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Regional MSK Pain Syndromes Flashcards

1
Q

overuse syndromes - defined

A

*repetitive action causes chronic trauma / irritation
*trauma → inflammatory cascade → painful range of movement & swelling → disability

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2
Q

overuse syndromes - epidemiology

A

*fairly common in the general population
*increase in incidence in systemic diseases (diabetes, rheumatoid arthritis)
*increase in incidence in particular occupations

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3
Q

overuse syndromes - general treatment principles

A

*education & prevention are most important
1. treatment of active inflammation:
-NSAIDs, anti-inflammatories
-ice initially, heat later
2. RICE: rest, ice, compression, elevation
3. decrease causative movements/triggers: time off sport or work; braces
4. control pain: NSAIDs (oral, topical), aspirin
5. steroid injections: pain control, decrease inflammatory process

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4
Q

stenosing tenosynovitis - symptoms

A

*aka “trigger finger”
*“locking” of the digit of the finger in flexed position
*describe having to use their other hand to extend their finger
*may also click or catch

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5
Q

stenosing tenosynovitis - physical exam

A

*aka “trigger finger”
*nodule/thickening of flexor tendon
*may have inflammation of retinacular sheath
*diagnosed based on history & exam

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6
Q

stenosing tenosynovitis - treatment

A

*steroid injection
*NSAIDs for pain relief (oral or topical)
*surgery if refractory

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7
Q

Dupuytren’s contracture - pathophysiology

A

*fibroproliferative disease of the palmar fascia with resultant deformity (most commonly 4th and 5th digit)

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8
Q

Dupuytren’s contracture - epidemiology

A

*men > women
*age > 50
*risk factors: DM, EtOH, smoking

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9
Q

Dupuytren’s contracture - symptoms

A

*often painless
*contracture of the 4th and 5th digits
*difficulty extending fingers (even with the other hand) and grasping objects

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10
Q

Dupuytren’s contracture - physical exam

A

*flexion contractures of most commonly the 4th and 5th digits (MCP, PIP joints)
*diagnosis based on history and exam

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11
Q

Dupuytren’s contracture - treatment

A

*no great therapy (surgery? collagenase injections?)

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12
Q

carpal tunnel syndrome - overview

A

*aka median nerve entrapment syndrome
*carpal tunnel bound on dorsal and lateral surfaces by carpal bones; on volar surface by transverse carpal ligament
*numerous flexor tendons and median nerve pass through this canal
*pressure on median nerve causes the symptoms; may be intrinsic or extrinsic to tunnel

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13
Q

carpal tunnel syndrome - risk factors

A

*aka median nerve entrapment syndrome
*risk factors include:
-pregnancy
-rheumatoid arthritis
-repetitive tasks involving wrist flexion (hairdresser, typist, receptionist)

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14
Q

carpal tunnel syndrome - symptoms

A

*aka median nerve entrapment syndrome
*symptoms include:
-paresthesia, pain, and numbness in the median nerve distribution: palmar side thumb, index, and middle fingers
-often worse at night

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15
Q

carpal tunnel syndrome - physical exam

A

*aka median nerve entrapment syndrome
* Tinel’s sign: percussion over median nerve reproduces the symptoms
*Phalen’s maneuver: wrist in complete flexion; pushing the dorsal surface of both hands together for 30-60 seconds; reproduces the symptoms
*diagnosis based on history and physical exam

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16
Q

carpal tunnel syndrome - treatment

A

*aka median nerve entrapment syndrome
*splints to keep wrist extended (night time)
*NSAIDs for pain control, if needed
*treat underlying cause, if present
*consider steroid injection
*surgery to remove transverse carpal ligament if conservative measures fail

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17
Q

important board information for carpal tunnel syndrome

A

*associated with:
1. acromegaly
2. hemodialysis-related amyloidosis

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18
Q

De Quervain’s tenosynovitis - overview

A

*noninflammatory thickening of abductor pollicis longus & extensor pollicis brevis tendons → pain or tenderness at radial styloid
*EPB (extensor pollicus brevis) and APL (abductor pollicus longus) tendons pass through a synovial sheath

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19
Q

De Quervain’s tenosynovitis - epidemiology

A

*women > men
*often seen post-partum

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20
Q

De Quervain’s tenosynovitis - symptoms

A

*pain on radial aspect of the wrist
*wrist pain
*difficulty grabbing objects, pinching

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21
Q

De Quervain’s tenosynovitis - physical exam

A

*Finkelstein test: fingers wrap around thumb and ulnar deviate the hand sharply; pain at the base of the thumb
*diagnosis = clinical

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22
Q

De Quervain’s tenosynovitis - treatment

A

*SPICA splint to rest thumb
*NSAIDs, rest
*injection if severe

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23
Q

lateral epicondylitis - pathophysiology

A

*aka tennis elbow
*inflammation/micro-trauma of extensor tendons at insertion on lateral epicondyle

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24
Q

lateral epicondylitis - risk factors

A

*aka tennis elbow
*age > 50
*non-professional tennis players
*gardeners
*carpenters

25
lateral epicondylitis - symptoms
*aka tennis elbow *pain on lateral aspect of the elbow *pain worsens with activity *difficulty lifting up heavier objects
26
lateral epicondylitis - physical exam
*aka tennis elbow *localized tenderness 1.5 cm distal to the origin of the extensor carpi radialis brevis (ECRB) *painless ROM at the elbow ***restricted wrist extension** with elbow in full extension reproduces pain
27
lateral epicondylitis - treatment
*aka tennis elbow *stop activities that aggravate, correct improper techniques *NSAIDs for pain control *counter-force brace *steroid injections
28
medial epicondylitis - pathophysiology
*aka Golfer's elbow *inflammation/micro-trauma of flexor tendons at insertion on medial epicondyle
29
medial epicondylitis - epidemiology
*aka Golfer's elbow *age 45-55 *seen in golfing / throwing sports
30
medial epicondylitis - symptoms
*aka Golfer's elbow *aching pain over the medial elbow *ulnar nerve symptoms possible
31
medial epicondylitis - physical exam
*aka Golfer's elbow *pain with **resisted wrist flexion** with the elbow in full extension
32
medial epicondylitis - treatment
*aka Golfer's elbow *stop activities that aggravate *correct improper techniques *NSAIDs for pain control *physical therapy
33
olecranon bursitis - epidemiology
*ages 40-50 yo *male > female *50% with preceding trauma *associated with repetitive trauma or systemic disease (RA, gout), can be infectious
34
olecranon bursitis - symptoms
*pain, redness, swelling over bursa of olecranon (elbow) *can have asymptomatic swelling
35
olecranon bursitis - physical exam
*erythema and swelling at bursa *tenderness to area *may have decreased ROM
36
olecranon bursitis - treatment
*aspirate the bursa to rule out infection, other causes *aspiration improves pain (decreases swelling) *elbow protection (if repetitive trauma) *consider steroid injection if persistent (and not infected)
37
trochanteric bursitis - pathophysiology
*acute or repetitive trauma leads to inflammation of the trochanteric bursa and surrounding tendons (sac surrounding the hip joint)
38
trochanteric bursitis - symptoms
*lateral hip pain, localized but may radiate *worsens with ambulation, standing, climbing stairs, or inclines *patient complains that they cannot lie on that side (may keep them up at night)
39
trochanteric bursitis - physical exam
*point tenderness over trochanteric bursa
40
trochanteric bursitis - treatment
*short course of NSAIDs *rest, stretching (especially IT band) *physical therapy for stretching *consider steroid injection if conservative therapy does not help
41
pes anserine bursitis - pathophysiology
*area on medial aspect of knee joint where tendons of 3 muscles (semitendinosus tendon, gracilis tendon, sartorius tendon) joint to form a common insertion point
42
pes anserine bursitis - risk factors
*obese *females *osteoarthritis
43
pes anserine bursitis - symptoms
*painful medial knee *exacerbated by activities such as rising from a chair or going up and down the stairs, walking up inclines (hills)
44
pes anserine bursitis - physical exam
*painful palpation around pes anserine (medial knee) *erythema
45
pes anserine bursitis - treatment
*NSAIDs *rest *RICE therapy *physical therapy *consider steroid injection
46
popliteal (Baker's) cyst - pathophysiology
*caused by distention of connecting gastrocnemius and semi-membranous bursae *often from underlying joint pathology (causes swelling)
47
popliteal (Baker's) cyst - symptoms
*may be asymptomatic *posterior leg edema/mass at back of knee (can look like DVT) *discomfort, potentially decreased ROM if big enough
48
popliteal (Baker's) cyst - treatment
*rest, ice, NSAIDs *ultrasound-guided drainage *treat underlying causes (arthritis of the knee)
49
plantar fasciitis - pathophysiology
*plantar fascia connects MTPs to calcaneus *insertion sites and the fascia itself can become inflamed
50
plantar fasciitis - risk factors
*peak incidence 40-60yo *obesity, excessive standing, runners, military recruits
51
plantar fasciitis - symptoms
*inferior heel pain *worse with movement (first few steps in the morning very painful)
52
plantar fasciitis - physical exam
*pain with dorsiflexion of the toes (like when walking on heels; toes to sky) *palpation along fascia from heel to forefoot elicits pain
53
plantar fasciitis - treatment
*NSAIDs, rest, RICE therapy *stretching exercise *rolling cold coke can/frozen water bottle along fascia *consider steroid injection
54
Morton's Neuroma - pathophysiology
*entrapment neuropathy of an interdigital nerve *more common in females > males
55
Morton's Neuroma - symptoms
*burning pain in third intermetatarsal space that can radiate towards the toes *numbness or pain that increases with activity
56
Morton's Neuroma - physical exam
***Mulder's sign:** clicking sensation upon palpation of the involved interspace while squeezing the metatarsal joints *tenderness to palpation
57
Morton's Neuroma - diagnosis
*clinical *MRI and ultrasound are options if diagnosis is questionable
58
Morton's Neuroma - treatment
*mechanical (inserts in shoes, proper shoe fit) *consider injection

Family Medicine Shelf (11 decks)

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