MUSCULOSKELETAL Flashcards
(40 cards)
Signs & Sxs:
- Unilateral elbow pain
- Dull ache that increases with grasping and turning
- Tenderness over insertion point
- Increased pain with extension of wrist against resistance
Lateral epicondylitis (tennis elbow)
Signs & Sxs:
- Burning pain and/or tingling in fingers, esp at night
- Sxs relieved by rubbing or shaking hands
- Sxs occur when driving, reading, or with repetitive maneuvers
Carpal Tunnel
Signs & Sxs:
- Decreased ROM, joint crepitus and pain
- Stiffness less than 15 min duration, esp morning and after sitting
- Weakness and wasting of muscles acting on the joint
- Common in DIP, PIP, hip, knee, spine
Osteoarthritis
Signs & Sxs:
- Swelling, heat, deformity, pain on PROM
- Morning stiffness
- Ulnar deviation, MCP and PIP swelling
- Malaise, fatigue, depression, anorexia, osteoporosis
- Common in knee, wrist, elbow, shoulder, ankle, neck
Rheumatoid arthritis
Signs & Sxs:
- Pain, swelling, redness and tenderness develop suddenly at joint
- Attacks generally 3-10 days
- First attack usually at MTP of great toe
Gout
Most common form of joint dz
Osteoarthritis
What are common sites of OA?
-DIP
-PIP
-hip
-knee
-spine
(Axial skeleton - large joints)
What signs or features might be seen on xray for osteoarthritis?
- asymmetric joint narrowing
- bony sclerosis
- subchondral cysts
- misalignment of joint
- marginal osteophytes
Where are Heberden’s Nodes found?
-seen in OA at the DIP joint
Where are Bouchard’s Nodules found?
-seen in OA at the PIP joint
Tx for OA
- weight reduction, exercise
- APAP, salicylates, intra-articular steroids
- surgical
Common sites for RA
- knee
- wrist
- elbow
- shoulder
- ankle
- neck
What are the diagnostic criteria for RA?
- 5 of 7 must be present
- morning stiffness >1 hour
- arthritis of >3 joint groups
- swelling of wrist, PIP or MCP
- symmetrical joint swelling
- subQ nodules
- positive rheumatoid factor test
- radiographic changes
What tests and results are expected for RA?
- ESR and CRP elevated
- Rheumatoid factor often positive
- bone erosions at the joint
- symmetrical joint space narrowing
Tx for RA
- consult rheumatologist
- PT
- NSAIDs and aspirin
- DMARDs: methotrexate, sulfasalazine, hydroxychloroquine
First joint usually attacked with gout
MTP of great toe
What causes gout?
-deposits of urate crystals in tissue results in arthritis, tophi, nephropathy, and nephrolithiasis
What tests are done for gout and what are the expected results?
- joint fluid analysis diagnostic
- serum uric acid level >7 mg/dL
- rat bite or punched out erosions on xray is late finding
Tx for Gout
- RICE, NSAIDs (naproxen and indomethacin)
- allopurinol to prevent further attacks
- colchicine to reduce inflammatory response
Most common neuropathy
carpal tunnel
What nerve is affected in carpal tunnel?
median nerve
Tinel’s Sign
positive if tapping over median nerve at volar wrist produces pain or tingling
Phalen’s Sign
palmar flexing the hands for 1 min elicits pain or tingling (positive test)
What are typical exam findings in a patient with carpal tunnel?
- positive Tinel’s
- positive Phalen’s
- finger sensory loss
- wasting of thenar or hypothenar muscles (late sign)
- hand weakness (early)
