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SAPE October 2015 > MUSCULOSKELETAL > Flashcards

MUSCULOSKELETAL Flashcards

1
Q

Signs & Sxs:

  • Unilateral elbow pain
  • Dull ache that increases with grasping and turning
  • Tenderness over insertion point
  • Increased pain with extension of wrist against resistance
A

Lateral epicondylitis (tennis elbow)

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2
Q

Signs & Sxs:

  • Burning pain and/or tingling in fingers, esp at night
  • Sxs relieved by rubbing or shaking hands
  • Sxs occur when driving, reading, or with repetitive maneuvers
A

Carpal Tunnel

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3
Q

Signs & Sxs:

  • Decreased ROM, joint crepitus and pain
  • Stiffness less than 15 min duration, esp morning and after sitting
  • Weakness and wasting of muscles acting on the joint
  • Common in DIP, PIP, hip, knee, spine
A

Osteoarthritis

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4
Q

Signs & Sxs:

  • Swelling, heat, deformity, pain on PROM
  • Morning stiffness
  • Ulnar deviation, MCP and PIP swelling
  • Malaise, fatigue, depression, anorexia, osteoporosis
  • Common in knee, wrist, elbow, shoulder, ankle, neck
A

Rheumatoid arthritis

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5
Q

Signs & Sxs:

  • Pain, swelling, redness and tenderness develop suddenly at joint
  • Attacks generally 3-10 days
  • First attack usually at MTP of great toe
A

Gout

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6
Q

Most common form of joint dz

A

Osteoarthritis

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7
Q

What are common sites of OA?

A

-DIP
-PIP
-hip
-knee
-spine
(Axial skeleton - large joints)

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8
Q

What signs or features might be seen on xray for osteoarthritis?

A
  • asymmetric joint narrowing
  • bony sclerosis
  • subchondral cysts
  • misalignment of joint
  • marginal osteophytes
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9
Q

Where are Heberden’s Nodes found?

A

-seen in OA at the DIP joint

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10
Q

Where are Bouchard’s Nodules found?

A

-seen in OA at the PIP joint

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11
Q

Tx for OA

A
  • weight reduction, exercise
  • APAP, salicylates, intra-articular steroids
  • surgical
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12
Q

Common sites for RA

A
  • knee
  • wrist
  • elbow
  • shoulder
  • ankle
  • neck
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13
Q

What are the diagnostic criteria for RA?

A
  • 5 of 7 must be present
  • morning stiffness >1 hour
  • arthritis of >3 joint groups
  • swelling of wrist, PIP or MCP
  • symmetrical joint swelling
  • subQ nodules
  • positive rheumatoid factor test
  • radiographic changes
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14
Q

What tests and results are expected for RA?

A
  • ESR and CRP elevated
  • Rheumatoid factor often positive
  • bone erosions at the joint
  • symmetrical joint space narrowing
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15
Q

Tx for RA

A
  • consult rheumatologist
  • PT
  • NSAIDs and aspirin
  • DMARDs: methotrexate, sulfasalazine, hydroxychloroquine
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16
Q

First joint usually attacked with gout

A

MTP of great toe

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17
Q

What causes gout?

A

-deposits of urate crystals in tissue results in arthritis, tophi, nephropathy, and nephrolithiasis

18
Q

What tests are done for gout and what are the expected results?

A
  • joint fluid analysis diagnostic
  • serum uric acid level >7 mg/dL
  • rat bite or punched out erosions on xray is late finding
19
Q

Tx for Gout

A
  • RICE, NSAIDs (naproxen and indomethacin)
  • allopurinol to prevent further attacks
  • colchicine to reduce inflammatory response
20
Q

Most common neuropathy

A

carpal tunnel

21
Q

What nerve is affected in carpal tunnel?

A

median nerve

22
Q

Tinel’s Sign

A

positive if tapping over median nerve at volar wrist produces pain or tingling

23
Q

Phalen’s Sign

A

palmar flexing the hands for 1 min elicits pain or tingling (positive test)

24
Q

What are typical exam findings in a patient with carpal tunnel?

A
  • positive Tinel’s
  • positive Phalen’s
  • finger sensory loss
  • wasting of thenar or hypothenar muscles (late sign)
  • hand weakness (early)
25
Q

Tx for Carpal Tunnel

A
  • wrist splinting to prevent flexion
  • NSAIDs
  • steroid injections
  • surgical decompression
26
Q

Tx for Lateral Epicondylitis

A
  • RICE, NSAIDs
  • PT
  • elbow straps
  • steroid injections
27
Q

Red Flag Sxs with Low Back Pain

A
  • age over 50 or under 20
  • hx of cancer
  • night sweats or weight loss
  • incontinence or saddle anesthesia
  • recent bacterial infx
  • pain worse when supine
  • hx of trauma
28
Q

How does a LBP patient typically present?

A
  • pain, muscle tension or stiffness at posterior belt line
  • occasionally referred pain to butt or posterior thighs
  • pain sudden after injury or gradual
  • bowel and bladder function preserved
  • normal motor, sensory and reflex exams
29
Q

Tx for LBP

A
  • usually self-limiting within 6 weeks
  • bed rest NOT recommended
  • NSAIDs, muscle relaxants
  • PT, exercise, mobilization
30
Q

Most commonly injured ligament in ankle sprain

A

anterior talofibular ligament (ATFL)

31
Q

What are the 3 types of ankle sprains?

A

lateral
medial (deltoid ligament)
syndesmotic (high ankle sprain)

32
Q

What is the usual MOI for ankle sprain?

A

-inversion

33
Q

How might an ankle sprain present?

A
  • may feel or hear pop/snap
  • rapid onset of pain, swelling, ecchymosis
  • weakness, difficulty bearing weight, tenderness
  • foot may be inverted
  • positive anterior drawer test
34
Q

Ottawa Ankle Rules

A
  • x rays indicated with malleolar pain AND
  • bone tenderness at tip of medial malleolus OR
  • bone tenderness at tip of lateral malleolus OR
  • inability to bear weight immediately and in ER OR
  • navicular or 5th metatarsal pain
35
Q

Tx for Ankle Sprains

A
  • RICE
  • +/- crutches
  • early mobilization
  • brace or tape for sports
36
Q

Salter Type I

A

-across the physis

37
Q

Salter Type II

A

-above the physis into the metaphysis

38
Q

Salter Type III

A

-below the physis into the epiphysis

39
Q

Salter Type IV

A

-through the physis (involves epiphysis, physis, metaphysis)

40
Q

Salter Type V

A

-crush injury of physis

SAPE October 2015 (12 decks)

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