Week 1: Med-Screening for the Shoulder and Upper Extremity Flashcards
MSK conditions to screen for during an exam for the upper extremity
- Cervical fracture
- Cervical myelopathy
- Upper cervical spine ligament laxity
- Spinal infection
Algorithm for determining if imaging is needed for cervical fracture
- High risk factor? If no, then…
- Low risk factor? If no, then…
- Able to rotate neck 45 degrees? If yes, then no imaging
High risk factors for cervical fracture
- 65+
- Dangerous MOI
- Upper extremity paresthesia
Low risk factors for cervical fracture
- Simple MVC
- Sitting position in ER
- Ambulatory at any time
- Delayed-onset neck pain
- Absence of midline cervical spine tenderness
What is cervical myelopathy
- UMN lesion
- Pressing or pressure against the spinal cord
Mechanical causes of cervical myelopathy
- Trauma (ligament instability, fracture)
- Spinal cord compression
- Degenerative changes
- Bulging discs, thickened ligamentum flavum
- RA w/ atlanto-axial subluxation
Systemic causes of cervical myelopathy
- MS, ALS
- Guillain-Barre
- Multifocal motor myelopathy
Diagnostic cluster for cervical myelopathy
3/5 positive tests:
- Gait deviation
- Hoffman’s test
- Inverted supinator sign
- Babinski test
- > 45 years old
What ligaments are we concerned with for upper cervical ligamentous laxity?
- Alar
- Transverse
Signs and symptoms of upper cervical ligamentous laxity
- Occipital headache and numbness
- Severe limitation during neck AROM in all directions
- Signs of cervical myelopathy
Causes of upper cervical ligamentous laxity
- Trauma
- RA w/ atlanto-axial subluxation, Down syndrome, and Klippel-Fiel
- Os odontoideum
- Odontoid fracture
Os odontoideum
-
Odontoid fracture
-
How to test for upper cervical ligamenout laxity
- Alar ligament stress test
- Transverse ligament test/anterior shear test
- Sharp-Purser test
Signs and symptoms for spinal infection
- Unrelenting spine pain
- Worse/severe pain at night (no change w/ positions)
- Fever, chills, fatigue
- Concurrent infection or IV drug use
- Possible redness, swelling, warmth
What to do in event of spinal infection
Refer for imaging and clinical lab tests
Treatment for spinal infection
- Antibiotic therapy
- Surgical decompression
Cardiovascular conditions to screen for during an exam for the upper extremity
- Cardiovascular event
- Cervical spine arterial dysfunction
Signs and symptoms of cardiovascular event
- Chest pain
- Abdominal pain
- Shortness of breath
- Heart palpitation
- Irregular HR
- Dizziness, nausea
- Peripheral edema
- Syncope
MSK complaints indicating cardiovascular event
- Jaw, neck, shoulder, arm, and back pain
- Myalgias, muscular fatigue, and muscle atrophy
- Weakness and fatigue
- Poor exercise tolerance
Signs and symptoms of cervical arterial dysfunction
5 D’s And 3 N’s
- Dizziness
- Drop attacks
- Dysphagia
- Dysarthria
- Diplopia
- Ataxia
- Nausea
- Numbness
- Nystagmus
Pulmonary conditions to screen for during an exam for the upper extremity
- Pulmonary event
- Pneumothorax
- Pulmonary embolism
Pain descriptors for a pulmonary event
- Sharp, localized
- Aggravated by breathing, coughing, sneezing, laughing, etc
- Better in upright/worse in recumbent
- Better w/ autosplinting
Signs and symptoms for pulmonary event
- Dyspnea/shortness of breath
- Persistent cough
- Fevers, chills, general malaise
- Weak, rapid pulse w/ fall in BP
- Cyanosis
Cyanosis
-
Signs and symptoms for pneumothorax
- Shortness of breath
- Dry cough
- Acute onset sharp pain in the chest
- Refer to ipsilateral shoulder/upper traps
- Drop in BP
- More pain in recumbent, better in sitting
Predictor variables for pulmonary embolism
- Clinical s/s of DVT (3)
- No alternative diagnosis (3)
- HR > 100 (1.5)
- Immobilization after surgery in past 4 wks (1.5)
- Previous DVT/PE (1.5)
- Hemoptysis (1)
- Malignancy (current/past 6 months) (1)
Probability of pulmonary embolism based on predictor variable
- <2 points = low risk = 3.6% probability
- 2-6 points = moderate risk = 20.5% probability
- > 6 points = high risk = 66.7% probability
Symptoms of stomach, duodenal, or pancreatic conditions
- Gnawing, cramping, burning, heartburn, aching
- Weight loss, nausea, vomiting, fever, malaise
- Pain in wave associated w/ eating/drinking
- Black “tarry” or light colored stools
Causes of stomach, duodenal, or pancreatic conditions
- Gastric, pyloric, or duodenal ulcers
- Stomach cancer
Review referral patterns for GI and renal conditions
-
Where is the most common site of metastases?
Skeleton
Where are metastases located in the spine?
- 60% thoracic
- 40% lumbosacral
- Rare in c-spine
“Lead kettle” for cancers that cause spinal pain
PB KTLL
- Prostate
- Breast
- Kidney
- Thyroid
- Lung
- Lymphoma
Cancers affecting the cervico-thoracic spine
- Thyroid and esophageal cancer
- Hodgkin’s lymphoma
- Pancoast’s tumor
- Multiple myeloma
- Breast cancer
- Organ cancers can refer to the T-spine
Diagnostic cluster for cancers
Age 50+ OR unexplained weight loss OR previous hx of cancer OR failure to improve over 1 month
Common risk factors for depression
- Current or hx of depression
- Family hx of major depression
- Hx of MI, CA, CVA, substance abuse
- Significant loss or change in social status
- Pregnant or post-partum
- Fatigue or sleep disturbance
- Women > men
- Chronic pain or 2+ chronic diseases
Risk factors for major depression disorder
- Depressed mood most of the day, nearly every day
- Markedly diminished interest or pleasure in all, or almost all, activities
Common risk factors for suicide
- Family hx
- Sense of hopelessness
- Previous attempts or plan
- Major depression and/or substance abuse
- Males (higher rate of completion)
- Females (higher attempt rate)
