Musk Flashcards
25140V
103
A 65-year-old man comes to the office due to right upper extremity pain after falling on his right outstretched hand 2 days
ago.
The patient has mild abrasions over his wrist and elbow with full range of motion and no tenderess over these joints.
He has severe pain when he tries to lift his arm above shoulder level or when he pulls or pushes with his right arm. He has been unable to sleep the last 2 nights due to pain and is unable to lie on the affected side. The patient has a 40-pack-year smoking history. His father died of multiple myeloma. Vital signs are normal. Examination shows limited active abduction and exteral rotation of the humerus; however, passive motion is comparable to the contralateral side. Palpation of the right shoulder, collarbone, and neck reveal no step-off deformities or point tenderness. Radial pulse, extremity sensation, muscle tone, and bulk are normal. Which of the following would most likely confirm the diagnosis in this patient? **Treatment **
O A Bone scan
O B. Chest x-ray
O C. CT scan of the shoulder
O D. MRI of the cervical spine
O E MRI of the shoulder
O F. Shoulder x-ray
Rotator cuff tear (D)
- weakness and pain with abduction and external rotation
- diagnostic : X-ray first to rule out fractures then MRI
- treatment : surgery especially within 6 weeks of the injury for best results
28/40
A 52-year-old man comes to the office due to lipper extremity weakness and pain in his shoulders and upper back since shoveling snow 3 weeks ago. His left arm also has started to feel heavy, and he has difficulty dressing and undressing because he lacks the strength to pull clothes over his head. The patient has not had similar symptoms before and recalls no other trauma to the area. He has a history of hypertension and hypothyroidism. Vital signs are within normal limits. Physical xamination of the shoulder joints shows no deformity, and passive range of motion is full with no pain. There is moderate eakness of left shoulder abduction, but strength in the other muscle groups is normal. Decreased sensation to light touch d pinprick is present on the left lateral forearm. The remainder of the examination shows no abnormalities. Which of the owing is the most appropriate next step in evaluation of this patient’s symptoms?
• A. CT- sean-efthe brain
B. MRI of the cervical spine
C. MRI of the shoulder joint
D. Nerve-cenductien-studies
E. ISH and creatine kinase levels
B. MRI of cervical spine
Explanation
This patient’s back/shoulder pain, loss of shoulder abduction strength, and reduced sensation in the left lateral forearm raise strong suspicion for C5-6 nerve root impingement from cervical radiculopathy. Most cases arise in ofder individuals when physical activity such as shoveling snow, golf, or diving from a board puts stress on the neck and results in acute cervical disc herniation or nerve root compression from underlying cervical spondylosis.
Cervical spondylosis is marked by cervical spine degeneration. It is generally associated with 2 clinical syndromes:
• Cervical radiculopathy: Degeneration and osteophyte formation in the zygapophyseal (facet) and uncovertebral joints lead to intervertebral foramen narrowing and compressive nerve root symptoms. Most patients have progressive neck, shoulder, and/or arm pain plus weakness in a myotome (eg, axillary nerve) and sensory loss in a dermatome (eg. lateral cutaneous nerve of the arm).
• Compressive cervical myelopathy: Degeneration and thickening of the lateral vertebral bodies and posterior longitudin ligament lead to spinal canal narrowing and subsequent spinal cord compression. This usually presents with neck pal lower motor neuron signs in the upper extremities, upper motor neuron signs (eg, increased reflexes, increased tone, positive Babinski sign) in the lower extremities, and bowel/bladder dysfunction.
58 yo has 1 month history of right shoulder pain and stiffness. Medical bc of DM2 , OA of knee and osteoporosis . Passive and active ROM affected . Sensory intact . Shoulder X-ray normal
. BRF for this patients disease
T2DM - adhesive capsulitis (stiffness I shoulder with decreased ROM passive and active
- other causes- idiopathic or due to trauma/sx/Tx, hypothyroidism
40 year women with SLE for 7 years on steroids and atraumatichip pain for 4 weeks with normal XRay
NBSIM
MRI more sensitive (see crescent shape (subchondral luceny)
- a vascular necrosis (osteonecrosis) especially at femoral head due to steroids
55 year old women from Mexico presenting with headaches and right sided weakness. BP 150/90. Imaging shows extraaxial calcified meningioma.
NBSIM
Surgical resection - can stage it too
Man presenting with bulbar symptoms such as soft voice , coughs when drinking liquids, food doesn’t taste as good as before , posture is stopped, gait is slow, increased resistance to joint movement on one arm, not as funny as before
Parkinson’s
Bulbar symptoms can present first sometimes and not tremor
Not as funny anymore- soft voice or maybe the masked face
Young girl gymnast hears a pop when landing . Significant selling and tenderness over medial side of right knee and large painful immobile deformity on lateral aspect. Divot over the tibial tuberosity
Diagnosis
Treatment
Patella dislocation
- deformity and divot is the knee cap
- tx- self resolve but can do close reduction if not then splint and rehab
Man playing basketball landed with foot planted and knee bent then heard pop . Unable to walk or extend. Low lying patella seen on X-ray
Quadriceps tendon rupture
If high riding patella- patella tendon tear
Soccer player felt knee buckle when planting foot to kick the ball. Others heard an audible pop as he fell. Increased anterior translation of tibia on the femur and knee is grossly swollen
Diagnosis
Confirmatory diagnosis
Treatment
Ant cruciate ligament injury
MRI
RICE
3t yo male training for marathon for the past 6 months. Now has pain for 3 months .OTC naproxen doesn’t work. What n examination tenderness at the right Achilles tendon 4cm proximal to its insertion.
Appropriate therapy
RF
Eccentric calf strengthening exercises
Achilles tendinopathy
- RF: abrupt increase athletic activity , increase use of fluoroquinolone
- treatment acute - modify activity, cold compress/ nada is
Chronic - eccentric resistance
Tenderness at medial knee with calf is laxity
Medial collateral ligament injury
Left ankle pain and when left calf is squeezed no movement in the left foot
(Thompson test) when orine
Diagnosis
What is most likely impaired on physical exam
Achilles tendon rupture
- can’t walk on tippy toes
23 yo female with is an active runner has pain in right forefoot for 6 weeks and has been worsening over last week. Burning pain over plantar surface and licking sensation when third and 4th metatarsal heads are squeezed together
Diagnosis
Diagnostic
Treatment
Morton neuroma
- worsen when wearing tight or high heels or walking on hard surfaces ; pain reproduced when laterally compression metatarsal heads
Clinical
Padding /padded shoes
Left elbow swelling for one week. Over past month has been intensely exercising. Focal swelling over top of the olecranon and flu crane on palparían. No earth, redness or abrasion on exam
NBSIM
Elbow protection and NSAIDA
OLECRANON BURSITIS - caused by overuse, trauma, infection, rheumatoid
Tennis player with right heel pain for a month. Significant tenderness over medioplabtar regio of the heel and it is worsened with doraiflexion of toes.
Best initial treatment
Prognosis
OTC heel inserts
Activity modification. And physical therapy
Plantar fasciitis- overuse causes degeneration of the aponeurosis that connects the calcaneus to the metatarsals.
- pain when standing from rest or from long standing or walking
- pain when toes are dorsiflwxed
- pain with exercise, any thing that puts stress on arches such as obesity and flat feet, standing on hard surfaces for awhile
80% reviver within a year
