Flashcards in MUSCULOSKELETAL DISORDERS Deck (85):
What connects bone to bone
What connects muscle to bone
bruise you can feel
pharmacological interventions for soft tissue injury:NSIAD
for mild to moderate pain
ibuprofen 400-800 TID or QID for 3/4 days
Naproxen 250-500 daily in divided doses
COX-2 inhibitor Celebrex (not common)
Pharmacological interventions for soft tissue
Metazalone (skelaxin) 800mg BID or TID (good for dic injury) (is a non-narcotic) (depresses CNS activity)
Narcotics to use in soft tissue injuries short term
Tramadol (Ultram): narcotic like
hydrocodone +acetaminophen (vicodin, lortab)
acetaminophen +codeine (tylenol #3)
Oxycodone/acetaminophen (percocet, tylox)
What is "locking" usually indicative of?
meniscal tear or loose bodies
What does McMurrays test for?
positive test for medial meniscal injury
What does a positive McMurrays test look like?
An audible or palpable click when the knee is raised slowly with 1 food externally rotated (knee is flexed than quickly straightened). HAnd on joint line
What are you assessing for in a Lachmans test?
Drawer test for anterior/posterior cruciate ligamet tear
How do you perform the Lachman's test?
place knee in 20-30 degree flexion, grasp with one hand with anterior force to proximal tibia (stresses the ACL/PCL) while the opposite hand stabilizes the thigh. Graded 1+ to 3+ grade of displacement for a positive test
What does the Apleys grind test test for?
medial or lateral collateral ligament damage and/ or meniscus injury
How do you perform the Apleys grind test?
Flex knee 90 degrees with patient PRONE, put pressure on heel with one hand while rotating the lower leg internally and externally; PAIN OR CLICK IS POSITIVE
Labs/ diagnostics for knee injury/ pain
lab in RA suspected
X-rays: AP and lateral
MRI if no improvement
Management of knee injury/ pain
Aspirate effusions as needed
What is torn or ruptured in an ankle sprain
Explain each grade of ankle sprain
Grade 1: Mild, localized tenderness, normal ROM, no disability
Grade 2: Moderate/ severe pain with weight bearing, difficulty walking and eccymosis; pain immediately after injury
Grade 3: Impossible to ambulate; resists any motion of feet; egg shaped swelling within 2 hours of injury
Diagnostics of ankle sprain
x-ray to rule out fracture
What causes muscle strains?
overuse of tendons, often occurring with repetitive movement, resulting in inflammation
s/sx of muscle strains
pain during ROM
inflammation of the bursa (closed sac lined with a synovial-like membrane in an area subject to friction or pressure)
Causes of bursitis
sepsis/ infection in a joint space
most common location of bursitis
s/sx of bursitis
Pain: especially with movement
Diagnostics of bursitis
Aspiration with gram stain and culture
Plan X-rays to rule out other bone/joint conditions
Management of bursitis
applying heat x30minutes TID or QID
ASA or NSAIDS
steroid injections (max 3 per year)
If septic, refer
Steroid injection side effect
Body stops making corticosteroids (addisons crisis)
What is the pathology of Osteoarthritis?
Degenerative joint disease with slow destruction of the articular cartilage
What is the pathology of RA?
Systemic autoimmune disease causing inflammation of connective tissue
What kind of symmetry occurs in OA
What kind of symmetry occurs in RA
Which arthritis is it more common for women?
What is the average age of OA?
53-64 years old
What is the average age of RA?
35-50 years old
What joints are most affected in OA?
Weight bearing joints (knees, hips) +fingers, hands and wrists
HEBERDEN's NODES- distal interphalangeal nodes (DIP)
BOUCHARD's NODES- Proximal interphalangeal joints (PIPS)
Where are the heberdens nodes
distal interphalangeal joints (DIP)
Where are the bouchards nodes
proximal interphalangeal joints (PIP)
What kind of joint swelling occurs in OA?
Swelling and edema but no redness or heat complaints to joints
What kind of joint swelling occurs in RA?
Swelling and edema with redness and hear
What joints are affected by RA
Proximal interphalangeal joints (PIPs), metacarophalangeal joints (MCPs), WRISTS
When is the swelling/stiffness/pain better and worse with OA
better in the morning, worse as day progresses with activity
When is the swelling/stiffness/ pain worse with RA
Worse in the morning, better as the day progresses
What are some other findings with OA?
Angular deformities of the affected joints
What are some other findings with RA
Which arthritis has elevated ESR and ANA +?
What does the synovial fluid look like in OA
What does the synovial fluid look like in RA
inflammatory changes and WBCs
xray findings for OA
Narrowing of the joint space
xray findings for RA
progressive cortical thinning
joint space narrowing
Management of OA
NSAIDS -check renal function (ibuprofen and naproxen)
Management of RA
High dose salicylates
DMARDS- disease modifying anti rheumatic drugs- corticosteroids, methotrexate, antimalarials (hydroxychloroquine) gold salts injections
What labs do you have to monitor for methotrexate
What is a positive Tinel's sign?
Tapping over the median nerve on the flexor surface of the wrist producing a tingling sensation radiating from the wrist to the hand (Carpal tunnel)
What is a positive phalen's test?
reproduction of symptoms after 1 minute of wrist flexion
What is the carpal compression test?
pressure over the carpal tunnel for 30 seconds elicits symptoms
diagnostics for carpel tunnel
electromyography to document motor involvement
What kind of splint do you order for carpal tunnel
What is the straight leg raise?
radiating or sciatic pain reproduced when the patient's legs are elevated off of the table
What is the pelvic rock test
screens for sacroiliac joint dysfunction. Pain on either or both sacroiliac joints when examiner places hands on each of the anterior or superior iliac spines and attempts to open and close the pelvis
Nerve root findings in L3-L4 disc pathology
Quad muscle weak and atrophic
PAIN RADIATING TO MEDIAL MALLeOLUS, numbness along the same path especially medial aspect of the knee
DIMINISHED OR ABSENT PATELLAR REFLEXES
screening: HAve patient squat and rise
Nerve root findings in L4-L5 disk pathology
weakness of the dorsiflexion of great toe and foot
pain radiating into the lateral calf, numbness of dorsum of foot and lateral calf
screening exam: Have patient walk on heels of feet
Nerve root findings in L5-S1 pathology
Weakness of plantar flexion of great toe and foot
Pain along buttocks, lateral leg and lateral malleolus, numbs to lateral aspect of foot and in posterior calf
DIMINISHED OR ABSENT ACHILLES REFLEX
Screening exam: have patient walk on toes (will cause pain)
Define Morton's Neuroma
A benign neuroma causing a compression neuropathy of an intermetatarsal plantar nerve, most commonly of the 3rd or 4th inter metatarsal spaces
What is Mortons neuroma caused by?
High-healed shoes, narrow
What are s/sx of mortons neuroma
feeling of standing on a pebble, shooting pain affecting the contiguous halves of 2 toes
tingling or numbness in the toes
Diagnostics od mortons neuroma
Define Plantar Fascitis
Inflammation of the plantar fascia, the thick tissue on the bottom of the food that connects the heel bone to the toes and creates the arch of the foot
s/sx of plantar fasciitis
Pain and stiffness at the bottom of the heel
heel pain may be dull or sharp, radiates from the heel to the toes
The bottom of the foot may also ache or burn
PAIN IS WORSE IN THE MORNING (first few steps) or after standing for a while
Management of plantar fasciitis
Where does Osgood-Schlatter disease occur?
Rupture of the growth plate at the tibial tuberosity as a result of stress on the patellar tendon
Primary sign of Osgood-Schlatter disease?
Pain/ limp pain below the knee cap
What is costochondritis
Inflammation of the cartilage that connects a rib to a sternum
s/sx of costochondritis
pain and tenderness where the ribs attach to the breastbone
Pain with deep inhalation or cough
What is plymyalgia rheumatica
an INFLAMMATORY disorder involving pain and stiffness in the shoulder and usually the hip
What is plymyalgia rheumatica usually associated with?
what are s/sx of plymyalgia rheumatica
stiffness in neck, shoulders, and hips
Loss of range of motion in affected areas
Fatigue, anemia and mild fever
management of plymyalgia rheumatica
corticosteroids and symptomatic
What is sarcopenia and what should you look out for?
decreased muscle mass and strength that occurs in geriatrics. Increases risk of disability, falls, and unstable gait
What happens with fat in the geriatric patient
redistributes along with loss of lean body mass. Increased % of body fat