musculoskeletal deck 1 Flashcards
What is the definition of NEXUS criteria
a set of validated criteria used to decide which trauma patients do not require cervical spine imaging.
What is the NEXUS (National Emergency X-Radiography Utilization Study) criterion?
alert and stable no focal neurologic deficit no altered level of consciousness not intoxicated no midline spinal tenderness no distracting injury
What is the Canadian C-spine rules definitition
a set of guidelines that help a clinician decide if cervical spine imaging is not appropriate for a trauma patient in the emergency department. The patient must be alert and stable.
What are the 3 Canadian C-spine rules
There are three rules:
is there any high-risk factor present that requires cervical spine imaging?
≥65 years
a dangerous mechanism
fall from elevation >3 ft (or 5 stairs)
axial load to the head
high-speed motor vehicle collision (e.g. >100 km/hr or ~60 mph, rollover, ejection)
motorized recreational vehicles
bicycle collision
paresthesias in extremities
If any high-risk factor is present, then cervical spine imaging is warranted.
is there any low-risk factor present? simple rear-end motor vehicle collision excludes being hit by a high-speed vehicle, a large vehicle (e.g. bus), or rollover sitting position in emergency department ambulatory at any time since the injury delayed onset of neck pain absence of midline C-spine tenderness If the patient does not meet the criteria of a low-risk injury, then cervical spine imaging is warranted.
If the patient meets the criteria of a low-risk injury, then one should assess on physical exam whether the patient can rotate the neck 45°.
if low-risk injury and the patient can rotate the neck 45°
no cervical spine imaging required
if low-risk injury and the patient cannot rotate the neck 45°
then cervical spine imaging is warranted
Shoulder pain- acute time line
< 2 weeks
acute shoulder pain, what should you consider?
trauma, fractures, dislocations, falls
common causes of chronic shoulder pain
-Rotator Cuff Injury
•Impingement syndrome
•Adhesive capsulitis
•Osteoarthritis
Common causes of chronic referred shoulder pain
Neural impingement –(at the level of the cervical spine) •Peripheral nerve entrapment –(distally to the spinal column) • Diaphragmatic irritation –(spleen laceration, perforated viscous, infection ruptured ectopic pregnancy)
Positive Kehrs sign
L shoulder pain indicative of a splenic lac
articular surface commonly associated with arthritis
glenohumeral
4 muscles that make up the rotator cuff
-Anterior: Supraspinatus, Subscapularis
–Posterior: Infraspinatus, Tres minor
test for subacromial impingement or a supraspinatus tendon lesion
Jobes test aka empty can test
Diagnostic imaging for Shoulder pain
• Lidocaine injection test (in office)- checks for
possible response to steroids. Can also be a
treatment.
•Plain X/rays- 2 views minimum
• MRI with or without-
–Can visualize better, but not definitive.
• U/S- Can be equal to MRI if done well.
Lab Diagnostics for shoulder pain
- CBC- look for infection
* Sed rate- Inflammation
Hawkins Kennedy test
pain is a positive test is most likely indicative of damage to the tendon of the supraspinatus muscle and greater tuberosity impingement
How is the hawkins kennedy test performed
Flexing the shoulder and elbow to 90 degrees and forcibly internally rotating the shoulder
Positive (Painful) arc sign
have the patient elevate the arm in the scapular plane and then reverse the motion. pain is produced between 60 and 120 degrees - means either supraspinatus tendonitis or a partial tear of the tendon
Neer Test
tests for subacromial impindgement.
Take arm up bast head and forcefully moves the arm through the full range of forward flexion or until reports of pain.
lag sign is indicative of
a muscle tear (rotator cuff)
Chronic shoulder pain generally is caused by the
Rotator cuff
What is impingement syndrome
used to describe symptoms that occur from the compression of the rotator cuff tendons and the subacromial bursa between the greater tubercle of the humeral head and the lateral edge of the acromion process
older adults tend to present with what in regard to shoulder pain
frozen shoulder ( adhesive capsulitis) and symptomatic osteoarthritis
What is adhesive capsulitis
also known as frozen shoulder….a stiffened glenohumeral joint that has lost significant range of motion (ROM)
Osteoarthritis
usually the glenohumeral joint….represents wear and tear of the articular cartilage. occurs due to trauma years earlier
Special tests used for rotator cuff problems
empty can test
Neers test
special tests looking for acromioclavicular joint disease
Cross arm test
special test for glenohumeral joint stability
apprehension test
Special test for maneuvers to test ROM
Scratch test
Painful Arc Test
Degenerative arthritis
Osteoarthritis (OA)
Inflammatory arthritis
Rheumatoid Psoriatic systemic lupus gout undifferentiated arthritis
Joint infection
parvovirus B19
Lyme disease
septic joint
Morning stiffness lasting more than 60 minutes indicates a
inflammatory process
The metacarpal joints (MCP) and wrists are painful in
Rheumatoid arthritis
Distal interphalangeal (DIP) and proximal interphalangeal joints (PIP) are painful in
OA
fever weight loss fatigue Hair loss mouth sores shortness of breath pleuritic pain chest pain palpitations abd pain n/v diarrhea personality change headaches numbness/tingling seizures malar rash photosensitive rashes
symptoms of Systemic Lupus Erythematosus
fever weigh loss fatigue hair loss chest pain palpitation
symptoms of Rheumatoid arthritis
