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Clinical Conditions > Musculoskeletal Pain Conditions And Orthropedics > Flashcards

Musculoskeletal Pain Conditions And Orthropedics Flashcards

1
Q

Musculoskeletal pain

A
  • discomfort that occurs as a result of impairment to the structural integrity of bones, joints, muscles, tendons, ligaments, bursae, or some combination of these anatomical structures
  • an umbrella term
  • pain = subject experience (very individualized)
    • influenced by emotional, environmental, and cultural factors
    • influenced by person’s pain threshold (min point at which a person experience some stimulus as painful) and tolerance (max amount of discomfort a person can endure)
  • pain is identified as radiating, throbbing, persistent, intermittent, burning, shooting, stabbing, tingling, and electrical
  • 20-33% of people around the world
  • chronic = lasting 3 months or more
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2
Q

Myofascial pain syndrome

A
  • a chronic pain disorder characterized by the presence of myofascial trigger points in the muscles
  • trigger points = hyper irritable spots in the skeletal muscle, causing pain and referred pain
  • trigger points or knots in different areas of your body, causing acute or chronic pain
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3
Q

Causes and risk factors of myofascial pain syndrome

A
  • muscle overuse
  • trauma
  • stress
  • poor posture
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4
Q

Symptoms of myofascial pain syndrome

A
  • localized muscle pain
  • stiffness
  • referred pain
  • muscle weakness
  • persistent, throbbing discomfort within a muscle
  • pain that persist or intensifies over time
  • sensitivity in a muscle, often forming a tender knot
  • sleep disturbances attributable to pain
  • a pervasive sense of unwellness, referred to as malaise
  • fatigue
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5
Q

Occupational implications of myofascial pain syndrome

A
  • difficulty with prolonged sitting or standing
  • reduced tolerance for repetitive tasks
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6
Q

Treatments for myofascial pain syndrome

A
  • trigger point release
  • stretching exercises
  • postural training
  • ergonomic adjustments
  • dry needling

*by treating the area that has the knots, the radiating pain goes away

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7
Q

Fibromyalgia

A
  • a rule-out diagnosis (ruling out other diseases, patient report, and exam)
  • a chronic condition characterized by widespread musculoskeletal pain, fatigue, sleep problems, memory and mood disturbances
  • altered pain processing in the central nervous system leading to increased sensitivity
  • widespread pain for more than 3 months, without other underlying conditions = constant dull ache
  • “fibrofog” = impaired alertness and concentration in daily activities
  • co-occurring conditions = chronic fatigue syndrome, irritable bowel syndrome, depression and anxiety, migraine and headache, sleep disorder, interstitial cystitis and painful bladder syndrome, and temporomandibular joint disorder
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8
Q

Occupational implications of fibromyalgia

A
  • difficulty with sustained attention, physical tasks, and social participation
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9
Q

Symptoms of fibromyalgia

A
  • headaches
  • brain fog
  • dry eyes and mouth
  • widespread pain
  • fatigue
  • numbness or tingling
  • insomnia
  • digestive problems
  • dizziness
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10
Q

Treatments for fibromyalgia

A
  • graded exercise therapy
  • cognitive-behavioral therapy
  • energy conservation
  • pain management strategies
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11
Q

Back pain

A

Low back pain:
- pain located in the lumbar spine area, ranging from acute to chronic pain
- estimated to affect 80% of people at some point
- most prevalent of all musculoskeletal pain syndromes and global leading cause of lost workdays
- radicular pain = type of pain that radiates from your back and hip into your legs through the spine
Neck pain:
- pain in cervical spine
- radiating symptoms (pain, tingling, weakness, numbness) extending down the upper extremity

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12
Q

Back pain diagnoses

A
  • lumbar radiculopathy
  • herniated nucleus pulposus
  • spondylolisthesis
  • spondylosis
  • facet joint syndrome
  • spinal stenosis
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13
Q

Lumbar radiculopathy

A
  • sciatica (goes through the piriformis muscle)
  • nerves that extend off the spinal cord become compressed by the bones and cartilage that have experienced structural changes as a result of injury, disease, or the aging process
  • bulging disk or bone spur compressing the nerve
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14
Q

Symptoms of lumbar radiculopathy

A
  • lower extremity = inflammation, muscular weakness, pain, tingling, electrical shooting sensation, and/or numbness
  • pain commonly radiates down the hip, buttock, leg, toes, and foot of the affected side and worsens with sneezing, straining, and coughing
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15
Q

Herniated nucleus pulposus

A
  • 2 vertebrae pressing down on one side
  • occurs when the soft inner gel of the intervertebral disc bulges or leaks out, compressing adjacent nerves
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16
Q

Symptoms of herniated nucleus pulposus

A
  • pain in the area of the involved vertebra
  • pain that radiates from its origin to the buttocks, legs, and feet
  • the occurrence of paresthesias such as burning, tingling, or numbness in the legs and feet
  • muscle weakness involved in lower extremity
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17
Q

Spondylolisthesis

A
  • one vertebrae slides in front of one another
  • spinal instability affecting the lumbar vertebrae in which one vertebra displaces or slides over one another
  • frequently between L4 and S1
  • degenerative spondylolisthesis = the disks lose water and begin to thin, facilitating vertebral instability (a result of the aging process)
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18
Q

Symptoms of spondylolisthesis

A
  • lower back pain
  • pain that radiates from the low back to the buttocks and thighs
  • muscle spasms occurring in the hamstring muscles
  • lumbar stiffness
  • pain when standing or walking for prolonged periods
  • pain elicited from bending forwards
  • weakness, tingling, and numbness in the foot
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19
Q

Spondylosis

A
  • a form of osteoarthritis characterized by age-related degenerative spinal column changes that can include disc compression and bone spurs
  • ex: degenerative disc disease
  • common
  • causes nerve compression
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20
Q

Symptoms of spondylosis

A
  • can be painful but the pain is not radiating
  • the deterioration of spinal column changes can adversely impact the spinal ROM
  • if nerve compression occurs, numbness, tingling, or weakness in the legs in result
  • stiffness, particularly after periods of prolonged inactivity
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21
Q

Facet joint syndrome

A
  • inflammation or degeneration of the facet joints, causing localized or referred pain
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22
Q

Symptoms of facet joint syndrome

A
  • low back pain
  • sometimes pain in the buttocks and thighs
  • stiffness
  • difficulty rising from a seated to a standing position
  • pain is elicited when motion is initiated
  • when pain is severe, some patients can be observed walking with their trunks in forward flexion (a hunched over position)
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23
Q

Spinal stenosis

A
  • degenerative condition that occurs when one or more spinal openings, or foramina, begins to narrow, causing pressure on the spinal cord within the spinal canal or spinal nerves as they exit through the intervertebral foramina
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24
Q

Symptoms of spinal stenosis

A
  • appears slowly and over time
  • pain tends to be intermittent rather than continuous
  • elected by the invitation of activity requiring the trunk and neck to be held upright
  • symptoms are relieved though rest and lying down because not much pressure on their back
  • radicular pain
  • tingling
  • numbness
  • weakness that radiates to a lower extremity
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25
Q

Medical management of back pain

A
  • Acetamnophen
  • NSAIDs
  • muscle relaxants
  • anticonvulsants
  • antidepressants
  • steroid injections at the area around the involved nerve root can help to reduce pain by decreasing inflammation of an irritated nerve
  • steroid injection is usually only effective for several months and is a limited form of intervention due to the risk of serious side effects resulting from too many and too frequently occurring injections (because it breaks down the muscle)
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26
Q

Surgical management of back pain

A
  • discectomy
  • laminectomy
  • spinal fusion
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27
Q

Discectomy

A
  • involves the removal of structures that are compressing the nerve
  • structures like herniated disc or bone spur
28
Q

Laminectomy

A
  • involves the removal of the lamina (the dorsal portion of the vertebra that covers the spinal canal) that is compressing the nerve
  • also referred to as the decompression surgery because it enlarges the spinal canal, relieving pressure on the spinal cord and the nerves
  • abnormality between the spinal cord vertebrae and pushing the nerves coming out of it
29
Q

Spinal fusion

A
  • a procedure in which a laminectomy is performed to decompress the involved nerves
  • a bone graft is then inserted into a disc space to realign the slipped vertebra
  • screws are inserted into the vertebrae and below the area of slippage and secured with a rod
30
Q

Causes shoulder impingement

A
  • rotator cuff tendinitis
  • shoulder bursitis
  • occur over time
  • can result both from prolonged activity (ex: sleeping on the same shoulder each night) or repeatedly ringing the upper extremity above the head
31
Q

Rotator cuff tendinitis

A
  • inflammation of the 4 shoulder muscles and tendons (supraspinatus, infraspinatus, teres minor, and subscapularis)
  • when one or more of the rotator cuff tendons is torn, the tendon becomes partially or completely detaches from the head of the humerus
  • most tears occur in the supraspinatus tendon
32
Q

Shoulder bursitis

A
  • bursa = soft fluid-filled pads that cushion and lubricate the shoulder structures
  • bursa is inflamed, referred to as subacromial bursitis
33
Q

Symptoms of rotator cuff tendinitis and shoulder bursitis

A
  • the shoulder is very mobile, NOT stable
  • pain and sometimes swelling on the anterior surface of the shoulder and lateral side of the upper arm
  • pain elicited upon shoulder flexion, extension, and internal and external rotation
  • decreased mobility and strength in the affected shoulder
  • crepitus or clicking elicited upon shoulder flexion
  • intense shoulder and arm pain that disrupts sleep
34
Q

Treatments for rotator cuff tendinitis and shoulder bursitis

A
  • ice
  • NSAIDs
  • cortisone injection
  • arthroscopic surgery to remove bone spurs or inflamed/thickened bursa
35
Q

Adhesive capsulitis (frozen shoulder)

A
  • when a client have a surgery and cannot use their arm for a period of time, then develops frozen shoulder
  • a condition in which the connective tissues of the shoulder joint become thickened, stiff, inflamed, and painful over time
  • scar tissue commonly forms in the shoulder capsule, further limiting mobility
  • patients commonly limit their shoulder use, causing the shoulder capsule to become immobile or frozen
  • may take 2-9 months to develop
36
Q

Symptoms of adhesive capsulitis

A
  • shoulder stiffness
  • pain
  • decreased range of motion
  • pain worsens at night and disrupts sleep
  • one surgical option involves manipulation of the shoulder capsule under anesthesia (goes in and rips the shoulder out of the capsule and break the adhesions
37
Q

Medial epicondylitis

A
  • medial epicondyles = flexors of the wrist
  • golfer syndrome
  • a painful condition occurring from the overuse of the muscles and tendons attached to the inside of the elbow or medial epicondyle of the humerus = wrist flexors
38
Q

Symptoms of medial epicondylitis

A
  • elbow pain just distal to the medial epicondyle of the humerus
  • pain radiates down the upper extremity on the medial or ulnar side of the forearm, wrist, and fingers
  • stiffness of the elbow commonly occurs with weakness in the hand and wrist
  • numbness or tingling in the fingers (particularly the last 2 digits)
  • pain can be elicited upon resisted wrist flexion and pronation
39
Q

Lateral epicondylitis

A
  • lateral epicondyles = extensors of the wrist
  • tennis elbow
  • more common than medial epicondylitis
  • caused by repetitive use of the forearm muscles responsible for wrist extension (ex: extensor carpi radialis brevis, extensor digitorum, extensor carpi radialis longus, extensor carpi ulnaris)
40
Q

Symptoms of lateral epicondylitis

A
  • pain that is elicited in response to palpation of the lateral epicondyle
  • radiate along the lateral forearm and in some cases to the 3rd and 4th digits
  • pain and weakness can commonly occur in response to lifting and gripping objects while the wrist is held in extension
41
Q

Olecranon bursitis

A
  • people with RA have this as well
  • occurs when the bursa between the skin and the olecranon process (elbow) of the ulna becomes inflamed
  • this bursa allows the elbow to extend and flex smoothly beneath the skin
  • when the olecranon bursa becomes irritated, it fills its fluid and causes inflammation at the tip of the elbow
  • can be caused by injury, trauma, or overuse syndromes (such as in occupational in which people frequently lean on their elbows)
  • truck drivers = resting their elbows on the window while driving and its bouncy, hitting the bursa
  • alcoholics =resting their elbows at the bar drinking
42
Q

Symptoms of olecranon bursitis

A
  • initial symptoms = inflammation
  • causes tenderness and pain at the elbow
  • pressure on the elbow will exacerbate the pain
  • if the bursa is infected, the surrounding skin may become red and warm
43
Q

Carpal tunnel syndrome

A
  • compression of the median nerve within the carpal tunnel
  • the carpal tunnel is formed by 2 rows of carpal bones and the flexor retinaculum
  • the median nerve supplies sensory innervation to the first 3 digits and the radial half of the 3rd digit
  • median nerve also supplies motor innervation to the 1st and 2nd lumbrical muscles and the muscles of the thenar eminence
  • most commonly occurs as a result of median nerve inflammation caused from overuse and repetitive motions, such as prolonged computer and hand tool use
  • median nerve allows opposition to be functional with the hands
  • if get the surgery, you can’t use the hands for awhile which can be problematic (only 1/3 gets the surgery and is able to resume normally afterwards)
44
Q

Symptoms of carpal tunnel syndrome

A
  • numbness, tingling, and pain in the first 3 digits
  • pain and causalgia extending proximally up the wrist and forearm
  • pain in the wrist that disrupts sleep
  • weakened grip strength
  • symptoms are aggravated when the wrist is overextended repeatedly
45
Q

DeQuervain’s tenosynovitis

A
  • inflammation of the tendons of the thumb (abductor pollicis longus and extensor pollicis brevis)
  • repetitive wrist motion requiring thumb radial abduction with simultaneous wrist extension and radial deviation (increasing with texting)
46
Q

Symptoms of DeQuervain’s tenosynovitis

A
  • wrist pain on the radial side that radiates to the forearm and worsens with thumb abduction or extension, wrist ulnar deviation, and grasping of the hand
  • pain is commonly described as constant, aching, and burning
  • crepitus or snapping can be heard in the wrist during the thumb movement and hand grasp is commonly weakened
  • movement such as opening jar lids becomes difficult
47
Q

Occupational implications of musculoskeletal pain conditions

A
  • chronic pain
  • difficulty doing ADLs
  • fatigue
  • mentally tired
  • depression, anxiety, and social isolation
  • frequent doctor’s appointments
  • cause sleep interruptions
  • need to take days off work or impaired performance at work
  • mobility issues
48
Q

Orthopedic conditions

A
  • involves injury and disease of bones, joints, and their related structures, which include ligaments, tendons, and muscles, causing pain and a decrease in function
  • acute traumatic injury or a chronic disease such as arthritis
  • may also be caused by chronic rheumatic diseases such as osteoarthritis and rheumatoid arthritis as well as osteoporosis
49
Q

Fractures

A
  • caused by a trauma or disease of the bone or joint
    2 factors that determine if a fracture occurs:
  • the amount of force applied to the bone (high energy = MVA; low energy = falls or chronic stress seen in long running)
  • strength or toughness of the bone = osteoporosis

*stress fractures commonly occur more in the lower extremity as opposed to upper extremity

50
Q

Osteopenia

A
  • mild reduction in bone density that is not as severe as osteoporosis but still indicates increased risk of fractures
  • starts first because its open spaces are small, getting more porous
  • is reversible with a balanced diet including foods high in calcium and vitamin D, supplements, weight-bearing exercises, and medications
51
Q

Osteoporosis

A
  • osteopenia can eventually lead to osteoporosis
  • a condition characterized by severe loss of bone density, resulting in fragile bones and higher susceptibility to fractures
  • not very strong
  • can fracture easily
52
Q

Types of fractures

A
  • open fracture
  • closed fracture
  • comminuted fracture
  • displaced fracture
  • green stick fracture
  • spiral fracture
  • hairline fracture
53
Q

Closed fracture

A
  • a fracture that has not broken through the skin
  • same as nondisplaced/stable fracture
54
Q

Open fracture

A
  • the bone breaks through the skin surface
  • also called as compound fractures
  • is considered contaminated as there is interaction between the fracture and the outside environment
  • can get infected
55
Q

Comminuted fracture

A
  • has two or more fragments
56
Q

Displaced fracture

A
  • involves segments that have become shifted from normal alignment
  • bone is no longer lined up
57
Q

Greenstick fracture

A
  • occurs when the bone breaks on one side and bends on the other rather than snapping into two
  • typically occur in long bones such as the fibula, tibia, ulna, radius, humerus, and clavicle
58
Q

Nondisplaced/stable fracture

A
  • bone is cracked though but is still lined up
59
Q

Distal radial fractures

A
  • caused by a fall on an outstretched arm (FOOSH)
  • may result in loss of sensation, ROM, and strength
  • resulting in limited functional use of the hand and possibly the arm
60
Q

Humeral factures

A
  • may present with humeral displacement and malposition of the distal limb
  • radial nerve injury is found in 18% of humeral shaft fractures
  • radial nerve runs really close to the humerus
  • loss of wrist extension and impaired sensation on the dorsal aspect of the wrist
  • if peripheral nerve gets damaged, it can grow back 1 cm a month
61
Q

Scaphoid fractures

A
  • commonly seen in young males with a sports injury involving wrist hyper extension more than 90 degrees with radial deviation
  • can take time to heal because of poor blood supply
62
Q

Hip fractures

A
  • hip = weight-bearing bone
  • generally refers to a fracture of the proximal femur
  • may experience pain, decreased proprioception, limited ability to bear weight on the involved lower extremity impacting gait, decreased muscle strength, impaired balance, and decreased ADL performance
  • impairments in gait following a hip fracture risk for injury
  • depending on the surgery, you have different weight-bearing status
  • weight-bearing increases circulation and have bone development
  • hip fractures is the beginning of the end for older adults (which is why it is so important that they don’t fall)
63
Q

Tibial plateau fracture

A
  • an injury where you break your bone and damage the cartilage on top of your tibia (where the femur connects)
  • no weight bearing until the tibia has been healed (uses wheelchair or crutches in the meantime)
  • lower energy = fall
  • higher energy = MVA
64
Q

Joint replacements

A
  • hip and knee
  • indications = severe osteoarthritis, avascular necrosis, or fractures
  • doing the replacements because you broke a hip or arthritis is so bad that it is painful
65
Q

Hip precautions after surgery

A
  • in order to get through the hip, it cuts through the glute muscles (medius and max) which destroys the tendons and ligaments to get to the hip (the muscles are cut and they need time to heal)
  • mobility limitations
  • needs adaptive equipment
  • avoid hip flexion beyond 90 degrees for 6-8 weeks
  • avoid hip rotation of operated leg
  • avoid hip adduction of operated leg (avoid crossing legs
  • hip replacements tend to do well because constantly sitting and standing which gets mobility into the hip throughout the day
66
Q

Total knee replacement

A
  • only works if you bend your knee
  • have to bend early and a lot
  • a situation where no pain, no gain is tue

Clinical Conditions (27 decks)

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