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#DOOS MSK > Neck, Back, Myofascial > Flashcards

Neck, Back, Myofascial Flashcards

1
Q

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

A

arthritis

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2
Q

_____ is ranked #1 in workers comp

A

lumbar pain

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3
Q

Define systemic dz

A

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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4
Q

Define local dz

A

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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5
Q

What is reiter’s syndrome

A

reactive arthritis d/t infection in the body

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6
Q

MSK pain can be caused by (4)

A

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

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7
Q

Important points to ask about with Hx (6)

A

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

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8
Q

Define nociceptive pain

A

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

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9
Q

define neuropathic pain

A

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

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10
Q

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

A

reactive arthritis

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11
Q

what is gunstock deformity

A

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

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12
Q

foot wear is important to assess b/c

A

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

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13
Q

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

A

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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14
Q

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

A

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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15
Q

How to test neurovascular

A

test pulses

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16
Q

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

A

spinal injury

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17
Q

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

A

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

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18
Q

Active RA pts normally have ___________ ___________ anemia

A

normochromic normocytic

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19
Q

Low Hct W/microcytic and elevated MCV often means…

A

low Fe or GI loss

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20
Q

Leukocytosis is seen in…. (5)

A

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

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21
Q

ESR is a good NON-specific indicator of

A

inflammationc (also of dz progression or therapy effectiveness)

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22
Q

ESR >___mm/hr is abnormal

A

15-20

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23
Q

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

A

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

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24
Q

Normal ESR reduces the likliness of _____

A

sepsis or active pathology

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25
Q

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

A

general non-specific inflammation

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26
Q

CRP declines with the use of … (3)

A

antinflammatory drugs, salicyclates, and steroids

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27
Q

high sensitivity CRP is used for

A

CVD risk factors or CVA

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28
Q

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

A

RA (not the gold standard)

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29
Q

Negative RF does/does not r/o RA?

Positive RF does/does not mean RA?

A

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

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30
Q

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

A

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

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31
Q

High _____ is 99% sensitive in SLE

A

ANA - higher titer = more likely SLE

but can be pos in many other autoim dzs(so not very specific)

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32
Q

ANA can be pos in ___ & _______

A

elderly and chronic hepatitis

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33
Q

Homogenous ANA pattern means ____ or ______

A

SLE or mixed CT d/o

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34
Q

speckled ANA pattern means… (6)

A

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

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35
Q

nucleolar ANA pattern means … (2)

A

polymyositis or scleroderma

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36
Q

centromere ANA pattern means .. (2)

A

CREST or Scleroderma

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37
Q

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

A

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

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38
Q

Neg ANA most likely r/o _____

A

SLE

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39
Q

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

A

HLA-B27

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40
Q

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

A

uric acid; crystals seen in synovial fluid draw

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41
Q

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

A

synovial fluid analysis

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42
Q

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

A

OA

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43
Q

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

A

Inflammatory dz (ie RA)

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44
Q

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

A

septic joint

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45
Q

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

A

gout

46
Q

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

A

psuedo-gout

47
Q

______ films are useful in early OA diagnostics

A

plain films (not so great for early RA)

48
Q

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

A

sacroiliac plain films (early on)

49
Q

trapezius trigger points refer to the _____and the ________

A

temples and neck behind the ear

50
Q

SCM trigger pts refer to _____and ________

A

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

51
Q

Scalene trigger points refer to ____ and ______

A

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

52
Q

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

A

stacked like coins, more vertical

53
Q

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

A

Kernig’s Sign and Brudzinski’s Sign meningitis

54
Q

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

A

X-ray

55
Q

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

A

CT

56
Q

What dermatome would be the lateral portion of the upper arm

A

C5

57
Q

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

A

C6

58
Q

what dermatome incorporated the middle finger

A

C7

59
Q

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

A

MRI

60
Q

_________ exam with suspected meningitis

A

CSF

61
Q

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

A

bone scan

62
Q

For _______ tissue pain use no or minimal narcotics

A

soft tissue(muscles)

63
Q

what is thoracic outlet syndome? (TOS)

A

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

64
Q

How does TOS present?

A

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

65
Q

What do you order to diagnose TOS? Treatment?

A

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

66
Q

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

A

mechanical

67
Q

most common back pain etiologies (3)

A

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

68
Q

2 most common causes of low back pain

A

prolapsed intervert disk, and strain(soft tissue)

69
Q

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

A

localized, one specific area of tenderness.

70
Q

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

A

nerve root irritation

71
Q

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

A

sciatica

72
Q

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

A

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

73
Q

pain in elderly, inc with walking relieved by leaning forward

A

spinal stenosis

74
Q

What are red flag sx for back pain (12)

A

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

75
Q

major categories of back pain

A

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

76
Q

severe, tearing pain midline in the back could mean

A

AAA, or a visceral injury

77
Q

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

A

pyelonephritis or a kidney stone

78
Q

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

A

cholelithiasis, peptic ulcer dz, or pancreatitis

79
Q

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

A

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

80
Q

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

A

upper hip and greater trochanteric area

81
Q

straight leg raise positive with pain between 30-70deg

A

sciatica

82
Q

X rays with LBP are…

A

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

83
Q

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

A

malignancy or inflamm

84
Q

__________ is elevated in paget’s dz and bone mets

A

ALK PHOS

85
Q

If you suspect mult myeloma check the urine for

A

Bence-Jones protein (lt chain)

86
Q

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

A

bone

87
Q

MRI is most useful for _________ pathology

A

spinal cord

88
Q

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

A

osteoporosis

89
Q

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

A

L4

90
Q

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

A

L5

91
Q

the ____ dermatome encompases the lat foot and pinky toe

A

S1

92
Q

facets are more __________ in the lumbar spine.

A

vertical

93
Q

the cauda equina starts at L____

A

L2-3

94
Q

What are the 5 waddels signs?

A

tenderness, simulation, distraction, regional disturbance, overreaction

95
Q

+____/5 is considered sig for waddels signs

A

3

96
Q

how to manage/treat mechanical LBP

A

NSAIDs, exercise, PT/OT, wt loss

97
Q

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

A

musc relaxants

98
Q

antidep may work for _______ LBP

A

chronic

99
Q

how do you manage a disk herniation

A

similar to acute LBP, NSAIDs, exercise, injections

100
Q

how do you manage spinal stenosis

A

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

101
Q

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

A

scoliosis

102
Q

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

A

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

103
Q

what is cauda equina

A

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

104
Q

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

A

bursitis(periarticular)

105
Q

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

A

supraspinatous

106
Q

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?

A

bicipetal tendonitis (periarticular)

107
Q

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

A

60-100 deg

108
Q

tennis elbow aka _____epicodylitis presents with weakness of hand extensors

A

lateral

109
Q

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

A

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

110
Q

what is central sensitization? (trigge pts)

A

decreased activation threshold

111
Q

for myofascial(trigger pt pain) opoids are….

A

NOT INDICATED

#DOOS MSK (4 decks)

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