MSK1-Table 1

Question 1

what are some important observations in msk?

Answer 1

gait, carrying angle, pain, function, atrophy, asymmetry, deformity, footwear, color.

Question 2

why is medication important? Esp steroids?

Answer 2

osteoporosis

Question 3

what about sexual hx?

Answer 3

gonorrhea reactive arthritis

Question 4

if your patient has a score of 3 on motor examination they can…?

Answer 4

active full ROM against gravity (no resistance)

Question 5

what is HLA-B27 antigen used for?

Answer 5

spondylomyopathy

Question 6

are x-rays useful in OA or RA?

Answer 6

OA in early dg and dz progression

Question 7

what should you order if you suspect spondyloarthropathy?

Answer 7

sacroiliac films!

Question 8

most common cause of neck pain?

Answer 8

mechanical!

Question 9

where does trapiezus pain refer to?

Answer 9

temporal lobe, jaw, mastoid,

Question 10

SCM pain may refer where and cause what automonic dysfunction?

Answer 10

above the eye, back of head, top of head. Auditory, corryza, lactorrhea, lactimation.

Question 11

scalene pain moves where?

Answer 11

shoulder, upper arm, chest

Question 12

when is the soonest time you can do an EMG/NCV nerve conduction study after neck injury?

Answer 12

1 month post onset

Question 13

where are your C5, C6, C7, C8, T1, T2 dermatomes???

Answer 13

C5 shoulder, 6-top forearm/thumb/1st digit. 7- middle digit/hand, 8-4th and 5th digits/wrist, T1- forearm to elbow, T2-upper arm

Question 14

what view is needed on x-ray to see C-7?

Answer 14

swimmer’s view

Question 15

what kind of curve should be seen on cervical x-ray?

Answer 15

lordotic

Question 16

when do you order an MRI for degenerative disc disease?

Answer 16

neuro compromise is apparent

Question 17

what are the main tx options for neck pain?

Answer 17

PT, NSAIDs, muscle relaxants, trigger point (trapezius)

Question 18

pt has chronic arm and shoulder pain with unknown cause, and weakness/wasting of hand muscles, plus sensory disturbance of palmar 5th digit?

Answer 18

thoracic outlet syndrome (TOS)

Question 19

Dg? Tx?

Answer 19

cervical x-ray and electrodiagnostics. EMG w/ slow conduction. Tx surgical resection of band.

Question 20

what nerve roots are compressed in TOS

Answer 20

C8 or T1

Question 21

where does sciatica occur?

Answer 21

buttock, posterior thigh, posterolateral leg including malleolus, dorsum and sole

Question 22

where do discs bulge?

Answer 22

posterior lateral

Question 23

what test do you use for low back pain w/radiation?

Answer 23

straight leg raise

Question 24

u/l LBP and buttock pain worse with standing in one position?

Answer 24

SI joint. Do compression test! Dg/tx- injection

Question 25

elderly pt with low back pain that increases with walking and is relieved by leaning forward?

Answer 25

spinal stenosis

Question 26

what are red flag sx for low back pain?

Answer 26

Fever, Wt. loss, morning stiffness, hx. of IV drug/steroid abuse, trauma, hx. of CA, saddle anesthesia, bowel/bladder function loss, major motor weakness

Question 27

when do you get an MRI in LBP?

Answer 27

cord, neural tumor, stenosis, disc infections

Question 28

colitis pain may refer where?

Answer 28

low back!

Question 29

where does the sciatic nerve refer pain to?

Answer 29

posterior calf.

Question 30

what should you measure in a back pain w/u?

Answer 30

leg length!

Question 31

what degrees are considered positive for sciatica in SLR?

Answer 31

30-70 degrees elict pain

Question 32

what else should you check for in back pain w/u?

Answer 32

fever, breast mass, pleural effusion, prostate dz, skin abscess, lipoma.

Question 33

elevated ESR may raise suspicion for?

Answer 33

malignancy or inflamm condition (polymyalgia)

Question 34

post menopausal female w/ back pain should get what?

Answer 34

DXA w/ VFA view for compression fx

Question 35

what are your leg dermatomes?

Answer 35

refer to slide 70. L5 heal, S1 outer leg/5th digit, S5- anus/inner thigh, L-4 knee, big toe. L5 and S1 important.

Question 36

what is spondylolisthesis?

Answer 36

vertebra slips onto bone below it

Question 37

how many signs do you need for Waddel's? what does it test?

Answer 37

3 or more. Suggestive malingering. Tenderness, simulation, distraction, regional disturbances, overreaction.

Question 38

what are red flags for emergency investigation of back pain?

Answer 38

loss of bowel or bladder, saddle anesthesia, loss sphincter tone, sensory level on neuro exam, B/L leg pain w/ B/L neuro deficit.

Question 39

what should you encourage your mechanical chronic low back pn pt do to?

Answer 39

exercise, keep moving, lose wt.

Question 40

medical mngmt of LBP?

Answer 40

NSAIDs: Ibuprofen 600mg TID . Flexeril 5-10mg TID. Tx depression.

Question 41

how do you dg disc herniation?

Answer 41

MRI w/ focal and neuro sx.

Question 42

what curvature is significant in scoliosis?

Answer 42

greater than 15 degrees. Commonly right thoracic T7 or T8.

Question 43

what degree do you refer? When do you x-ray?

Answer 43

refer over 20. x-ray q3-4 mo in 15-20 degrees.

Question 44

leg pain, numbness, saddle anesthesia and/or paralysis, with loss of bowel or bladder?

Answer 44

cauda equina. Sg emergency

Question 45

what is the difference in perarticular vs articular disorder?

Answer 45

articular- limited ROM w/active and passive; swelling. Periarticular- pain with active ROM only, tender to adjacent structure, pain w/ specific movement.

Question 46

what is bursistis associated with?

Answer 46

rotator cuff tendinitis

Question 47

tx of bursitis?

Answer 47

NSAID, rest, occ steroid inj.

Question 48

where is the most common location of tendinitis?

Answer 48

supraspinatus

Question 49

dull aching, worse at night, interferes w/ sleep, severe w/ abduction and overhead reach, tender lateral humeral head?

Answer 49

supraspinatus tendinitis. Tx: NSAID, PT, steroid inj, surg decompression.

Question 50

painful ROM esp resisted supination?

Answer 50

bicipital tendinitis.

Question 51

inflammation at lateral epicondyle, possible weak hand extension, pt types a lot.

Answer 51

lateral epicondylitis- tennis elbow. Tx- counterforce tennis elbow brace.

Question 52

Taut band, tender spot, referred pn, motor dysfunction and autonomic phenomena…

Answer 52

trigger point (MTrPs)

Question 53

what are the 3 components in Motor Endplate Hypothesis?

Answer 53

1. motor componenet (contraction knot). 2. sensory (allodynia and hyperalgesia). 3. autonomic (lacrimation, coryxa, salivation, dizzy)

Question 54

MTrPs is the result of…

Answer 54

mechanical, chemical and neuro dyf in mscle and CNS. Chronicity-> recruit additional mscle and sensory regions resulting in hyperalgesia, allodynia and widespread stimulus.

Question 55

tx?

Answer 55

get blood to it, diet, posture, vitamins.

Question 56

Local or regional pain syndrome (usually aching and poorly localized) with spasm, tightness, referral along well established pattern, with possible autonomic symptoms and articular dysfunction.

Answer 56

myofascial pain

Question 57

what is main dg for myofascial pain?

Answer 57

palpation! Tight band!

Question 58

where should you NEVER inject on neck?

Answer 58

high and right= vertebral artery

Question 59

what is the goal of dry needling or 0.5% lidocaine?

Answer 59

elicit LTR spinal reflex to contract fibers in taut band. Then vapocoolant spray, stretch and heat.

Question 60

what is never indicated in myofascial pain?

Answer 60

opiods!

Question 61

what are some important observations in msk?

Answer 61

gait, carrying angle, pain, function, atrophy, asymmetry, deformity, footwear, color.

Question 62

why is medication important? Esp steroids?

Answer 62

osteoporosis