Musculoskeletal Flashcards
(187 cards)
1
Q
What are risk factors for acute gouty arthritis?
A
Obesity
HTN
Kidney disease
DM
Family Hx
Purine rich foods
Alcohol
Medications
2 or more sugar-sweetened soft drinks/day, fruits high in fructose or any fruit juices
2
Q
What types of foods are rich in purines and not recommended for Gout?
A
-Seafood (mussels, anchovies, scallops, sardines, shrimp, lobster)
-Organ Meat
-Alcohol (beer more than wine/liquor
-Beans
-Spinach
-Asparagus
-Oatmeal
-Bakers/Brewer’s yeast (supplement use)
3
Q
What medications are known to precipitated Gouty attacks by causing hyperuricemia?
A
-Diuretics
-Loop Diuretics (Thiazides Prograf)
-Niacin
-Aspirin
-Cyclosporin
4
Q
What is Gout?
A
Inflammatory arthritis that is caused by a decrease in excretion by the kidneys or uric acid. The uric acid accumulates in the joints, bones and subcutaneous tissue.
5
Q
What are some causes of secondary Gout that produce and increase in renal uric acid clearance?
A
-Psoriasis
-Myeloproliferative/Lymphoproliferative Dis
-Hemolytic anemia
6
Q
What are some causes of secondary Gout that produce and decrease in renal uric acid clearance?
A
-Kidney Disease
-Renal failure
7
Q
What is Gouty Toe?
A
-Pain, swelling, erythema of big toe
-Swelling on the medial boarder of the big toe
-100 x more common than monoarticular septic arthritis
8
Q
What are tophi (Gout)?
A
-accumulate with frequent flare ups
-nontender firm nodules in soft tissues
-gouty crystals fill the tophi
-precipitates in cooler areas of the body (external ear, nasal cartilage, extensor, surfaces of hand/feet/elbow
9
Q
What are the diagnostics and labs used for Gout?
A
-analysis of joint aspirate (urate crystals)
-uric acid serum levels (elevated)
-ESR (elevated)
-CRP (elevated)
10
Q
What is the treatment of acute Gout?
A
-Minimize/remove contributing factors
NSAIDs (avoid aspirin it precipitates UR)
-Colchicine
-Oral steroids (prednisone)
-Corticoid steroid local injection
-Pegloticase (IV infusion q 2 wks)
11
Q
What is the treatment for prevention of Gouty flare ups?
A
-Allopurinol
-Febuxostat
-Probenecid
12
Q
Why is colchicine often poorly tolerated?
A
GI issue (recommend to tape does)
13
Q
Why is aspirin contraindicated in the treatment of Gout flare ups?
A
Aspirin is a precipitate for gout
14
Q
When should you avoid treating Gout flare ups with NSAID for patients?
A
Patients taking warfarin, renal failure, peptic ulcer disease
15
Q
What is Pegloticase indication, MOA, and, adverse effects, administration for Gout?
A
-Use for patients with chronic gout that is refractory to other medications
-contains an enzyme that catalyzes the oxidation of uric acid to allantoin (water soluble metabolite readily eliminated from the body, thus lowering serum UR)
-infusion rxn, and CHF exacerbation
-IV infusion q 2 weeks for at least 6 months
16
Q
What medication are used to prevent Gout and if they limit the body’s production or improve kidney excretion of uric acid thus affecting serum uric acid levels?
A
-Allopurinol (limits ur production)
-Febuxostat (limits ur production)
-Probenecid (improves kidneys ability to remove ur from the body)
17
Q
What is Probenecid MOA, and adverse effects?
A
-improves kidneys ability to remove ur from the body thus leading to high concentrations of ur in the urine
-greater risk of kidney stones
-rash, abdominal pain
18
Q
What are common adverse effects of allopurinol?
A
-rash, low blood counts
-limits amount of ur the body makes
19
Q
What are common adverse effects of febuxostat?
A
-limits the amount of ur the body makes
-rash
-nausea
-reduced liver function
20
Q
What is the purpose of a 24-hour urine collection and when it is indicated when treating/managing a gouty flare up?
A
-determine if there is overproduction or under secretion of uric acid and will determine which medications are best used for long term management of gout
-overproduction (allopurinol, febuxostat)
-under secretion (probenecid)
21
Q
What additional medications have been found to work as adjuncts to gout medications and aid in urate excretion?
A
-fenofibrate
-losartan
22
Q
What is pseudogout? Where is most commonly seen? What are risk factors? What are the S/S?
What other endocrine conditions is it associate with? How do you diagnosis? What is the treatment?
A
-presence of (CPPD) calcium pyrophosphates deposition in the joints
-knees, wrists, ankles
-RF: older age, family history, mineral imbalances)
-warm, swollen, painful joints
-Hypothyroidism, hyperparathyroidism
-Dx: presence of CPPD crystals in the affected joint
-Treatment: NSAIDs, colchicine, oral corticosteroids (pain relief and improve joint function)
23
Q
What are some causes of secondary gout?
A
-psoriasis
-hemolytic anemia
-renal failure
24
Q
What is seen in the clinical presentation of a gouty toe?
A
-swelling on the medial aspect of the join
-pain, swelling of joint
25
What is the most helpful diagnostic test to perform during acute gouty flare up?
-analysis of aspirate from the affected joint
26
What is the first line therapy for treating patients with gouty athritis?
Naproxen sodium (NSAIDs)
27
Where is the most common place for tophi?
-auricles
-elbows
-extensor surfaces of hands
28
What medications are used to treat Gout?
-NSAIDs
-colchicine
29
What medications are used to manage gout?
-febuxostat
-allopurinol
-probenecid
30
How does Pegloticase reduces serum uric acid levels?
by converting uric acid into allantoin that is readily excreted from the body
31
What dietary supplement are associated with increased risk for gout?
Bakers/Brewer's yeast
32
Pseudogout is cause by what?
formation of CPPD crystals in the joints
33
Pseudogout is linked with abnormal activity of what gland or orange?
parathyroid
34
What will help to differentiate between gout and pseudo gout?
-analysis of minerals in the blood
-analysis of joint fluid
-measuring thyroid function
35
What is recommended for treatment of pseudogout?
-NSAIDS
-colchicine
-oral corticosteroids
36
What are the joints and soft tissues involved in gout?
-Joint Involvement: Peripheral joints/bursae on great toe; Other joints (midfoot, ankle, wrist/interphalangeal joints/elbow common)
-Soft tissue Tophus: Chalk substance from subcutaneous nodule under transparent skin with overlying vascularity and
Located on the ear, olecranon bursa and fingers
37
What is important to ensure you include in your assessment for gout?
-Identify an acute onset of hot, painful, red, tender swollen joints. S
-Systemic complications include a fever, elevated CBC, renal failure, calculi, and tophi.
-Gout may be associated with obesity, impaired glucose tolerance/Diabetes Mellitus, hyperlipidemia, hypertension, trauma, surgery, or infection.
-You may conduct a serum urate level 2 weeks after flare resolves (may be normal during acute attack).
38
Acute gouty arthritis is defined as the presence of 6 of the following 12 criteria:
-More than one attack of acute arthritis
-Maximal inflammation developed with 1 day
-Attack of monoarticular arthritis
-Joint redness on physical exam
-First metatarsophalangeal joints (MTP) painful/swollen
-Unilateral attack involving first MTP
-Unilateral attack involving tarsal joint
-Suspected tophus
-Hyperuricemia
-Asymmetric swelling within a joint (X-Ray)
-Subcortical cysts without erosions (X-Ray)
-Negative culture of joint fluid for -microorganisms during attack of joint inflammation
39
What defines chronic gout?
Chronic gout is defined as having urate crystals in the joint fluid and tophus containing urate crystals diagnosed by chemical means or polarized microscopy
40
Recommended lifestyle changes for gout management?
- DASH diet, and
-low fat/low purine diet
-avoiding alcohol
-losing weight
-increasing exercise
-avoiding sugar soft drinks (containing fructose)
-consume skin milk, low fat yogurt, veggies/veggie protein, and soybeans
41
Recommendations of medications when managing Gout
-avoid aspirin use
-stop thiazides/loop diuretics and consider other medications to manage HTN
42
What are medication recommendations for acute gout?
Acute attack:
-Initially, use Indocin and oral Colchicine
-Then oral steroids (Prednisone) if needed
43
What are medication recommendations for hyperuricemia?
-Reduce sodium uric acid < 6 mg%. Low dose oral Colchicine 6 weeks till attack gone.
-Allopurinol 4-6 wk after acute attack or give separately.
-Normal renal function, uric acid under-excreter: Probenecid, sulfinpyrazone
-Decreased renal function, uric acid over producer: Colchicine, Allopurinol
44
What happens when uric acid in the blood becomes too high?
-it can lead to the formation of sharp, needle-like crystals that accumulate in the joints
-causing sudden and severe pain, inflammation, redness, warmth, and swelling.
45
What condition is characterized by form of inflammatory arthritis that results from the deposition of uric acid crystals in the joints.
Gout
46
What can happen if chronic gout is left untreated?
-joint damage
-deformity
-decreased joint function
47
This is the most common type of arthritis and is degenerative.
Osteoarthritis
48
his is an inflammatory arthritis and occurs when an individual’s immune system goes awry.
Rheumatoid Arthritis
49
This is an inflammatory arthritis that also affects the skin.
Psoriatic
50
This is a metabolic arthritis that is caused by a buildup of uric acid that is related to breaking down purines found in red meat, alcohol, shellfish, and soda.
Gout
51
What is bursitis?
How many bursae are in the body?
What is the treatment for bursitis?
-Painful, inflamed bursae.
-160 bursae in the body
-Treatment: for this condition is resting and protecting the affected area from repetitive trauma
PT for maladaptive movement patterns
52
What is tendinosis (long term damage)/tendonitis?
What is the recommended for treatment?
When is PT recommended?
-Collagen degeneration of the tendon and inflammation of the tendon
-Rest/ice for 24-72 hours
-Physical therapy is recommended for manual therapy (friction massage, exercises) to treat maladaptive movement patterns
53
What is the difference between a sprain and strain?
-Sprain (stretching/tearing of ligament)
-Strain (stretching/tearing of muscle/tendon)
54
What is the function of a ligament?
Connects 2 bones together
55
What is the function of tendons?
-Tendons are fibrous cords of tissue
-Connect muscles to bones
56
What are the shared common side effects of the following NSAIDS? (Ibuprofen, Naproxen, Meloxicam, Diclofenac, Etodolac)
-gastrointestinal upset
-kidney damage
-ulcers
57
What joints can be treated with Voltaren Gel 1% (diclofenac)?
What should you teach a patient about application and use?
-superficial joints such as hands, toes, and knees.
-Once you apply it to the affected area, do not wash for 1hr after using and wait 10 min to get dressed
-be careful with combination use of other NSAIDs
58
What should you consideration must be considered when prescribing tramadol?
-risk of serotonin syndrome when combined with selective serotonin reuptake inhibitors (SSRIs).
59
How long should a prescribed course of Methyl prednisone not exceed?
taken for a maximum of 1 -2 weeks
60
What type of drug is Kenalog?
How long does Kenalog last for treatment?
What condition should you use caution with when treating a patient with Kenalog and why? What should be considered in DM patients before giving Kenalog?
-Injectable corticosteroid
-provides relief for up to 3-6 months.
-DM and increase BS up to 5 days (BS peaks -5-84hrs after injection)
-BS greater than 200.
-It is questionable if the benefit outweighs the risk in patients with an A1C greater than 7.0
61
Why is Zilretta a possible injectable corticosteroid alternative for DM patients?
-new on the market! So, it can be expensive.
-Offers extended-release triamcinolone -Preliminary results show a minimal bump in blood sugar
62
Examples of muscle reactants?
Cyclobenzaprine (Flexeril)
Tizanidine (Zanaflex)
Carisoprodol (Soma) **Abuse potential
Diazepam (Valium) **Abuse potential
63
What TCAs are commonly prescribed to help musculoskeletal pain management?
What condition are they indicated to treat neuropathic pain?
What are the side effects of TCAs?
TCAs are superior to what other drug class?
-Nortriptyline and Amitriptyline
-Fibromyalgia
-side effects: of dry mouth, drowsiness, and dizziness
-superior to SNRIs (can be used but can cause insomnia) for treating pain/depression
64
What is plantar fasciitis?
-Inflammation of plantar fascia that causes pain in the arch of the foot and radiates to the heel
65
What is the most common cause of heel pain?
Plantar fasciitis
66
What are some predisposing factors for plantar fasciitis?
-Over use injury (running)
-tight or weak muscles/tendons (Achilles tendon, heel cord, gastrocnemius, soleus muscle)
-Anatomical abnormalities: low arch support, flat foot, high arch, tibial torsion, overpronated foot, leg length discrepancy, forefoot varus, thinning fat pad
-Overweight/obesity
67
Signs and symptoms of plantar fasciitis?
-stabbing foot pain at bottom of heel in the morning first thing "start up" pain and improves with the day but gets worse at night
-burning pain w/walking
-stiffness foot/heel
-increased foot pain w/walking after long periods of sitting/standing
68
Treatment/management for plantar fasciitis?
-strength training
-stretching exercises
-NSAIDs
-PT
-proper foot ware
-avoid walking on hard surfaces
-Ice therapy
-corticosteroid injections (sever cases)
- it can take months for resolution
69
What is the most common cause of bursitis?
Joint over use
70
What is first line treatment for busititis?
NSAIDs
71
Patients with olecranon bursitis typically present with what smptom?
Swelling and redness over the affected area
72
What symptom do patients with subscapular bursitis typically present with?
Localized tenderness und the superomedial angle of the scapula
73
What symptom do patients with gluteus medius or deep trochanteric bursitis present with?
increased pain from resisted hip abduction (moving away from axis of the body)
74
What is a common sequalae of intrabursal corticosteroid injection?
-soreness at injection site
-after injection infection, tissue atrophy, and inflammatory reaction are possible
75
What is first line therapy for prepatellar bursitis?
bursal aspiration
76
What clinical conditions have similar presentation to acute bursitis?
-RA
-septic arthritis
-joint trauma
-pseudo gout
77
Clinical presentation for prepatellar bursitis? What are some risk factors?
-swelling
-pain in front of knee
-normal ROM
-RF: frequent kneeling (house maid's knee)
78
Clinical presentation and risk factors for olecranon bursitis?
-pain
-swelling behind the elbow
-ball or sack hanging from elbow
-RF: prolonged pressure/trauma to elbow (draftsman's elbow)
79
Clinical presentation and risk factors for trochanter bursitis?
-gait disturbance
-local trochanter tenderness
-pin on hip rotation/resisted hip abduction
-normal ROM
-RF: back disease, leg length discrepancy, leg issues leading to gait disturbance
80
Clinical presentation and risk factors for subscapular bursitis?
-local tenderness superomedial angle of scapula over adjacent rib
-normal ROM
-no nerve impingement
-RF: repeated back and forth motion
-common in assembly line workers
81
Clinical presentation for pre-Achilles bursitis?
-pain/swelling in the heel
-minimal pain with dorsiflexion
-norma ankle ROM
-does not contribute to tendon rupture
82
Clinical presentation and risk factors of retrocalcaneal bursitis?
-pain behind ankle worse w/walking
-patient will run fingers on both side of the Achilles tendon
-RF: wearing high heels, repetitive movement, (stair climbing, running, jogging, walking)
83
What is the Ottawa Ankle rule?
-tool to use for determining severity of injury (safe to discharge from ER)
-useful tool for assessing the urgency of imaging for acute ankle injuries in the emergency department
-5 Rules (reliability, accuracy, clinical judgment, validity, uses)
84
When should you not use the Ottawa Ankel rule
Children under 6, open wounds/fractures, compartment syndrome
85
What is the typical presentation with a person with lateral epicondylitis (tennis elbow)
-decreased hand grip strength
86
What are risk factors for lateral epicondylitis (tennis elbow)?
-repetitive lifting
-playing tennis
-hammering
87
Up to what % of people with medial epicondylitis (golfer's elbow) recover without surgery?
80-95%
88
What is initial treatment for lateral epicondylitis (tennis elbow)?
-rest/activity modification
-topical/oral NSAIDs
-counterforce bracing
89
Extracorporeal shock-wave therapy can be used in the treatment of epicondylitis as a means to...
promote natural healing process
90
Clinical presentation of medial epicondylitis (golfers' elbow)?
-decreased grip strength
-pain over medial epicondyle on inner aspect of lower humerus
-pain worsens w/wrist flexion and pronation
-local tenderness (elbow pain)
-forearm weakness
-full ROM
91
What are some risk factors for medial epicondylitis (golfers' elbow)?
-golf
-lifting certain tools
-playing sports that require a tight grip
92
What are strategies to prevent medial epicondylitis (golfers' elbow)?
-prevent recurrence of palm-up lifting
-using a tennis elbow band
-proper tool use
-proper body mechanics
-develop muscle strengthen and stretching
93
Clinical presentation of lateral epicondylitis (tennis elbow)?
-pain over lateral epicondyle or outer aspect of elbow or outer aspect of lower humerus
-pain increases w/ resisted wrist extension,
-hand grip is weak
-ROM normal
94
What are some risk factors for lateral epicondylitis (tennis elbow)?
-repetitive activity (lifting)
-sports with tight grip
-use of certain tools
95
What are strategies to prevent lateral epicondylitis (tennis elbow)?
-avoid preciptation factor
-proper tool use
-proper body mechanics
-develop muscle strengthen and stretching
96
What is the most common type of sprain?
ankle sprain while jumping or running (inversion or rolling of the ankle
-knee, wrist, elbow are less common
97
What are risk factors for ankle sprains?
-poor conditioning
-inappropriate footwear
-lack of warm up prior to exercising
98
What is the best description of a grade 2 ankle sprain?
-moderate swelling
-mild/moderate ecchymosis
-moderate joint instablity
99
A person with a grade 3 ankle sprain presents with?
-complete ankle instability
-significant swelling
-moderate/severe ecchymosis
100
Patients with a grade 3 ankle sprain should be advised that full recovery can take how long?
many months
101
What is the treatment for a sprain?
RICE, NSAIDS, immobilizers, PT, joint rest
102
How long should weight bearing be avoided for a grade 1 sprain?
for at least 24 hours
103
A short leg cast or cast brace for 2-3 weeks is often needed for what type of ankle sprain?
Grade 3
104
What are helpful strategies that may help to avoid an ankle sprain?
-good footwear
-taping
-pre exercise warm up
-improved conditioning
105
What is a grade 1 ligament sprain and interventions?
-slight stretching or microscopic tear
-no instability
-RICE, immobilizer, limit weight bearing, -analgesia
-rest for a few days
106
What is a grade 2 ligament sprain and interventions?
-partial tear
-moderate instability
-moderate swelling
-mild/moderate ecchymosis
-slight stretching or microscopic tear
-no instability
-RICE, immobilizer, limit weight bearing, --analgesia
-few weeks to few months for recovery
107
What is a grade 3 ligament sprain and interventions?
-complete tear
-complete instability
-significant swelling
-moderate/severe ecchymosis
RICE, immobilizer, limited WB, analgesia, recovery several months
108
What type of motion is seen with a grade 3 sprain of the ankle?
excessive anterior motion
109
What test is used to assess for excessive laxity of the tibiotarsal joint?
ankle anterior drawer test
110
What grades of ankle sprains are associate with persistent joint laxity and risk of future sprain?
Grade 2 and 3
111
Avoid bearing weight for how long after the initial sprain?
24 hours
112
What grade of sprain requires an immobilizer or splint?
Grade 2
113
What percentage of people with low back pain will have symptoms resolve within 1 months without specific therapy?
90%
114
What are risk factors for development of low back pain?
-older age
-overactivity
-overweight/obesity
-degenerative disorders (scoliosis, spondylolisthesis, spinal stenosis)
115
What is the cause of most episodes of low back pain?
lumbosacral strain/muscle/ligament strain
116
What will a patient with lumbosacral strain report?
stiffness, spasms, reduced ROM
117
With the straight leg raising test the NP is evaluating tension on which nerve roots?
L5 and S1
118
You see a 54-year-old man complaining of low back pain and who is diagnosed with acute lumbosacral strain. What advise would you give about exercising?
back strengthening exercises may cause mild muscle soreness
119
What are risk factors for lumbar radiculopathy?
male gender
being overweight
smoking
120
What does a patient with sciatic typically report?
shooting pain that starts at the hip and radiates to the foot
121
What are some early changes in patients with lumbar radiculopathy?
loss of deep tendon reflex
122
What are some common causes of sciatica?
herniated disk
spinal stenosis
compression fracture
123
You see a 48-year-old women who reports low back pain. During the evaluation, she mentions new onset loss of bowel and bladder control. What does this most likely indicate?
cauda equina syndrome (go to the ER ASAP)
124
Loss of posterior tibial reflex often indicates a lesion at what level?
L5
125
Loss of Achilles tendo reflex most likely indicates a lesion at what level?
L5-S1
126
Which test is demonstrated when the examiner applies pressure to the top of the head with neck bending forward, producing pain or numbness in the upper extremities?
Spurling
127
When should you reserve immediate imaging for low back pain should be reserved for what conditions?
prescience/sighs of cauda equina syndrome
presence severe neurological deficits
presence of risk factors for cancer
128
Which test yields the greatest amount of clinical information in a patient with acute lumbar radiculopathy?
MRI
129
A lumbar x ray would be most helpful to aid in the diagnosis of new onset low back pain?
patient that reports slipping/falling on icy sidewalk or fall in general eliciting pain (bone)
130
Where is the most common site for cervical radiculopathy?
C6- C7
131
What is the most common site for lumbar disk herniation?
132
What interventions would you recommend for a 37-year-old man complaining of low back pain consisting of stiffness, and spams but without any signs of neurological involvement. What would you recommend for management?
-no bed rest
-application of cold pacts 20 min 3-4 times a day
-use of NSAIDs or Tylenol for pain
-initiation of toning aerobic exercise
133
When considering the use of opioids for low back pain, the NP considers what factors before prescribing.
-evaluate for abuse potential
-common adverse effects include sedation and constipation
-limit use to patients with severe pain or pain refractory to meds
-
134
What non-pharmacological methods is helpful in preventing low back pain recurrence?
-low impact aerobic exercises
-toning exercises
-massage therapy
135
What should you advise a patient when considering use of muscle relaxants for treating low back pain?
-agents have abuse potential
-use at night to improve sleep
-caution when operating heavy machinery
136
What are the 3 categories of back pain?
-Acute less than 6 weeks
-Subacute 6-12 weeks
-Chronic +3 months
137
What describes herniated nucleus pulposus?
Leg pain greater than back pain
Pain L1-L3
Radiates to hip/knee
Pain form L4-L5 radiates to below the knee
138
What describes lumbar strain/sprain?
Diffuse back pain with/without buttock pain
Pain worsens with movement
Pain improves with rest
139
What describes a compression fracture?
-predicated by a history of trauma (unless osteoporotic)
-point tenderness at spine level
-pain is worse with flexion and pulling up from supine to sitting and sitting to standing
140
What describes spinal stenosis?
-leg pain is greater than back pai
-pain is worse with standing/walking and
-pain improves with rest or when the spine is flexed
-pain may be unilateral (foraminal stenosis)
-pain may be bilateral (central or bilateral foraminal stenosis)
141
What describes spondylosis (stress fracture through pars interarticularis)?
pain is worse with extension and activity
142
What describes spondylolisthesis (forward slippage)?
Leg pain is greater than back pain
It gets worse with standing and walking
Pain improves with rest and when the spine is flexed
Pain can be bilateral or unilateral
143
What describes spondylosis (DDD, facet joint arthropathy, arthritis)
Pain that worsens with flexion activity and sitting
Facet pain worsens with extension activity, standing or walking
It is chronic and pain can be diffuse in the lower back
144
What considerations should you make when determining potential for neurological compromise in patients with low back issues?
-Radicular pain to the lower extremities
-Intermittent leg pain that resolves with rest (pseudoclaudication)
-Stenosis, Herniated Disc
-Loss of bowel/bladder function, numbness in saddle region and weakness of the lower extremities = CAUDA EQUINA SYNDROME
RED FLAG and is a NEUROLOGICAL EMERGENCY
145
What are the signs/symptoms of cauda equina syndrome and what should you do ASAP?
-loss of bowel/bladder function
-numbness in saddle region
-weakness of the lower extremities
146
When preforming a physical exam on a patient with low back complaints what should you include in your exam?
-observe gait
-ease of movement
-inspect the back by taking note of the body habitus, posture, and obvious abnormalities such as scoliosis, kyphosis, pelvic tilt, excessive lordosis
-palpate spine
147
Preforming hip flexion assess what muscle or never root origin of pain?
iliopsoas
L2
L3
148
What is scoliosis?
Sidways curve in spine or back bone
149
What is kyphosis?
-excessive forward curve of your spine
-cause you to lean forward like you’re hunching over
150
What is pelvic tilt?
pelvic muscles lean too much toward one side
151
What is lordosis?
forward curved spine in your neck or lower back
152
Preforming knee extensors assess what muscle or never root origin of pain?
Quadriceps, L4
153
Preforming knee flexion what muscle or never root origin of pain?
hamstrings, L4
154
Preforming ankle dorsal flexors assess what muscle or never root origin of pain?
L5
155
Preforming great toe extension assess what muscle or never root origin of pain?
L5
156
Preforming plantar flexors assess what muscle or never root origin of pain?
S1
157
Nerve root L3 is a/w what motor/reflex/ and sensory area
Neurological Testing in Lumbar Vertebral Problems
Motor: hip flexion
Reflex: patella
Sensory Area: medial knee
158
Nerve root L4 is a/w what motor/reflex/ and sensory area
Neurological Testing in Lumbar Vertebral Problems
Motor: foot dorsal flexion
Reflex: patella
Sensory Area: medial calf
159
Nerve root L5 is a/w what motor/reflex/ and sensory area
Neurological Testing in Lumbar Vertebral Problems
Motor: great toe dorsiflexion
Reflex: medial hamstring
Sensory Area: medial foot
160
Nerve root L1 is a/w what motor/reflex/ and sensory area
Neurological Testing in Lumbar Vertebral Problems
Motor: foot eversion
Reflex: Achilles
Sensory Area: lateral foot
161
Straight leg raises
-Conduct this test with the patient supine to assess for tension on L5 S1 nerve root.
-Test at 30-70 degrees. I
- If there is leg pain below the knee, the test is POSITIVE, with or without back pain.
-It is probably Herniated nucleus pulposus (HNP). If there is leg pain above the knee, the test is negative.
-There is referred pain from the back and tight hamstrings.
-If there is just back pain, the test is negative.
-It is probably muscle strain or a mechanical pathology.
162
Positive slump test can indicate what?
-herniated disc or never root entrapment
163
Dix Hallpike Test
vertigo
164
Spulings test
cervical radicular syndrome
foraminal compression test
-patient’s head into extension and lateral bending and assess if symptoms
occur distal to the elbow
165
Flexion rotation test
-upper cervical hypomobility
-patient lays supine with cervical spine in maximal flection
166
Cozen's Test
lateral epicondylitis (tennis elbow)
167
Straight leg raise
lumbar radicular syndrome
168
Lachman
anterior cruciate ligament test (ACL)
169
Thompsons test
Achilles tendon rupture
170
Indications for Cancer lumbar/sacra/cervical
Strong: Known mets to bone
Intermediate: Unexplained weight loss
Weak: Pain unrelieved by rest
Weak Exam findings: Vertebral tenderness, limited ROM
171
Indications for cauda Equina Syndrome
Strong: bladder/bowel incontinence, urinary retention, progressive motor or sensory loss
Exam findings strong: Major motor weakness, sensory deficit, loss of anal sphincter tone, saddler anesthesia (loss of sensation buttock/anal)
172
Indications for fracture lumbar/sacra/cervical
Strong: trauma (related to age)*
Intermediate: Prolonged use of steroids
Weak: older than 70, history of osteoporosis
Exam findings weak: vertebral tenderness, limited ROM
173
Indications for infection lumbar/sacra/cervical
Strong: Severe pain and history of lumbar spine surgery within 1 year
Intermediate: IVDA, immunosuppression
Exam findings strong: Fever, urinary tract infection (UTI), wound in spinal region
Exam findings weak: Vertebral tenderness, limited ROM
174
X ray is not recommended for the most acute presentations. When should you consider and x-ray?
suspicious of “red flag” problems
if the situation is unimproved in 6-8 weeks.
An x-ray can identify fractures, bony tumors, arthritis, and disk height
175
What can and x-ray identify?
fractions, bony tumors, arthritis disc height
176
What can and MRI identify? When should you consider and MRI for a patient?
-soft tissues, disk herniations, soft tissue tumors, nerve compression
-consider MRI: patient exhibits motor/reflex deficits or radicular symptoms not improved in 6-8 weeks
177
What to educate patients about manging/treating acute back pain?
-modify your activities
-avoid heavy lifting, pushing or pulling
-avoid bed rest
-use progressive ROM
-light exercise like walking or pool activities
-NSAID, muscle relaxants, analgesics
-follow up 1-3 wks then with no improvement PT
-continue to modify plan 4-6 wks
-reassure that most pain resolves in 3-4 wks
-refer as needed
178
What should the NP consider with assessing/managing hip pain related issues?
-For hip pain check to see if it may actually be a back issue.
-Pain patterns are essential to assess, to better assist in determining causes and treatment modalities.
-Referred pain includes pain impacting the pelvis, femur, hip joint, and soft tissues
179
Issues with flexion associated with conditions for back and leg pain
back: arthritis, DDD fracture
leg: radiculopathy, ITBS, tight hamstrings
180
Issues with extension associated with conditions for back and leg pain
back: arthritis, DDD fracture, facet arthropathy
leg: radiculopathy, neuroforaminal stenosis
181
Issues with lateral flexion associated with conditions for back and leg pain
back: guarding or tensing muscles, hesitation, asymmetry
leg: leg pain not typically associated with lateral flexion, could indicate referred pain from a different source
182
Facet arthritis
wear and tear arthritis
183
When conducting strength testing while the patient is standing -bilateral toe stand (findings)
Look for weakness of gastroc-soleus complex. S1 spinal nerve.
184
When conducting strength testing while the patient is standing -stand on one leg (findings)
Conduct the Trendelenburg test to assess weakness of gluteus Medius, L5 spinal nerve.
185
When conducting strength testing while the patient is standing -heel walking (findings)
This tests ankle and toe dorsiflexor muscles to assess the L5 and partial L4 nerve roots
186
Trendelenburg test
-identify the weakness of the hip abductors
-positive Trendelenburg sign usually indicates weakness in the hip abductor muscles: gluteus Medius and gluteus minims
-findings can be a/w various hip abnormalities (congenital hip dislocation, rheumatic arthritis, osteoarthritis)
187
What muscle is often implicated in a lumbosacral stain?
-erector spinal muscle
-sitting aggravates pain
-relief lying supine on firm surface
