MSK Dx Flashcards by Julia B

Worse pain in the AM
Pain lasts >45 min
Swelling, warmth, erythema

Inflammatory Arthritis

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Worse pain at night

Pain lasts < 45 min

Swelling but less common than inflammatory

Bony hypertrophy

Non-inflammatory Artiritis

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Typically symmetrical

Joint deformities if untreated
Ankylosis

Inflammation, joint pain, swelling, warnth, prolonged stiffness

Polyarticular disease w/ gradual onset

Hands mc involved- wrists, metacarpophalangeal (spares DIPJ)

Rheumatoid Arthritis

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Skin and genital lesions

Eye and bowel inflammation

Association w/ preceding or ongoing infectious disorders

Inflam of axial joints

Asymmetrical oligoarthritis

Dactylitis

Enthesitis

Low back/inflam back pain usually at night and improves with exercise but NOT rest

Spondyloarthritis

SpA

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MC affects DIPJ and PIPJ, hips and knees

Bony deformities
Bouchard’s nodes (PIPJ)
Heberden’s Nodes (DIPJ)
Squaring of thumb

Persistent use-related joint pain, morning stiffness ≤ 30 min

Osteoarthritis

DJD

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Dull, aching pain over invovled area

Night pains “growing pains”

± fever, night sweats, weight loss

Tenderness to palpation of involved area, lim AROM of adj joint, limp, muscle atrophy, ± swelling, mass, deformity

± spontaneous fx

Pain from injury that doesn’t go away even after weeks

13-16 yo MC

Osteosarcome

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Deep, dull, achy pain

MC in pelvis, ribs and hip

Pain at night

Chronic >1 yr

50-70 yo

Chondrosarcoma

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Bone pain, tenderness on palpation, mass on exam

B sx (fever, night sweats, weight loss)

MC locations are pelvis, knee, prox humerus and femur disphysis

5-30 yo

Ewing Sarcoma

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Dorsal surface of wrist at scapholunate joint

Joint instability, weakness, limited ROM

Normal overlying skin, compressible but firm movable mass

Transilluminates

May be adherent to bone, joint or tendon

Ganglion Cysts

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What is the GS to diagnosis septic arthritis?

Arthrocentesis

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MC affected bursa in adults

Olecranon

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MC affected bursa in children

Prepatellar

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GS to diagnose gout

Diagnostic Arthrocentesis

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Monoarticular presentation (if pt comes in w/ monoarticular joint pain its septic arthritis until proven otherwise)

Abrupt swelling, warmth, and pain

Fever and chills

Antalgic gait (limp)
Guarding of limb
Extreme tenderness

Marked limitation in passive and active ROM

Septic Arthritis

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Septic Arthritis etiology

S. aureus MC

Gonococcal

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Infection of bone

Osteomyelitis

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Osteomyelitis etiology

S. aureus

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Tenosynovitis (inflammation of entire digit)

Dermatitis around palms and soles (pustules, hemorrhagic bullae)

Polyarthralgia starts in one joint and moves to another (migratory or additive)

GU sx

fevers/chills

Gonococcal Arthritis

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Test of choice for gonococcal arthritis

(NAAT) of synovial fluid is preferred as more sensitive than culture

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monoarticular or oligoarticular arthritis

Cold, large effusions Neurologic disease
Cutaneous involvement

Lyme Arthritis

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Testing for Lyme arthritis

ELISA and confirm with Western blot due to high false ✚

Lyme IgM:1-2 wks
only 20- 40% ✚ at time of EM rash

Lyme IgG: 2-6 wks

Synovial fluid Lyme PCR

Most Lyme pts remain seropositive (including IgM) for yrs after successful tx with abx

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Acute symmetric polyarthritis

Symmetric arthralgia or polyarthritis involving hands, wrists, knees, feet

Skin rash: lasts 2-4 days, face and trunk/limbs

Viral Arthritis

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Septic Bursitis diagnostic test of choice

Aspiration and cx of bursitis = GS

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Septic Bursitis etiology

s. aureus

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MC site 1st MTP of foot= Podagra Onset night or early morning Pain, warmth, redness, swelling, fever (due to IL1), leukocytosis Tenosynovial or bursal involvement

Acute Gout

Chronic Gout

Frequent attacks (≥2 per year) Tophus Erosive arthritis CKD stage ≥2 Past urolithiasis (of any type)

Skeletal d/o characterized by compromised bone strength predisposing to inc risk of fx

Osteoporosis

Dx test of choice for Osteoporosis

Dual X-ray Absorptiometry (DXA) MC used

What pts should you use T score for?

used for dx of osteoporosis after menopause

What pts should you use Z score for?

used for dx of osteoporosis in children and YA

What fx requires greater force proximal humerus or humeral shaft?

humeral shaft

What should you look for on plain film if you suspect radial head fx

look for pulp findings (fat pad)

Anterior shoulder pain Radiation down toward biceps Tenderness over the bicipital groove

Biceps Tendinitis

Period of shoulder immobilization *Loss of passive ROM* and active Pain w/ active and passive ROM, progressive loss of ROM Shoulder stiffness Rest pain and night pain

Adhesive Capsulitis "frozen shoulder syndrome"

Slowly progressive vague and diffuse shoulder pain Pain is present at rest and exacerbated with activity Progressive limitations on passive and active movement of shoulder (mostly due to pain) Crepitus, ↓ ROM (w/ pain)

Glenohumeral Osteoarthritis

Galeazzi Fracture

fracture of the distal 1/3 of the radius with dislocation of the distal radioulnar joint

What is the mc type of metacarpal fx

Boxer's Fracture

What is mc type of metatarsal fx

Jones Fracture

fx btwn the base and shaft of the fifth metatarsal bone

Starts w/ painless nodule over MCP joint in 1 or more fingers Nodule expands in proximal direction to form cord along tendon (over course of several mo-yr) Cord and nodule begin to limit finger extension → persistent flexion of finger toward palm

Duuytren's Contracture

What is the most sensitive test for ACL tear?

Lachman's

Shoulder pain worse w/ overhead activity, lifting arm above shoulder level Located sup and lat aspect of shoulder over deltoid May be acute/burning (bursitis) or intermittent and dull (tendinopathy) ↓ active ROM due to pain but should have full passive ROM

Impingement Syndrome | Rotator Cuff Syndrome or Rotator Cuff Disease

Pain in anterior lateral shoulder with radiation distally (but below elbow) Weakness of the shoulder, especially with overhead movement Night pain Active ROM may show some weakness, esp with overhead reaching (above 90°) Passive ROM is usually fine

Rotator Cuff Tears

What is MC involved ligament in low ankle sprains

Anterior Talofibular Ligament (ATFL)

c/o ”Walking on a Marble” Pain & dysesthesias in the forefoot and corresponding toes Pain is described as sharp and burning Toe numbness Intermittent & episodic pain Occasional night pain

Morton Neuroma

Dull/sharp pain when first ge tout of bed in the AM Pain after standing following long periods without weight-bearing Pain improves with walking Greater pain after exercise or activity Pain worsening through the day

Plantar fasciitis

Pain worse after work or activities involving repeated wrist extension and supination against resistance (think turning a screwdriver; painting a house; playing tennis) Radiation of pain down posterior (dorsal) forearm Pain reproduced with shaking hands, opening/turning doorknob Weakened grip, difficulty picking up heavy objects (bc tryin to avoid pain not bec inability) ROM fully intact

Lateral Epicondylitis | tennis elbow

50-60 yo symmetric weakness trouble climbing stairs

Polymyositis

Pain after initial trauma but then dissipates unless infected Progressive formation of boggy swelling over elbow If infected → erythema, warmth, and pain

Olecranon Bursitis

muscle pain, weakness, dark urine

Rhabdomyolysis

Duuytren's Contracture

What is the most sensitive test for ACL tear?

Lachman's

>3 months Multifocal pain (above and below waist and on both sides of the body) “tender points” Cognitive problems/ Psychological distress Fatigue, non-resorative sleep, arthralgias, cog dysfn, muscle spasm, parasthesias, depression/anxiety Tension/migrain HA Irritable bowel, restless legs, urinary infrequency, 1° dysmenorrhea/pelvic pain, temporomandibular pain, chem sensitivity

Fibromyalgia

Tests for ACL tear

✚Lachman's Test *most sensitive ✚ Pivot Shift ✚Anterior drawer test (not very sensitive) ✚Swelling MRI is most sensitive test

What is MC involved ligament in low ankle sprains

Anterior Talofibular Ligament (ATFL)

c/o ”Walking on a Marble” Pain & dysesthesias in the forefoot and corresponding toes Pain is described as sharp and burning Toe numbness Intermittent & episodic pain Occasional night pain

Morton Neuroma

Plantar fasciitis

5-15 yo and 45-65 yo Symmetric muscle weakness trouble climbing stairs ``` Gottrons papules Heliotrope rash V-sign Shawl sign Holster sign Mechanics hands Nailfold changes Subcutaneous calcification ```

Dermatomyositis

Motor disturbances are the earliest finding → triceps and hand intrinsic weakness Clumnisess, can't button shirt, dropping things, poor fine motor control Spasticity in LE Sensory sx can be minimal (can be stocking-glove dist) Hyper-reflexive reflexes Cord compression sx

Cervical Myelopathy

Insidious- progressive over mo-yrs Asymmetric, distal AND proximal muscle weakness (forearms and flexor fingers) PAINLESS weakness Ant thighs mc involved > arms Atrophy is prominent Neuropathy

Inclusion Body Myositis

muscle pain, weakness, dark urine

Rhabdomyolysis

Pain/stiffness of shoulder and/or pelvic girdles Morning stiffness 45 min Weakness/stiffness when brushing hair Pain may wake up pt early morning/night May have swelling

Polymyalgia Rheumatica

Rapid decomp over mo 15% risk of blindness (mostly due to ischemic optic neuritis) Jaw claudication is very specific Constitutional sx HA Scalp tenderness Abrupt field deficet (curtain coming down) - unilateral Enlarged temporal arteries, absent temporal artery pulse, temporal artery tenderness

Giant Cell Arteritis | Temporal Arteritis

Fibromyalgia

“My back hurts, and I peed my pants” Urinary retention (or overflow incontinence) Fecal incontinence Saddle Anesthesia *mc sensory deficit (most sensitive) Significant motor weakness Sciatic pain – generally bilateral Back pain

Cauda Equina Syndrome

neck pain, sore deltoids, trouble holding up arm due to weakness, pain/sensory sx and sensory lat shoulder

C4-5 disc herniation | compress C5 root

neck pain, triceps, wrist drop (wrist extension), pain and sensory sx in upper arm 2nd-3rd fingers

C6-7 disc herniation (compress C7 root)

Arthralgias, fatigue Dry eyes, dry mouth, neuro problems Skin disorders- raynaud's, cutaneous vasculitis Nutritional malabsorption Dry throat, dysphagia, liver abnormalities

Sjogrens Syndrome

Degenerative process that results in overall narrowing of spinal canal and neural foramen

Cervical Spondlyosis

Cervical Myelopathy

pain post leg to hamstrings and to little toe side of the foot, motor weakness in plantar flexion, ↓ sensation in lat malleolus and lat foot

L5-S1 HLD (S1 nerve root

pain to post leg wrapping to shin below knee, motor weakness in tibialis anterior (foot drop), ↓ sensation in top of foot to big toe

L4-5 HLD *MC (effects L5 nerve root)

pain in ant thigh, motor weakness in quads, ↓ sensation in medial malleolus and medial foot

L3-4 HLD(effects L4 nerve root

bilat pain or discomfort in buttocks, worse w/ walking Releived w/ rest of Δ in posture Back pain Used to be able to walk 2 mi now can walk 2 block before rest (rest on shopping cart/lean over)

Lumbar Spinal Stenosis

vertebral slip

Spondylolisthesis

Cauda Equina Syndrome

Malar rash *spates nasolabial folds Photosensitivity- rash in sun exposed areas Oral or nasopharyngeal ulcers- usually painless Arthritis- inflam, tenderness, swelling, non-erosive polyarthritis

SLE

Thickened skin Edema, tight puffy fingers, disffuse swelling Contractures, skin ulcers, dignital tip ulcers (assoc w/ Raynaud's) Symmetric polyarthralgias- stiffness of fingers, wrists, knees and ankles Lip thinning, ↓ oral aperature

Scleroderma

Arthralgias, fatigue Dry eyes, dry mouth, neuro problems Skin disorders- raynaud's, cutaneous vasculitis Nutritional malabsorption Dry throat, dysphagia, liver abnormalities

Sjogrens Syndrome

Classically involved lungs but can also involve other organs (skin, joints, brain, liver) Acute polyarthritis (usually ankles) Erythema nodosum Eyes popping out

Sarcoidosis

Young pt w. Claudication or gangrene

Thromboangiitis Obliterans

MSK Dx Flashcards

(81 cards)