Musculoskeletal Flashcards
Ankylosing Spondylitis cause
seronegative spondyloarthropathy progressing to fusion of vertebrae; 3rd/4th decades of life
Ankylosing Spondylitis s/s
back or butt pain/stiffness, hip pain; worse in AM; restricted lumbar motion, shoulders, hips; synovitis of knees, plantar fasciitis, Achilles tendinitis; hip contractures, fixed cervical, thoracic, lumbar hyperkyphosis; uveitis, cardiac abnormalities, interstitial lung disease; difficulty w/ Schober test, cervical rotation, thoracolumbar rotation/flexion
Ankylosing Spondylitis dx
ESR/CRP (elevated); Thoracolumbar Xray (“bamboo spine”); HLA-B27 positive; generalized osteopenia
Ankylosing Spondylitis tx
physical therapy (posture, extension, breathing, swimming); NSAIDs
Back Strain/Sprain cause
mechanical use, muscle spasm
Back Strain/Sprain s/s
back pain, radiating down leg; sciatica; worse with standing, increased by walking, relieved by leaning forward
Back Strain/Sprain dx
CT/MRI (bony stenosis, nerve root involvement, herniated disk); imaging not necessary
Back Strain/Sprain tx
NSAIDs; muscle relaxers (valium, baclofen); physical therapy/postural exercises; surgery as needed
Lumbago (DJD, sciatica) cause
age related, degeneration of spine (dysfunction, instability, restabilization)
Lumbago (DJD, sciatica) s/s
local tenderness, contracted muscles, hypomobility, painful extension (dysfunction); “giving way”/”catching” of back w/ movement, pain w/ standing after flexion (instability); muscle tenderness, stiffness, reduced movement, scoliosis (restabilization); normal neuro exam; pain radiating down posterior lower extremity
Lumbago (DJD, sciatica) dx
MRI/CT Lspine; transforaminal selective nerve root blocks; CBC, ESR/CRP, HLA-B27, uric acid (r/o inflammatory, arthritis, ankylosing spondylitis, gout)
Lumbago (DJD, sciatica) tx
exercise/proper movements; muscle relaxants; NSAIDs; corticosteroid injections (epidural); lumbar decompression/discectomy
Cauda Equina Syndrome cause
midline disk herniation compressing nerve roots (L4/L5); injury, age
Cauda Equina Syndrome s/s
bowel/bladder impairment; leg pain, numbness, saddle anesthesia, paralysis
Cauda Equina Syndrome dx
clinical; CT/MRI
Cauda Equina Syndrome tx
surgical emergency
Herniated Nucleus Pulposus cause
mechanical degeneration, osteoporosis, stress/compression fracture
Herniated Nucleus Pulposus s/s
back pain, radiates down legs, difficulty with ROM; weakness, reflex change, dermatomal numbness
Herniated Nucleus Pulposus dx
MRI/CT (herniated disk)
Herniated Nucleus Pulposus tx
NSAIDs, muscle relaxants; physical therapy/chiropractic therapy; microdiscectomy
Scoliosis cause
UMN/LMN disease, myopathies; idiopathic (girls)
Scoliosis s/s
lateral curvature of the spine (usually T7/T8, right curve); asymmetry of shoulder and iliac height, scapular prominence, flank crease w/ bending forward; right thoracic and left lumbar prominence
Scoliosis dx
single, standing AP x-rays (>5 degrees); Cobb method (>15%)
Scoliosis tx
clinical eval q 6-12 months (10-15 degrees); serial AP x-rays q 3-4 months/6-8 months (15-20 degrees); bracing, e-stim, surgery (>20 degrees)
Kyphosis cause
increased convex curvature; Scheuermann disease (idiopathic, juvenile); TB; Pott’s disease (progressive kyphosis)
Kyphosis s/s
round back appearance (multiple vertebrae), angular curve (one vertebrae); result of faulty posture, resolves w/ spinal flexion; excessive lumbar lordosis
Kyphosis dx
standing lateral films
Kyphosis tx
exercises (curves 45-60 degrees); Milwaukee brace (curve >60 degrees); surgery (curve unresponsive to treatment)
Spinal Stenosis cause
idiopathic/developmental narrowing; narrowing event
Spinal Stenosis s/s
neural claudication and exacerbated pain w/ walking; relieved when leaning forward; variable back/leg pain
Spinal Stenosis dx
CT/MRI (diagnosis); X-rays (soft-tissue and thecal narrowing)
Spinal Stenosis tx
rest, isometric abdominal exercises, flexion exercises, NSAIDs, weight loss; epidural corticosteroid injections; decompression/fusion w/ neural compression
Osteoporosis cause
postmenopausal, age, malignancies, corticosteroid use, GI disorders, hormone imbalance, chronic electrolyte imbalance
Osteoporosis s/s
trabecular bone, vertebrae, hip, distal radius fracture (postmenopausal); trabecular/cortical bone, hip and pelvis fractures (poor calcium absorption)
Osteoporosis dx
DEXA scan (bone density); Ca, Ph, Alk Phos, serum protein electrophoresis
Osteoporosis tx
bisphosphonate; hormone replacement therapy/selective estrogen receptor modulators; calcitonin, teriparatide (PTH analogue); exercise, smoking cessation, calcium/Vit D supplements (preventative)
Acute Osteomyelitis cause
pyogenic organism (staph aureus); long bones of children; sickle cell risk (salmonella)
Acute Osteomyelitis s/s
pain, loss of motion, soft tissue swelling; drainage (rare)
Acute Osteomyelitis dx
blood culture/bone biopsy (organism); WBC, ESR/CRP (elevated); late sequestra and involucrum appear in several weeks
Acute Osteomyelitis tx
IV antibiotics x6-8wks; immobilization and surgical drainage; surgical debridement
Chronic Osteomyelitis cause
after original acute infection has completed appropriate treatment (abx, surgery), viable colonies of bacteria harbored in necrotic/ischemic tissue cause recurrence
Chronic Osteomyelitis s/s
recurrent acute flare-ups of tender, warm, swollen areas; malaise, anorexia, fever, weight loss, night sweats; pain/drainage from sinus tract; bone necrosis, soft tissue damage, bone instability
Chronic Osteomyelitis dx
blood culture/bone biopsy (organism); WBC, ESR/CRP (elevated); late sequestra and involucrum appear in several weeks
Chronic Osteomyelitis tx
IV antibiotics x4wks-24mos; immobilization and surgical drainage; surgical debridement
Osteoarthritis cause
older age, obesity, overuse, genetics
Osteoarthritis s/s
decreased ROM, joint crepitus, pain gradually worsening throughout day; DIP joint (Heberden nodes), PIP (Bouchard nodules), wrist, hip, knee, spine
Osteoarthritis dx
Xrays (asymmetric narrowing, subchondral sclerosis, bony cysts, marginal osteophytes)
Osteoarthritis tx
Acetaminophen; NSAIDs, weight reduction, physical therapy, injections; total joint replacement
Rheumatoid Arthritis cause
autoimmune, sex, obesity, family hx
Rheumatoid Arthritis s/s
pain in small joints (DIP spared); pain worse in mornings; can cause changes in skin, lungs, kidneys, eyes, liver, blood system, heart
Rheumatoid Arthritis dx
joint aspiration (yellow-opalescent, 3-5K WBC, 25-50 PMN, negative culture); ESR/CRP elevated; RF and antiCCP antibodies positive; 6/10 on diagnostic scale (joint involvement, serology, duration >6wks, ESR/CRP); X-rays (soft tissue swelling, articular demineralization)
Rheumatoid Arthritis tx
DMARDs (methotrexate), NSAIDs; corticosteroids; physical therapy; reconstructive surgery
Septic Arthritis cause
hematogenous spread of bacteremia, periarticular osteomyelitis, infection from diagnostic procedure or other localized infection; staph aureus, gonorrhea
Septic Arthritis s/s
acute swelling, fever, joint warmth/effusion, tenderness to palpation, increase pain w/ minimal ROM; affects knee, hip, shoulder, ankle, wrist
Septic Arthritis dx
joint aspiration w/ synovial fluid evaluation (yellow-green, >50K WBC, 75 PMN, positive culture)
Septic Arthritis tx
IV antibiotics x2wks (ceftriaxone) followed by PO antibiotics x4wks; arthrotomy and arthrocentesis
Reactive Arthritis (Reiter syndrome) cause
STDs (chlamydia) or GI (shigella, salmonella, yersinia, campylobacter)
Reactive Arthritis (Reiter syndrome) s/s
asymmetric arthritis of large joints (knee, ankle); mucocutaneous lesions (balanitis, stomatitis); urethritis; conjunctivitis; (cant see, pee, or climb a tree)
Reactive Arthritis (Reiter syndrome) dx
HLA-B27 positive; synovial fluid (negative culture)
Reactive Arthritis (Reiter syndrome) tx
NSAIDs, physical therapy; antibiotics at time of infection (preventative)
Gout cause
altered purine metabolism, sodium urate crystal precipitation
Gout s/s
MTP initial attack (podagra) but can affect feet, ankles, knee; pain, swelling, redness, exquisite tenderness of joint
Gout dx
joint fluid analysis (rod shaped, negatively birefringent urate crystals); serum uric acid >8; Radiographs (small, punched out lesions, interosseous tophi (chalky deposits of urate crystals adjacent to joint))
Gout tx
NSAIDs (indomethacin), Colchicine, oral prednisone; colchicine, probenecid, allopurinol (prevention)
Pseudogout (Calcium pyrophosphate dihydrate disease) cause
intraarticular deposition of calcium pyrophosphate
Pseudogout (Calcium pyrophosphate dihydrate disease) s/s
painful inflammation of knee, wrist, and elbow (mimics gout)
Pseudogout (Calcium pyrophosphate dihydrate disease) dx
joint fluid analysis (rhomboid-shaped calcium pyrophosphate crystals, positively birefringent); radiographs (fine, linear calcifications in cartilage)
Pseudogout (Calcium pyrophosphate dihydrate disease) tx
NSAIDs, colchicine, intraarticular steroid injections
Systemic Lupus Erythematosus cause
autoimmune, genetic
Systemic Lupus Erythematosus s/s
malar rash, discoid rash, oral ulcers, photosensitivity, arthritis, serositis, renal disease, hematologic disorders (hemolytic anemia, leukopenia, thrombocytopenia), immunologic disorders, neurologic disorders
Systemic Lupus Erythematosus dx
ANA positive; 4/11 criteria (above sx); CBC, BUN/Cr, UA, ESR, C3/C4; smith antigen antibodies, double stranded DNA, or depressed serum complement (progression of disease)
Systemic Lupus Erythematosus tx
exercise, sun protection; NSAIDs; antimalarials (hydroxychloroquine, quinacrine); corticosteroids (topical, intralesional); methotrexate (arthritis)
Polymyositis cause
unknown; occult malignancy
Polymyositis s/s
insidious onset; painless, proximal muscle weakness (proximal limbs, neck, pharynx); dysphagia; skin rash (malar, heliotrope); polyarthralgias; muscle atrophy; dermatomyositis
Polymyositis dx
CPK, aldolase (elevated); muscle biopsy (myopathic inflammatory changes)
Polymyositis tx
high-dose steroids, methotrexate, or azathioprine (until resolved)
Polymyalgia Rheumatica cause
unknown; associated with giant cell arteritis
Polymyalgia Rheumatica s/s
stiffness and pain (neck, shoulder, pelvic girdles); bilateral, proximal, symmetrical; fever, fatigue, weight loss, depression; r/o giant cell arteritis (jaw claudication, scalp tenderness, headache, temporal tenderness, vision loss)
Polymyalgia Rheumatica dx
ESR elevated (>50); biopsy (giant cell arteritis)
Polymyalgia Rheumatica tx
low-dose corticosteroid (high-dose for giant cell arteritis)
Polyarteritis Nordosa cause
unknown; associated w/ hepatitis B
Polyarteritis Nordosa s/s
small/medium artery inflammation (skin, kidney, peripheral nerves, muscle, gut); fever, anorexia, weight loss, abdominal pain, peripheral neuropathy, arthralgias, arthritis; skin lesions (palpable purpura, livedo reticularis); hypertension, edema, oliguria, uremia
Polyarteritis Nordosa dx
vessel biopsy or angiography; ESR/CRP (elevated); proteinuria; HBsAg positive; ANCA positive (antineutrophil cytoplasmic antibody -> Wegener’s granuloma, hemoptysis)
Scleroderma cause
unknown; collagen buildup
Scleroderma s/s
swelling/tightness of skin, heart lungs, GI tract, kidneys (diffuse); swelling/tightness of skin of face, neck, distal elbows, knees, pulmonary HTN (limited); swelling in fingers and hands worsens to trunk and face; vasospasm of digital arteries; CREST syndrome (calcinosis cutis, Raynaud phenomenon/blue fingers, esophageal dysfunction, sclerodactyly, telangiectasias)
Scleroderma dx
ANA positive; anticentromere antibody positive; antiSCL70 positive
Scleroderma tx
no cure; PPI (GERD), ACE (renal disease), CCB (Raynaud), immunosuppressive (pulmonary hypertension)
Sjögren’s Syndrome cause
autoimmune; connective tissue disorder (RA, SLE, polymyositis, scleroderma)
Sjögren’s Syndrome s/s
mucous membranes affected; dry mouth (xerostomia), dry eyes (xerophthalmia); parotid gland enlargement
Sjögren’s Syndrome dx
RF present; ANA, anti-Ro antibodies, anti-La antibodies may be present; Schirmer test (evaluates tear secretions; wetting <5mm filter paper); biopsy of lower lip mucosa (lymphocytic infiltrate, gland fibrosis)
Sjögren’s Syndrome tx
artificial tears and saliva, increase PO fluids, ocular and vaginal lubricants; pilocarpine (increased salivation); cyclosporine (ocular symptoms)
Fibromyalgia cause
idiopathic; occur w/ RA, SLE, Sjogren
Fibromyalgia s/s
nonarticular musculoskeletal aches, pains, fatigue, sleep disturbance, multiple tender “trigger” points; bilateral, axial pain above and below the waist, present >3 months; mood changes, cognitive disturbances, anxiety, depression, HA, IBS, dysmenorrhea, paresthesias
Fibromyalgia dx
typical pattern (11/18 trigger points); r/o hypothyroidism, hep C, vit D deficiency
Fibromyalgia tx
Pregabalin; SSRIs (fluoxetine), SNRIs (venlafaxine, duloxetine), TCAs (amitriptyline); exercise, education, stress reduction
