Musculoskeletal System

Question 0

Musculoskeletal Pathology

Systemic Causes of Carpal Tunnel Syndrome

Answer 0

• DM
• hormonal imbalances
• pregnancy
• gout
• Grave’s disease (hyperthyroidism)
• hyperparathyroidism
• hypothyroidism
• liver disease
• oral contraceptives
• obesity

Question 1

Musculoskeletal Pathology

Osteoporosis

Answer 1

• severe & localized T-L-spine pain
• ^ pain w/ prolonged posture
• ^ pain w/ valsava
• ¡ pain in hook-lying
• loss of height > 1”
• kyphosis
• Dowager’s hump

Question 2

Musculoskeletal Pathology

Fibromyalgia Syndrome

Answer 2

• wide spread pain for > 3 months
• myalgia & AM stiffness
• fatigue & sleep disturbances 2º ¡ GH released @ night
• soft tissue swelling
• HA, dyspnea, dizziness
• hypersensitivity to light
• dry eyes & moth
• presence of 11 of 18 tender points

Question 3

Rotator Cuff Muscles : Supraspinatus

Answer 3

w/ UE (upper extremity) back in maximal extension & IR (internal rotation), palpate from the supraspinatus fossa to the tendon anterior to AC joint

Question 4

Rotator Cuff Muscles : Infraspinatus

Answer 4

in prone on elbows position, palpate posterior-lateral of acromion (just inferior to inferior angle of acromion)

Question 5

Rotator Cuff Muscles : Subscapularis

Answer 5

in side lying, maneuver the relaxed UE to allow you to slide your thumb under the axillary / lateral border of the scapula

Question 6

Rotator Cuff Muscles : Teres Minor

Answer 6

in prone on elbows position, palpate just inferior to infraspinatus

Question 7

Thoracic Outlet Syndrome : Pathology

Answer 7

• results from compression of any one of many sites 2º postural or muscular imbalances or osseous anomalies
• may be d/t vascular (only 5-10%) or neural compression; locations of compression include sternocostovertebral space, scalene triangle, costoclavicular space & coracopectoral space
• most common in middle aged women or after surgery

Question 8

Thoracic Outlet Syndrome : Signs & Symptoms

Answer 8

• kyphotic posture & forward head
• awakened @ night w/ pins & needles in hand
• poorly localized aching pain
• pain w/ carrying heavy objects
• (+) tests: ULNT (upper limb neurodynamic test), Adson’s, Wright’s, military brace, & Allen’s
• DBP > 20 mm Hg difference between arms
• AP X-ray needed to rule out cervical rib (very rare)
• EMG results are controversial
• need to r/o CTS (carpal tunnel syndrome), radiculopathy, pronator syndrome

Question 9

Carpal Tunnel Syndrome : Pathology

Answer 9

• an overuse injury related to repetitive trauma
• occurs in men > women
• may occur during pregnancy

Question 10

Carpal Tunnel Syndrome : Signs & Symptoms

Answer 10

• thenar atrophy but no swelling or trophic changes
• nighttime numbness of hand (median nerve pain)
• thumb weakness & loss of opposition/abduction
• (+) tests: Phalen’s, reverse Phalen’s, ULNT & Tinel’s sign
• (-) TOS (thoracic outlet syndrome
• normal pulses (medial & ulnar arteries do not pass through tunnel)
• sensation of palm is spared
• need to rule out C-spine problem
• confirmed w/ CT or MRI