Musculoskeletal Disease Flashcards
(174 cards)
1
Q
53 y/o postal worker presents with lower back pain. on exam he has decreased pinprick on the left lateral thigh and web of his left big toe. this indicates discogenic disease in the dermatomal pattern of which area?
A
L4/L5 (L5 root involvement)
2
Q
C5 myotome innervates _
A
shoulder abduction
3
Q
when wrist and finger extension causes pain over the extensor carpi radialis brevis tendon, when lifting with wrist extended and elbow extended, you would expect _
A
tennis elbow
4
Q
to aid in diagnosis of meniscus damage, which test would you perform?
A
McMurray test
5
Q
sprain
A
injury to ligaments that attach to bones in a joint
6
Q
tx of osteoarthritis
A
acetaminophen, NSAIDS
exercise!
glucosamine and chondroitin for moderate to severe OA
corticosteroid injections for short term relief (4-8 weeks)
hyaluronic injections - longer relief but more $$
total joint replacement
7
Q
cortical bone
A
dense, concentric layers around a vascular supply
found in diaphysis of long bones
80% of human skeleton
8
Q
cancellous or trabecular bone
A
found at end of cortical bone
spongy, porous
found in vertebrae, ribs, plvis and ends of long bones covered by Periosteum
9
Q
articular structures include
A
joint capsule and articular cartilage, synovium and synovial fluid, intra-articular ligmanets and juxta-articular bone
10
Q
extra-articular structures include _
A
periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, and overlying skin
11
Q
ligaments
A
ropelike bundles of collagen fibrils that connect bone to bone
12
Q
tendons
A
collage fibers connecting muscle to bone
13
Q
cartilage
A
collagen matrix overlying bony surfaces
14
Q
bursae
A
pouches of synovial fluid that cushion the movement of tendons and muscles over bone or other joint structures
15
Q
synovial joint
A
freely moveable, bones are covered by articular cartilage bones are separated by synovial cavity synovial membrane secretes synovial fluid that lubricates joint movment IE ::: shoulder & knee
16
Q
cartilaginous joint
A
joint is slightly moveable
bones separated by fibrocartilaginous discs
discs contain nucleus pulposus that cushions bony movement
ie: vertebral bodies of the spine
17
Q
fibrous joint
A
no appreciable mvmt
bones separated by fibrous tissue or cartilage
ie: sutures of skull
18
Q
SYNOVIAL JOINTS
A
spheroidal (ball & socket)
hinge
condylar
19
Q
spheroidal joints (ball and socket)
A
wide ranging
flexion, extension, abduction, adduction, rotation, circumduction
hip && shoulder
20
Q
hinge joint
A
motion in one plane
extension & flexion
interphalangeal joints of hand and foot, ELBOW
21
Q
condylar joint
A
movement of 2 articulating surfaces, not dissociable
knee, TMJ
22
Q
sprain
A
tearing ligaments that bid the joint as joint is forced beyond it’s normal ROM
23
Q
strain
A
overstretching or overusing muscles, tear in tendons
24
Q
dislocation
A
bone is displaced t the joint, causing articlating surfaces of bone to detach
25
subluxation
partial dislocation
26
grade i sprain
microscopic tear of ligament due to overstretching
27
grade ii sprain
incomplete tear with some functional impairment
28
grade iii sprain
full or complete loss of integrity
29
avulsion
ligament pulls away from bone, bringing bone fractures with it
30
fracture
may occur due to neoplasm, trauma, or incresed stress on bone
31
closed fracture
don't underestimate the associated soft tissue injury
32
open fracture considerations
```
soft tissue damage
blood supply
infection
emboli
age/nutrition/anemia
```
33
dermatome C5
area over shoulder
34
dermatome C6
thumb and part of forearm
35
dermatome C7
middle finger
36
dermatome C8
smallest fingers and part of forearm
37
dermatome L4
thigh
38
dermatome L5
medial part of calf and foot, big toe
39
dermatome S1
lateral part of calf and foot, smaller toes
40
myotome C5
deltoid muscle
| abduction of arm at shoulder
41
myotome C6
biceps
| flexion of arm at elbow
42
myotome C7
triceps
| extension of arm at elbow
43
myotome C8
small muscles of the hand
44
myotome L4
quadriceps (extension of leg at the knee)
45
myotome L5
tibialis anterior
| upward flexion of the foot at the ankle
46
myotome S1
gastrocnemius muscle
| downward flexion of foot at the ankle
47
reflex C5
flexion at elbow, biceps
48
reflex C6
flexion at elbow, brachioradialis
49
reflex C7
extension at the elbow, triceps
50
reflex C8
finger flexion
51
reflex L4
knee reflex, quadriceps
52
reflex L5
no reflex
53
reflex S1
ankle reflex, gastrocnemius
54
bursitis
bursae = fluid filled sacs thru/o body that decrease friction over bony prominences
bursitis caused by trauma or overuse
55
subjective questions re: joints
pain
stiffness
swelling, heat, redness
56
subj questions re: muscles
cramps
| weakness
57
subj questions re: bones
pain
deformity
trauma (fractures, sprains, dislocations
58
assessing joint pain
ask patient to point to the pain
clarify "mechanism of injury" esp if it was trauma
local v diffuse
acute v chronic
traumatic v atraumatic
inflamm v noninflamm
59
MS exam (inspection)
Inspection SEADS
- Swelling
- Erythema
- Atrophy
- Deformity
- Scars (surgical)
symmetry, color, skin changes
60
MS Exam principles
Palpation - tenderness /fluid
Range of Motion
Ausculation ( crepitus? injury-popping)
Neurovascular status
61
joint examination
inspect/palpate for skin changes, nodules, muscle atrophy
asssess any degen or inflamm changes ie: swelling warmth, tenderness, redness
perform range of motion , use joint-specific maneuvers
62
signs of inflammation /arthritis
Swelling
{- synovial membrane boggy or doughy
-effusion from excess syovial fluid
-soft tissue such as bursa tendons, tendon sheaths}
```
Warmth
Tenderness
Redness
Loss of Function
Deformity
```
63
muscle strength
apply opposing force
grade 5 = normal
grade 3 - full ROM with gravity but not against resistance
64
bone imaging
radiograph
CT scans
nuclear bone scan
PET
65
muscle imaging
EMG
| biopsy
66
joint imaging
```
u/s
radiograph
MRI
examination of synovial fluid
arthroscopy
```
67
labs for systemic disease
```
ESR -inflammation
CRP -inflammation
ANA -automimmune / *SLE
anti-nuclear antibody
RF -rheumatoid factor
anti-cyclic citrullinated peptide CCP -also for RA
```
68
vectra DA
12 biomarkers , single score to assess RA disease activity
69
joint pain w/ butterfly rash
lupus
70
joint pain w/ scaly rash and pitted nails of psoriasis
psoriatic arthritis
71
joint pain w/ papules, pusutules, or vesicles on reddened base found on distal extremities
gonococci arthritis
72
joint pain w/ expanding erythematous patch
lyme
73
joint pain w/ hives
serum sickness
74
joint pain w/ erosion or scaling on the penis and crusted scaling papules on the soles and palms of the feet
Reiters syndrome
75
joint pain w/ red burning itching eyes
Reiters syndrome
76
joint pain w/ preceding sore throat
acute rheumatic fever
| or gonococci arthritis
77
joint pain w/ diarrhea, abdominal pain, cramping
arthritis w/ ulcerative colitis, scleroderma
78
joint pain w/ mental status changes facial weakness, stiff neck
lyme with CNS involvement
79
management of MSK injuries
```
RICE
immobilization
NSAIDs
topical agents
narcotic analgesia
```
80
emergency referrals
Neurovascular injury
fracture - open unstable
unreduced joint dislocation
septic arthritis
81
urgent (w/in 7 days) referral
fracture closed & stable
after reduction of a joint dislocation
locked joint
tumor
82
early (2-4 weeks) referral
motor weakness
constitutional symtoms
multiple joint involvement
83
subacromial impingement syndrome aka rotator cuff tendinitis
shoulder pain with overhead motion
night pain with sleeping on shoulder
pain with internal rotation - hand behind small of back
84
Hawkin's Test
Elevate patient's arm forward to 90 degrees while internally rotating the shoulder
+ Hawkins = subacromial impingement or rotator cuff tendinitis
85
Neer's impingement sign / "painful arc"
have pt fully pronate the arm and upwardly abduct
stabilize the scapula to prevent motion during the maneuver
+ neer's = subacromial impingement between 70-120
86
rotator cuff tears
injury from fall on outstretched arm or repeated impingement
usually after age 40
weakness, atrophy of suprasinatus adn infraspinatus muscles, pain, tenderness
87
complete tear of supraspinatus tendon
active abduction and forward flexion - characteristic shrugging
and postive drop arm test
88
drop arm test
fully abduct arm to shoulder level
lower it slowly
tap arm briskly
cannot hold or control = + for rotator cuff tear
89
empty can test
```
elevate arms to 90 degrees
internally rotate so thumbs point down
apply downward pressure
weakeness is + test
rotator cuff tear or impingment of supraspinatous tendons
```
90
dislocated shoulder
shoulder instability - anterior dislocation of humerus
rounded lateral aspect of shoulder appear flattened
+ apprehension test
acute dislocation needs to be reduced ASAP
91
apprehension test
shoulder is abducted 90 degrees and elbow is bent
attempt to externally rotate the shoulder
+ test = pt apprehensive
indicates glenohumeral instability
92
labral tear
labrum is rim of cartilage that surrounds glenoid and supports humeral head
cartilage can be torn by a fall, dislocation , subluxation or repetitive trauma
clicking, grinding, weakness
*MRI test of choice
refer to orthopedic surgeon
93
O'Brien's test
arm extended with thumb rotated down -pain elicited with resisted motion
- labral tear !
94
adhesive capsulitis (frozen shoulder)
FIBROSIS of glenohumeral joint capsule
diffusive dull aching pain
progressive restriction of active and passive range of motion
usually no localized tenderness
usually unilateral and occurs in people 50-70
95
apley test
touch opposite scapula , both by reaching up (external rotation) and by reaching internally - placing hand behind lower back
96
acromioclavicular arthritis
common
prior injury -> degenerative changes in the joint
tenderness localized to AC joint
pain with abduction
97
cross arm test
for acromioclavicular arthritis
patient addcuts arm across chest
palpate and compare bilateral shoulders for swelling and tenderness
98
shoulder pain imaging
radiographs
arm @ 30 degrees rotation AP view
outlet Y view
axillary view
MRI - most accurate
99
shoulder pain tx
```
RICE
NSAIDS, acetaminophen
supervised rehab
corticosteroid injections
if it all fails --> surgery
```
100
elbow exam
| resisted flexion
C5-C6
101
elbow exam
| resisted extension
C7-C8
102
elbow exam
| resisted supination
C5-C6
| & lateral epicondylitis
103
elbow exam
| resisted pronation
C6-C7
| & medial epicondylitis
104
lateral epicondylitis
TENNIS ELBOW
repetitive extension of wrist or pronation/supination of forearm
pain near lateral epicondyle
pain when patient tries to extend wrist against resistance
pain when lifting with palm down
105
medial epicondylitis
```
pitchers/golfers/little league elbow
reptitive wrist flexion
tenderness near medial epicondyle
wrist flexion against resitance increases pain
pain when liftin with palm up
```
106
radial head fracture
fall onto outstretched hand
| pain with rotation
107
ulnar neuritis
cubital tunnel syndrome
| compression of ulnar nerve -parasthesia in nerve distribution
108
olecranon bursitis
trauma, or rheumatoid or gouty arthritis
goose egg or redness
swelling superficial to olecranon process
local swelling, acutely painful
109
tx for olecranon bursitis
r/o infection by aspiration
also fever, warmth etc signs of infection
infective bursitis most likely caused by staph aureus
tx: local heat, rest, NSAIDs, corticosteroid injection
110
elbow arthritis
synovial inflammation or fluid
palpate for boggy , soft, swelling / tenderness
causes can be rheumatoid, gout, OA, trauma
pain stiffness / restricted mvmt
111
rheumatoid nodules
subcutaneous nodules at pressure points along ulna - in RA or rheumatic fever
firm, nontender
may be attached to underlying periosteum
may develop in area of olecranon bursa, but often occur more distally
112
wrist and hand exam
check range of motion of: wrist, fingers, and thumbs
check hand grip strength
test sensation of median, ulnar, and radial nerves
113
trigger finger
painless nodule in flexor tendon in the palm
nodule is too big to enter into tendon sheath
finger extends and flexes with a palpable and audible snap as nodule pops into tendon sheath
114
dupuytren's contracture
benign fibrosing disorder
thickened plaque overlying flexor tendon of ring finger
skin in area puckers and thickened fibrotic cord develop
flexion contracture
can lead to limited function
surgical consult
115
carpal tunnel syndrome
commpression of median nerve as it traveels through carpal tunnel
pain, burning, numbness, tingling
116
Tinel's sign
tapping over median nerve produces numbness or tingling
117
Phalen's test
hold hands , backs of hands pressed together for 60 seconds - pain, tingling
118
carpal tunnell features
common w/ pregnancy
pain of numbness of first three fingers but not in palm, WORSE AT NIGHT
loss of sensation
WEAK ABDUCTION OF THUMB
119
ganglionic cyst
from capsule of a joint or tendon synovial sheath
joint fluid
translluminates & well circumscribed
dorsal wrist - accounting for 60-70%
asymptomatic - nerve compression - limitations in ROM
120
tx for ganglionic cyst
simple aspiration
arthroscopic ganglion excision
don't smash with book
121
De Quervan's Tenosynovitis
pain with palpation over the tendon sheath of the thumb
swelling may be present
numbness of thumb and index finger
more common in women- can occur 3-4 weeks after pregnancy
122
Finklestein Test
make a fist with thumb encloses
| flex wrist, tenderness along outer edge of the wrist
123
tx of trigger finger
```
rest , NSAIDS
splint PIP
thumb spica splint,
corticosteroid injections
surgical release
```
124
tx of tensynovitis
ice, NSAIDs, immobilization with gutter splint, cortisone injections
125
tx of palmar fibrosis
any contracture greater than 30 degrees - hand surgeon referral
126
tx of carpal tunnel
neutral wrist splints, NSAIDs, ice, OT, steroid injections, surgical intervention
127
inspection of hip
2 phases of gait
swing and stance
inspect anterior and poteiro surfaes of hip for muscle atrophy or bruising
128
femoral neck and intertrochanteric fracture
most common fractures
incidence increases with age (peak 70-80)
women 5x more likely than men
25-30% mortality in 1 year
129
assessment of femoral neck / intertrochanteric fracture
Flexion Abduction External Rotation
(FABER or Patrick's test)
internal rotation best diagnostic tool for intra-articular hip pathology
affected extremity shortened, externally rotated, and abducted
130
tx of femoral neck / intertrochanteric fracture
pain meds
immobilize
surgery ASAP as most will result in aseptic necrosis
131
complications of femoral neck / intertrochanteric fracture
ipsilateral pelvic and lower extremity fractures
sciatic nerve injry
arterial injury
embolism
132
trochanteric bursitis
inflammation or degeneration of sac-like structures that protect soft tissues from underlying bony prominences
pain with movmenet and rest
swelling
localized tenderness over site of inflammation
corticosteroid injetion under fluoroscopy, US or CT guidance
133
flexion deformity
excess lordosis
| as opposite hip is flexed with thigh against chest, the affected hip does not allow full leg extension
134
hip osteoarthritis
restricted abduction
restrictions of internal and external rotation
pain deep in groin
swelling
loss of active and passive ROM with severe OA
135
hip pain diagnosticcs
x-ray
AP view of pelvis, froleg and AP views of hip
weight bearing films to assess for joint space narrowing and degen
MRI if avascular necrosis suspected
joint aspirate for C&S crystalline deposits and cell count
136
hip pain tx
nsaids/ acetaminophen
topical agents
supplements
JOINT REPLACEMENT SURGERY IS EFFECTIVE AND COST-EFFECTIVE - IMPROVES FUNCTIONAL LIMITATIONS, PAIN, QOL
137
knee pain - mechanical dysfunction
injury to menisci or ligaments
degenerative diseas: OA
fracture as a result of trauma
138
knee pain - intra-articular inflammation
injury to menisci or ligaments
rheumatoid disease
acute monoarticular arthritis
Baker's cyst
139
peri-articular inflammation
injury to menisci or ligaments
prepatellar or anserine bursitis
knee sprain
140
medial knee pain differentials
OA
MCL strain
medial meniscal injury
anserine bursitis
141
anterior knee pain differentials
OA
prepatellera bursitis
septic arthritis
gout or other inflam disease
142
lateral knee pain differentials
lateral meniscal injury
| LCL sprain
143
posterior knee pain differentials
popliteal or baker's cyst
OA
meniscal tears
hamstring or calf tendinopathy
144
knee effusion
can occur with intra-articular pathology such as OA, meniscus and cruciate ligament tears
acute swelling - hemarthroiss - w/in 2 hours may indicate ligament injury, patellar dislocation or fracture
145
bulge sign
for knee effusion
146
medial collateral ligaments
stabilize aginst valgus stress
147
lateral collateral ligaments
stabilize against varus stress
148
valgus stress
test for stability of MCL
149
varus stress test
test for LCL stability
| adduction or varus stress test
150
cruciate ligaments
anterior ligaments prevent tibia from anterior mvmt
| posterior cruciate ligaments prevent tibia from posteriro movemnt
151
anterior cruciate ligament injury
audible pop when knee buckles
acute swelling w/in 2 hours
instability occurs with lateral movment activities and going down stairs
152
Lachman Test
stability of ACL
| forward excursion ACL tear
153
anterior drawer test
stability of ACL
| forward jerk = +
154
posterior cruciate ligament injury
usually follows an anterior trauma to the tibia
knee may freely dislocate and reduce
1/3 of injuries involving PCL have neurovascular complications
155
posterior drawer tests
PCL stabilitiy
| isolated PCL tears are rare
156
menisici
shock absorbers during weight bearing, protect articular cartilage
patient may or may not report an injury
joint line pain & pain with deep squatting
difficulty with extension suggests internal derangement - MRI and referral
157
McMurray's test!
test for meniscus
158
knee OA
degeneration of joint cartilage
pain with bending or twisting activities
swelling
loss of active and passive ROM
tx
acetaminophen, NSAIDs, topicals,
viscosupplemntation, platelet rich plasma injections
joint replacement
159
knee pain tx
```
isolated 1st and 2nd degree sprains = RICE
unstable knee = brace
swelling = avoid weight bearing
weight loss
NSAIDs
topical agents
rehabilitation
cortisone injections
orthopedic surjery
```
160
ankle pains
sprains, fractures
achilles tendon rupture
DVT - Homan's sign
161
foot pains
digital deformities
plantar fasciitis
fracure
162
flat feet
```
pes planus
medial border becomes convex
sole touches floor
tenderness from medial malleolus down
swelling may develop
```
163
plantar fasciitis
inflamation of plantar fascia
40-60 and younger runners
```
obesity
prolonged standing or jumping
flat feet
reduced ankle dorsiflexion
heal spurs
```
164
morton's neuroma
women > men
high heels
bunions and claw toes
165
inversion ankle sprain
localized pain and swelling
ligaments, tendons, bones
RICE
166
eversion ankle sprain
```
severe or prolonged pain
limited ROM
mild swelling
difficulty weight bearing
conservative tx with boot or cast for 4-6 weeks
```
167
achilles tendinopathy
pain w/ or w/o swelling
runners
pain with exercise increases in severity with rest
pain in heel
168
achilles tendon rupture
```
middle aged athlete
misdiagnoses - calf muscle tear/strain
direct trauma to taut tendon vs forceful dorsiflexion with ankel relaxed
agonizing pain preceded by snap
weakness with push off
soft tissue gap
+ Thompson's test (calf squeez)
tx: splint vs surgery
```
169
Thompson's test
achilles tendon rupture
| plantar flexion
170
osteochondritis dissecans
```
small fragment of bone becomes avascular and necrotic
adolescents and young adults
male> females
knee and ankle
ortho surgeon
```
171
peripheral neuropathy
```
parasthesias to severe pain
diabets,inflamm, nutrition, toxicity
EMG to calssify
tx: anti-eleptics
avoid toxins
analgesics
can lead to disuse and injury
neuro referral
pt and ot
```
172
hallux valgus
great toe is abnoramlly abducted from first metatarsal
| bursa may form at pressure point
173
callus
if callus in painful, suspect an underlying plantar wart
174
plantar wart
HPV!
common on the ball of the foot
tender to touch and painful with ambulation
