Musculoskeletal Flashcards
How are sprains and strains graded?
Grade 1: mild
Grade 2: partial tear
Grade 3: complete tear of tissue
What is a sprain and strain?
A sprain is a stretching or tearing of ligaments
A strain is a stretching or tearing of muscle or tendon
What does ligaments and tendons attach?
ligaments connect bone to bone
tendons attach bone to muscle
How are sprains and strains treated?
Protection: soft padding to minimize impact with objects
Rest: to accelerate healing and reduce potential for injury
Ice: reduce swelling
Compression: reduce swelling (ACE wrap)
Elevation: keeps blood from pooling (swelling)
What are s/s of sprain and strains?
Pain
Swelling
Bruising
Limited ability to move the affected joint
What are s/s of fracture?
boney point tenderness
pain w/ movement
swelling
deformity
What are goals for fracture treatment?
Splint in position of function to allow decrease in swelling
Open fx (risk of infection) = ER
reduce complications
Rehabilitation early as possible
What are imaging considerations for fractures?
Bone Scan
CT
In nondisplaced fx and stress fx X-ray may mot show immediately (re X-ray in 1-2 weeks & get films above and below joint)
What is translation, angulation, and shortening in regards to displacement?
Translation-Sideways motion of the fracture (% of movement when compared to the diameter of the bone)
Angulation- Is the amount of bend at a fracture described in degrees (respect to the apex of the angle or direction of distal fracture)
Shortening- amount a fracture is collapsed (expressed in cm)
What is a Collie’s fracture?
Fracture at the wrist
What are S/S of a hip fracture?
History of fall
leg externally rotated
pain often related to groin or may refer to knee
May be able to support weight(ability to walk does not rule out fracture)
What are concerns about clavicle fracture?
most frequently fractured part of the body
transmitted to 1-2 rib
alert for lung injury
Can be child abuse in children
How do Boxer’s Fracture occur? Treated?
caused by closed fist hitting a stationary object
requires splinting and referral
What is compartment syndrome?
Compartments swell, fascia dosent, leads to necrosis
Usually w/ crush injury but can be with fx only
What are signs of compartment syndrome?
Pain Pallor Paralysis Paresthesia Pressure Pulses
How is compartment syndrome treated?
Refer for emergent fasciotomy
What is bursitis? Causes?
inflammation of bursa
Caused by overuse (housemaid knees, olecranon bursitis)
Inflammation (Gout, RA, Septic)
What are the s/s of septic joint and its treatment?
Bacteria spreads to joint
pain, swelling, decreased ability to move joint, passive ROM painful
Refer for emergent care (aspirate joint fluid; can destroy joint in hours)
What are radiculopathies?
compression or irritated nerve root existing from spine: herniated disk, tumor, OA
What are S/S of radiculopathies?
pain
numbness
paresthesias
How are radiculopathies treated?
refer is severe or has weakness conservative initially (NSAIDs, Flexeril, sometimes steroids, analgesia) > epidural injections > surgery
What is Cauda Equine Syndrome? How is it treated?
caused by a massive midline disk herniation or mass compressing cord
Needs EMERGENT SURGICAL REFERAL
What are S/S of Cauda Equine Syndrome?
bilateral lower extremity weakness
numbness or progressing neuro deficit
saddle anesthesia
incontinence/retention (urinary or fecal)
What is carpal tunnel syndrome? S/s?
Medial nerve compression
Numbness in 1st 2nd fingers
+ Phalen’s and Tinnel’s test
How is carpal tunnel treated?
Hand and wrist splints 24 hours per day
May require surgical nerve decompression
How is osteoporosis diagnosed and treated?
DEXA scan
Treated with Bisphosphanates (Actonel, Fosomax, Evista) Estrogen, calcium, and Vit D
What are the S/s of ACL?
History of POP, sudden swell, rotatory injury, + Lachman, + anterior drawer test
What are the S/s of meniscal injury?
History of rotatory injury, gradual swelling, “locking”, + McMurray, + joint line tender
What are the S/s of Medial collateral strain/tear?
History of clipping injury (Valgus directed force), +medial collateral testing
What are the S/s of Pes Anserine Bursitis?
History of New activity; medical knee pain at rest,often associated with arthritis/DJD disease, medial tenderness over proximal tibia metaphysis
What are the S/s of iliotibial band friction syndrome?
History of lateral pain in runners; pain over lateral condyle
What are the ottawa rules?
a set of rules for x-ray of ankle or foot based upon:
Bone tenderness at + inability to walk 4 steps
A) posterior edge or tip of lateral malleolus (Ankle)
B) Posterior edge or tip of medial malleolus (Ankle)
C) Base of 5th Metatarsal (Foot)
D) Navicular (Foot)
What is Valgus vs Varus?
Valgus (knock kneed) is a deformity involving oblique displacement of part of a limb away from the midline.
Varus (bowlegged) a deformity involving oblique displacement of part of a limb toward the midline
What are the S/s of shoulder instability?
History of
What are the S/s of stage I impingement (Supraspinatous tendonopathy)
History of 25-40, gradual onset overhead activity, + empty can, + neer
What are the S/s of stage II/III impingement (partial of complete rotator cuff tear)?
History of >40, pain, overhead activity, pain at night, + empty can, + neer, + Hawkins
What are the S/s adhesive capsulitis?
History of gradual onset, painful stiff shoulder, no trauma, + decrease activity and passive ROM, + neer test
What are the S/s bicep tendonitis?
History of repetitive motion, new lifting regimen, OA, + speed, + yergason
What is dermatome testing used for?
To define areas of intact, impaired, absent sensation
Identify line of demarcation
Documents variability
Guide the therapist to the patient’s problem
Can be associated with spinal level
What is Spurling sign and how is it performed?
Test for Cervical Radiculopathy; pain radiates down the arm when the c-spine is compressed and deviated toward the side with arm pain
What is Axial compression test and how is it performed?
Test for Cervical Radiculopathy; pain in the arm aggravated with simple downward compressing pressure on the head compressing the c-spine
What is Distraction test and how is it performed?
Test for Cervical Radiculopathy; pain in the arm is relieved when lifting the patients head from the chin and occiput
What is Arm abduction sign and how is it performed?
Test for Cervical Radiculopathy; he shoulder abduction test is performed by asking the seated patient to place their hand on top of their head, pain is relieved
What is Lhermitte’s sign and how is it performed?
Electric like symptoms that shoot down the legs when the patient maximally flexes their neck; sign suggests a lesion of the dorsal columns of the cervical cord or of the caudal medulla, MS, or radiculopathy
What are S/s of cervical degenerative disc disease?
Pain worse with sitting and relieved when supine
associated with crepitus
stiffness and difficulty turning the head
Occasional pain radiation to the shoulder and chest (pseudoangina)
narrowing disk space
What is cervical radiculitis? S/s?
pinched nerve; arm pain and paresthesia, arm weakness associated with C6-7 neural compression
How is cervical radiculitis treated?
Therapy, NSAID’s, Rest if no demonstrable weakness
Cervical epidural steroid injection for refractory pain and no weakness
Surgery
What is cervical spondylotic myelopathy?
compression of the spinal cord that leads to spastic paraparesis or quadraparesis; caused by spondylitis spurs, redundant ligament flavum
What are the S/s of spondylotic myelopathy?
spastic gait loss of coordination/ freuent falls Paresthesias in the hands and feet Long tract signs: Hoffman's/Babinski/Clonus/Hyper-reflexia Bowel bladder dysfunction
What is the treatment for cervical spondylotic myelopathy?
surgery is always indicated for weakness and loss of coordination
What is whiplash injury?
sudden hyperextention force followed by flection
severity ranges from mild strain of cervical musculature to cervical fractures or dislocations
How is whiplash treated?
rest in soft cervical collar
NSAIDs
Occasional muscle relaxer
PT
What is the initial treatment for cervical trauma?
immobilization with c-collar and back board
How to evaluate acute c-spine trauma?
Assess ABCs volunatily move extremities assess for sensory deficits Assess for neck pain X-ray; CT when in doubt
What are Stingers/Burners? What causes them? How is it treated?
Common football injury when tackling forced lateral deviation neck stretches upper trunks of brachial plexus Stinging burning in arms and hands Weakness in C5-6 muscles Usually treated without Rx
How is adhesive capsulitis treated?
PT, NSAIDs, corticosteroids for symptoms less than 3months
What is acromioclavicular arthritis? S/s?
a common degenerative disorder that can lead to pain and difficulty during everyday use of the shoulder. The acromion is the part of the scapula that makes up the roof of the shoulder; it connects with the clavicle at the AC joint Aggravated with adduction - or + O'Brien test Prominient AC joint Tender AC joint
What is gleno-humeral Arthrosis? S/s
inflammation of the humeral head
Varying degrees of stiffness
Crepitus and grinding
pain referred down the arm
How is gleno-humeral Arthrosis treated?
NSAIDs PT Activity avoidance Corticosteroid injection MRI if no improvement with conservative treatment
What are non-muscloskeletal causes of shoulder pain?
Angina (left shoulder)
Gallbladder (right shoulder)
Pleurisy Lung mass
*referred pain from c-spine
What is treatment for irreparable cuff tears?
if patient can actively elevate arm more than 90 degrees (arthroscopic debridement and partial cuff repair)
if arthritis as well (partial hemiarthroplasty *partial shoulder replacement)
if pseudo paralysis and arthrosis (reverse shoulder replacement)
What is the treatment for AC arthritis?
corticosteroid injection
Distal clavicle excision
How to treat shoulder arthrosis?
corticosteroid injection
visco-supplements (hyaluronic acid)
anatomic shoulder shoulder replacement surgery (unconstrained)
How to treat a dislocated shoulder?
prompt atraumatic closed shoulder reduction
Sling for 4 weeks
Mostly non surgical care
What is Acromio-clavicular separation ?
A dislocation of the clavicle and scapula at the AC joint
Grades 1 through 6 depending on the severity of displacement
Often occurs with downward force to the acromion
(Football collision or motorcycle accidents)
What are the grade for Acromio-clavicular separation ?
Grade 1 – sprained AC capsule
Grade 2 – ruptured AC capsule
Grade 3 – AC capsule and CC ligaments
Grades 4 thru 6 – as above + varying degrees of trauma to the trapezius, platysma, etc.
What is the treatment for Acromio-clavicular separation?
Non-surgical care for grades 1 thru 2 Simple sling No real role for Kenny Howard brace Surgical care for grades 4 through 6 Surgery an option for grade 3
What is Lateral epicondylitis ?
aka Tennis elbow Pain lateral elbow Worse with lifting Often associated with repetitive lifting (Rarely seen in tennis players)
What are signs of Lateral epicondylitis?
Tender over the common extensor origin Supra-condylar ridge Pain with resisted wrist and finger extension Pain with overhand lifting – chair test Relieved with under hand grip X-rays usually normal
What is treatment for Lateral epicondylitis?
First line treatment is NSAIDs, stretching, counterforce brace, under hand lifting
Failing this, corticosteroid injection
Rarely is surgery required
What is Medial epicondylitis ?
aka Golfers elbow
Rarely seen in golfers
Tender over the medial elbow flexor pronator mass
Usually seen with repetitive lifting
Much less common than lateral epicondylitis
Pain worse with active wrist flexion
What are S/s of Olecranon Bursitis ?
Posterior elbow pain and fluctuant swelling
Almost always associated with injury to posterior elbow or habit of leaning on elbow
Often accompanies tophaceous gout
Olecranon spur is incidental – not pathologic in most cases
What is treatment of Olecranon Bursitis?
If infected surgical debridement and antibiotics Otherwise NSAIDs , elastic wrap, padding Aspiration and steroid injection Surgical excision in refractory cases
What is Cubital Tunnel Syndrome ?
Ulnar nerve compression in the tunnel formed by the humerus
What are S/s of Cubital Tunnel Syndrome?
Rarely causes pain
Usually tingling and numbness in ulnar nerve distribution
Motor weakness involving ulnar nerve innervated muscles just below the elbow
What is Carpal Tunnel Syndrome ?
Compression of the median nerve in the carpal tunnel
Commonly associated with workplace
What are S/s of Carpal tunnel syndrome?
Paresthesia in a median nerve distribution
Weakness of median nerve innervated muscles - LOAF
Nighttime pain
Hand and arm aching with driving
Clumsiness/frequent dropping of things
+ Tinel sign
+ Phalen sign
Atrophy of the thenar muscle group
↓ Pinch strength – measure with dynamometer
↓ two point discrimination in median nerve distribution
What disease process are associated with Carpal tunnel syndrome?
Diabetes Hypothyroidism Pregnancy RA Recent menopause Obesity amyloidosis
What is DeQuervain’s Tenosynovitis ?
Radial wrist pain
Tenosynovitis of first dorsal compartment
Tender over radial wrist
What are S/s of DeQuervain’s Tenosynovitis?
\+ Finkelstein’s test Tender radial styloid Pain resisted radial deviation Commonly seen in new mothers Pain with lifting Initial treatment thumb spica brace, NSAID Corticosteroid injection Surgery in refractory cases
What is Intersection Syndrome ?
Dorsal wrist pain associated with repetitive lifting, wrist extension
Often confused with DeQuervain’s tenosynovitis
What causes Intersection Syndrome?
Caused by friction between the 1st and 2nd dorsal compartment
Treatment is relative rest, NSAIDs, bracing and corticosteroid injection
What is Wartenberg’s Neuralgia ? S/s
Entrapment of the radial sensory nerve as it emerges from beneath the brachioradialis
Pain with pronation of the wrist and pinch
Paresthesia of the dorsal radial hand
Positive tinel over the radial sensory nerve
What is Trigger Finger ? Who does it commonly affect?
Snapping of finger going from flexion to extension
Tenderness over metacarpal neck
Occasional palpable nodule in the palm
More common in women, diabetics, and those with RA
What is treatment of Trigger Finger?
Corticosteroid injection effective at least 90%
Failures more common in diabetics
Surgery is definitive treatment – incision of the A1 pulley (and occasionally the A3 pulley)
What are S/s of Arthritis of the first CMC joint?
Tender over the thumb CMC joint
Pain with pinch
Decreased pinch strength
+ grind test
What is neer’s test?
Remember: “Neer - closer to the ear”
Elbow extended, forearm pronated
Examiner stabilizes shoulder, and lifts arm to ear. Pain is a positive test.
What is Hawkin’s Kennedy test?
Shoulder flexed forward 90°, elbow flexed 90°, forearm parallel to floor Examiner then passively rotates the forearm clockwise (causing internal rotation at the shoulder. Pain at the tip of the shoulder is a positive test.
What is drop arm test?
Assessed during abduction as patient actively brings arm back to sides from an overhead abducted position. If arm suddenly drops to side, this indicates a torn supraspinatus. Alternatively, with the arm abducted to 90°, examiner chops down on the arm. If arm suddenly drops to side, this indicates a torn supraspinatus.
What is scarf test?
Patient places hand on the opposite shoulder. Examiner then pushes arm into the body while stabilizing the opposite shoulder. Pain around the acromioclavicular joint suggests acromioclavicular pathology.
What is speeds test?
Elbow extended, arm supinated and forward at 45 degrees. Patient then resists downward pressure from the examiner. Pain at the biceps tendon indicates bicepital tendonitis.
What is apprehension test?
With the patient lying supine, passively abduct and externally rotate the arm at 90°. With one hand holding the wrist, apply upwards pressure against the head of the humerus in an anterior direction to pull the humeral head forward. If the patient becomes apprehensive and complains of pain, this is indicative of recurrent anterior subluxation.
What is empty can test?
Position the arm as though emptying a can: arm abducted 45°, flexed forward 45°, thumb pointing down. Patient resists examiners downward pressure on the arm. Pain at the tip of the shoulder is a positive test.
What does external rotation of humeral head test?
infraspinatus
What does internal rotation of humeral head test?
subscapularis
What is relocation test?
Continuing from the Apprehension Test, apply downward pressure on the head of humerus. If the patient becomes relaxed and looks relieved, this is a positive relocation test for recurrent anterior subluxation.
What is sulcus sign?
With the opposite shoulder stabilized, apply downward pressure on the arm by grasping just above the elbow. Appearance of a sulcus at the tip of shoulder indicates inferior instability.
What is Fukuda test?
is widely used in neurology and for the diagnosis of vertigo-associated disease
What is Yocum test?
place hand on opposite shoulder and ask pt to hold
shoulder flexed to 90 degrees
What is jobe “full can” test?
arm abducted to 20o, in the plane of the
scapula, thumb pointing down
What is patte test?
90o flexion, flexed elbow and resisted external rotation
What is Yergason’s Test?
With patient’s arm at side, elbow flexed at 90°, and hand in neutral position. Hold the patient’s wrist and attempt to pronate the forearm. Patient resists by trying to supinate. Pain at the biceps tendon indicates bicepital tendonitis
