acute: USUALLY 2 weeks or less, joint inflammation with bacteria there
- How to differentiate?
- comes on quickly
- is there an abrasion, cut? — can come from exogenous factors, also can come from hematogenous factors
- common in elbow,
- erythemitus, edemitus (red and swelling is what you write down)
a. joint destruction if not promptly treated
b. acute joint pain and stiffness
c. warmth, tenderness, swelling
d. fever, chills, leukocytosis
e. with anti-inflammatory meds, no sxs or sns
f. joint aspiration with culture
g. antimicrobial therapy
B. urgent
1. fractures - not every fracture is an emergency
- sometimes even better to wait a day or two for edema to go down for imaging
a. compound fractures are an emergency - the bone has pierced the skin and sticking out
Bursitis
- definition
- location
A. acute or chronic inflammation of a bursa
B. locations - subacromial, olecranon, prepatellar, ischial, trochanteric, retrocalcaneal - about 52
Bursitis
- etiology
- trauma, overuse, inflammatory arthritis, infection - mostly unknown
Bursitis
- signs and symptoms
Acute:
- pain, localized tenderness, limited ROM
- possible swelling, erythema, warmth (esp if acute, chronic not so much)
Chronic:
- previous attacks, repeated trauma
- pain, swelling, tenderness
- thickened bursal wall, adhesions, calcium deposits - thickened wall with more fluid in it
Bursitis
- diagnosis
- clinical
- MRI
- R/O: tendinitis, muscle tears, synovitis, osteomyelitis, cellulitis
Tendinitis
- definition
A. inflammation of a tendon
B. tenosynovitis if tendon sheath involved
1. usually both
Tendinitis
- etiology
- repeated trauma, strain
Tendinitis
- signs and symptoms
- diagnosis
- tenderness
- pain, especially with active ROM
- clinical — (not much done around this)
Shoulder pain
- causes
- inflammatory conditions
- adhesive capsulitis - frozen shoulder, often comes from bursitis or tendinitis
- rotator cuff tears
a. 70% of people over 80
b. 30% of people under 70 - labral tears
- dislocation - Head of humerus out of glenoid fossa
- separation - AC joint
Shoulder pain
- etiology
- overuse, trauma, idiopathic
a. falling onto outstretched hand - “SLAP tear” very common
b. repetitive overhead use
c. lifting heavy objects
Shoulder Pain
- signs and symptoms
- pain
- limitation of movement
a. difficulty with daily activities, i.e. combing hair, brushing teeth, dressing - Drop Arm test for rotator cuff tears
a. supraspinatus most commonly torn -(Superior Labrum from Anterior to Posterior) - SLAP tears
a. Superior Labrum from Anterior to Posterior
b. deep shoulder pain
c. ‘catching’ sensation on abduction of arm
Shoulder pain
- diagnosis
- clinical
- drop arm test - patient abducts arms to 90 degrees, holds, then slowly brings arms down (immediate drop of the arm positive)
- empty can test
- “full cans test”
- Yergason’s - testing biceps - attachment of biceps at supraglenoid tubercle (at Supraspinatus attachment so not very reliable in isolating biceps) - MRI
a. contrast using gadolinium
b. especially for tears
