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75 Cards in this Set
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SIGN OR SYMPTOM:
BACK PAIN differential |
Think of: Musculoskeletal,
DJD, arthritis, pancreatitis, peptic ulcer disease (PUD), pyelonephritis, renal infarct, kidney stones, sometimes renal vein thrombosis as well as cholecystitis, dissecting aortic aneurysms, ectopic pregnancy, spinal canal stenosis, radiculopathies (disk problems), pelvic or abdominal tumors, and others. |
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Symptoms
Pain in area of infection (e.g., persistent backache in vertebral os- teomyelitis). Also, fever/chills/malaise, history of prior infection, refusal to walk (infant). |
Osteomyelitis (Infection of Bone)
Pathology Etiology by hematogenous spread (S. aureus most common), and di- rect bone infection (open fracture, trauma). Direct infection extension is possible, as in postoperative infection Osteomyelitis: bone infection, fever, metaphyseal area of bone tender, elevated CBC and sed rate, bone aspiration, S. aureus most common all ages. Acute osteomyelitis— more common in children, usual site is long bone metaphysis. |
DIAGNOSIS OF
OSTEOMYELITIS Diagnosis can be difficult and often an opinion of an infectious disease specialist is helpful. • Lab findings can include elevated white blood cell (WBC) count, ESR, and C-reactive protein. • Radiologic studies have pluses and minuses. • X-ray (Fig. 10–1) can miss very early osteomyelitis. • Bone scan will pick up bony abnormalities but is very nonspecific and often picks up noninfectious lesions. • MRI is the most sensitive and specific but also costly. • Bone biopsy may be done surgically to confirm infection and organism causing infection, but results are sometimes negative if antibiotic treatment started prior to biopsy. Treatment Steps 1. Antibiotics. 2. Surgical debridement may be needed. |
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Symptoms
Joint pain/swelling/motion limitation, fever/chills, redness |
Septic Arthritis
Description Joint infection, usually in patient with coexisting illness or debilitated state Pathology May be bacterial (S. aureus most frequent in older adult and child- hood, with gonococcus [GC] most common in ages 20 to 50), viral, fungal; most frequently by hematogenous spread; risk factors in- clude drug abuse(Pseudomonas), chronic disease/cancer, and prior joint pathology. Septic arthritis: joint infection, fever, pain with joint motion, elevated CBC and sed rate, joint aspiration, S. aureus children and elderly, gonococcus young adult females. |
Diagnosis
History and physical exam, blood culture, joint fluid culture, lab (complete blood count [CBC], erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), x-ray. Treatment Steps 1. Antibiotics. 2. Surgical drainage (arthroscopic vs. open) or repeated arthrocentesis. |
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children most often, hip
pain and lack of motion, |
Septic hip arthritis
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surgical drainage is
necessary |
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Symptoms
Tenosynovitis, pain, inflamed/red joint, fever, migratory polyarthri- tis, and wrist/knee/ankle arthritis. |
Gonococcal Tenosynovitis
Description Tendon sheath inflammation. A common manifestation of dissemi- nated GC infection |
Diagnosis
History and physical exam, culture of joint fluid. Treatment Steps Penicillin G or ceftriaxone. |
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usually presents
with tenosynovitis, multiple migratory arthralgias, and skin pustules. |
Gonococcal arthritis
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Treat with ceftriaxone
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ARTHRITIS IN HANDS
DIP vs PIP&MCP |
Classic differentiation:
• OA affects the distal interphalangeal joint (DIP). • Rheumatoid arthritis affects the proximal interphalangeal joint (PIP) and metacarpophalangeal joint (MCP). |
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Description/Symptoms
Chronic inflammatory joint disorder. Presents with joint pain and stiffness. A significant problem as the population ages. Diagnosis Clinical, x-ray (narrowed joint cartilage, osteophytes, and sclerosis) (see Fig. 10–2). |
Osteoarthritis (OA)
Pathology Cartilage damage/erosion, with bone cyst/osteophyte lesions, and bone sclerosis. • Heberden’s nodes on DIPs • Bouchard’s nodes on PIPs |
Treatment Steps
1. Nonsteroidal anti-inflammatory drugs (NSAIDs), rest, weight re- duction, physical therapy modalities. 2. Corticosteroid injection. 3. Hyaluronate viscosupplementation. 4. Joint replacement. MEDICAL TREATMENT OF OA • NSAIDs have been problematic, as long- term use can cause GI ulcers and bleeding. • COX-2 inhibitors (celecoxib, valdecoxib) have been promising but questions have arisen regarding cardiovascular risks since Merck withdrew its drug Vioxx (rofecoxib) from the market. • Intra-articular steroid injections can control symptoms without systemic side effects |
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Symptoms
Back pain, loss of full motion, stiffness, referred pain, muscle spasm. |
Degenerative Disk Disease and Low Back Pain
Description Disk-space narrowing, with resulting signs and symptoms Diagnosis History and physical exam, x-ray (including computed tomography(CT)/magnetic resonance imaging (MRI) for disk and cord-compression evaluation), bone scan Herniated disk: Most at L4–5 (weak big toe) and L5–S1 (reduced Achilles reflex). |
Treatment Steps
1. NSAIDs, physical therapy, back support, weight reduction, rest. 2. Corticosteroid injection. 3. Surgery—rarely |
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Symptoms
Fingertip and/or hand numbness/weakness, and pain. Most commonly due to entrapment of the median nerve at the wrist. |
Carpal Tunnel Syndrome
Tinel’s = tapping Phalen’s = “phlexing” Pathology Median nerve compression. Most commonly noted with overuse. Also seen with myxedema, rheumatoid arthritis (RA), pregnancy, injuries, amyloid disease, and others. |
Diagnosis
History and physical (Tinel’s [wrist percussion] and Phalen’s [wrist flexion]signs), electromyogram (EMG), and nerve conduction velocity (NCV) study Treatment Steps 1. Rest, wrist splint, workplace modifications. 2. NSAIDs to decrease inflammation. 3. Corticosteroid injection. 4. Surgery (nerve release) |
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Symptoms
Joint swelling, deformity, mild pain, warmth, and erythema. Charac- teristic changes are seen on x-ray. |
Charcot Joint
Description Charcot joint is actually a neuropathic osteoarthropathy, or neuro- pathic joint. Although exact pathology is debated, basically a patient first has peripheral neuropathy (commonly due to diabetes, but can also include amyloidosis, spinal cord injury, others). As the patient cannot sense pain or position, the joint is repeatedly injured and deformed. |
Treatment Steps
1. Joint immobilization (acute stage). 2. Shoes, braces (chronic stage). 3. Surgery for unbraceable deformity. |
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Symptoms
Fever, gastrointestinal (GI) and central nervous system (CNS) symp- toms (meningeal irritation, muscle weakness/spasm, encephalitis), respiratory paralysis. |
Poliomyelitis (Infantile Paralysis)
Pathology Poliovirus infection resulting in CNS injury (anterior horn motor cells of spinal cord). |
Diagnosis
History and physical exam, spinal fluid examination. Treatment Steps 1. Supportive treatment, bedrest, physical therapy (acute stage). 2. Physical therapy, braces, surgery (chronic stage). |
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Description
A congenital malformation in which the hand or foot is directly con- nected to the trunk |
Phocomelia
Pathology Classically noted with thalidomide, but can be inherited (genetically transmitted). |
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Symptoms
Anterior knee pain and lump. Clinical diagnosis. |
Osgood–Schlatter’s Disease
Description Inflammation of the tibial tubercle. Usually affects preteen/teenage boys. Common in a fast-growing child. |
Treatment Steps
1. Rest. 2. Immobilization. |
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Symptoms
Knee pain, effusion, locking. Ankle or elbow pain |
Osteochondritis Dissecans
Description Disorder in which portion of articular cartilage and subchondral bone separates from normal location in skeletally immature individual. Pathology Ischemia or trauma, usually of medial femoral condyle, in teenage males. |
Diagnosis
History and physical exam, x-ray (joint mouse), MRI (see Fig. 10–3) Treatment Steps 1. Casting. 2. Surgery. |
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Symptoms
Groin/thigh or knee pain, and limp in adolescent. Bilateral involvement in approximately one-third of cases. |
Slipped Capital Femoral Epiphysis
Description Adolescent hip disorder, more common in overweight/obese children/adolescents. Pathology Displacement of femoral epiphysis at hip. |
Diagnosis
History and physical exam, x-ray evaluation (see Figs. 10–4 and 10–5) Treatment Steps Surgical (pinning). |
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Symptoms
Hip or knee pain and limp |
Legg–Calvé–Perthes Disease
Description Avascular necrosis of the hip in children. More common in males. “Osteochondritis deformans. |
Diagnosis
History and physical exam, x-ray. Treatment Steps 1. Observation, pain relief. 2. Bracing in abduction. 3. Surgery may be necessary. |
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Symptoms
Hip pain, low-grade fever possible, limp. |
Transient Synovitis
Description Most common cause of childhood hip pain. Occurs in young children, ages 3–10. Etiology unknown. If temperature high, or elevated WBCs/sed rate: consider patient to have a septic joint and aspirate. |
Diagnosis
History and physical, x-ray, joint aspiration (to rule out septic arthri- tis), sedimentation rate, CBC. Treatment Steps Bed rest (at least 7–10 days). |
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Symptoms
In-toeing gait (neutral position to 20° out-toeing is normal) |
In-Toeing
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—forefoot adduction (front
of foot turns in), passively correctable |
Metatarsus Adductus Deformity
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treat with foot stretching
(casting if not passively correctable) |
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inward tibia rotation with knee straight but whole
foot pointing inward (thigh–foot angle normally neutral to 30° outward) |
Tibial Torsion
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no treatment
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internal hip rotation over 65°,
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Femoral Anteversion
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no treatment.
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Symptoms
Pain, fractures (vertebral compression common) |
Osteoporosis
Description Decreased bone mass. Risk factors iclude early menopause (medical or surgical), alcohol use, Caucasian, thin body habitus, tobacco use Pathology May be primary (postmenopausal), or secondary (drugs/alcohol, nutritional, and endocrine). |
Rule out multiple
myeloma (serum protein electrophoresis, bone marrow study, etc.), which may present like osteoporosis. Diagnosis Dual-energy x-ray absorptiometry (DEXA) scan is definitive for bone mass (see Clinical Pearl). Labs include calcium, phosphate, thyroid- stimulating hormone (TSH). The World Health Organization (WHO) has defined osteoporosis on the basis measurements of bone density on DEXA scanning (T-scores). • Normal: > –1 • Osteopenia: –1 to –2.5 • Osteoporosis: > –2.5 It is important to note that these scores are based on the DEXA scan. A patient may be diagnosed with osteoporosis if the DEXA scan shows osteopenia but she has fractures. It is also important to rule out secondary causes of osteoporosis, such as hyperthyroidism, multiple myeloma. Treatment Steps 1. Weight-bearing exercise. 2. Correct secondary cause (stop alcohol, smoking, etc.). 3. Calcium and vitamin D. 4. Estrogen–progesterone (somewhat controversial). 5. Biphosphonates (inhibit osteoclastic bone resorption). 6. Calcitonin (effectiveness may wane after 2 years). 7. Estrogen-modifying drugs |
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bones are
soft, with low serum calcium and elevated alkaline phosphatas |
Osteomalacia:
inadequate bone mineralization; a result of renal disease or malabsorption |
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Symptoms
Pain, redness, swelling, and warm joint. Diagnosis Clinical, positive joint aspiration for rodlike negative birefringent in- tracellular urate crystals, serum uric acid. |
Gout
Description Monarticular arthritis. Extremely painful. Caused by monosodium urate crystals Pathology Hyperuricemia with crystal deposition in joints; first metatarsal phalangeal (MTP) joint most often affected. Gout: Monarticular—first metatarsal phalangeal joint common, often elevated serum uric acid; x-ray—possible articular erosions; aspirate— intracellular sodium urate crystals (negative birefringence) |
Treatment Steps
Acute—Indomethacin or colchicine. Chronic—Allopurinol and probenecid |
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Symptoms
Acute joint inflammation, similar to gout. Diagnosis History and physical exam, x-ray (chondrocalcinosis–cartilage calcification), extracellular calcium pyrophosphate crystals in aspirate. |
Pseudogout
Description Arthritis caused by deposition of calcium pyrophosphate crystals. |
Treatment Steps
1. NSAIDs. 2. Intra-articular corticosteroids. |
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Symptoms
Craniotabes (soft skull), frontal bossing, lethargy, rachitic rosary (large costochondral junction bumps), bow-legs, potbelly Harrison’s groove sign: indentation of lower ribs at diaphragm insertion site; typical of rickets |
Rickets
Description Inadequate bone mineralization, in growing bone. Pathology Due to vitamin D deficiency (poor intake, malabsorption) or vitamin D resistance; growing plates affected, so a disease of children. Phenytoin sodium (Dilantin) and phenobarbital affect vitamin D metabolism, and may predispose to rickets. Other causes: liver and renal disease. |
Diagnosis
History and physical examination, x-ray (frayed/widened growth plates, pseudofractures), elevated alkaline phosphatase. Treatment Steps Vitamin D and light |
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Symptoms
Hip and shoulder muscle pain/stiffness in elderly patient Diagnosis History and physical exam, elevated sed rate. Both x-rays and muscle biopsy are normal. |
Polymyalgia Rheumatica (PMR)
Description Inflammatory disorder of elderly Pathology Inflammatory disorder. Human leukocyte antigen (HLA) associated. |
Treatment Steps
1. Corticosteroids give rapid relief. 2. NSAIDs—mild cases. |
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Symptoms
Multiple trigger points,irregular sleep pattern, anxiety/depression/hysteria, widespread achiness, fatigue Diagnosis History and physical exam, classic trigger points (superior or inferior medial scapula border are common points) and widespread pain |
Fibromyalgia
Description Nonarticular, noninflammatory muscular pain. Etiology unknown. |
Treatment Steps
1. Patient education. 2. Cyclobenzaprine, amitriptyline. 3. Stretching, aerobic exercise. 4. Trigger-point injection. |
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Symptoms
Arthralgias (hip joints and hands typically), Raynaud’s phenomenon, morning stiffness, myalgias. |
Lupus Arthritis
Description Polyarthritis, without destructive joint disease. Autoimmune disease Pathology More common in young women. Lupus arthritis: polyarthritis, arthralgias, myalgias, and Raynaud’s phenomenon, joint preserved, antibody to native DNA and antinuclear. |
Diagnosis
History and physical exam, serologic testing (antibody to native deoxyribonucleic acid [DNA], antinuclear antibodies [ANA]). Treatment Steps 1. Rest. 2. NSAIDs. 3. Corticosteroids. 4. Hydroxycholoroquine |
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Symptoms
Weak muscles proximally, arthralgias, heliotrope (eyelid) rash, dysphagia. |
Polymyositis, Dermatomyositis
Description Skeletal muscle inflammatory disorder. Autoimmune disorder Pathology Abnormal muscle biopsy (degenerated/regenerated muscle fibers). • Dermatomyositis is polymyositis plus a rash. • Coexisting malignancy may be present with both polymyositis and dermatomyositis. • No ocular muscle problems with polymyositis or dermatomyositis (unlike myasthenia gravis). |
Diagnosis
History and physical examination, elevated muscle enzymes, muscle/skin biopsy, abnormal EMG study. Treatment Steps 1. Rest. 2. Physical therapy. 3. Corticosteroids. 4. Methotrexate if corticosteroids fail. |
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systemic polyarthritis,
rheumatoid nodules, pleural effusion, joint deformity, elevated sed rate and rheumatoid factor. Classic x-ray finding: “bamboo spine” |
Rheumatoid arthritis
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Symptoms
Back pain and stiffness, joint pains and swelling. Diagnosis History and physical exam (reduced chest expansion), positive hu- man lymphocyte antigen (HLA)-B27, elevated ESR, x-ray (sacroiliitis). |
Ankylosing Spondylitis
Description A chronic inflammatory condition commonly causing inflammation of the sacroiliac joint. Common in young males. Ankylosing spondylitis: back pain and stiffness, joint arthralgias, sacroiliitis, reduced chest expansion, positive HLA- B27 antibody. |
Treatment Steps
1. NSAIDs. 2. Physical therapy. 3. Sulfasalazine, methotrexate. |
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fever, joint
deformity, iridocyclitis, rash, splenomegaly, negative rheumatoid factor and ANA possible. |
Juvenile rheumatoid
arthritis: |
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Symptoms
Nontender swelling (prepatellar) or pain (hip). Other common sites include elbow and shoulder. Clinical diagnosis. |
Bursitis
Pathology Bursa inflammation from overuse, abnormal joint motion, trauma. |
Treatment Steps
1. Rest. 2. NSAIDs. 3. Physical therapy. 4. Aspiration (with/without corticosteroid injection). 5. Surgery. |
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Description/Symptoms
Inflammation of the tendon, causing pain at tendon insertion, or along tendon. |
Tendinitis—General Information
Pathology Inflammation secondary to overuse or abnormal mechanics. |
Diagnosis
History and physical exam, MRI. Treatment Steps 1. Rest. 2. NSAIDs. 3. Physical therapy. 4. Corticosteroid injection. 5. Surgery. |
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Symptoms
Distal thigh and lateral knee pain. Diagnosis Pain with stretching leg/hip on affected side (Ober’s sign). Pain worse with stairs. |
Tendinitis—Iliotibial Band Syndrome
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Treatment Steps
1. NSAIDs. 2. Adjust mechanical factors (shoes, terrain, activity level, etc.). 3. Physical therapy (stretching). 4. Corticosteroid injection. |
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Symptoms
Pain along heel/Achilles tendon (see Fig. 10–6). |
Achilles Tendinitis
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Treatment Steps
1. NSAIDs. 2. Heel lift. 3. Correct mechanical dysfunction. 4. Therapy (stretching). 5. Immobilization. 6. Surgery. |
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Symptoms/Diagnosis
Patellar tendon tenderness. |
Patellar Tendinitis (Jumper’s Knee)
Pathology Overuse and jumping sports resulting in quadriceps contraction and tendon inflammation. |
Treatment Steps
1. Rest. 2. NSAIDs. 3. Physical therapy (stretching). 4. Surgery. |
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Symptoms
Lateral shoulder pain, worse with overhead activity. Diagnosis History and physical exam (tender anterior acromion, pain with re- sisted shoulder abduction), x-ray, MRI. |
Rotator Cuff Tendinitis
Pathology Overuse, repetitive activity with arm overhead, trauma, and anterior acromial osteophytes. |
Treatment Steps
1. Rest. 2. NSAIDs. 3. Physical therapy. 4. Corticosteroid injection. 5. Surgery |
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Symptoms
Pain, mass, limping, metastatic signs (usually lungs). Diagnosis History and physical exam, x-ray (long bone metaphysis destruc- tion), biopsy, elevated alkaline phosphatase, bone scan, CT scan, MRI. |
Osteosarcoma
Description Most frequent primary bone cancer Pathology Osteoid production by the tumor, which is usually near knee joint; in 10- to 25-year-old age group. Osteosarcoma: most common primary bone malignancy, bone pain and lethargy, long bone metaphyseal destruction, elevated serum phosphatase, common near knee |
Treatment Steps
Surgery (limb-sparing usually), plus chemotherapy (preoperative and postoperative) |
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Symptoms
Pain (worse at night). Diagnosis History and physical examination, pain relieved by NSAID, x-ray (sclerotic area with central lysis), biopsy, bone scan, CT scan. |
Osteoid Osteoma
Description Benign bone tumor Pathology Affects young individuals |
Treatment Steps
1. Observation and NSAID. 2. Surgical removal. |
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Description/Symptoms
Most frequent benign bone tumor. Can be asymptomatic or present with pain. Diagnosis History and physical examination, x-ray (pedunculated metaphyseal tumor), biopsy (see Fig. 10–7). |
Osteochondroma
The most common site for osteochondroma is the distal femur. Osteochondroma: most common benign bone tumor, asymptomatic or localized tenderness, pedunculated metaphyseal tumor, common distal femur. |
Treatment Steps
1. Observation. 2. Surgical removal. |
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Symptoms
Pain, fever, swelling, and tenderness. Pathology Pelvis and femur most often |
Ewing’s Sarcoma
Description Malignant round-cell bone tumor; frequently children. Ewing’s sarcoma: malignant round cell bone tumor, children frequently, fever and bone tenderness, destruction of any portion of long bone. |
Diagnosis
History and physical exam, x-ray (any portion of long bone), bone biopsy. Treatment Steps Radiation, chemotherapy, and surgery |
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Symptoms
Arthritis, clubbing, diaphoresis Description Pulmonary and arthritis syndrome |
Hypertrophic Osteoarthropathy
Pathology Etiology unknown; lung cancer/chronic obstructive pulmonary dis- ease (COPD) often present. |
Diagnosis
History and physical examination, x-ray (periostitis). Treatment Steps 1. Treat primary condition. 2. NSAIDs. 3. Therapy. 4. Corticosteroids. |
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Symptoms
Pain, reduced glenohumeral motion. |
Frozen Shoulder Syndrome (Adhesive Capsulitis)
Pathology Adhesions and shoulder capsule fibrosis. |
Treatment Steps
1. Range-of-motion exercise. 2. NSAIDs. 3. Manipulation. 4. Surgery. |
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Symptoms
Burning pain, skin changes (temperature/color), edema in a patient with a prior injury to that area. Clinical diagnosis. |
Reflex Sympathetic Dystrophy (Sudeck’s Atrophy)
Pathology Posttraumatic sympathetic nerve disorder, with reflex vasospasm- induced symptoms |
Treatment Steps
Can be difficult to treat. 1. NSAIDs, amitriptyline, gabapentin. 2. Physical therapy. 3. Sympathetic block. |
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Description/Symptoms
Lump in the hand; contracture of fourth or fifth fingers, in flexion. Clinical diagnosis |
Dupuytren’s Contracture
Pathology Thick palmar fascia, of unknown etiology. Genetic component. Positive association with cirrhosis, diabetes, and epilepsy. |
Treatment Steps
Surgical. |
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Symptoms
Anterior knee pain; worse with hills/steps, and distance running. |
Patellofemoral Pain Syndrome
Pathology Chondromalacia patella. Increased softening and roughness of cartilage under patella |
Diagnosis
History and physical exam (crepitus), x-ray, arthroscopic examination Treatment Steps 1. Rest. 2. NSAIDs. 3. Physical therapy including quadriceps strengthening. 4. Knee brace. 5. Surgery. |
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Symptoms
Symptoms depend on area of bone affected. May be asymptomatic or pain, bone deformity, arthritis, and fractures. |
Paget’s Disease of Bone
Description Bone disorder; more common in elderly; osteitis deformans Pathology Excessive/overactive osteoclasts Complications of Paget’s— osteogenic sarcoma, spinal cord compression, and high-output congestive heart failure (CHF) (affected bone has higher blood flow). |
Diagnosis
History and physical exam, elevated alkaline phosphatase, bone scan, x-ray. Treatment Steps 1. NSAIDs. 2. Antiresorptive agents (calcitonin, bisphosphates, and plicamycin). 3. Physical therapy. 4. Surgery |
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Symptoms
Vertebral collapse, pain. |
Histiocytosis (Eosinophilic Granuloma)
Description Reticuloendothelial proliferative disorder (histiocytosis). Pathology Destructive eosinophilic/histiocytic infiltrate in bone; most often childhood disorder. |
Diagnosis
History and physical examination (tenderness, swelling), x-ray, biopsy. Treatment Steps Rest and bracing, low-dose radiation, surgery, and corticosteroids have been tried. |
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Symptoms
Exercise-induced lower leg pain, medial location. Clinical diagnosis. |
Shin Splints
Description Painful lower leg disorder in athletes (posterior tibialis periostitis). |
Do x-ray and/or bone scan to rule out stress fracture.
Treatment Steps 1. Rest. 2. NSAIDs. 3. Physical therapy (stretching). 4. Control mechanical dysfunctions. |
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Symptoms
Patient initially relates neck pain (then relates his attorney’s name and telephone number). |
Cervical Sprain (Whiplash)
Pathology Hyperextension and flexion injury |
Diagnosis
History and physical examination, x-ray, and CT/MRI to rule out disk disease (if indicated). Treatment Steps 1. Rest. 2. Cervical collar. 3. NSAIDs. 4. Physical therapy. |
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Description/Symptoms
Arm pain from compression of nerve/vascular structures. Hand/arm/back numbness and pain; may be positional. Diagnosis History and physical exam (positive Adson’s test), Doppler study, x-ray. |
Thoracic Outlet Syndrome
Pathology Anatomic neurovascular compression. |
Treatment Steps
1. Exercises. 2. Physical therapy. 3. Surgical rib/muscle resection |
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Symptoms
Elbow pain, arm held flexed. Child will not use arm Diagnosis History (child pulled by arm), and physical. No fracture on x-ray. |
Nursemaid’s Elbow
Pathology Subluxed radial head. |
Treatment Steps
Push back head of radius with arm supinated and flexed. |
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Symptoms/Diagnosis
On history and exam, area under metatarsal head(s) is tender. |
Metatarsalgia
Description Forefoot pain disorder. Pathology Overuse or faulty mechanics. |
Treatment Steps
1. NSAIDs. 2. Shoe padding. 3. Arch support. 4. Achilles tendon stretching. 5. Surgery. |
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Description/Symptoms
Shoulder pain disorder, after fall/injury. Diagnosis History and physical (AC tenderness), x-ray (elevated end of clavicle possible). |
Acromioclavicular (AC) Separation
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Treatment Steps
1. Sling prn if mild (first-degree without separation on x-ray), sling 7 to 14 days for second-degree injury (second-degree, separation not greater than clavicle width), and conservative or internal fixa- tion for third-degree (greater AC separation). 2. Physical therapy after sling. 3. Surgery for residual symptoms. |
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Symptoms
Elbow pain, increasing with activity. Diagnosis History, physical (lateral epicondyle tender, and pain on resisting pa- tient’s attempts on hand/middle finger dorsiflexion). |
Lateral Epicondylitis (Tennis Elbow
Pathology Overuse of forearm muscles creates inflammation at tendon insertion. |
Treatment Steps
1. Rest/brace/NSAIDs. 2. Physical therapy. 3. Corticosteroid injection. 4. Surgery |
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NEUROLOGIC EXAMS
Sensation=Medial Leg (answer on third side) Nerver root/Disk Level? |
NEUROLOGIC EXAMS
Motor=Tibialis anterior (answer third side) Nerver root/Disk Level? |
L4, between L3-L4
Patella Reflex |
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NEUROLOGIC EXAMS
Sensation=Dorsum foot(answer on third side) Nerver root/Disk Level? |
NEUROLOGIC EXAMS
Motor=Extensor hallucis longus (answer third side) Nerver root/Disk Level? |
L5, between L5-L6
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NEUROLOGIC EXAMS
Sensation=Lateral foot (answer on third side) Nerver root/Disk Level? |
NEUROLOGIC EXAMS
Motor=Gastroenemius (answer third side) Nerver root/Disk Level? |
S1, between L5-S1
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NEUROLOGIC EXAMS
Sensation=Lateral arm (answer on third side) Nerver root/Disk Level? |
NEUROLOGIC EXAMS
Motor=Biceps (answer third side) Nerver root/Disk Level? |
C5 between C4-C5
Biceps Reflex |
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NEUROLOGIC EXAMS
Sensation=Lateral forearm(answer on third side) Nerver root/Disk Level? |
NEUROLOGIC EXAMS
Motor=Wrist estensor (answer third side) Nerver root/Disk Level? |
C6 between C5-C6
Brachioradialis Reflex |
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NEUROLOGIC EXAMS
Sensation=Middle finger (answer on third side) Nerver root/Disk Level? |
NEUROLOGIC EXAMS
Motor=Triceps (answer third side) Nerver root/Disk Level? |
C7 between C6-C7
Triceps Reflex |
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NEUROLOGIC EXAMS
Sensation=Medial forearm(answer on third side) Nerver root/Disk Level? |
NEUROLOGIC EXAMS
Motor=Finger flexors (answer third side) Nerver root/Disk Level? |
C8 between C7-C8
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NEUROLOGIC EXAMS
Sensation=Medial arm (answer on third side) Nerver root/Disk Level? |
NEUROLOGIC EXAMS
Motor=Hand intrinsics (answer third side) Nerver root/Disk Level? |
T1 between C8-T1
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Neurologic Exams
—Quadriceps muscle |
L3
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Neurologic Exams
—Patella reflex. |
L4
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Neurologic Exams
—Great toe dorsiflexion, sensation at web of great and first toes. |
L5
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Neurologic Exams
—Achilles reflex, gastrocnemius muscle, and plantar flexors. |
S1
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Neurologic Exams
—Deltoid muscle, biceps tendon reflex. |
C5
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Neurologic Exams
—Biceps/thumb muscle, brachioradialis tendon reflex. |
C6
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Neurologic Exams
—Affects triceps muscle, triceps reflex, sensation middle finger |
C7
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Neurologic Exams
—Grip strength |
C8
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Neurologic Exams
—Intrinsic hand muscles |
T1
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