Flashcards in MSS Tables Deck (85):
What type of back pain is aching in the lumbosacral area, may radiate into lower leg, and refers to anatomic or functional abnormality in the absence of neoplastic, infectious, or inflammatory disease?
Mechanical low back pain
In what type low back pain is there tenderness, and pain with movement, loss of normal lumbar lordosis but no motor or sensory loss of reflux abnormalities ?
Mechanical low back pain
What is mechanical low back pain most commonly caused by?
Muscle and ligament realted injuries
What is a shooting pain below the knee, common in lateral leg or posterior calf. Typically accompanies low back pain. There are paresthesais and weakness.
Sciatica (Radicular low back pain)
What is sciatica mostly commonly caused by?
Herniated intervertebral disc with compression or traction of nerve roots (L5 or S1)
In what low back pain is there psudoclaudation- pain in back or legs that improves with rest, lumbar flexion, or both. Pain is vague, usually bilateral with paresthesias.
Lumbar Spinal Stenosis
What is lumbar spinal stenosis caused by?
Hypertrophic degenerative disease or one of more vertebral facets and thickening of the ligamentum flavum leads to narrowing of spinal canal.
In lumbar spinal stenosis, what position is most comfortable for the patient?
Flexion of spinal cord
Will get thigh pain after 30 seconds of lumbar extension
What is an inflammatory polyarthritis most common in men younger than 40?
What are two causes of chronic back stiffness?
Diffuse idiopathic hyperostosis (DISH)
Noctural back pain, unrelieved by rest is commonly seen in what condition?
Metastatic malignancy to the spine from cancer of the prostate, breast, lung, thyroid, kidney, and multiple myeloma
In what type of back pain are spinal movements not painful and range of motion isn't affected.
Pain referred from abdomen or pelvis
In what type of neck pain is there bilateral weakness and paresthesias in both UE and LE, often with urinary frequency. Neck flexion exacerbates symptoms.
What is the most common cause of cervical myelopathy?
Cervical spondylosis (cervical DDD from spurs, protursion of ligamentum flavum, disc herniation)
In what type of neck pain is there hyperreflexia, positive Babinski, gait disturbances, Lhermitte's sign
In what type of neck pain is neck immobilization and neurosurgical evaluation required?
What type of neck pain is achign pain in the cervical paraspinal muscles and ligaments with associated muscle spasms, stifness lasting up to 6 weeks?
Mechanical neck pain
What is mechanical neck pain that often begins after an injury. Seen with occipital headache, diziness, fatigue.
Mechanical Neck Pain- Whiplash
How long must neck pain last in whiplash neck pain to be considered chronic?
More than 6 months
What causes whiplash?
Musculoligamentous sprain or strain from forced hyperflexion-hyperextension injury to the neck
What type of neck pain is a sharp burning or tingling pain in the neck and one arm with associated paresthesias and weakness. Often in a myeotomal pattern.
Cervical radiculopathy (nerve root compression)
What nerve root is affected most in cervical radiculopathy?
C7 nerve root with weakness in tricpes and finger flexors and extensors
What is cervical radiculopathy often due to?
Formainal encroachment of teh spinal nerve
Herniated cervical disc
What disease is due to chronic inflammation of synovial membranes with secondary erosion of adjacent cartilage and bone?
When is stiffness prominent in RA?
For an hour or more in the mornings
Are joint in RA red?
No, but often warm and tender
What joint pain disorders have insidious onsets?
What condition is due to degernation and progressive loss of cartilage within the joint, damage to underlying bone, and formation of new bone at the margins of cartilage?
Osteoarthritis (degenerative joint disease)
In osteroarthritis, are joint tender, warm, red?
How long does stiffness in joints last in OA?
5-10 minutes in the morning
In what joint condition does the patient also experience weakness, fatigue, weight loss, and low fever?
What type of gout is multiple local accumulations of sodium urate in teh joints and other tissues (tophi) with or w/o inflammation.
Chornic tophaceous gout
What type of gout is an inflmmatory rxn to microcrystal of monosodium urate?
Where does acute gout normally appear?
Base of big toe (in the first metatarsophalangeal joint)
Instep of foot
Ankles, knees, elbows
What type of gout has a sudden onset, often at night; often after injury, surgery, fasting, excessive food or alcohol intake?
What type of gout has a gradual development of chornicity with repeated attacks?
Chronic topheaceous gout
In what condition are joint typically red, hot and tender?
What condition is additive, but not as symmetric as RA?
Chronic tophaceous gout
What condition does a patient have a fever and may also develop symptoms of renal failure and renal stones.
Chronic tophaceous gout
What is a disease of unclear etiology in people older than 50, especially women; overlaps with giant cell arteritis?
What areas does polymyalgia rheumatica occur in?
Muscles of hip and shoulder girdles and neck
In what disorders are symmetric joints affected?
In what condition do you also have the generalized symptoms of malaise, depression, anorexia, weight loss, fever, but no true weakness
In what three conditions is stiffness often prominent in the mornings?
What is widespread musculoskeletal pain and tender point. Mechanism amy involve aberrant pain and signaling ampliciation?
In what joint pain condition is there no swelling?
In what joint conditions is motion limited primarily by pain?
In what condition is swelling and edema present over dorsum of hands, wrists, feet
What is a condition caused by repeated shoulder motion. Patients report sharp catches of pain, grating, weakness when lifting arm overhead. If supraspinatus tendon is involved tenderness is maximal just below tip of acromion.
Rotator Cuff Tendinitis (impingement syndrome)
In this condition patients often complain of chronic shoulder pain, night pain, catching, grating. Look for atrophy of deltoid, supraspinatus, or infraspinatus. Positive drop arm. Active abduction and forward flexion at GH joint are severely impaired.
Rotator Cuff Tear
What is a degenerative process in the tendon associated with calcium salt deposition in the suprspinatus tendon. Often in women over 30. Arm is held close to side and all movement inhibited by pain. Tenderness maximal at tip of acomion. Subacrominal brusae may be inflamed.
Patient shows increased pain when you have them place their arms at side with elbows flexed and have them supinate forearm against your resistance.
Refers to fibrosis of the GH joint capsule, mainfested by diffuse, dull, aching pain in the shoulder and progressive restriction of active and passive ROM, especially in external rotation. Age of those affected- 40-60. Often another condition has decreased shoulder movements. May take 6 months to 2 years to resolve.
Adhesive capsulitis (frozen shoulder)
Results from prior direct injury to the shoulder girdle with resulting degenerative changed. Pain with movements of scapula and arm abduction.
Shoulder slips out of the joint when arm is abducted and externally rotated. Positive apprehension sign for anterior instability when the examiner places the arm in this position. Usually due to a fall or forceful throwing motion.
Anterior dislocation of the humerus
What is swelling that is superficial to the olecranon process. Causes include trauma, gout, or RA.
SQ nodules that develop at pressure points along the extensor surface of the ulna. Firm and nontender, not attached to overlying skin but may be attached to underlying periosteum.
Synovial inflammation of fluid felt in the grooves b/w olecranon and epicondyles. Boggy, soft, or fluctuant swelling. Causes- RA, gout, pseudogout, OA, trauma. Patients reports pain, stiffness, restriction ROM.
Arthritis of the elbow
Tennis elbow. Follows repetitive extension of the wrist or pronation-supination of the forearm. Pain and tenderness 1 cm distal to the lateral epicondyle. Pain increases when resist is extended against resistance.
PItcher's, golfer's, little league elbow. Follows repetitive wrist flexion, as in throwing. Tenderness is maximal just lateral and distal to the medial epicondyle. Pain increases with wrist flexion against resistance.
What are the three most commonly affected joints in actue rheumatoid arthritis?
In what condition may swan neck deformities (hyperextension of teh proximal interphalagneal joints with fixed flexion of the distal interphalangeal joints) appear?
Chronic Rheumatoid arthritis
What is the name for persistent flexion of the proximal interphalageal joint with hyperextension of the distal interphalagneal joint seen in chronic RA
What is seen in osteoarthritis (degenerative joint disease) and appears on the dorsolateral aspects of the distal interphalangeal joints from bony overgrowths. Usually hard and painless.
What are nodes seen in OA that appear on the proximal interphalangeal joints. Metacarpophalangeal joints are spared.
What condition of the hands is not symmetric, with knobby swellings around the joints that ulcerate and discharge white chalklike urates.
Chronic Tophaceous Gout
What condition have a thickened nodule overlying the flexor tendon of the ring (and possibly little) finger near the distal palmar crease. A fibrotic cord develops and finger extension is limited, but flexion is usually normal.
What is caused by a painless nodule in a flexor tendon in the palm near the metacarpal head. Finger extends and flexes with an audible pop and palpable snap.
What disorder is suggested by thenar atrophy?
Median nerve disorder (CTS)
What does hypothenar atrophy suggest?
Ulnar nerve disorder
What are round nontender swellings along tendon sheaths or joint capsules, frequently at the dorsum of the wrist. Cyst contains synovial fluid arising from erosion or tearing of the joint capsule or tendon sheath. Flexion makes it more prominent. Disappear spontaneously
What is an infection of flexor tendon sheaths that may follow local injury. Tenderness and swelling develop along the course of the tendon sheath. Finger extension is difficult.
What about if it progresses to the thenar space?
Acute tenosynovitis and thenar space involvement
What is an injury to a fingertip that may result in infection of the enclosed fascial spaces of the finger pad, normally from Staph aureus. Severe pain and dusky redness are characteristic. I & D are important.
This is usually seen in health care workers exposed to herpes simplex virus in human saliva. Presents with vesicles.
Metatarsophalangeal is commonly affected. Very painful, tender, hot, dusky red swelling that extends beyond the margin of the joint. Easily mistaken for cellulitis.
Acute Gouty arthritis
Longitudinal arch of the foot flattens so the sole approaches or touches teh floor. Normal concavity on the medial side of the foot becomes convex. Swelling may develop anterior to the malleoli.
Lateral deviation of the great toe and enlargement of the head of the first metatarsal on its medial side forming a bunion or bursa. May become inflamed. More common in women.
Appears with tenderness over the plantar surface b/w the third and fourth metatarsal heads. From perineural fibrosis of the common digital nerve due to repetitive nerve irritation.Pain radiates to the toes when you press on the plantar interspace. Symptoms include aching, numbness, burning from the metatarsal head into the 3rd and 4th toes.
Sharp edge of the toenail digs into and injures the lateral nail fold leading to inflammation and infection. Great toe most often affected. Will ahve a tender, reddened overhanging nail fold.
Hyperextenion at the metatarsophalangeal joint with flexion at the proximal interphalangeal joint. Corn frequently develops from pressure point over the proximal interphalangeal joint.
Painful conical thickening of skin that results from recurrent pressure on the normally thin skin. Commonly on the 5th toe.
involves skin that is normally thick. In an area of recurrent pressure. Usually painless. Tender to direct pressure
Hyperkeratotic lesion caused by HPV. Has characteristic small dark spots that gie a stippled appearance to a wart. Is tender if pinched side to side.
May develop at pressure points on the feet when pain sensation is diminished. Often deep, infected, indolent, but painless