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632 Advanced Anesthesia Health Assessment > Musculoskeletal Assessment > Flashcards

Musculoskeletal Assessment Flashcards

1
Q

What are the 3 components of a Synovial joint

A
  1. Bones
  2. Synovial membrane
  3. Fibrous joint capsule
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2
Q

Who tends to have increased soft tissue laxity?

A

Younger people & women

= increased ROM (double-jointed)

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3
Q

How are fibrous joint capsules strengthened?

A

Strengthened by & in some cases continuous w/ ligaments extending from bone to bone

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4
Q

Bones are covered by what type of cartilage?

A

Covered by articulate cartilage (a collagen matrix containing charged ions/water that allows it to change shape in response to pressure or load

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5
Q

4 properties of Bones in the synovial joint

A
  • do not touch
  • joint articulation - freely movable w/in the limits of the surrounding ligaments
  • covered by articulate cartilage
  • separated by a synovial cavity that cushions joint movement
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6
Q

Synovial membrane in the joint?

A

Lines the synovial cavity

- secretes a small amount of viscous lubricating fluid called SYNOVIAL FLUID

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7
Q

What is the purpose of synovial fluid

A

Provides nutrition to the adjacent relative a vascular articulate cartilage

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8
Q

What determines the direction & extent of joint motion

A

The shape of the articulating surfaces of synovial joints
as well as:
surrounding soft tissues

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9
Q

What is a Bursae? And what does it do ?

A

Disc shaped synovial sacs

  • facilitate joint action
  • allow adjacent muscles or muscles & tendons to glide over each other during movement w/ reduced friction
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10
Q

Where is the bursae located?

A

Between the skin & the convex surface of a bone or joint (pre-patellar bursa of the knee)

  • in areas where tendons or muscles rub against bone, ligaments, & each other (subacromial bursa of the shoulder)
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11
Q

What is a cartilaginous joint?

A
  • fibrocartilaginous discs separate the bony surfaces

- fibrocartilage is compressible & shock absorber

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12
Q

What surrounds a cartilaginous joint?

A

Surfaces on either side of the joint are covered w/ Hyaline cartilage

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13
Q

What are 3 examples of Cartilaginous joints?

A
  1. Intervertebral joints
  2. Symphysis pubis
  3. Sternomanubrial joint
    - Small amount of movement
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14
Q

What is a Fibrous Joint and what does it consist of?

A

The sutures of the skull

  • have intervening layers of fibrous tissue or cartilage that hold the bones together
  • almost in direct contact
  • no appreciable movement
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15
Q

List the articular structures (4)

A
  1. The joint capsule & articular cartilage
  2. The synovial & synovial fluid
  3. Intro articular ligaments
  4. Juxtaarticular bone
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16
Q

What are the common pathologies seen in the articular structures? (4)

A
  1. Swelling & tenderness of the joint
  2. Crepitus
  3. Instability, “locking,” or deformity
  4. Limits ACTIVE & PASSIVE ROM due to stiffness, mechanical blockage or pain
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17
Q

Name the extra articular structures: (8)

A
  1. Periarticular ligaments
  2. Tendons
  3. Bursae
  4. Muscle
  5. Fascia
  6. Non-articular bone
  7. Nerves
  8. Overlying skin
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18
Q

What are common pathologies of extra-articular structures?

A

Typically involves point or focal tenderness in regions adjacent to articular structures
- Limits ACTIVE ROM only

  • Rarely causes intra-articular joint swelling, instability, or joint deformity
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19
Q

What are the 3 common or concerning symptoms:

A
  1. Joint pain
  2. Neck pain
  3. Low back pain
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20
Q

When assessing joint pain, what do you need to determine?

A
  • Whether the pain is articular or extra-articular
  • Acute (usually days to weeks) vs. Chronic (usually months to years)
  • Inflammatory or non-inflammatory
  • Localized (mono articular) or diffuse (poly articular)
  • Clarify: context, associations, & chronology
  • Characterize the pain (“OLD CARTS”)
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21
Q

Pain in a single joint includes:

A
  • Injury
  • Monoarticular arthritis
  • Extraarticular causes:
    • tendinitis
    • bursitis
    • soft tissue injuries
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22
Q

Oligoarticular arthritis includes:

A

Infection:

  • gonorrhea
  • rheumatic fever
  • connective tissue disease (Ether- Danlos)
  • OA
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23
Q

Polyarthritis can be caused by:

A

Viral or inflammatory from:

- RA
- Systemic Lupus erythmatosus (SLE)
- Psoriasis
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24
Q

2 causes of smaller joint involvement

A

RA & SLE

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25
Q

What causes a migratory patter of pain spread?

A

Rheumatic Fever & Gonococcal arthritis

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26
Q

What causes an additive, progressive, symmetric pain pattern?

A

Rheumatoid arthritis

- gets worse over time

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27
Q

What are potential causes of ASYMMETRIC pain patterns?

A
  • Psoriatic, Reactive, & Inflammatory bowel disease (IBD) - associated arthritis
28
Q

Pain from the hip joint radiates where?

A

To the groin (poss. Knee pain)

29
Q

Sacral/ Sacroiliac pain radiates where?

A

Buttock

30
Q

Trochanteric pain radiates where?

A

Lateral thigh

31
Q

Causes of inflammation:

A
  1. Infectious: Neisseria gonorrhea or Mycobacterium tuberculosis
  2. Crystal-induced: Gout, pseudogout
  3. Immune: RA & SLE
  4. Reactive: Rheumatic fever, reactive arthritis
  5. Idiopathic
32
Q

How does activity affect inflammatory joint disorder?

A

Inflammatory = RA
- Rest tends to worsen the pain & activity improves pain

Morning stiffness that gradually improves w/ activity

33
Q

How does activity affect mechanical joint disorders?

A

Mechanical = OA

  • Activity increases the pain & stiffness & rest improves the pain
  • Wax & Wayne = intermittent stiffness
  • non-inflammatory = overuse (bursitis, tendinitis), degenerative changes (OA), or fibromyalgia
34
Q

How does articular joint stiffness/pain affect ROM?

A
  • Decreased active ROM (by the patient)

- Decreased passive (by the examiner) ROM with stiffness

35
Q

How does periarticular joint pain affect ROM?

A
  • Periarticular tenderness & pain w/ active ROM

- Passive ROM remains intact

36
Q

True or False: Neck Pain often requires treatment?

A

False. Usually self-limited w/o the need for treatment

37
Q

If your neck pain causes radiation, where does it normally radiate to?

A

The arm or scapular area

- Causes arm weakness, numbness, or parenthesis

38
Q

Neck pain that causes radicular pain signals what?

A

Signals spinal nerve compression/irritation

- C6/C7 most common

39
Q

What is the most common neck pain?

A

Degenerative joint changes (70%)

- compared to disc herniations (20-30%)(n. Compression)

40
Q

What are the 3 categories of low back pain?

A
  1. Non-specific (>90%)
    • musculoligamentous injuries & age-related degenerative processes of the intervertebral discs & facet joints
  2. Nerve root entrapment w/ radiculopathy or Spinal stenosis (~5%)
  3. Specific underlying disease (1%)
41
Q

Back pain that is midline, over the spinous process includes:

A
  • Musculoligamentous injury
  • Disc herniations
  • Degenerative disc disease
  • Degenerative disease of the facet joints of the spine
  • Vertebral fracture or collapse
  • Spinal cord metastases or epidural abscess (rare)
42
Q

Back pain that is off the midline, in the paraspinal muscles surrounding the spine include:

A
  • Muscle strain
  • Myofascial pain (trigger points)
  • Sacroilitis
  • Greater trochanteric pain syndrome
  • Hip arthritis
  • Renal conditions: pyelonephritis or stones
43
Q

What is Sciatica?

A

Radicular gluteal & posterior leg pain usually caused by impingement nerve roots at the L4-S1 root levels

  • Pain w/ forward flexion of the spine or straight leg raise or seated slump maneuvers
  • or Valsalva or sneezing
44
Q

Majority of Sciatica is assoc. w/ what?

A

85% of cases are assoc. w/ disc disorders usually L4-L5 or L5-S1 levels

45
Q

How do you distinguish sciatic with spinal stenosis

A

Pain that improves w/ lumbar forward flexion is spinal stenosis

46
Q

What can cause Cauda Equina Syndrome?

A

An S2-S4 midline disc herniations or tumors

47
Q

What sign of Cauda Equina Syndrome is an emergency?

A

Bowel or Bladder dysfunction

- pursue immediate imaging & surgical evaluation

48
Q

Inspection during a musculoskeletal exam should include:

A
  • signs of deformity
  • swelling
  • scars
  • inflammation
  • muscle atrophy
49
Q

Red flags for underlying systemic disease?

A
  • age <20 or > 50
  • Hx of cancer
  • unexplained weight loss, fever, or decline in general hlth
  • pain lasting > 1 mo or not responding to tx
  • pain at night or present at rest
  • Hx of intravenous drug use, addiction, or immunosuppression
  • presence of active infection or HIV
  • long-term steroid therapy
  • Saddle anesthesia
  • bladder or bowel incontinence
  • neurological symptoms or progressive neurological deficit
  • lower extremity weakness
50
Q

Non-pharmacological Acute lower back pain treatment

A
  • reassurance
  • staying active
  • heat
  • massage
  • acupuncture
  • spinal manipulation therapy
51
Q

Pharmacological Acute lower back pain treatment

A
  • NSAIDs

- smooth muscle relaxants

52
Q

Name the factors assoc. with poor outcomes of acute lower back pain

A
  • maladaptive pain-coping behaviors: avoiding work, movement, or activities for fear of causing back damage
  • multiple nonorganic physical examination findings
  • psychiatric disorders
  • poor general health
  • high levels of baseline functional impairment
  • low work satisfaction
53
Q

Nonpharmacologic Chronic lower back pain treatment?

A
  • all acute LBP tx’s
  • back exercises
  • multidisciplinary rehabilitation programs
  • mindfulness-based stress reduction
  • behavioral therapy
54
Q

Pharmacological Chronic lower back pain treatment?

A
  • all acute LBP tx’s

- Duloxetine (Cymbalta, SNRI) & tramadol

55
Q

Where is the primary location of osteoporosis in those over 50 yo?

A

Femoral neck or lumbar spine

56
Q

What is the prevalence of osteoporosis in race/ gender?

A

Mexican -American > Non-Hispanic white > non-Hispanic blacks

  • Half of all post menopausal women sustain an osteoporosis related fx during their lifetime
  • prevalence increases w/ age
57
Q

What is osteoporosis? Osteopenia?

A

-porosis = weak & brittle bones

  • penia = condition when the body doesn’t make new bone as quickly as it reabsorption old bone (lower than normal bone density)
    • accounts for the majority of fragility fractures
58
Q

Risk factors for Osteoporosis? (9)

A
  • postmenopausal
  • age > 50 yo
  • prior fragility fx
  • low body mass index
  • low dietary calcium & Vit D deficiency
  • tobacco & excessive alcohol use
  • immobilization
  • inadequate physical activity
  • 1st degree relative w/ osteoporosis
59
Q

Clinical conditions that increase the risk for osteoporosis ?

A
  • thyrotoxicosis
  • celiac Sprue
  • IBD
  • cirrhosis
  • chronic renal disease
  • organ transplantation
  • diabetes
  • HIV
  • Hypogonadism
  • multiple myeloma
  • anorexia nervosa
  • rheumatologic & autoimmune disorders
60
Q

Medications that increase the risk factors for osteoporosis ?

A
  • oral & high dose inhaled corticosteroids
  • anticoagulants (long-term use)
  • breast cancer
  • methotrexate
  • selected anti seizure medications
  • immunosuppressive agents
  • proton pump inhibitors (long-term use)
  • androgen deprivation therapy for prostate cancer
61
Q

What is the World Health Organization’s bone density criteria for osteoporosis?

A

T score < -2.5

> 2.5 standard deviations below the young adult mean

62
Q

What is the World Health Organization’s bone density criteria for osteopenia?

A

T score between - 1.0 & - 2.5

(1. 0 to 2.5 standard deviations below the young adult mean)
- penia progresses to -porosis as T score becomes more negative

63
Q

If you screen a patient for osteoporosis for fall risk and they say yes, what test should you do?

A

Do a gait, strength, & balance assessment with the TIMED GET UP & GO test

  • high risk older adults that have a gait strength, or balance problem & at least 2 falls or at least one fall w/ an injury
64
Q

Physical examination for the elderly at risk for falls include?

A

Assessment of:

  • visual acuity
  • postural dizziness/hypotension
  • a cognitive screen
  • inspection of the feet & use of footwear
  • use of mobility aids

Follow up w/in 30 days

65
Q

Your patient has received a neuraxial anesthetic technique what should you tell pack you?

A

Notify PACU about the block to alert that the patient is an Increased Fall Risk

  • assess dermatomes if able
  • S3 could poss. Ambulate

632 Advanced Anesthesia Health Assessment (12 decks)

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