Muscoskeletal injury Flashcards
What is fluoroscopy?
realt time evaluation; to guide procedures
cons are radiation exposure and image quality
What is the role of ultrasound?
cheap, guide procedures, evaluate tendons and ligmanets or cortical surfaces
no radiation, portable however user dependent and not all structures can be evaluated
What is the role of ct scans?
evaluate and characterize osseous problems;
fast and available
cons radiation, metal artifacts and cost
What is the role of MRI?
gold standard for evaluation of soft tissue and bones;
great resolution with no radiation
but expensive, long exams cause claustrophobia and metal causes artifacts
What is the role of nuclear medicine?
provide functional detail by injecitng radioactive material and imaging distribution
high sensitivity
but poor anatomic detail, radiation and expensive with low sensitivity
What are the red flags of muscoskeltal exam?
hot swollen, red exptremely painful with passive movement– r/o septic joint
night pain r/o tumor
deformity and loss of motioon r/o fracture /dislocation
rapidly progressing neurological changes –r/o compartment syndrome
significant changes in limb swelling, pain and bluish sking – r/o DVT
point bony pain – r/o open fractre
What do you have to r/o with a joint that is hot swollen, red, painful with passie movment?
septic joint
What do you have to rule out with night pain?
tumor
What do you have to rule out with deformity and loss of motion?
dilocationa dn fracure
What do you ahve to rule out with rapidly progressing neurolgcial changes of limb?
compartment syndrome
What do you have to r/o with point bony pain and bleeding?
open fracutre
What is pain only with active motion or resistance suspicious for?
muscle or tendon injury
What is pain with both active and passive motion suspicious for?
joint problems
What is weakness suspicious for?
muscle or tendon injury
What is instability suspicious for?
ligament injury
Waht is locking suspicious for?
loose body or cartilage injury
Difference between spraina nd strain?
sprain ligament
strain muscle
What does valgus stress test in elbow?
ulnar collateral ligament
What is Tinels sign?
tapping over the median nerve to try and elicit carpel tunnel syndrome
What is phalens sign?
holding wrists back to back in full flexion to elicit carpal tunnel
What is the presentation of AC sprain?
pain with overhead movement, deformity of superior shoulder
pain with cross aduction of arm
painful arc of abduction over 150 degrees
What is th presentation of rotator cuff injury?
positive impingement sign neers test positive empty can test positive hawkins test positive rotator cuff weakness painful arc abductions tender at insertions on greater tuberosity
What is the adhesive capsulitis presentation?
painful stiff shoulder
limited passive and active ROM especially noted in external rotation
What is the presentation of medial epicondylitis?
from overuse of wrist flexors
painful medial elbow with secondary weakness
tenderness over the medial epicondyle and pain with resisted flexion and forearm pronation
What is the presentation of lateral epicondylitis?
overuse from repetitive extension
Sxs pain over lateral elbow radiating into forearm; late weakness; pain with resisted wrist
What is the scaphoid fracture symptoms?
fall on outstretched hand
tenderness in anatomic snuffbox
What is the symptoms of wristt ganglion problems?
overproduction of fluid by a joint of tendon sheath; filled with thick gelatinous material
lump usually firm and mobile
pain caused by compression of nearby nerve or pinching
Unexplained weight loss is a red flag for what?
r/o malignancy
What is loss of bowel or bladder control red flag for what in spinal exam?
myelopathy or stenosis
What is signficant weakness is a red flag for what in spinal exam?
myelopathy or stenosis
What is saddle anesthesia a red flag for in spinal exam?
myelopathy or cauda equina syndrome
What is traum a red flag for in spinal exam?
fracture
What is chronic corticosteroid use a red flag for in spinal exam?
compression fracture
What is immunosuppression for a red flag for in spinal exam?
r/o infection
What are fever or IV drug use a red flag for in a spinal exam?
r/o infection
What is prior spinal surgery a red flag for in a spinal exam?
r/o hardware failure, adjacent segment disease, recurrent disc herniation
What is weakness and or numbness a clue for in spinal exam?
nerve involvement
What is morning stiffness a clue for in a spinal exam; improves with activity but not with rest, <40 yo?
suspicious for spondyloarthopathy
What is spondylolysis?
fracture of pars interarticularis
What is spondylolisthesis?
anterior displacement of one vertebrae on another
What is lumbar strain clinical exam?
azial low back pain after acute injury, muscle disruption from excessive stretch or tension
localized muscle tenderness reduced ROM
What is Cervical osteoarthiritis clinical exam?
axial low back pain, gradual onset worse with cervical extension
What is osteoarthiritis lumbar spine clinical exam?
worse standing/walking; better sitting/lying
What is the clinical exam for lumbar stenosis?
slowly progressive back and unilateral or bilateral leg pain (worse standing walking, better sitting) shopping cart sign
to differentiate from vascular claudication (must sit or bend to relieve symptoms)
What is the etiology of lumbar stenosis?
narrowing of the spinal canal due to disc herniation/protrusionn, ligamentum flavum thickening, osseous thickening of bone/facet joint, sponyloisthesis)
What is teh clinical presentation of cervical myelopathy?
pain numbness, weakness in arms and or legs. balance and gait diffciulties; bowel bladder dysfunction
arm and/or leg weakness, UMN signs
What is the compression fracture clinical presentation?
suddent thoracic or lumbar pain with little or no trama
tender over spinous process, worse with lumbar flexion and better with lumbar extension
What is the clinical presentation of ankylosing spondylitits?
onset of low back pain below age 40, insiduous, better with excercise, pain at night and
