MSS Tables Flashcards by Meg Dolohanty

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

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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

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What is mechanical low back pain most commonly caused by?

Muscle and ligament realted injuries

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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)

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What is sciatica mostly commonly caused by?

Herniated intervertebral disc with compression or traction of nerve roots (L5 or S1)

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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

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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.

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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

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What is an inflammatory polyarthritis most common in men younger than 40?

Ankylosing spondylitis

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What are two causes of chronic back stiffness?

Ankylosing spondylitis

Diffuse idiopathic hyperostosis (DISH)

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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

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In what type of back pain are spinal movements not painful and range of motion isn’t affected.

Pain referred from abdomen or pelvis

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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.

Cervical Myelopathy

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What is the most common cause of cervical myelopathy?

Cervical spondylosis (cervical DDD from spurs, protursion of ligamentum flavum, disc herniation)

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In what type of neck pain is there hyperreflexia, positive Babinski, gait disturbances, Lhermitte’s sign

Cervical myelopathy

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In what type of neck pain is neck immobilization and neurosurgical evaluation required?

Cervical myelopathy

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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

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What is mechanical neck pain that often begins after an injury. Seen with occipital headache, diziness, fatigue.

Mechanical Neck Pain- Whiplash

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How long must neck pain last in whiplash neck pain to be considered chronic?

More than 6 months

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What causes whiplash?

Musculoligamentous sprain or strain from forced hyperflexion-hyperextension injury to the neck

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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)

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What nerve root is affected most in cervical radiculopathy?

C7 nerve root with weakness in tricpes and finger flexors and extensors

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What is cervical radiculopathy often due to?

Formainal encroachment of teh spinal nerve

Herniated cervical disc

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What disease is due to chronic inflammation of synovial membranes with secondary erosion of adjacent cartilage and bone?

Rheumatoid arthritis

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When is stiffness prominent in RA?

For an hour or more in the mornings | After inactivity

Are joint in RA red?

No, but often warm and tender

What joint pain disorders have insidious onsets?

Rheumatoid arthritis osteoarthritis polymyalgia rheumatica

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?

Possibly tender Seldom Warm Rarely red

How long does stiffness in joints last in OA?

5-10 minutes in the morning | After inactivity

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?

Acute Gout

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?

Acute gout

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?

Gout

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?

Polymyalgia rheumatica

What areas does polymyalgia rheumatica occur in?

Muscles of hip and shoulder girdles and neck

In what disorders are symmetric joints affected?

Polymyalgia rheumatica | Rheumatoid arthritis

In what condition do you also have the generalized symptoms of malaise, depression, anorexia, weight loss, fever, but no true weakness

POlymyalgia rheumatica

In what three conditions is stiffness often prominent in the mornings?

Rheumatoid arthritis Polymyalgia rheumatica fibromyalgia

What is widespread musculoskeletal pain and tender point. Mechanism amy involve aberrant pain and signaling ampliciation?

Fibromyalgia syndrome

In what joint pain condition is there no swelling?

Fibromyalgia

In what joint conditions is motion limited primarily by pain?

Acute gout | Polymyalgia rheumatica

In what condition is swelling and edema present over dorsum of hands, wrists, feet

Polymyalgia rheumatica

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.

Calcific Tendinitis

Patient shows increased pain when you have them place their arms at side with elbows flexed and have them supinate forearm against your resistance.

Bicipital Tendinitis

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.

Acromioclavicular arthritis

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.

Olecranon bursitis

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.

Rheumatoid nodules

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.

Lateral epicondylitis

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.

Medial epicondylitis

What are the three most commonly affected joints in actue rheumatoid arthritis?

Proximal interphalangeal Metacarpophalgeneal Wrist

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

Boutonniere deformity

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.

Heberden's node

What are nodes seen in OA that appear on the proximal interphalangeal joints. Metacarpophalangeal joints are spared.

Bouchard's nodes

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.

Dupuytren's Contracture

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.

Trigger finger

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

Ganglion

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 | 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.

Felon

This is usually seen in health care workers exposed to herpes simplex virus in human saliva. Presents with vesicles.

Herpetic whitlow

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.

Flat feet

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.

Hallux Valgus

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.

Morton's Neuroma

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.

Ingrown toenail

Hyperextenion at the metatarsophalangeal joint with flexion at the proximal interphalangeal joint. Corn frequently develops from pressure point over the proximal interphalangeal joint.

Hammer Toe

Painful conical thickening of skin that results from recurrent pressure on the normally thin skin. Commonly on the 5th toe.

Corn

involves skin that is normally thick. In an area of recurrent pressure. Usually painless. Tender to direct pressure

Callus

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.

Plantar Wart

May develop at pressure points on the feet when pain sensation is diminished. Often deep, infected, indolent, but painless

Neuropathic ulcer

What sign is neck flexion with resulting sensation of electrical shock radiating down spine? What problem do you see it?

Lhermitte's sign, Cervical myelopathy from cervical cord compression