Week 1: Med-Screening for the Shoulder and Upper Extremity Flashcards by Devin Bastian

MSK conditions to screen for during an exam for the upper extremity

Cervical fracture
Cervical myelopathy
Upper cervical spine ligament laxity
Spinal infection

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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

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High risk factors for cervical fracture

65+
Dangerous MOI
Upper extremity paresthesia

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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

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What is cervical myelopathy

UMN lesion

- Pressing or pressure against the spinal cord

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Mechanical causes of cervical myelopathy

Trauma (ligament instability, fracture)
Spinal cord compression
Degenerative changes
Bulging discs, thickened ligamentum flavum
RA w/ atlanto-axial subluxation

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Systemic causes of cervical myelopathy

MS, ALS
Guillain-Barre
Multifocal motor myelopathy

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Diagnostic cluster for cervical myelopathy

3/5 positive tests:

Gait deviation
Hoffman’s test
Inverted supinator sign
Babinski test
> 45 years old

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What ligaments are we concerned with for upper cervical ligamentous laxity?

Alar

- Transverse

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Signs and symptoms of upper cervical ligamentous laxity

Occipital headache and numbness
Severe limitation during neck AROM in all directions
Signs of cervical myelopathy

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Causes of upper cervical ligamentous laxity

Trauma
RA w/ atlanto-axial subluxation, Down syndrome, and Klippel-Fiel
Os odontoideum
Odontoid fracture

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Os odontoideum

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Odontoid fracture

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How to test for upper cervical ligamenout laxity

Alar ligament stress test
Transverse ligament test/anterior shear test
Sharp-Purser test

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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

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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)