Note Set 1 Flashcards
Differential Diagnosis
the distinguishing of a disease or condition from others presenting with similar signs and symptoms
ROWS
rule out worse case scenarios
What does the DDX process involve
clinical signs and symptoms physical examinations knowledge of pathology mechanisms of injury provacative and motion tests palpation laboratory findings diagnosis imaging
Common Bone Conditions
Tumor - primary, metastatic Osteochondrosis / Apophysitis Fracture Osteopenia / Osteoporosis Osteomyelitis Congenital Anomalies and Variants
Common Soft Tissue / Muscle Conditions
Strain or Rupture Trigger Points Atrophy Myositis Ossificans Muscular Dystrophy Rhabdomyositis (muscle breaks down, release myoglobin protein into blood) Ligament: sprain / rupture Bursa: bursitis Fascia: myofascitis
Common Joint Conditions
Arthritis, OA, DDD
Subluxation / Fixation
Joint Mice
Dislocation / Subluxation (medical)
Acute Traumatic Pain look for:
rule out fx, dislocation, instability, neural and vascular injury
Nontraumatic Pain look for:
rule out tumors, inflammatory arthritis, infix, visceral referral
If traumatic:
what is the mechanism of injury
If overuse:
what is the repetitive motion and what is the positional status of the patient
If insidious:
are there systemic signs; fever, lymphadenopathy, multiple areas affected, local signs of inflammation, deformity, associated weakness, numbness, tingling, or neurologic dysfunction
Evaluation
always examine the area of complaint visualization palpation AROM, PROM, resisted ROM Orthopedic and Neurologic Exam Radiographs Specialized Imaging Laboratory Manage Co-Manage Emergent Referral
Orthopedic Exam
Reproduce Complaints
Reveal Laxity
Demonstrate Weakness
Demonstrate Restriction
Radiographs
decision to radiograph is based on relative risk
are there red flags
is the patient high risk or low risk
combine history, clinical presentation and history
Red Flag: > 6 weeks
tumor, infxn, rheumatologic disorder
Red Flag:
congenital defect, tumor, infxn, spondylolysis, spondylolisthesis
Red Flag: > 50 yo
tumor, intra-abdominal processes (AAA) , infxn
Red Flag: Major Trauma or Minor Trauma in Elderly
fx
Red Flag: Cancer
tumor
Red Flag: fever, chills, night sweats
tumor, infxn
Red Flag: weight loss
tumor infxn
Red Flag: injection drug use
infxn
Red Flag: immunocompromised status
infxn
Red Flag: recent genitourinary or gastrointestinal procedure
infxn
Red Flag: night pain
tumor, infxn
Red Flag: unremitting pain, even when supine
tumor, infxn, AAA, nephrolithiasis
Red Flag: pain worsened by coughing, sitting, or Valsalva
herniated disc
Red Flag: pain radiating below knee
herniated disc or nerve root compression below the L3 nerve root
Red Flag: incontinence
cauda equina, spinal cord compression
Red Flag: saddle anesthesia
cauda equina, spinal cord compression
Red Flag: severe or rapidly progressive neurologic deficit
cauda equina, spinal cord compression
WIRS
weakness
instability
restricted movement
surface complaints and pain
Weakness
may be due to to pain inhibition, muscle strain or neurologic interuption
Instability
maybe due to damaged ligaments, muscles, or inherent looseness
Restricted Motion
due to pain, muscle spasm, soft tissue contracture, joint mice, fracture or soft tissue swelling/effusion
Surface Complaints
skin lesions, cuts/abrasions, swelling, patient subjective sense of numbness or paresthesia
Pain
pain is nonspecific; is it local or referred pain
General Management
refer fx/dislocations, infxn and tumors for ortho mgmt
refer or co-manage rheumatoid and connective tissue disorder
instability without ligament rupture, stabilize the joint through exercise or brace
weakness - strengthen muscle
manipulation/mobilization for articular disfunction
