Study sets, textbooks, questions
Upgrade to remove ads
DD Test 2 Musculoskeletal only (bold and main points only)
Terms in this set (74)
Most common sources of complaint for m/s issues:
low back pain
injury-acute or repetitive motion
joint pain-gout, OA, RA
Common Low Back Pain disorders:
Lumbosacral strain or sprain (LBS)
Herniated nucleus pulposa (HNP)
Bone spurs and sitting compression
What is Lumbosacral strain or sprain (LBS)?
most common low back pain issue
stretching or tearing of muscles, tendons, ligaments, or fascia 2nd to trauma/mechanical injury seen in older children, adolescents and adults
What is a Herniated Nucleus Pulposa (HNP)?
RUTPTURE of intervertebral disc with herniation of np into spinal canal (uncommon in children)*
only 10% of patients with actual HNP
--we see sciatica-"associated pain syndrome" pain extending down the leg in a dermatomal pattern (nerve roots L4, L5, S1, 2, and 3)
Present in 95% of HNP
but only 2-3% in LBS
Stress fracture of posterior arch in lower LS (L5 most common) due to over use
Common in dancers, gymnasts, football lineman, wrestlers and divers
--forward slipping of one vertebra over another
--after spondyloysis forward to the next vertebral body
--5 Types: Dysplastic, Isthmic, Degenerative, Truamatic, Pathologic
What is the scotty dog sign?
Normal lumbar spine sign on x-ray
if you see a collar on the dog = spondylolysis
What is a red flag with Low Back Pain?
Bowel and Bladder changes!
- most common cause of back pain
minimal pain at event but increases with stiffness occurring 12-36 hours later as soft tissue swells
MUST keep walking!! Do not stop moving!
**Radicular pain--"shooting or electric" to below the knee, down back of butt into the knee and around the calf, sciatic
-- worse with valsalva maneuvers
+ Straight leg raise!
Unable to walk on toes
Calf muscles mostly S1
Unable to walk on heels
ankle/toe dorsiflexion muscles L5 and some L4
Gold standard for Neuro/MS exam
Perform Sraight Leg Raise (SLR) and lying standard and crossed--gold standard
What is positive with HNP?
DTR's of knees (L4) & Achilles (S1) will be absent or diminished with this---
What is positive with L 4-L5 nerve root dysfunction?
weakness in dorsiflexion of ankle or great toe suggests this--
also--single squat and rise test quads--mostly L4
This is the presentation of L5/S1 Disc prolapse:
pain along posterior thigh with radiation to heel
weakness on plantar flexion (may be absent)
Sensory loss in the lateral foot
Absent ankle jerk reflex and DTR at ankle-- (mostly S1)
This is the presentation of L4/L5 disc prolapse:
pain along the posterior or posterolateral thigh with radiation to the top of the foot
--weakness of dorsiflexion of toe and foot
--paresthesia and numbness of great toe
--no reflex changes noted
This is the presentation of L3/L4 disc prolapse:
pain in front thigh
--wasting of quads may be present
--decreased sensation front of the thigh lower leg
--reduced knee jerk (mostly L4)
What are Waddell signs?
Drug seeking behavior
--3 out of the 5 signs below are indicative of drug seeking behavior
1 distraction: inconsistent pain response after distraction
2 Overreaction to slight touch
3 Regionalization: pain that radiates to an anatomically incorrect region
4 Simulation: axial loading and rotation
5 Tenderness: superficial and diffuse tenderness and/or non-anatomic tenderness
AHCPR (Agency for Health Care Policy and Research)--Guidelines for low back pain
Applicable for ages 18-50 with back pain less than 3 months
--search for the red flags
--perform frequent reevaluations
--focus on improving patients activity tolerance
Worst thing is inactivity! KEEP MOVING!
Delay imaging studies for 4-6 weeks in the absence of red flags and neurodysfunction
What are the 3 Red flags to rule out with low back pain?
1 Possible fracture (recent trauma, fall, MVA, osteoporosis hx?)
2 Tumor or infection (age >50 or < 20, hx of cancer, constitutional sx: fever, chills wt loss, recent infection?, immunosuppression, pain worsens when supine or no improvement with position change, severe nightime pain--all red flags)
3 Clauda Equina Syndrome: Bowel/Bladder problems--indicates nerve root compression (lumbar nerve roots)--knee extension weekness or foot drop
Low Back Pain: Diagnostic testing:
--***No justification for imaging studies within first 30 days of complaint when all other things are excluded (no neuro deficits)
IF back pain persists > 4 weeks: do CBC, ESR, X-ray, bone scan
**Stenosis-get MRI, CT
**Sciatica- surgeon-MRI, CT, EMG
Definition of Sprain:
injury to a ligament
Definition of strain
an injury to a muscle, usually caused by overexertion or excessive forcible stretch
Definition of fracture:
Loss in bone continuity
Testing KEY to remember:
NEVER order and orthopedic MRI WITHOUT plain films (x-ray) first!
What are growing pains?
Long bone pain in kids--not joints
-deep aching pain
-commonly occurs at night
What are shin splints?
refers to pain in the anterior and medial portions of the leg, commonly due to overuse
-**increases with exercise and decreases with rest
** Tenderness on palpation at medial tibia and possible warmth
What are Stress Fractures?
Due to repetitive forces applied to lower leg during strenuous activity
--fatigue muscles cause tiny cracks in bones
--most heal in 4-12 weeks
What is the female athlete triad?
disordered eating, amenorrhea, osteoporosis
What is a tibial fracture?
seen with athletes, diffuse tenderness is typical, occurs at the beginning of activity, resolves with rest, then is continual
What is a femoral neck fracture?
seen with dancers and long distance runners--pain in the groin can progress to AVN, osteonecrosis of the femoral head
What is pelvic stress fracture?
most common to long distance runners, pain in the inguinal, perineal, or adductor area after an increase in training, maybe unable to stand on affected side--healing can take 3-5 months
What is bursitis?
inflammation/pain/tenderness of a bursa/tendonitis
Positive ARC test (pain b/w 60 and 120 degrees with active ABDUCTION
How do rotator cuff problems present?
***Classic: Increased pain at night!
--difficult to abduct
--crepitus, pain with palpation, asymmetric movement
--Positive Drop sign, Positive Arc test beyond 90 degrees, Positive Neer test (passive arc)
What is epicondylitis?
Inflammation of a tendon where it attaches to a bone
** Tennis Elbow- Lateral epicondyle, POSITIVE book test
** Golfer's Elbow-Medial epicondylitis
What is a radial head subluxation?
-Most common elbow injury in ages 1-4
-Sudden vigorous arm pull
-Sudden pain with inability to use arm
-Elbow flexed and forearm pronated held close to body
-no bony tenderness or swelling at the affected joint
What is a Colles fracture?
-fracture of the distal radius
-Fall on outstretched hands (FOOSH)--common in adults
-pain and resistance to ROM--classic dinner fork, cannot hold a can of soup
What is a scaphoid fracture?
Common carpal bone fracture
--common in young adults-FOOSH
Wrist pain localized to the snuffbox area with palpation
What is Gamkeepers or Skiers thumb?
ulnar collateral ligament injury cause by hyper abduction of thumb
--painful ulnar aspect of the MCP thumb joint
What is a boxer's fracture?
fracture of the 5th metacarpal
most common hand fracture
What is Osgood-Schlatter disease?
Rupture of the growth plate at the tibial tuberosity from stress on patellar tendon
--knee extension worsens pain, occurs with strenuous activity, sports-soccer example
self limiting, resolves after puberty
What is Patellofemoral Pain Syndrome (PFPS)?
Caused by overuse/overload, biomechanical problems and muscular dysfunction
--Mild malalignment of the extensor mechanism of the knee
--seen in runners commonly
--more often in females
--worse pain when descending steps or hills!
What are common injuries related to a wide Q Angle?
Illiotibial band friction syndrome (ITBFS)
--Anterior knee pain or patella femoral pain syndrome
**a high Q angle causes quad to pull on patella---leads to misaligned patellar tracking
**knee is stable without swelling or redness
**pain with quad tightening which contracts the patella
What is chondromalacia patella?
Crunching sound, degeneration of cartillage on articular surface of patella, caused by overuse and misalignment--frequent in adolescents
What is illiotibial band syndrome?
irritation/overuse between the IT band and the femoral condyle
--r/t change in footwear, increase running schedule, or prolonged downhill running, mild pain over lateral side of knee
Presentation of meniscus injury:
tear in lateral or medial meniscus 2nd to sport injury
--mild swelling, joint line tenderness, Positive McMurrays
Presentation of MCL injury:
joint line pain, mild swelling, joint effusion, pain with VALGUS stress test
Presentation of LCL injury:
Joint line pain, joint effusion, pain with VARUS stress
Presentation of ACL injury:
Twisting quick stop--hear "pop", hyperextension, Joint effusion with Positive anterior drawer test, Positive Lachmans, Positve Pivot shift
Presentation of PCL injury:
Direct blow to anterior tibia
minimal swelling, Positive posterior drawer test, Positive sag
What is the Ottawa Knee Rule?
Get X-ray only if meet 1 or more of the following (almost 100% sensitive for knee fx)
1 55 or older
2 Isolated tenderness of the patella (no other bony tenderness)
3 Tenderness at the head of the fibula
4 Inability to flex 90 degrees
5 Inability to bear weight immediately and walk more than 4 steps in the ER regardless of limp
What is osteochondritis dissecans?
seen in young men
joint condition in which a piece of cartilage comes loose from the end of a bone
-most common in knee but can occur in other joints
What are ankle sprains usually due to?
85% of time inversion injuring lateral ligaments
mild swelling over lateral ligaments
joint laxity, positive anterior drawer sign
What are the Ottawa ankle rules?
Obtain x-rays (mortus view) if pain at malleolus or midfoot plus one of the following:
-Tenderness at distal 6 cm tibia or tip of medial malleolus
-Tenderness at distal 6 cm fibula or tip of lateral malleolus
-Tenderness at base of 5th metatarsal
-Tenderness at navicular bone
-Inability to take 4 steps immediately and in ED
Ankle injury grades:
Grade 1: mild sprain
Grade 2: Moderate sprain
Grade 3: Severe-usually rupture of both anterior talofibular ligament and calcaneofibular ligament= joint instability
What is a Jones fracture?
fracture of the base of the 5th metatarsal
--Toe swollen, contused and painful on palpation
Consider X-rays with significant swelling, effusion, or contusion
Joint pain stages:
Acute: less than 6 weeks
Subacute: symptoms 6-12 weeks
Chronic: symptoms greater than 12 weeks
What is carpel tunnel syndrome?
Compression of median nerve as travels through carpel tunnel
**Most common focal mononeuropathy seen in practice--more females affected
Positive Tests: Phalen, Tinel, Manual carpel compression, hand elevation test
Dx: Electrodiagnostic testing with nerve conduction studies is standard
What is the Finkelstein Test?
Tendon testing, test for DeQuervain tendonopathy
--tilt hand down, pain along wrist area near thumb
Presentation of Gout
Crystals in joints
Results from increased Purine --holding onto purine and decreases uric acid excretion
--can be asymptomatic 10 + years before 1st gout episode
--common with ETOH and poor diet--high in meats--organ meats
--associated disorders: DM and HLD
--Cherries can lower r/o gout attack
--Vit C and Coffee lowers urate level
--Whole food diet needed (DASH)
What is primary gout?
--caused by decreased excretion or increased production of uric acid
---MSU crystals are soluble at body temp but crystalize at lower temp--this is why we generally see it in the big toe--lower body temp there
--Women protected until menopause b/c E2 promotes uric acid excretion
What is secondary gout?
Caused by acquired conditions which cause overproduction or undersecretion of uric acid
Overproduction: leukemia, multiple myeloma, hemolytic anemia, disseminated carcinoma
Undersectrion: lead poisoning, CRI, drugs: Levodopa, ASA
Classic Gout presentation:
Classic Podagra: pain and redness at base of great toe, can occur in other joints too
low grade fever
4 stages of gout:
(1) asymptotic tissue deposition of crystals,
(2) acute gout flares
(3) intercritical/ interval segments (occurring after an acute flare, but before the next flare)--most ppl experience 2nd episode within 2 years
(4) chronic gout (symptoms of chronic arthritis and/or tophi).
Gout Diagnostic Rule: High if greater than 8--refer for synovial fluid analysis--Gold Standard!
What is Pseudogout?
calcium pyrophosphate crystals-SX Pain, swelling, redness--may come on suddenly and be severe--closely resembling gout
**Differentiating factor: Crystals in joint are calcium phosphate NOT uric acid!
Facts about Osteoarthritis (OA)
degenerative disease causing breakdown of cartilage in joints--leads to joint pain and stiffness
--unknown cause, joints lose elasticity
--up to age 45 M>F but after 55 F>M
--Risk factors: Genetics, obesity, aging
--bone can overgrow and cause osteophytes (bone spurs) = pain, crepitation, dysfunction
--joint space may lock and "give way"
--wear is asymmetrical
S/S: Pain is worse after prolonged periods of inactivity and weather changes
**Morning stiffness or stiffness after rest is a short duration--less than 30 min
**slow onset--weeks, months, years
**no systemic findings
Physical Exam: Antalgic Gait
Fingers: Redness, Tenderness, Aching Joint
Hips: Unilateral pain around groin or inner thigh with possible radiation to buttock or knee
Pelvic Flexion Sign--supine, flex good hip, and pelvis will tilt upward and contralateral leg will raise slightly off table
Knees: Chronic and slow progressive pain with ambulation is hallmark
Feet: Pain and tenderness at base of great toe
Spine: Stiffness in back and neck
What are Herberdons nodes?
Enlargement of DIP-more in women
What are Bouchard's nodes?
enlargement of the PIP joint
Arthritis Foundation Guidelines for diagnosing OA:
1 Joint pain
2 Osteophytes on X-ray (x-ray shows loss of joint space)
3 AND one of the following:
stiffness for at least 30 min
Presentation of Rheumatoid Arthritis (RA)
Peaks 60-70 years, M=F
**Autoimmune Disease with predilection for synovial tissue and associated tendon sheath
Onset: follows a stress event: virus, surgery, infection, trauma, pregnancy
Prognosis: better in men than women
Patho: ***Cartilage loss is symmetrical!--this differentiates it from OA.
S/S: Join pain and stiffness develops over weeks to month. Also have fatigue, low grade fever, malaise, weakness, and weight loss/anorexia--spongy joints, gelling or stiffening up after prolonged imobility
PE: Baker's cysts behind knees, possible boutinnaire finger, ulnar deviation, soft warm and tender joints
Dx Tests: LFT's to r/o hepatitis, synovial fluid aspiration, Xrays--classic finding is marginal bony erosion--may also see subchondral csyt formation
RA 4 Stages:
Stage 1: Disease present but asymptomatic
Stage 2: Disease interferes with ADL
Stage 3: Major compromise in function--affects life and work
Stage 4: Incapacitation, confined to bed or w/c
What is Sjogren's syndrome?
A systemic autoimmune disease that affects exocrine galnds - causes a deficiency in saliva, tears, skin lubrication----vasulitis and pulm nodules
What is Felty's syndrome?
RA + splenomegaly + anemia + thrombocytopenia
Students also viewed
DD test #3
Pharm Test #4 Plus others
test 3 Pharmacology
Clinical management test #1
Sets found in the same folder
DD test #3
DD Test 3 Bold and Important points HEADACHE
DD Test 3: bold and main points: Reproductive only
Differential Diagnosis Module 2
Other sets by this creator
U of C Well Woman 8063 Exam 2
U of C Well Woman 8063 Exam 1
DD Test 4-CT/MRI
DD Test 4-- Ortho Xrays
Recommended textbook solutions
Health: The Basics
Rebecca J. Donatelle
Fitness for Life
Charles Corbin, Guy Le Masurier
健身 与 生活
Charles Corbin, Guy Le Masurier, Karen McConnell
Pharmacology for Nurses
Carol Urban, Michael P Adams, Norman Holland
Other Quizlet sets
Arbets- och organisationspsykologi I
Overview of Codes, Acts and Regulations
Chapter 5 Test (Money Matters)
history chapter 6