Musculoskeletal Disorders

Question 1

Soft Tissue Injuries

Answer 1

Injury to non-osseous structures of: muscles, bursa, ligaments, tendons, cartilage

Question 2

Ligaments

Answer 2

connects bone to bone. fibrous connective tissue

Question 3

Tendons

Answer 3

connects muscle to bone. fibrous connective tissue

Question 4

Cartilage

Answer 4

dense connective tissue with not blood supply

Question 5

Strains vs Sprains

Contusions vs hematomas

Answer 5

Strains –> muscles
Sprains –> joints
Contusion –> bruise
Hematoma –> bruise you can feel

Question 6

Noraml Values BUN & Creatitine

Answer 6

Bun –> 10 -20

Creatinine –> 0.5 - 1.5

Question 7

soft tissue injury management

Answer 7

1. RICE –> rest, ice, compression, elevate
2. Immobilization prn
3. Pt
4. NSAIDS, Muscle relaxants, narcotics (short term)

Question 8

NSAID considerations

1. labs
2. risks
3. frequency of use
4. examples

Answer 8

1. Chest Creatinine b/f starting long term
2. All NSAIDS (except ASA) increase risk of MI & CVD regardless of previous risk factors
3. NSAIDs: Takes 3-4 tablet, 3-4 times a day for 3-4 days
4. NSAID> Ibuprofen, naproxen, celebre (last ditch med)

Question 9

Knee injury/pain

1. causes
   * *special considerations

Answer 9

1. mechanical, inflammatory, degenerative
   * medial meniscus tears 10x more common than lateral tears
   * * do least invasive and expensive first

Question 10

Knee injury/pain: S/S

*labs?

Answer 10

1. locking –> meniscal tear (feels like coiled ribbon)
2. giving away
3. • McMurray test
4. • Lachman test
5. • Apley grind test
     * only need lab if suspect arthritis, then do

Question 11

Apley Girnd

1. how to
2. what’s +?
3. what’s it test for?

Answer 11

1. flex knee 90 degress, put pressure on heel and rotate leg internally/externally.
2. • if click/pain during movement
3. medial/lateral collateral ligament damage/meniscus injury

Question 12

McMurray Test
1. How to?
2. What’s +?
3 What’s it test for?

Answer 12

1. flex knee and straighten with hand on knee
2. • if feel/hear click
3. test for Medial meniscal injuries (MMM)

Question 13

Lachman

1. How to?
2. What’s +?
3. What’s it test for?

Answer 13

1. knee 20-30 degree. force to proximal tibia
2. • if displacement
3. ACL/PCL ligament

Question 14

Ankle sprain –> def?

Answer 14

–>streched, partial/torn ligaments

Question 15

Ankle Sprain Grade

Answer 15

1. no disability
2. difficulty walking
3. impossible to ambulate

Question 16

1. Bursitis –> def
2. S/S
3. diagnostics
4. Mgt

Answer 16

1. –> inflammation of bursitis
2. Pain especially w/ movement ex: can’t raise arm above shoulder
3. xray r/o bone/joint conditions
4. STEROID INJECTIONS INTO BURSA….
   RICE, splinting, Heat (30min TID/QID), NSAIDS,

Question 17

Lower Back Pain

1. def
2. incidence

Answer 17

1. –> pain perceived from lumbo sacral region & may be localized/radiating to leg and/or feet
2. 2nd leading cause of lost days of work in US after HA

Question 18

Positive pelvic rock test #

Answer 18

1. to assess low back pain
2. • if feel pain when try to “open/close” pelvis
3. if + = sacroiliac joint dysfunction

Question 19

Positive straight leg test

Answer 19

1. radiating/sciatic pain reproduced when pt legs are elevated off exam table.

Question 20

L3-L4 disk pathology

Answer 20

1. Quadricepts problems
2. pain/numbness radiating to medial malleolus and medial aspect of knee
3. have pt squat and raise

Question 21

L4- L5 disk pathology

Answer 21

1. toes point up, weakness to dorsiflexion of great toe and foot
2. have pt walk on heels

Question 22

L5 - S1 disk pathology

Answer 22

1. diminished/absent achilles reflex (weakness of plantar flexion
2. have pt walk on toes
   * 80-85% herniated disks in this area

Question 23

complains of herniated disk

Answer 23

probably L5 - S1

decreased archilles reflex

Question 24

plantar fascitis

Answer 24

pain/stiffness of bottom of heel caused by inflammation of plantar fascia, a thick tissue on bottom of foot that connects the heel bone to the toes and creates arch of foot.

Question 25

Osgood-schlatter Disease 1. S/s 2. def 3. mgt 4. Incidence

Answer 25

1. painful limp w/ pain below knee cap, will hurt when press on tibial tuberosity, exacerbated with running, jumping, climbing stairs. "bump below knee". 2. rupture of growth plate at tibial tuberosity due to stress on patellar tendon (associated w/ rapid growth spurt...so onset is close to onset of growth spurt) 3. rice, nsaids, will go away on own once finish growth spirt 4. peak ages 11 -14 yrs

Question 26

Pain/tenderness where the ribs attach to breastbone

Answer 26

Costochondritis | often seen with URI

Question 27

#Pelvic girdle pain with loss of ROM in shoulder 1. name? 2. incidence 3. mgt 4. risk

Answer 27

Plymyalgia Rheumatica 1. ==> inflammation w/ pain/stiffness of shoulder & usually hip 2. usually people >50yrs 3. corticosteroids 4. may be associated w/ temporal arteritis (ha or jaw pain which can lead to permanent blindness

Question 28

Gerontology Considerations

Answer 28

1. Sarcopenia occurs (decrease in muscle mass and strength) ==> increases risk of falls, unsteady gait, and disability 2. Lean body mass replaced by fat 3. redistribution of fat occurs

Question 29

Kids age 11 -14 at risk for?

Answer 29

Osgood-schlatter Disease

Question 30

age 2 - 6 at risk for

Answer 30

Toxi synovitis

Question 31

Toxic Synovitis 1. s/s 2. mgt 3. incidence

Answer 31

1. Hip pain, limping = - internal rotation of hip cause spasm = dx - no swelling/tenderness to outside 2. need to r/o osteomylitis (CBC, xray, joint aspiration) - anagesics - bed reset 3. M>F, often in kids 2-6yrs but can be 1-15yrs too

Question 32

aseptic or avasular necrosis of femoral head

Answer 32

Legg-calve-perthes disease (LCPD) | "moth ball eaten bone/lack of blood supply to femoral head"

Question 33

Legg-calve-perthes disease (LCPD) 1. cause 2. mgt

Answer 33

1. unknown 2. refer if lose of full ROM observe if: less than 6yrs, involves less than 1/2 femoral head, full rom perserved ultimately need to stop whatever is causing this problem, otherwise kid will get new hip

Question 34

Genu varum

Answer 34

" bowleg"