Final exam - Musculoskeletal Flashcards
(40 cards)
Carpal tunnel syndrome
Inflammation of the Median Nerve
Symptoms of carpal tunnel syndrome
wrist achiness that radiates to the base of the thumb on the palm of the hand;
may be awakened at night with pain and numbness in the area
Treatment for carpal tunnel syndrome
Wrist splint and NSAIDS
Surgery
Shoulder pain in over 55s
More likely to have rotator cuff tears and degenerative arthritis.
Fractures and dislocations with falls more prevalent
Shoulder pain in under 30s
Glenohumeral dislocation
Shoulder pain in middle age
Impingement syndrome more likely
Differential diagnoses for shoulder pain
- fractures
- dislocations
- acute tendon rupture
- chronic or repetitive injuries (impingement syndromes, most rotator cuff tears and biceps tendon ruptures)
- degenerative conditions
- inflammatory conditions
- idiopathic conditions (glenohumeral and AC arthritis, frozen shoulder)
Dislocated shoulder
Dislocates due to excessive pressure on the joint.
Pain noted when shrugging shoulders
Shoulder pain - Musculoskeletal Differential Diagnoses
Adhesive capsulitis (frozen shoulder)
Rotator cuff syndrome
Impingement
Calcific tendinitis
Subacromial bursitis
Degenerative arthritis: glenohumeral, acromioclavicular
Shoulder pain - Trauma Differential Diagnoses
Fractures: humerus, clavicle, acromion
Acromioclavicular joint sprains
Rotator cuff tear
Dislocation: glenohumeral
Nerve injuries: compression
Shoulder pain - Neurovascular Differential Diagnoses
Reflex sympathetic dystrophy (shoulder–hand syndrome)
Thoracic outlet syndrome
Cervical root compression
Brachial plexus injury
Shoulder pain - Systemic Disease Differential Diagnoses
Inflammatory disease
Cancer
Herniated disc - Risk factors
- age-related degenerative changes (it is often difficult to distinguish between normal aging of the spine and pathological changes)
- cigarette smoking
- a narrowed lumbar vertebral canal
- obesity
- osteoporosis
- stress
- muscle tension.
Causes of herniated disc
Trauma (sudden or over time), frequent lifting without proper utilization of body mechanics, and vibration, such as driving and/or riding in a motor vehicle for prolonged periods of time.
What is the most common herniated disc?
L4-L5 (weakness in the great toe)
Evaluating a herniated disc - diagnostics
MRI should also be considered for patients with neurologic symptoms, specifically weakness, loss of deep tendon reflex, or bilateral symptoms.
Xray for patients with trauma
Evaluating herniated disc - physical exam
- Range of motion
- Sensory function
- Numbness/tingling
- Straight leg raise test
- patient unable to walk on toes or heels
Preventing recurrence of herniated disc
- smoking cessation
- weight reduction
- good posture and body mechanics
- adherence to an exercise regimen
Patellofemoral dysfunction
continuum of disorders due to overuse of the knee
Management of knee pain
NSAIDS and quadriceps strengthening exercises
How to evaluate for meniscus tears?
the McMurray test
Phalen’s test
involves flexing the wrist for 60 seconds, leads to painor paraesthesia in the median nerve
Anterior drawer test
used in initial clinical assessment of suspected rupture of the cruciate ligaments in the knee
Low back pain workup
Focus on HPI:
1.Mode of onset (abrupt or insidious?)
2.Characteristics
*Provoking factors
*Aggravating factors
*Relieving factors
3.Effects of activities
*Posture
*Coughing, sneezing, straining
*Exercise, exertion, rest
*Sleep
4.History
*Similar or different pains
*Course (progressive, decreasing, increasing, fluctuating, episodic?)
*Associated limb and/or neurologic symptoms (pain, paresthesias, numbness, weakness, atrophy, cramps, fasciculations?)
5.Associated symptoms
*Urinary problems (frequency, urgency, retention, incontinence?)
*Bowel problems (incontinence or constipation?)
6.Previous back pain history and treatment (medications, types of surgery, nonpharmacologic management, lifestyle and work modifications, litigation or compensation issues?)
