Musculoskeletal Flashcards
What is the most common joint disease in the US?
Osteoarthritis (OA)
Asymmetric joint pain with morning stiffness <1 hour then gets better but resumes after periods of activity. What is this?
OA
Clinical findings of OA
Asymmetric joint
cool
possible crepitus
Limited ROM
bony enlargements (herberdens/bouchards nodes)
Where do herberdens nodes occur?
DIP joint - joint closest to the nail
where do bouchards nodes develop?
PIP joint - 2nd knuckle from nail
Number 1 non pharm management for OA
WEIGHT LOSS
10% reduction can improve symptoms
Pharm management for OA
Short acting NSAIDs
-concomitant use of misoprostol (Cytotec) to prevent gastric ulcer
or
Cox-2 inhibitor for GI protection
(Celebrex)
or topical NSAIDs
what is the most common immune mediated inflammatory arthritis
Rheumatoid Arthritis
what type of arthritis is inflammatory with bone loss, worn cartilage and thickened synovial membranes.
RA
Tx for RA
goal: reduce rate of bone loss & improve QOL
Analgesics/NSAIDs
glucocorticoids - short term
Nonbiologic DMARDS (methotrexate)
biologics “mab’s” (rituximab)
What occurs in gout?
Deposition of monosodium urate crystal in joint and causes joint inflammation and pain
assessment findings for gout
acute joint pain
swelling
warmth
erythema
usually single joint- often big toe
what can develop in advanced gout
tophi and MSU depositis in subcutaneous tissues of antihelix of ears and extensor aspects of elbow occur
tophi can involve eyes - conjunctival nodues, blurred vision
fever
kidney stones
Can you diagnosis gout with a serum uric acid level?
eh. Normal levels are common during acute attack. should diagnosis with clinical presentation in conjunction with diagnostic studies
gold standard for Gout diagnosis
synovial fluid aspiration - not typically performed but gold standard
presence of monosodium urate crystals is diagnostic
what medication do we use for acute gout attacks
Colchinice - best within 36 hours of flare onset
Steroids
NSAIDs
what are the 3 main urate lowering agents we give to prevent gout flare ups?
Allopurinol
Febuxostat
Probenecid
what do you need to monitor when patients are on urate lowering drugs such as allopurinol
when do we monitor?
CBC (bone marrow suppression)
Renal fx
Liver fx
Draw labs: 1 week, 6 weeks, Q3 months while on allopurinol
what is plantar fasciitis?
painful, inflammatory/degenerative injury of the planter surface - bottom - part of your foot fascia
what muscle allows for abduction of arm?
Supraspinatus
what synovial joint has the greatest ROM?
Shoulder
What is tinels sign?
test for carpal tunnel
tap on median nerve, if symptoms occur = positive
what is phalens sign
push hands together for 60 seconds, occluding medial nerve
symptoms = positive
what is the nerve distribution for the medial nerve?
palmer thumb + 2.5 fingers
dorsal = tip of same fingers to first joint from nail
what is the nerve distribution of the ulnar nerve in the hand.
palmer/dorsal coverage of pinky + .5 of ring finger
what is the nerve distribution for radial nerve in hand
dorsal part of hand for thumb, index, middle, and half of ring finger up to the 1st joint (PIP joint)
what does McMurrary test look for?
Meniscal injury/ Joint line pain
what happens in cauda equina syndrome?
loss of sensation/ function of legs with loss of bowel d/t cord compression
EMERGENCY –> lead to permanent paralysis
how do you grade DTRs
DTR responses are graded as follows
0= no response
\+1 = 1 diminished response
\+2+ = Normal response
\+3 = Increased response
\+4 = Hyperactive response
