Flashcards in Acute and chronic Lower Back Pain Deck (66):
most common cause of low back pain?
prolapsed intervertebral disk and low back strain
what does pain orginiating iin the back and radiating down the leg mean?
nerve root damage
what does localized pain mean?
more likely MSK cause
pain in the distribution of the sciatic nerve- felt in the buttock, posterior thigh, postero-lateral aspect of the leg, lateral malleolus to the lateral dorsum of the foot
unilateral low back and buttock pain?
esp if gets worse w/ standing--> sacroiliac joint involvment
pain in elderly that is increased by walking and relieved by leaning forward?
low back pain red flags?
fever, weight loss, morning stiffness, hx of IV drug or steroid use, trauma, hx of cancer, saddle anesthesia, loss of anal sphincter tone, major motor weakness
What is a CT helpful for
bony stenosis and identifying lateral nerve root entrapment
what is a MRI helpful for?
identifying cord pathology , neural tumors, stinosis, herniated disks,infx
insidious onset of anterior chest wall pain exacerbated by certain movmentes of the chest and deep inflammation
PE of costochondritis
pain is reproducible upone exam-palpation of costochondral joings
tx of costochondirits?
NSIADS (add PPi if risk of GI bleed)
what is costochondritis is infections?
surgical drainage and or debridement w/ appropriate abx
de Quervians sydrome?
stenosing tenosynovities involving abductor pollicis longus, extensore pollicis brevis (APL, EPB)
dx for DQ Syndrome?
tx of DQ syndrome?
thumb spica splint, NSAIDs, PT for at least a mnth
*can injx steroid into tendon sheath
may need surgical decompression of the first dorsal compartment
inflammatory ds of the bursa
can be caused by trauma or over use
common sites of bursitis?
subacromial, subdeltoid, trochanteric, ischial, ilipsoas, olecranon, prepatellar and suprapateller
what is housemaid's knee?
CF of bursitis>
pain, swelling, tenderness that can persist for wks
tx of bursitis?
prevention, NSAIDs, steroid injgx
inflammation of the tendone
inflammation of the enclosed tendon sheat
what are common cause of tenosynotivits?
over use, or systemic dz
what sites do you commonly see tendinitis and tenosynovitis?
rotator cuff, supraspinatus, biceps, flexor carpi ulnaris, flexor carpi radialis, flexor digitorum, patella, hip adductor, and Achilles
CF of tendonitis?
pain with movement, swelling, and impaired function.
o The condition may resolve over several weeks, but recurrence is common
tx of tenosenovitis?
o Ice, rest, and stretching help to relieve inflammation
o NSAIDs may alleviate pain but do not penetrate the tendon circulation adequately. An injection with corticosteroids combined with anesthesia and administered alongside the tendon may be beneficial. Intratendon injection should be avoided because of the risk of rupture
o Excision of scar tissue and necrotic debris may be performed if conservative measures are unsuccessful. The scar tissue is caused by repetitive microtrauma to the tissue.
- A seronegative arthritis that presents with a tetrad of urethritis, conjunctivitis, oligoarthritis, and mucosal ulcers
what is reactive arthritis a common sequalae of?
STIs (chlamydial urethritis or Ureaplasma) or gastroenteritis (Shigella, Salmonella, Yersinia or Campylobacter)
what joints are usually involved in reactive arthritis?
larger joints, usually below the waist (knee/ankle)
what dx fx may be see in reactive arthritis?
tx of reactive
PT and NSAids
- The hematogenous spread of bacteremia, periarticular osteomyelitis, infection caused by diagnostic or therapeutic procedure (e.g., intra-articular injection), or infection elsewhere (e.g., cellulitis, bursitis) may lead to infectious arthritis
CF of Septic arthritis?
involves single joint (most commonly the knee, followed by hip, shoulder, ankle wrist
-swelling, fever, joint warmth and effusion, TTP, increased pain w. minimal ROM
what is the most common cause of septic arthritis?
what can also cause Septic arthritis (think sexually active young adults
joint tap of Septic arthrists
WBC > 50,000
culture is positive
tx for septic arthritis
IV abx for 2 wks, ceftriaxone is remcommended for empriic tx
adjustment of abx post culture and sensitivity
-arthrotomy and arthrocentisis is oftne needed, (not if N gonorrhea is the causative agent though)
-oral abx should follow IV ab x for up to 2 wks after
inflammatory arthritis w/ skin involvement usually preceding joint dz by mnths to years
CF of Psoriatic arthritis
-mild/intermittent course affecting a few joings
-may resemble RA may involvve hands and feet
-pitting of nails and onycholysys may be seen
-sausage-finger appearance cuased by arthritis and tenosynovits of flexor tendon
DX studies of psoriatic arthritis
normocytic, normochromic anemia
hyperuriciemia canbeen seen
"pencil in a cup"?
seen with psoriatic arthritis, deformity of the proximal pahlanx on radiography
tx of psoriatic arthritis
- Treat mild cases with NSAIDS
- Methotrexate for skin inflammation and arthritis
- Avoid corticosteroids and antimalarials
- May need reconstructive surgery (arthrodesis or joint replacement) for painful end-stage arthropathy
- Benign lesion sac of synovial fluid, most often on dorsal aspect of hand and/or wrist. Seen more in females. Aspiration can be therapeutic and diagnostic
tx of ganglion cysts
surgical excision. Patients with neurovascular compromise will go straight to surgical route
pain and stiffness in the neck, shoulder pelvic girdles and is accompained by constitutional sx (like fever, fatigue, weight loss, depression)
epidimiology or polymyagia rheumatica
affects women twice as often as men usually presents in pts older than 50 yrs
etiology of polymyalgia rheumatica
cause is unknown, may be associated w/ giant cell temporal arteritis
Clinical features of polymyalgian rheumatica
-stiffness, most severe after rest and in the am
-MSK sx usually are bilateral, proximal, symmetrical
giant cell must be ruled out (sclap tenderness, jaw claudication HA temporal artery tenderness)
dx studes of polymyalgia rheymatica?
EsR elevaated (
(temporal arteritis confirmed by bx need at least 2.5 cm)
tx of polymyalagia rheumatica
low-dose corticosteroid therapy, which may be required for up to 2 years and slowly tapered
- An autoimmune disorder characterized by inflammation and positive ANAs and involvement of multiple organs
who is commonly affected by SLE
AA women of childbearing age
dx of SLE?
4 of the following must be met (and high titer ANA)
o Malar rash
o Discoid rash
o Oral ulcers
o Serositis (heart, lungs, or peritoneal)
o Renal disease (proteinuria, cellular casts)
o Hematologic disorders (hemolytic anemia, leukopenia, leukocytosis, thrombocytopenia)
o Immunologic disorders (LE cell, anti-DNA, anti-Sm, false-positive serologic test for syphilis)
o Neurologic disorders (seizures or psychosis in absence of any other cause
what must be ruled out when trying to dx SLE
- Drug-induced lupus must be rule out. There are many drugs that cause a lupus-like syndrome
o Procainamide, hydralazine, isoniazid, methyldopa, quinidine, chlorpromazine
Routine lab studies for an SLE workup
CBC, BUN, creatinine, urinalysis, ESR, serum complement (C3 or C4)
o Antibodies to Smith antigen, double-stranded DNA, or depressed levels of serum complement may be used as markers for disease progression
o ANA is present (99%), but low titers have low predictive value
tx of SLE
o Regular exercise and sun protection are important for all patients
o NSAIDs for musculoskeletal complains
o Antimalarials (quinacrine, hydroxychloroquine) can be used for musculoskeletal complaints or cutaneous manifestations
o Corticosteroids (topical or intralesional) for cutaneous manifestations
Low or high dose oral corticosteroids used for disease flares and tapered as symptoms resolve
o Methotrexate is used at low doses for arthritis, rashes, serositis, constitutional symptoms
central pain disorder whose cause and pathogenesis are poorly understood
what can FM occur with?
RA, SLE, Sjorgren's syndrome
CF of FM?
nonarticular MSK aches, pains, fatigue, sleep disturbance, multiple tender points on exam
-anxiety depression, HA, IBS, dysmenorrhea, paresthesias
what do you need to rule out when working up FM?
hypothyroidism, chep C, vitamin D def
how to tx FM?
pregabalin (lyrica) is the only FDA approved drug for it
adr of pergabalin?
fatigue, trouble concentrationg, sleepiness, edema
- A result of traction of the interdigital nerve against the transverse metatarsal ligament causing degeneration of the nerve and chronic inflammation
CF of Morton's neuroma
of pain and localized numbness when walking and standing, which is relieved with rest
- Pain is usually localized to the web space and, often, a mass is palpable
- Squeezing the forefoot will often reproduce the symptoms