Musculoskeletal Flashcards
Joint Pain: Leading complaint for seeking health care
Duration may be? Location may be?
Acute vs chronic
Localized vs diffuse
Joint Pain: Leading complaint for seeking health care
May be associated with?
constitutional symptoms and systemic manifestations from other organ systems, injury, previous surgery or repetitive motion
Joint Pain: Leading complaint for seeking health care
Common complaint areas are?
Neck
Low back
MSK Overview:
Symptoms can be ___ vs ___ joints
single vs multiple
MSK Overview:
If there is injury, what do you ask?
What was the Mechanism of Injury
MSK Overview:
Additional questions?
Were there prior issues with specific areas?
Systemic symptoms?
Joint Pain
Ask the patient to?
joint pain may be?
One joint = ?
“point to the pain”
Articular or extra-articular
monoarticular
Joint Pain
Hands and feet tend to be more?
Multiple joints = ?
Pattern of involvement:?
localized than in larger joints
polyarticular, typically four or more
migrating, steadily spreading, symmetric, affecting similar joints on both sides of the body?
Joint Pain
Extraarticular means?
Myalgia means?
Arthralgia means?
joint pain w/ involvement of bones, muscles, and tissues around the joint (tendon, bursae, or even overlying skin)
Generalizes “aches and pains” if muscular in origin
joint pain is present, and no evidence of arthritis
Joint Pain
Decreased or limited movement - ask about?
any changes in activity related to the involved joint, especially ADLs
Joint Pain
Musculoskeletal stiffness is?
tightness or resistance to movement
Joint Pain
Acute joint pain lasts up to?
Chronic pain?
6 weeks
>12 weeks
Joint pain
Assess what of the joint symptom?
site
onset
duration
quality
severity
Joint Pain
Check for sings of inflammation?
swelling
warmth
redness
Joint Pain
Patterns of stiffness questions
worse in Am?
better with activity?
worse with activity?
Joint Pain
Localized or diffuse:
Which joints are painful?
Monoarticular vs Oligoarticular vs Poly articular?
Axial?
Joint Pain
Pain in more than one joint, is it?
Symmetric vs asymmetric
What is axial joint pain?
Spine is primarily affected
Joint Pain
If patient is < 60 y/o consider what?
repetitive strain or overuse syndromes (tendinitis or bursitis)
Crystalline arthritis (gout)
RA
Psoriatic arthritis
Infectious arthritis from gonorrhea, Lyme disease or viral or bacterial infections
Joint Pain
What type of arthritis is considered for patients < 60 with IBD?
Reactive (Reiter)
Joint Pain
If patient is >60 y/o consider what?
OA
gout
pseudo gout
polymyalgia rheumatica
osteoporotic fracture
septic bacterial arthritis
Four Cardinal Features of Inflammation
Swelling
Warmth
Redness
Pain
Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems:
Skin Conditions: Butterfly (malar) rash on the cheeks is a sign of?
SLE
Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems:
Papules, pustules or vesicles with reddened bases on the distal extremities are a sign of?
Gonococcal arthritis
Associated Constitutional Symptoms/Systemic Manifestations from Other Organ Systems:
Expanding erythematous “target” or “bulls eye” patch early in an illness is a sign of?
Lyme’s disease
Neck Pain
Rarity?
Always ask if what was a precursor?
Ask about radiation into the?
is the arm feeling what?
Common
trauma
arm, scapular area
weakness, numbness, or parasthesia
Neck Pain
Nexus Criteria:
Normal alertness
no posterior midline cervical spine tenderness
no focal neurologic deficits
no evidence of intoxication
no painful distracting injury
Low Back Pain
Three groups
Nonspecific accounts for ___% of cases
Nerve root entrapment with radiculopathy or spinal stenosis ____%
Pain from a specific underlying disease ___%
90
5
1-2
Low Back Pain
Ask what about the location?
Is the pain on the midline, over the vertebrae, or off the midline?
Low Back Pain
If there is radiation into the buttock or lower extremity ask about?
is there associated numbness or parasthesia?
Low Back Pain
If there is any associated bladder or bowel dysfunction, what does this indicate?
What should you immediately do?
Cauda equina
pursue immediate imaging and surgical evaluation
Red Flags for Lower Back Pain from underlying systemic disease
Age <20 years to >50 years
Hx of CA
Unexplained weight loss, fever, or decline in general health
Pain lasting more than 1 month and not responding to treatment
Red Flags for Lower Back Pain from underlying systemic disease
Part 2
Pain at night or present at rest
Hx of IV drug use, addiction, or immunosuppression
Presence of active infection or HIV infection
Long-term steroid use
Saddle anesthesia, bladder or bowel incontinence
Neurologic symptoms or progressive neurologic deficit
Health Promotion
Nutrition?
Healthy weight does what for joints?
Calcium intake
reduced mechanical stress on weight-bearing joints (hips and knees)
Health Promotion
Physical Activity helps with?
Improved sleep quality
cognitive function
risk reduction of early death
CV disease
HTN
DMT2
Breast and Colon CA
Obesity
Osteoporosis
falls
depression
When should women be screened for osteoporosis?
age >/= 65 years w/o previous known fxs or secondary causes of osteoporosis
age </=65 years whose 10 year fx risk is >/= a 65 y/o white woman w/o additional risk factors
How much Calcium should men and women 19-50 yrs old intake?
Vitamin D?
1000mg/d
600 IU/d
How much Calcium should women 51-70 yrs old intake?
Vitamin D?
1200mg/d
600 IU/d
How much Calcium should men 51-70yrs old intake?
Vitamin D?
1000mg/d
600 IU/d