MUSCULOSKELETAL DISORDERS Flashcards Preview

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Flashcards in MUSCULOSKELETAL DISORDERS Deck (85):
1

What connects bone to bone

ligaments

2

What connects muscle to bone

tendons

3

abrasion

scrape

4

contusion

bruise

5

hematoma

bruise you can feel

6

Laceration

tear

7

strains

muscle

8

sprains

joints

9

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)

10

Pharmacological interventions for soft tissue

Metazalone (skelaxin) 800mg BID or TID (good for dic injury) (is a non-narcotic) (depresses CNS activity)

11

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)

12

What is "locking" usually indicative of?

meniscal tear or loose bodies

13

What does McMurrays test for?

positive test for medial meniscal injury

14

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

15

What are you assessing for in a Lachmans test?

Drawer test for anterior/posterior cruciate ligamet tear

16

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

17

What does the Apleys grind test test for?

medial or lateral collateral ligament damage and/ or meniscus injury

18

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

19

Labs/ diagnostics for knee injury/ pain

lab in RA suspected
X-rays: AP and lateral
MRI if no improvement

20

Management of knee injury/ pain

RICE
NSAIDs
ROM
Aspirate effusions as needed
referral

21

What is torn or ruptured in an ankle sprain

the ligament

22

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

23

Diagnostics of ankle sprain

x-ray to rule out fracture
MRI

24

What causes muscle strains?

overuse of tendons, often occurring with repetitive movement, resulting in inflammation

25

s/sx of muscle strains

pain during ROM
Edema
Ecchymosis

26

Define bursitis

inflammation of the bursa (closed sac lined with a synovial-like membrane in an area subject to friction or pressure)

27

Causes of bursitis

trauma
sepsis/ infection in a joint space

28

most common location of bursitis

olecranon
subdeltoid
ischial
prepatellar

29

s/sx of bursitis

Pain: especially with movement
swelling
tenderness
erythema

30

Diagnostics of bursitis

Aspiration with gram stain and culture
WBC
Plan X-rays to rule out other bone/joint conditions

31

Management of bursitis

Splinting
RICE
applying heat x30minutes TID or QID
ASA or NSAIDS
steroid injections (max 3 per year)
If septic, refer

32

Steroid injection side effect

Skin discolorations
tissue breakdown
Body stops making corticosteroids (addisons crisis)

33

What is the pathology of Osteoarthritis?

Degenerative joint disease with slow destruction of the articular cartilage

34

What is the pathology of RA?

Systemic autoimmune disease causing inflammation of connective tissue

35

What kind of symmetry occurs in OA

ASYMMETRICAL

36

What kind of symmetry occurs in RA

SYMMETRICAL

37

Which arthritis is it more common for women?

RA

38

What is the average age of OA?

53-64 years old

39

What is the average age of RA?

35-50 years old

40

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)

41

Where are the heberdens nodes

distal interphalangeal joints (DIP)

42

Where are the bouchards nodes

proximal interphalangeal joints (PIP)

43

What kind of joint swelling occurs in OA?

Swelling and edema but no redness or heat complaints to joints

44

What kind of joint swelling occurs in RA?

Swelling and edema with redness and hear

45

What joints are affected by RA

Proximal interphalangeal joints (PIPs), metacarophalangeal joints (MCPs), WRISTS

46

When is the swelling/stiffness/pain better and worse with OA

better in the morning, worse as day progresses with activity

47

When is the swelling/stiffness/ pain worse with RA

Worse in the morning, better as the day progresses

48

What are some other findings with OA?

Genetics
increased age
obesity
Angular deformities of the affected joints
Limited ROM
crepitus possible

49

What are some other findings with RA

Autoimmune
fatigue
weakness
malaise
anorexia
weight loss

50

Which arthritis has elevated ESR and ANA +?

RA

51

What does the synovial fluid look like in OA

clear/yellow

52

What does the synovial fluid look like in RA

inflammatory changes and WBCs

53

xray findings for OA

Narrowing of the joint space
osteophytes
juxta-articular sclerosis
subchondral bone

54

xray findings for RA

Joint swelling
progressive cortical thinning
Osteopenia
joint space narrowing

55

Management of OA

ASA
Acetaminophen
NSAIDS -check renal function (ibuprofen and naproxen)
COX-2 inhibitors

56

Management of RA

High dose salicylates
NSAIDS
DMARDS- disease modifying anti rheumatic drugs- corticosteroids, methotrexate, antimalarials (hydroxychloroquine) gold salts injections

57

What labs do you have to monitor for methotrexate

LFTs

58

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)

59

What is a positive phalen's test?

reproduction of symptoms after 1 minute of wrist flexion

60

What is the carpal compression test?

pressure over the carpal tunnel for 30 seconds elicits symptoms

61

diagnostics for carpel tunnel

electromyography to document motor involvement
X-rays

62

What kind of splint do you order for carpal tunnel

"cock-up" splint

63

What is the straight leg raise?

radiating or sciatic pain reproduced when the patient's legs are elevated off of the table

64

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

65

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

66

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

67

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)

68

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

69

What is Mortons neuroma caused by?

High-healed shoes, narrow

70

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

71

Diagnostics od mortons neuroma

ultrasound
MRI

72

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

73

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

74

Management of plantar fasciitis

NSAIDS
corticosteroids
orthotics
night splints
PT
surgery

75

Where does Osgood-Schlatter disease occur?

Rupture of the growth plate at the tibial tuberosity as a result of stress on the patellar tendon

76

Primary sign of Osgood-Schlatter disease?

Pain/ limp pain below the knee cap

77

What is costochondritis

Inflammation of the cartilage that connects a rib to a sternum

78

s/sx of costochondritis

pain and tenderness where the ribs attach to the breastbone
Pain with deep inhalation or cough

79

What is plymyalgia rheumatica

an INFLAMMATORY disorder involving pain and stiffness in the shoulder and usually the hip

80

What is plymyalgia rheumatica usually associated with?

temporal arteritis

81

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

82

management of plymyalgia rheumatica

corticosteroids and symptomatic

83

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

84

What happens with fat in the geriatric patient

redistributes along with loss of lean body mass. Increased % of body fat

85

What happens to joints in aging

fibrosis and decreased joint elasticity