Musculoskeletal Flashcards
How often does lower back pain resolve?
90% in 6-12 weeks
DD for lower back pain?
Lumbar strain, disc buldge, Degenerative disc disease, spinal stenosis, spondyloarthropathy, spondylosis, sacroiliac dysfunction
What do you do to test for spondylosis?
HLA-B27
When do you do radiographic tests?
Hx trauma, 55 years with persistent pain, noted spinal deformity, S&S of spondyloarthropathy, suspicion for tumor or infection, failure of conservative treatment after 6 weeks.
When is lower back pain an emergency?
Cauda Equina syndrome
Treatment for lower back pain?
NSAIDs, steroids, non-narcotics, muscle relaxers, narcotics rarely indicated, Physcial terapy, surgery
What is herniated disc?
Nucleus pulpus is forced through a weakened part of the disc;
Symptoms of herniated disc
Low back pain with associated leg symptoms
How successful is conservative treatment with herniated disc?
90% symptom management with non operative management
What is a tendon?
Attach muscle to bone
Common sites of tendonitis?
Rotator cuff, insertion of wrist extensors and flexors at elbow, tibial tenon at leg, patellar and poplital, illiotibial, achilles tendons
Symptoms of Tendonitis?
Pain under pressure, restricted movement, burning sensation, swollen, red, warm
Treatment of tendonitis?
Radiology is rarely indicated, PRICE, brace area, anti-inflammatory agents
Treatment for DeQuervian’s Tendonitis?
Base of thumb, occurs over snuff box, point for 3-6 weeks, NSAIDS for two weeks
What is bursitis?
Painful inflammation of bursa
Risk factors for bursitis?
Over use, not stretching, rheumatoid disease, staphylococcal or other bacterial infections
Symptoms of bursitis
Pain that increases with movement of joint, joint tenderness, with swelling and redness in affected area
Treatment of bursitis?
Anti-inflammatory drugs, injection of corticosteroids, may need surgical intervention
Three types of femoral neck fractures?
Femoral neck (high risk for avascular necrosis), intertrochanteric, and subtrocanteric
Diagnosis and S&S of hip fracture?
Pain, inability to bear weight, shortened leg, externally rotated, tenderness over groin, hip motion painful, XR of hip. If negative, do MRI
What is carpel tunnel syndrome?
repetitive stress injury due to inflammation of the tissues around the median nerve
S&S of Carpal tunnel?
Pain in wrist and hand, nubness, pain that wakes you up at night, all but pinky and side of ring fever
DD of carpel tunnel syndrome?
Arthritis, cervical radiculopahty, (C6 thumb and index finger only), DM with neuropathy, cubism, wrist arthritis
Exam for carpel tunnel?
Tunnel’s sign, phalen’s sign, hypothenar atrophy
Diagnostic test for carpel tunnel?
Electromyography, XR to r/o fractured bones
Conservative tx for carpel tunnel?
RICE, NSAIDs, srugery, B6, acupuncture, electromagnetic fields
When do you refer for carpel tunnel?
Thenar atrophy or failure of conventional treatment
What is plantar fasciitis?
Inflammation of plantar fascial tissue, adjacent to its insertion into heel.
Etiology of plantar fasciitis?
strucutral abnormlaitis, flat foot, high arch, runners
Symptoms of plantar fasciitis?
Foot pain with worst pain in morning, sharp, dull,
Treatment for Plantar Fasciitis?
NSAIDs, night splints, ice the sore area, supporting splints, weight loss
Lumbar stenosis pathology
Narrowing of the canal with compression of the nerve roots
Symptoms of lumbar stenosis?
Pseudoclaudication causing radiuclar complaints, unlike claudication, does not get better with rest. May bend over to reduce pain, may have atrophy, incontenence
Treatment of lumbar stenosis?
PT, NSAIDS, injections, refer to neurosurgery for bad pain
What about Paget’s disease?
Second most common disease after osteoarthritis, leading to weaker bones
When does pain occur with paget’s disease?
Occurs at night
Test for Paget’s disease?
Radionucleotide test
Differential diagnosis for Paget’s disease?
Cancer/ metastasis
Treatment for Paget’s disease?
Biphosphinates, calcitonin for patients that can’t handle biphosphanates
Path of multiple sclerosis?
Demyelinating disease of CNS and usually begins in young adulthood and frequently associated with vision changes, weakness, numbness, loss of balance
Four types of multiple sclerosis?
- Replasing remitting
- Primary Progressive
- Secondary Progressive
- Progressive relpasing
Subjective complaints of MS?
Sensory disturbances, spasticity, ataxic gait, paresthesias, fatigue, optic neuritis, trigeminal neuralgia
Diagnosis of MS?
Done by neurologist, two or more parts of the CNS must be involved
Treatment of MS?
Glucocorticoids are mainstay of treatment, with new medications prescribed by neurologist. May need plasma exchange for patients refractory to glucocorticoids
Symptoms of polymyalgia rheumatica
usually older than 50 y.o., involves shoulders, hip girdle, neck, and torso, decreased ROM, subjective weakness
Other condition that occurs with polymyalgia rheumatica?
Occurs with GCA- jaw claudication, new headache, scalp tenderness.
Diagnosis of PM?
ESR >40, the rest of the labs should be normal for rheumatoid diseases. Should resolve quickly with steroids
Differential diagnosis for PM?
rheumatoid arthritis, bone disease, drug induced myalgia, inflammatory myopathy, fibromyalgia
Fibromyalgia symptoms and chronic fatigue syndrome?
Post exercise malaise, fatigue, multiple joint pains, headaches, impaired memory and concentration, depressed mood, cognitive disturbances, sore throat, restless and disordered sleep, vague symptoms
What should you rule out for fibromyalgia symptoms?
sleep apnea
Objective assessment for FM?
Widespread apin, at least 11/18 trigger points.
Treatment for FM?
CBT and graded exercise has best outcomes. May use amitriptyline, lyrics, and SSRI.
What two diseases are associated with carpel tunnel syndrome?
Hypothyroidism and pregnancy because of swelling
Most common cause of bursitis?
Joint overuse
Most symptoms of low back pain are caused by?
Muscle or ligamentous strain.
Primary prevention for CTS includes?
Stretching and toning exercises
Straight leg tests compression of which roots?
L5 S1
First line bursitis treatment includes?
NSAIDS
Red Flags for back pain?
Unexplained fever or wt loss, immunospression, >70 y.o., osteoporosis, duration >6 weeks, indwelling catheter, recent UTI or cellulitis, bowel/bladder incontenece, trauma/heavy lifting > 50 y.o., Hx malignancy or IVDU, prolonged steroid use, focal neuro deficit, new back pain >50 y.o., pain at night, urinary retention.
Four muscles of the rotator cuff?
1 supraspinatus
2 infraspinatus
3 teres minor
4 subscapularis
