Other MSK MDT Flashcards
The following describes what injury:
- Major cause of chest pain in the ambulatory setting
- Causes of this syndrome poorly studied and documented
- Likely secondary to viral illness and other causes of inflammation
- Other rheumatic diseases such as fibromyalgia a common cause of chest wall pain
- Chest pain is said to “reproducible”
Costochondritis
What must you r/o before dx of Costochondritis
- Myocardial ischemia
- Infarction
- Pulmonary embolism
- Aortic dissection
- Pneumothorax
Pt presents with:
- Chest pain is said to “reproducible”
- Able to exacerbate pain with palpation on physical exam
Costochondritis
Treatment of Costochondritis
- Most cases improve course of few weeks:
- NSAIDS
- Home stretching program
- Activity modification
- Refer all patients in which the diagnosis is unclear
The following describes what injury:
- Knee joint accounts for approximately 80% of cases
- Also affects:
Hand
Spine
Hip
Osteoarthritis
The following are risk factors for what condition
- Age: more common in older population
In general population age over 50
-Gender: greater risk in females
1.7 times as likely as males
-Family history
-Joint injuries
-Chronic inflammation
-Obesity
-Occupation
Heavy workload
Osteoarthritis
Common sites of osteoarthritis
- Hips
- Knees
- Spine
- Hands
Pt presents with:
- Joint Pain that is exacerbated with use, alleviated with rest
- Joint Pain is aching, deep in later stages
- Sharp joint pain in beginning stages
Osteoarthritis
Plain films show the following:
- Joint space narrowing
- Osteophytes
- Subchondral sclerosis
- Cysts
Osteoarthritis
Treatment of Osteoarthritis
- Control Pain
- NSAIDs
- Tylenol
- Activity/lifestyle modification
- Weight reduction
- Loss of 10% body weight associated with 50% reduction in pain over 18 months
- Rehabilitation
- Aerobic and strengthening exercises
The following describes what injury:
- Unknown etiology
- Autoimmune disorder
- Insidious onset, distal joints first (DIPJ of hands are spared)
- Extra-articular manifestations (pulm, CV, eyes)
- Mostly small joints and bilateral: hands, finger, wrists, feet, ankle
Rheumatoid Arthritis
Pt presents with:
4 of 7 ACR criteria:
- Morning stiffness (1 hour for 6 weeks)
- Arthritis (>/= 3 joints for 6 weeks)
- Swelling of hand joints (6 weeks)
- Symmetrical joint swelling (6 weeks)
- Rheumatoid nodules
- Positive RF factor
- Erosions or osteopenia in hand XR
- May have myelopathy with C1-C2 involvement
Rheumatoid arthritis
Pt PE:
- Nodules (elbow mostly)
- Swelling/hypertrophy (esp PIP early sign)
- Swan neck deformity
- Lateral drift of toes
- Boggy sensation
- ROM Diminished and painful
Rheumatoid arthritis
Treatment of Rheumatoid arthritis
- MEDAVICE with GMO or refer to Internal Medicine
- Typical medications used:
NSAID/Tylenol
DMARD (Disease-Modifying Anti-Rheumatic Drug)
-ab, , etanercept, methotrexate, hydroxychloroquine, cyclosporine - Physical Therapy/Surgery
The following describes what injury:
- preceeded and precipitated by infection in the body
- Urinary Tract Infection
- Diarrheal illness
- Sexually Transmitted Infections
- Incidence estimated around 10 per 1,000
Interval of days to weeks between infection and onset of pain
Reactive arthritis
Pt presents with:
- Acute onset of joint pain 1-4 weeks after infection
- Peripheral arthritis
Knees
Small joints of hands/wrists
Enthesitis
- Inflammation of insertion sites of ligaments, tendons, fascia
- Achilles tendon commonly involved
- Dactylitis (“sausage digits”)
- Lower back pain
- Extra articular manifestations
Reactive arthritis
Treatment of reactive arthritis
- Treat infection if active
- Symptoms self limited
- May last up to 6 months
- NSAIDs for pain
- Severe cases
- Refer to specialist
DMARDs/steroids considered
The following describes what injury:
- Common inflammatory skin disease
- Most common manifestation: well-demarcated erythematous plaques with silver scale
- Other presentations: guttate, pustular, erythrodermic, inverse, nail psoriasis
- Affects women and men equally
- 1 to 2 per 1000 people affected in general population
Psoriatic arthritis
Pt presents with:
- Pain and stiffness in affected joints
- Stiffness sometimes alleviated by physical activity
- Asymmetric distribution of joint pain
SI joint, large joints (such as knee), small joints (such as DIP)
- Majority have skin lesions prior to pain
- Pain may precede lesions
- Soft tissue inflammation: enthesitis, dactylitis, tenosynovitis
- Nail lesions
- Ocular involvement
Psoriatic arthritis
Treatment of Psoriatic arthritis
- Do not attempt to manage
- Refer to rheumatology and dermatology
- Treat symptoms in the interim
- NSAIDs
- DMARDs to be considered by specialist
The following describes what injury:
- Inflammatory arthritis of the spine
- Potential cause of chronic lower back pain
- More common in men
- Estimated prevalence in North America: 31.9 per 10,000
- Also periarticular features:
- Uveitis
- Psoriasis
- Inflammatory Bowel Disease
Ankylosing Spondylitis
Pt presents with:
- Back pain in almost all patients
-“Bamboo spine”: severe restriction in back mobility seen in about half of patients in later stages of disease progression
- Large joints involved:
Sacroiliac joint, spine, hip, shoulder
Peripheral arthritis common
Chest wall inflammation
Enthesitis
Dactylitis
Ankylosing Spondylitis
Treatment of Ankylosing spondylitis
For our purposes, recognize and refer
- Initial pain relief with NSAIDs
- Expect use of DMARDs after rheumatology referral
- Minimize damage to spine
- Minimize other manifestations
- Psychological screening and surveillance
The following describes what injury:
- Monosodium urate crystal deposition in joints and tissues (tophi)
ie: uric acid deposition
Gout
Pt presents with:
- Mostly monoarticular (80% of the time)
- Common sites of involvement
1st toe, ankle, knee, wrist, fingers, elbow
- Intense pain, redness, swelling,
- Occurs in hours to days
Gout
Pt PE:
- Big toe Swelling, erythema; tophi
- Severe tenderness even to light touch
- Limited and guarded
Gout
Treatment of Gout
Acute Episode
- NSAID (Indomethacin)
- Colchicine (n/v/d; bone marrow suppression, neuropathy)
- Steroids
Prophylaxis gout
- Allopurinol (overproducers)
- Probenecid (underexcreters; UA <600mg/day)
What food should be avoided for gout
- Meat
- Seafood
- Alcohol
-High-fructose corn syrup
The following describes what injury:
- Similar clinical presentation to gout
- Intensely painful,joint swelling,erythema
- Larger joints such as the knee often affected
- Uric acid levels are NORMAL
- Pathophysiology is based on calcium pyrophosphate deposition (CPPD)
Pseudogout
How is Pseudogout and gout differentiated
Analysis of joint aspiration reveals rhomboid shaped crystals confirms pseudogot
The following describes what injury:
- Staphylococcus aureus most common
- Infection of the joint space
- Direct inoculation, hematogenous spread, or from a bone infection
Septic Arthritis
Pt presents with:
- Severe pain, swelling, decreased mobility
- Difficulty bearing weight
- Fever, tachycardia
- Post-surgical patients
- Previous STI
Septic Arthritis
Treatment of Septic Arthritis
- MEDEVAC
- Supportive if having shock (IV, monitors, O2, VS, bolus of IVF)
- IV antibiotics (ceftriaxone, vancomycin)
What is virchow’s triad
- Hypercoagulability
- Venous Stasis
- Endothelial Damage
Pt presents with:
- Pain in the limb
- Edema (unilateral)
- Erythema
DVT
Pt PE:
- Edema is common finding
- Palpable veins (cords) may be present
- Fever
- Homans sign (pain with ankle dorsiflexion)
- Erythema around the clot site
DVT
Venous thrombosis wil become a what in most cases?
Pulmonary embolism
Non-displaced fracture definition
in anatomic alignment
Displaced fracture definition
not in anatomic alignment; described as a percentage
Bayonetted fracture definition
distal fragment overlaps proximal fragment
Distracted fracture definition
fragments are separated
Angulation fracture definition
deviation at an angle
Treatment of fractures is guided by the four R’s
- Recognition
- Reduction
- Retention of reduction while achieving union
- Rehabilitation
What should be checked before and after a splint?
Pulses and sensation
How should femoral fractures be splinted?
With traction
How should the spine be splinted?
Spine board/C-collar
How should the clavicle be splinted?
Sling
How should the pelvis be splinted?
Pelvic binder
