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Family Practice Nursing > Musculoskeletal > Flashcards

Musculoskeletal Flashcards

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1
Q

How are sprains and strains graded?

A

Grade 1: mild
Grade 2: partial tear
Grade 3: complete tear of tissue

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2
Q

What is a sprain and strain?

A

A sprain is a stretching or tearing of ligaments

A strain is a stretching or tearing of muscle or tendon

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3
Q

What does ligaments and tendons attach?

A

ligaments connect bone to bone

tendons attach bone to muscle

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4
Q

How are sprains and strains treated?

A

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)

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5
Q

What are s/s of sprain and strains?

A

Pain
Swelling
Bruising
Limited ability to move the affected joint

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6
Q

What are s/s of fracture?

A

boney point tenderness
pain w/ movement
swelling
deformity

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7
Q

What are goals for fracture treatment?

A

Splint in position of function to allow decrease in swelling
Open fx (risk of infection) = ER
reduce complications
Rehabilitation early as possible

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8
Q

What are imaging considerations for fractures?

A

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)

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9
Q

What is translation, angulation, and shortening in regards to displacement?

A

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)

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10
Q

What is a Collie’s fracture?

A

Fracture at the wrist

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11
Q

What are S/S of a hip fracture?

A

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)

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12
Q

What are concerns about clavicle fracture?

A

most frequently fractured part of the body
transmitted to 1-2 rib
alert for lung injury
Can be child abuse in children

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13
Q

How do Boxer’s Fracture occur? Treated?

A

caused by closed fist hitting a stationary object

requires splinting and referral

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14
Q

What is compartment syndrome?

A

Compartments swell, fascia dosent, leads to necrosis

Usually w/ crush injury but can be with fx only

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15
Q

What are signs of compartment syndrome?

A 
Pain
Pallor
Paralysis
Paresthesia
Pressure
Pulses
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16
Q

How is compartment syndrome treated?

A

Refer for emergent fasciotomy

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17
Q

What is bursitis? Causes?

A

inflammation of bursa
Caused by overuse (housemaid knees, olecranon bursitis)
Inflammation (Gout, RA, Septic)

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18
Q

What are the s/s of septic joint and its treatment?

A

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)

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19
Q

What are radiculopathies?

A

compression or irritated nerve root existing from spine: herniated disk, tumor, OA

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20
Q

What are S/S of radiculopathies?

A

pain
numbness
paresthesias

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21
Q

How are radiculopathies treated?

A 
refer is severe or has weakness
conservative initially (NSAIDs, Flexeril, sometimes steroids, analgesia) > epidural injections > surgery
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22
Q

What is Cauda Equine Syndrome? How is it treated?

A

caused by a massive midline disk herniation or mass compressing cord
Needs EMERGENT SURGICAL REFERAL

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23
Q

What are S/S of Cauda Equine Syndrome?

A

bilateral lower extremity weakness
numbness or progressing neuro deficit
saddle anesthesia
incontinence/retention (urinary or fecal)

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24
Q

What is carpal tunnel syndrome? S/s?

A

Medial nerve compression
Numbness in 1st 2nd fingers
+ Phalen’s and Tinnel’s test

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25
Q

How is carpal tunnel treated?

A

Hand and wrist splints 24 hours per day

May require surgical nerve decompression

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26
Q

How is osteoporosis diagnosed and treated?

A

DEXA scan

Treated with Bisphosphanates (Actonel, Fosomax, Evista) Estrogen, calcium, and Vit D

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27
Q

What are the S/s of ACL?

A

History of POP, sudden swell, rotatory injury, + Lachman, + anterior drawer test

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28
Q

What are the S/s of meniscal injury?

A

History of rotatory injury, gradual swelling, “locking”, + McMurray, + joint line tender

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29
Q

What are the S/s of Medial collateral strain/tear?

A

History of clipping injury (Valgus directed force), +medial collateral testing

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30
Q

What are the S/s of Pes Anserine Bursitis?

A

History of New activity; medical knee pain at rest,often associated with arthritis/DJD disease, medial tenderness over proximal tibia metaphysis

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31
Q

What are the S/s of iliotibial band friction syndrome?

A

History of lateral pain in runners; pain over lateral condyle

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32
Q

What are the ottawa rules?

A

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)

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33
Q

What is Valgus vs Varus?

A

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

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34
Q

What are the S/s of shoulder instability?

A

History of

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35
Q

What are the S/s of stage I impingement (Supraspinatous tendonopathy)

A

History of 25-40, gradual onset overhead activity, + empty can, + neer

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36
Q

What are the S/s of stage II/III impingement (partial of complete rotator cuff tear)?

A

History of >40, pain, overhead activity, pain at night, + empty can, + neer, + Hawkins

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37
Q

What are the S/s adhesive capsulitis?

A

History of gradual onset, painful stiff shoulder, no trauma, + decrease activity and passive ROM, + neer test

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38
Q

What are the S/s bicep tendonitis?

A

History of repetitive motion, new lifting regimen, OA, + speed, + yergason

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39
Q

What is dermatome testing used for?

A

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

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40
Q

What is Spurling sign and how is it performed?

A

Test for Cervical Radiculopathy; pain radiates down the arm when the c-spine is compressed and deviated toward the side with arm pain

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41
Q

What is Axial compression test and how is it performed?

A

Test for Cervical Radiculopathy; pain in the arm aggravated with simple downward compressing pressure on the head compressing the c-spine

42
Q

What is Distraction test and how is it performed?

A

Test for Cervical Radiculopathy; pain in the arm is relieved when lifting the patients head from the chin and occiput

43
Q

What is Arm abduction sign and how is it performed?

A

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

44
Q

What is Lhermitte’s sign and how is it performed?

A

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

45
Q

What are S/s of cervical degenerative disc disease?

A

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

46
Q

What is cervical radiculitis? S/s?

A

pinched nerve; arm pain and paresthesia, arm weakness associated with C6-7 neural compression

47
Q

How is cervical radiculitis treated?

A

Therapy, NSAID’s, Rest if no demonstrable weakness
Cervical epidural steroid injection for refractory pain and no weakness
Surgery

48
Q

What is cervical spondylotic myelopathy?

A

compression of the spinal cord that leads to spastic paraparesis or quadraparesis; caused by spondylitis spurs, redundant ligament flavum

49
Q

What are the S/s of spondylotic myelopathy?

A 
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
50
Q

What is the treatment for cervical spondylotic myelopathy?

A

surgery is always indicated for weakness and loss of coordination

51
Q

What is whiplash injury?

A

sudden hyperextention force followed by flection

severity ranges from mild strain of cervical musculature to cervical fractures or dislocations

52
Q

How is whiplash treated?

A

rest in soft cervical collar
NSAIDs
Occasional muscle relaxer
PT

53
Q

What is the initial treatment for cervical trauma?

A

immobilization with c-collar and back board

54
Q

How to evaluate acute c-spine trauma?

A 
Assess ABCs
volunatily move extremities 
assess for sensory deficits
Assess for neck pain
X-ray; CT when in doubt
55
Q

What are Stingers/Burners? What causes them? How is it treated?

A 
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
56
Q

How is adhesive capsulitis treated?

A

PT, NSAIDs, corticosteroids for symptoms less than 3months

57
Q

What is acromioclavicular arthritis? S/s?

A 
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
58
Q

What is gleno-humeral Arthrosis? S/s

A

inflammation of the humeral head
Varying degrees of stiffness
Crepitus and grinding
pain referred down the arm

59
Q

How is gleno-humeral Arthrosis treated?

A 
NSAIDs
PT
Activity avoidance
Corticosteroid injection
MRI if no improvement with conservative treatment
60
Q

What are non-muscloskeletal causes of shoulder pain?

A

Angina (left shoulder)
Gallbladder (right shoulder)
Pleurisy Lung mass
*referred pain from c-spine

61
Q

What is treatment for irreparable cuff tears?

A

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)

62
Q

What is the treatment for AC arthritis?

A

corticosteroid injection

Distal clavicle excision

63
Q

How to treat shoulder arthrosis?

A

corticosteroid injection
visco-supplements (hyaluronic acid)
anatomic shoulder shoulder replacement surgery (unconstrained)

64
Q

How to treat a dislocated shoulder?

A

prompt atraumatic closed shoulder reduction
Sling for 4 weeks
Mostly non surgical care

65
Q

What is Acromio-clavicular separation ?

A

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)

66
Q

What are the grade for Acromio-clavicular separation ?

A

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.

67
Q

What is the treatment for Acromio-clavicular separation?

A 
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
68
Q

What is Lateral epicondylitis ?

A 
aka Tennis elbow
Pain lateral elbow
Worse with lifting 
Often associated with repetitive lifting
(Rarely seen in tennis players)
69
Q

What are signs of Lateral epicondylitis?

A 
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
70
Q

What is treatment for Lateral epicondylitis?

A

First line treatment is NSAIDs, stretching, counterforce brace, under hand lifting
Failing this, corticosteroid injection
Rarely is surgery required

71
Q

What is Medial epicondylitis ?

A

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

72
Q

What are S/s of Olecranon Bursitis ?

A

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

73
Q

What is treatment of Olecranon Bursitis?

A 
If infected
surgical debridement and antibiotics
Otherwise
NSAIDs , elastic wrap, padding
Aspiration and steroid injection
Surgical excision in refractory cases
74
Q

What is Cubital Tunnel Syndrome ?

A

Ulnar nerve compression in the tunnel formed by the humerus

75
Q

What are S/s of Cubital Tunnel Syndrome?

A

Rarely causes pain
Usually tingling and numbness in ulnar nerve distribution
Motor weakness involving ulnar nerve innervated muscles just below the elbow

76
Q

What is Carpal Tunnel Syndrome ?

A

Compression of the median nerve in the carpal tunnel

Commonly associated with workplace

77
Q

What are S/s of Carpal tunnel syndrome?

A

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

78
Q

What disease process are associated with Carpal tunnel syndrome?

A 
Diabetes
Hypothyroidism
Pregnancy
RA
Recent menopause
Obesity
amyloidosis
79
Q

What is DeQuervain’s Tenosynovitis ?

A

Radial wrist pain
Tenosynovitis of first dorsal compartment
Tender over radial wrist

80
Q

What are S/s of DeQuervain’s Tenosynovitis?

A 
\+ 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
81
Q

What is Intersection Syndrome ?

A

Dorsal wrist pain associated with repetitive lifting, wrist extension
Often confused with DeQuervain’s tenosynovitis

82
Q

What causes Intersection Syndrome?

A

Caused by friction between the 1st and 2nd dorsal compartment
Treatment is relative rest, NSAIDs, bracing and corticosteroid injection

83
Q

What is Wartenberg’s Neuralgia ? S/s

A

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

84
Q

What is Trigger Finger ? Who does it commonly affect?

A

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

85
Q

What is treatment of Trigger Finger?

A

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)

86
Q

What are S/s of Arthritis of the first CMC joint?

A

Tender over the thumb CMC joint
Pain with pinch
Decreased pinch strength
+ grind test

87
Q

What is neer’s test?

A

Remember: “Neer - closer to the ear”
Elbow extended, forearm pronated
Examiner stabilizes shoulder, and lifts arm to ear. Pain is a positive test.

88
Q

What is Hawkin’s Kennedy test?

A

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.

89
Q

What is drop arm test?

A

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.

90
Q

What is scarf test?

A

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.

91
Q

What is speeds test?

A

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.

92
Q

What is apprehension test?

A

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.

93
Q

What is empty can test?

A

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.

94
Q

What does external rotation of humeral head test?

A

infraspinatus

95
Q

What does internal rotation of humeral head test?

A

subscapularis

96
Q

What is relocation test?

A

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.

97
Q

What is sulcus sign?

A

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.

98
Q

What is Fukuda test?

A

is widely used in neurology and for the diagnosis of vertigo-associated disease

99
Q

What is Yocum test?

A

place hand on opposite shoulder and ask pt to hold

shoulder flexed to 90 degrees

100
Q

What is jobe “full can” test?

A

arm abducted to 20o, in the plane of the

scapula, thumb pointing down

101
Q

What is patte test?

A

90o flexion, flexed elbow and resisted external rotation

102
Q

What is Yergason’s Test?

A

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

Family Practice Nursing (9 decks)

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