Neck, Back, Myofascial Flashcards by ajriffic .

this #1 ranked life-altering dz affects 50 million people

arthritis

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_____ is ranked #1 in workers comp

lumbar pain

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Define systemic dz

less common, includes systemic sx such as fever, wt loss, derm changes, general feeling of unwell, change in appetite (tend to be autoimmune/congenital such as RA

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Define local dz

more common, occurs in otherwise healthy people, d/t overuse, strain or arthritis(age), orthopedic (things like tennis elbow, bursitis, back pain)

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What is reiter’s syndrome

reactive arthritis d/t infection in the body

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MSK pain can be caused by (4)

muscle/soft tissue, nerve, referred, other(STDs, shingles, Tb)

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Important points to ask about with Hx (6)

warmth/drainage/erythema, pop/click/snap, instability/fxnl impairment(motion strength), hand dominance, neuro sx, impact on daily life

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Define nociceptive pain

dull (can be sharp), aching, broad (musc), caused by damage to body tissues

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define neuropathic pain

d/t nerve damage or impinged nerve root, sharp, electric**, traveling, burning (along dermatome).

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It’s important to ask about sexual Hx b/c ______ can be transmited/result from sex

reactive arthritis

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what is gunstock deformity

pt carries arm 5-15 deg away from body – important to eval “Carrying angle” of limbs.. (AKA cubitus varus)

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foot wear is important to assess b/c

fall risk.. and wearing of one side vs other.

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Articular injuries show pain with… (tenderness, ROM, stability, swelling?)

AROM and PROM (and limited ROM with both), deep diffuse pain, swelling synovial thickening, bony enlargement (juxtaarticular bone, Articular cartilage, Intraarticular ligaments, Menisci (knee), Synovial fluid, Synovium, Joint capsule) may be unstable

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periarticular injuries show pain with… (tenderness, ROM, stability, swelling?)

AROM only, USUALLY HAVE FULL ROM, point or focal tenderness w/specific movements, generally w/o swelling or crepetis(Tendons, Bursae, Extraarticular ligaments, Muscle, Fascia, Bone, Nerve, Skin) no instability

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How to test neurovascular

test pulses

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with motor/muscle testing, score of 0-3 are normally only seen in _____ pts

spinal injury

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with motor/muscle testing a 4 is….. a 5 is…….

4 = can do full AROm, but weak against resistance, 5= normal

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Active RA pts normally have ___________ ___________ anemia

normochromic normocytic

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Low Hct W/microcytic and elevated MCV often means…

low Fe or GI loss

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Leukocytosis is seen in…. (5)

acute gout, septic arthritis, systemic idiopathic juevinille arthritis, systemic vasculitis, and chronic corticosteroid use.

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ESR is a good NON-specific indicator of

inflammationc (also of dz progression or therapy effectiveness)

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ESR >___mm/hr is abnormal

15-20

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ESR is a poor indicator of ______, C-reactive protein measures this better

disease remission (B/c sed rate stays elevated for a while, protein changes more quickly)

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Normal ESR reduces the likliness of _____

sepsis or active pathology

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CRP is a marker of ___________, similar to ESR but rises and falls more rapidly(greater accuracy)

general non-specific inflammation

CRP declines with the use of ... (3)

antinflammatory drugs, salicyclates, and steroids

high sensitivity CRP is used for

CVD risk factors or CVA

The higher the titer of RF, the more likely it is that the pt has

RA (not the gold standard)

Negative RF does/does not r/o RA? | Positive RF does/does not mean RA?

NEg RF doesn't r/o RA - 25% pts don't have RF but have RA | Pos RF doesn't mean RA, bc many other autoimmune dzs have RF as well

RF can be positive in___(5) dz in addition to RA

Scleroderma, subacute bacterial endocarditis, SLE, vasculitis, and some viral infections

High _____ is 99% sensitive in SLE

ANA - higher titer = more likely SLE | but can be pos in many other autoim dzs(so not very specific)

ANA can be pos in ___ & _______

elderly and chronic hepatitis

Homogenous ANA pattern means ____ or ______

SLE or mixed CT d/o

speckled ANA pattern means... (6)

SLE, scleroderma, sjogren's, Mixed CT d/o RA, polymyositis

nucleolar ANA pattern means ... (2)

polymyositis or scleroderma

centromere ANA pattern means .. (2)

CREST or Scleroderma

ANA titer above _____ is considered +, but a rate of ______ has a fare lower rate of false positives

1:40 1:160 (but titers fluctuate not necc indicative of severity)

Neg ANA most likely r/o _____

SLE

__________ is positive in 90% of spondyloarthropathies (ankylosing spondylitis)

HLA-B27

low/high levels of _______ don't r/o or r/i gout; ______is the GOLD STANDARD diagnostic

uric acid; crystals seen in synovial fluid draw

_________ is indicated when joint effusion is present to differentiate b/w inflamm and non-inflamm process

synovial fluid analysis

Yellow synovial fluid with 200-300 WBCs and 25% PMNs is indicative of

yellow-opal synovial fluid 3,00-5,000 WBCs is indicative of

Inflammatory dz (ie RA)

yellow-green (snot-like) synovial fluid with >50,000 WBCs and a positive culture is indicative of

septic joint

cloudy-yellow synovial fluid with monosodium urate (crystals) is indicative of

gout

cloudy-yellow synovial fluid with calcium pyrophosphate (crystals) is indicative of

psuedo-gout

______ films are useful in early OA diagnostics

plain films (not so great for early RA)

If you suspect a pt has spondyloarthropathy very important to get _________ __________ films

sacroiliac plain films (early on)

trapezius trigger points refer to the _____and the ________

temples and neck behind the ear

SCM trigger pts refer to _____and ________

around the eye and the back of the head (occipital region)

Scalene trigger points refer to ____ and ______

the lateral portion of upper arm, and medial border of the scapula

Facets in the neck are _______ which allows them to slide more easily out of place

stacked like coins, more vertical

Neck pain with fever, you should perform _________and ________ special tests for ________

Kernig's Sign and Brudzinski's Sign meningitis

__________ films needed w/trauma including hyperext, whiplash or LOC

X-ray

___________ films needed in severe trauma (fall from height, baseball to neck)

What dermatome would be the lateral portion of the upper arm

what dermatome incorporates the lateral portion of the lower arm and the thumb/pointer finger

what dermatome incorporated the middle finger

_____ is indicated with suspected disk problems and/or nerve root compression or spinal sx(sphincter or weakness)

MRI

_________ exam with suspected meningitis

CSF

tumor/mets expected in neck mean you need to order a __________

bone scan

For _______ tissue pain use no or minimal narcotics

soft tissue(muscles)

what is thoracic outlet syndome? (TOS)

neurogenic thoracic outlet compression of C8 or T1 nerve roots by C7 and 1st rib CT band

How does TOS present?

weakness/wasting of hand muscles with sensory disturbance of 5th digit

What do you order to diagnose TOS? Treatment?

cervical X-ray and surgical resection of cT band b/w C7 and 1st rib or remove the 1st rib.

90% of back pain is ________ in origin and resolves in 1-2wks

mechanical

most common back pain etiologies (3)

musc/soft tissue injury, disc dz, arthritis of facet

2 most common causes of low back pain

prolapsed intervert disk, and strain(soft tissue)

W/ MSK pain is typically ________. if it is regional, that is suspicious.

localized, one specific area of tenderness.

pain in the back with radiation down the legs is suggestive of

nerve root irritation

_______ pain is seen in the buttock, post thigh, postlat leg, including lat malleolus dorsum and sole

sciatica

unilat LBP with buttock pain that worsens with standing in one position

SI joint pathology (do a compression test of the SI joint)

pain in elderly, inc with walking relieved by leaning forward

spinal stenosis

What are red flag sx for back pain (12)

elderly, fever, wt loss, morning stiffness, hx IV drug use, steriod use long term, hx CA, Hx trauma, saddle anesthesia, bowel/bladder dysfxn, major motor weakness, less than 20yo

major categories of back pain

mechanical(spondylosis, stenosis, discogenic), inflamm(ankylosis spondylitis), metabolic(Pagets, osteoporosis), neoplastic, referred pain, other(DISH, fibromyalgia)

severe, tearing pain midline in the back could mean

AAA, or a visceral injury

Colicky pain at the lower border of the ribs on either side of the spine could mean

pyelonephritis or a kidney stone

colicky pain on the right upper back just inferior to the scapula could mean (3)

cholelithiasis, peptic ulcer dz, or pancreatitis

deep seated pelvic pain (of the butt) could indicate what to dzs? females only? males only?

crohns, and ulcerative colitis Females: PID, ectopic preg, endometriosis, fibroids Males: prostatitis

Trigger pts in the QL refer pain to _____and ________... this looks like hip bursitis

upper hip and greater trochanteric area

straight leg raise positive with pain between 30-70deg

sciatica

X rays with LBP are...

usually not helpful. use if red flags or greater than 1 month pain

anemia, CRP elevation, and/or ESR should raise suspiscion of ______ or _________

malignancy or inflamm

__________ is elevated in paget's dz and bone mets

ALK PHOS

If you suspect mult myeloma check the urine for

Bence-Jones protein (lt chain)

_____ scans are helpful in pagets, osteomyelitits, metastasis and some fx

bone

MRI is most useful for _________ pathology

spinal cord

In a postmenopausal female with a low BMI and frail looking suspect

osteoporosis

the __________ dermatome runs from the lateral leg(trochanteric area) down to the medial surface of the foot and nthe big toe

the _______ dermatome runs from the lat calf to the 3 middle toes

the ____ dermatome encompases the lat foot and pinky toe

facets are more __________ in the lumbar spine.

vertical

the cauda equina starts at L____

L2-3

What are the 5 waddels signs?

tenderness, simulation, distraction, regional disturbance, overreaction

+____/5 is considered sig for waddels signs

how to manage/treat mechanical LBP

NSAIDs, exercise, PT/OT, wt loss

IF pt has spasms or trouble sleeping with acute LBP you can prescribe

musc relaxants

antidep may work for _______ LBP

chronic

how do you manage a disk herniation

similar to acute LBP, NSAIDs, exercise, injections

how do you manage spinal stenosis

Similar to acute LBP NSAIDs musc relaxants, PT (maybe eventual surgery-fusion)

Girls at the start of puberty until maturity are at a greater risk for _______________

scoliosis

thoracic curve to the _____ is common at the level of T__ - T___. if to the ______ suggest other cord pathology. Curve > ____ deg is sig

right at T7-T8; to the left is very rare and suggests other pathology >15deg

what is cauda equina

large midline disc herniation compressing L4-L5 (bowel bladder dysfxn, leg pain saddle anesthesia, numbness)

Overuse and repatative motion can lead to _____, which is treated with NSAIDs, steroid injection via ultrasound guidence

bursitis(periarticular)

the _______ muscle is most likely to be impinged or cause rotator cuff tendonitis

supraspinatous

45 y/o male complains of dull aching pain in his upper arm that radiates distally after 3 days of bowling in a tournament... dx?

bicipetal tendonitis (periarticular)

supraspinatous tendonitis pain would be felt at ___-____deg of abduction

60-100 deg

tennis elbow aka _____epicodylitis presents with weakness of hand extensors

lateral

what are the 3 components of the motor endplate hypothesis(trigger pts)

1)motor component (contraction knots) 2)sensory component binds to nociceptors and transmits pain 3)Autonomic component (localized swellinglacrimation, dizziness)

what is central sensitization? (trigge pts)

decreased activation threshold

for myofascial(trigger pt pain) opoids are....

NOT INDICATED