Musculoskeletal Flashcards
Patient has hx of falling forward with outstretched hand to break the fall. Check for
scaphoid bone fracture
Xray diagnostic for scaphoid wrist fracture
May be initially normal but repeat in 2 weeks will show fracture
Patient presents with dorsal displacement of wrist. Suspect for
Colles fracture (fx of distal radius)
s/s of hip fracture
inability to bear weight, severe hip pain with external rotation of hip, leg shortening
Acute onset of saddle anesthesia (less of sensation in buttocks and inner thighs), bladder/fecal incontinence
cauda equina syndrome
Caused by pressure by a bulging disc on a sacral nerve root. A surgical emergency
cauda equina syndrome
The cartilage lining the open surfaces of bones in a joint
articular cartilage
tendons connect
muscle to bone
sac-like structures located on anterior and posterior areas of a joint that act as padding
bursae
Genu recurvatum
hyperextension or backward curvature of knees
Genu valgum
knock knees (“GUM” stuck between knees)
Genu varum
Bow legs
Within the first 48 hours of an injury, do NOT
exercise, perform active ROM, or apply heat
Weight bearing exercises are only good for:
osteoporosis
test for ACL injury
anterior drawer (ACL injury), posterior drawer (PCL injury); Lachman’s sign shows knee laxity
Finkelstein’s test is used to dx for
DeQuervain’s tenosynovitis
inflammation of the tendon and it’s sheath
DeQuervain’s tenosynovitis
how to perform Finkelstein’s test
pain on thumb side of wrist upon ulnar deviation
test for meniscal injury
McMurray’s test
increase in laxity during the valgus stress test of knee indicates
damage to MCL (“GUM” push knee in and ankle out)
increase in laxity during the varus stress test of knee indicates
damage to LCL
varus is known as
abduction; movement going away from body (“RUN”)
valgus is known as
adduction; movement going towards body (“GUM” stick inward)
refers to bones of hand and wrist
carpal
refer to finger and toes
phalanges (singular: phalanx)
pain with plantar fasciitis is aggravated by
walking
caused by microtears in the plantar fascia d/t tightness in achilles tendon
plantar fasciitis
risk factors for plantar fasciitis
obesity, diabetic, aerobic exercise, flat feet, prolong standing
nonpharm trx for plantar fasciitis
orthotic foot appliance at night x few weeks; ice; rolling a golf ball
pharm trx for plantar fasciitis
NSAIDs (oral or diclofenac gel to soles of feet bid).
inflammation of the digital nerve of the foot between the 3rd and 4th metatarsals.
morton’s neuroma
risk factors for morton’s neuroma
high-heeled shoes, obesity, dancer, runner
s/s of morton’s neuroma
burning/numbness to space between 3rd-4th toes, small nodule b/t 3-4th toe.
Mulder test
for morton’s neuroma: squeeze forefoot, positive if there is a click or pain
degenerative, chronic damage to articular surface of joints
osteoarthritis
s/s of osteoarthritis
transient joint stiffness for less than 60 minutes; worse with activity, better with rest; crepitus
nodes to DIP in osteoarthritis
Heberden’s
nodes to PIP in osteoarthritis
Bouchards
nonpharm trx for OA
nonweight bearing (walking, swimming, biking, resistance);
Patellar taping by physical therapist;
Glucosamine supplements
first line trx for osteoarthritis
Tylenol 325-650 mg q4-6 hours or Tylenol extra strength 500-1000 mg every 6 hours
second line trx for osteoarthritis
short to medium acting NSAIDs
Complications of long term NSAID
GI and CV disease, decreased renal perfusion, liver damage.
topical trx for osteoarthritis
diclofenac gel (Voltaren) apply and massage BID; capsaicin cream apply QID
NSAIDs with highest risk for GI bleed
diclofenac (ketorolac)
NSAIDs with lowest risk for GI bleed
ibuprofen, celecoxib (Celebrex)
NSAIDs with highest risk for CV events
diclofenac and celecoxib (Celebrex)
NSAIDs with lowest risk for CV event
naproxen
autoimmune disease that affects skin, kidneys, heart, and blood vessels. Common in black and hispanic women
SLE (lupus)
management of SLE
- rheumatologist
- avoid sun 10-4 pm
- wear SPF sunblock; wide brim hats
s/s of rheumatoid arthritis
weight loss, anorexia, morning stiffness for more than an hour; symmetrical bone pain, warmth, and tenderness
progressive inflammation and thickening of synovial membrane
rheumatoid arthritis
flexion of the DIP joint with hyperextension of the PIP joint
Swan neck deformity in RA
Hyperextension of the DIP joint with flexion of the PIP joint
Boutonniere deformity in RA
Diagnostic for RA
normocytic anemia, ESR and RF elevated
meds for RA
NSAIDs, DMARDs
swelling of the uvea, the middle layer of the eye that supplies blood to the retina
Uveitis (refer to ophthalmologist STAT)
complication of RA
uveitis
Plaquenil
antimalarial; can be used for RA
Methotrexate
DMARD used for RA
deposition or uric acid crystals inside joints and tendons
gout
podagra
pain in great big toe
meds for gout
only indomethacin or naproxen sodium (Anaprox DS) work well;
Colchicine 0.5 mg
when to start maintenance uric lowering therapy after acute gout attack
wait 4-6 weeks
education about allopurinol
stop during acute gout phase; restart 4-6 after it is resolved
when initiating allopurinol, check baseline
CBC, LFT, renal status
uric acid lowering therapy
allopurinol
chronic inflammatory disorder that is more common in young males
ankylosing spondylitis
ankylosing spondylitis most commonly affects
spine and sacroiliac joints
s/s of ankylosing spondylitis
chronic back pain that improves with activity; marked loss of ROM in spine
s/s of uveitis
eye irritation, photosensitivity, eye pain, blurred vision
diagnostic for ankylosing spondylitis
ESR and CRP elevated;
xray shows “bamboo spine”
trx for ankylosing spondylitis
refer to rheumatologist;
NSAIDs
s/s of supraspinatus tendinitis
shoulder pain with movement, elevation, and abduction (reaching for back pocket); tenderness over anterior shoulder
lateral epicondylitis
tennis elbow
medial epicondylitis
golfer’s elbow
Grade II sprain
incomplete tear; painful weight bearing
Grade III sprain
completely torn ligament.
Positive Ottawa rules: inability to bear weight, inability to take 4 steps, tenderness over medial or lateral malleolus
s/s of ruptured Baker’s cysts
similar to cellulitis (redness, swelling, tenderness to calf)
trx for Baker’s cysts
RICE, NSAIDS;
large bursae can be drained (if cloudy, r/o septic arthritis)
diagnostic criteria for RA
morning stiffness more than 1 hour, swelling of more than 3 joints for more than 6 weeks, at least one joint has to be in the hand or wrist
patients with rotator cuff tear may show weakness with
abduction and external rotation
disorders of the flexor tendons of the fingers or thumb; caused by a nodule or thickening in the tendon and impedes tendon movement
stenosing tenosynovitis (trigger finger)
diagnostic for trigger finger
pain when patient tries to extend finger
referral to orthopedist if pain in trigger finger or tenosynovitis does not resolve in
2 weeks
In palmer fibrosis (Dupuytren’s contracture), referral for surgery should be done for a contracture of more than
30 degrees
risk factor of carpal tunnel
pregnancy, menopause, DM, arthritis, HTN, hypothyroidism
can be a possible complication of corticosteroids
avascular necrosis
s/s of patellofemoral pain syndrome
“runners knee”, pain to the anterior portion of the knee; worse when walking up stairs
nonpharm trx for low back pain
modify activities for 3-6 weeks; limit bedrest to 2-4 days
result from a tearing of the ligaments that bind the joint.
sprain
result from an overstretching or overuse of muscles.
strain
Unilateral or bilateral tibial pain, exacerbated by exercise, pain with squatting or crouching.
Osgood-Schlatter disease
common in adolescent boys and girls who play sports
Osgood-Schlatter disease
Avascular necrosis of the femoral head found in preadolescent boys that causes hip/knee pain with a limp
Legg-Calve-Perthes disease
Severe hip or knee pain associated with a limp; common in adolescent boys
Slipped capital femoral epiphysis
s/s of fibromyalgia
widespread musculoskeletal pain for more than 3 months, fatigue, sleep disorder, depression, IBS
patient with polymyalgia rheumatica is at high risk for
temporal arteritis
labs for RA
RF, ESR, CRP, Anti-CCP antibodies
trx for fibromyalgia
amitryptyline, duloxetine (Cymbalta), pregabalin (Lyrica)
Empty can test
abduct shoulder 90 degrees, internally rotate where thumb is pointing to floor. Pain or weakness while pressing down is positive test.
s/s of rotator cuff tendinopathy (impingement syndrome)
pain with reaching overhead, positive empty can test, normal passive ROM
Difference between rotator cuff impingement and tear
impingement has pain only with testing; tear has pain AND weakness with testing
Adhesive capsulitis is associated with
DM
If shoulder pain is not reproducible, then consider
CV cause
suspect scaphoid fracture when there is tenderness in
anatomic snuffbox (right under thumb)
clues on when to get xray for back pain
age greater than 50, hx of cancer, unexplained weight loss, nighttime pain, pain for more than 4 weeks
sciatica is nerve root irritation on
L5-S1
lateral hip pain aggravated by direct pressure
trochanter bursitis
constant hip pain, especially at night
infectious, inflammatory, neoplastic cause
hallmark sign of plantar fasciitis
local heel point tenderness
how to diagnose hip pain in children
Trendelenburg’s test: ask child to stand on affected leg; abnormal if unaffected hip sits lower “dip in the hip”.
diagnostics for SCFE and Legg-Calve Perthes
xray of hip AP and frog-leg
difference between SCFE and Legg-Calve Perthes
SCFE is common in adolescents; Legg-Calve Perthes is common in preadolescents
s/s of transient synovitis of the hip in children (irritable hip)
acute limp and hip pain; negative Trendelenburg test; hx of URI 7-14 days prior
trx for transient synovitis of the hip in children (irritable hip)
self-limited
s/s of osteogenesis imperfecta
triangular face, blue sclera, bones that fracture easily, hearing loss
s/s of Prader-Willi syndrome
craving for food and rapid weight gain
meds that increase uric acid excretion
colchicine, probenecid
first line trx for osteoarthritis
exercise
other diseases that can be confused with RA
lupus, scleroderma, Fifth’s disease
Diagnostic test for RA
no specific diagnostic test; based on symptoms. RF can be false negative or positive.
test for impingement syndrome
Hawkin’s Kennedy test
