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65 Cards in this Set
- Front
- Back
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What connects bone to bone? |
ligaments |
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What connects muscle to bone? |
tendons
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What is cartilage? |
dense connective tissue with no blood supply |
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Knee Injury/Pain |
caused by: trauma exercise
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Locking of the knee is congruent with? |
meniscal tear
loose bodies |
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McMurray's test |
audible/palpable click when keen is raised slowly with one foot externally rotated
knee is flexed and then quickly straightened
Test is + for medial meniscal tear |
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Medial Meniscal Tear |
+ McMurray's test
Remember MMM Medial Meniscal McMurray's |
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Lachman's test |
drawer test to assess fro anterior/posterior cruciate ligament tear
easy to perform on swollen painful knee
place knee in 20-30 degree flexion and grasp with one hand with anterior force to proximal tibia while opposite hand stabilizes the thigh
graded 1+ to 3+ grade of displacement with positive test |
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Apley's 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 for medial or lateral collateral ligament damage and/or meniscus injury |
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Management for knee injury/pain |
RICE NSAIDS ROM Aspirate effusions as needed consult and refer to ortho PRN |
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Muscle Strain S/S |
Pain during ROM Edema Ecchyomosis
Won't be able to lift hands over head without pain with bursitis |
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Management of Muscle strain |
RICE Assistive devices as needed Analgesics NSAIDS Prevention education |
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Are ligaments sprained or strained? |
sprained
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Are muscles sprained or strained? |
strained |
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Bursitis |
caused by: trauma sepsis/infection in joint space
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Most common locations of bursitis |
oclecranon subdeltoid ischia prepatellar |
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S/S Bursitis |
pain especially with movement swelling tenderness erythema |
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Diagnostics of Bursitis |
aspiration with gram stain and C&S WBC (elevation suggestive of bacterial infect) plain x-ray to rule out other bone/joint issues |
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Management of Bursitis |
splinting RICE heat 30 min TID or QID ASA NSAIDS (Naproxen 250 BID or TID) steroid injections into bursa If septic: I & D and give abx |
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Osteoarthritis |
degenerative joint disease with slow destruction of articular cartilage |
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Inflammation in OA |
asymmetrical |
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Who is affected by OA |
53-64 year olds
men and women equally affected |
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Which joints are affected by OA |
knees hips fingers hands wrists no redness or heat edema
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What are bouchard's nodes |
associated with OA
Proximal interphalangeal joints |
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Heberden's nodes |
associated with OA
distal interphalangeal joints |
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Stiffness/Pain with OA |
better in AM
worse as day progresses
aggravated by activity
relieved by rest |
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X-Ray findings with OA |
narrowing of joint space osteophytes juxta-articular sclerosis subchondral bone |
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Other findings in OA |
genetic predisposition likely increased incidence with age obesity is an exacerbating factor limited ROM angular deformities of affected joints |
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Management of OA |
ASA Tylenol NSAIDS: Ibuprofen, meloxicam, diclofenac, naproxen
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Supportive care for OA |
weight loss cane on opposite side of affected side ex. right side affected, use cane on left side ice for improved ROM moist heat to decrease spasm physical therapy refer for joint replacement |
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Rheumatoid Arthritis (RA) |
systemic autoimmune disease causing inflammation of connective tissue |
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Inflammation in RA |
symmetrical |
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Who does RA affect |
35-50 years more common in women |
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What joints are affected with RA |
Proximal interphalangeal joints (PIPs) Metacarpophalangeal joints (MCPs) Wrists Swelling & edema with redness and "heat" complaints to joints |
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Stiffness and Pain with RA |
worse in the morning better as day goes on |
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Other findings with RA |
autoimmune-multifactorial etiology fatigue weakness malaise anorexia weight loss |
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Labs for RA |
ESR usually elevated ANA (+) in 1/5 patients |
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Diagnostics for RA |
synovial aspiration with changes and WBCs |
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X-Ray findings with RA |
joint swelling progressive cortical thinning osteopenia joint space narrowing |
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Management of RA |
high dose salicylates NSAIDS Disease modifying anti rheumatic drugs (DMARDS) corticosteroids methotrexate antimalarials gold salts injections |
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Supportive care for RA |
early rheumatology referral rest physical therapy surgery |
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With NSAIDs, what lab tests do you watch? |
Kidney function |
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Carpel Tunnel Syndrome |
Frequently affects dominant hand
associated with repeated wrist flexion
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S/S Carpal Tunnel |
numbness, tingling, burning above median nerve nocturnal pain pain exacerbated with dorsiflexion of wrist positive tineal's sign positive phalen's sign carpal compression test
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Tineal's sign |
tapping over the median nerve on the flexor surface of the wrist produces a tingling sensation radiating from the wrist to the hand |
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Positive Phalen's test |
reproduction of symptoms after 1 minute of wrist flexion |
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Carpal compression test |
pressure with the examiner's thumb over the patient's carpal tunnel for 30 seconds elicits symptoms |
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Diagnostics for carpal tunnel syndrome |
electromyography to document motor involvement
routine x-rays to rule out other disorders/complications |
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Management of carpal tunnel syndrome |
elevation occupational splinting or bracing NSAIDs Injection of carpal tunnel with corticosteroids referral for surgical intervention COCK splint |
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Common causes of Low Back Pain |
mechanical strain obesity poor body mechanics trauma repetitive twisting, bending, or lifting herniated lumbar discs |
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S/S Low back pain |
pain in low back region may radiate numbness along specific dermatome bowel, bladder or sexual dysfunction decreased muscle strength or actual atrophy of muscle decreased or absent reflexes Positive straight leg test Positive pelvic rock test Ataxic gait |
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Straight leg test |
radiating or sciatic pain reproduced when the patient's legs are elevated off the table |
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Pelvic rock test |
place hands one act of the anterior superior iliac spines and attempt to "open and close" the pelvis"
Positive if feels pain in either or both sacroiliac joints |
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If L3-L4 injury |
quads weak and/or atropic pain radiating to medial mallelous numbness along same path, especial medial aspect of knee diminished or absent patellar reflexes
Have patient squat and rise |
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L4-L5 injury |
weakness of the dorsiflexion mechanism of the great toe and foot
Pain radiating to the lateral calf; numbness of dorsum of foot and lateral calf
have patient walk on heels of feet |
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L5-S1 injury |
weakness of plantar flexion of great toe and foot
pain along buttocks, lateral leg and lateral malleolus
Numbness to lateral aspect of foot and posterior calf
Diminished or absent achilles reflex
have patient walk on toes |
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Diagnostics for Low back pain |
X-Rays: AP/lateral films of the spine
CT or MRI
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Management of low back pain |
rest limit activities that increase pain orthotic braces physical therapy alternate heat/ice weight loss proper body mechanics ultrasound/TENS NSAIDS (ibuprofen 400-800 TID for 3-4 days) 3-4 for 3-4 |
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Morton's Neuroma |
Benign neuroma causing compression of intermetatarsal plantar nerver
3-4th intermetatarsal spaces
Usually from heels or narrow toe boxes
Flat feet or hammer toe may also contribute
S/S: feel as though STANDING ON A PEBBLE tingling or numbness in toes shooting pain affecting the
Lab/Diag: Ultrasound MRI for lesions
Management: orthotics and corticosteroid injections referral for cryogenic neuroblation or neurectomy |
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Plantar Fasciitis |
Inflammation of the plantar fascia
Causes: common in runners foot arch pain/problems obesity or sudden weight gain common ages 40-70
S/S: pain and stiffness in bottom of feet may be worse in the first few steps in the morning or after standing for a while ache burn
Diagnostics: PE x-ray to rule out other problems
Management: NSAIDS corticosteroids orthotics night splints physical therapy refer |
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Osgood-Schlatter Disease |
rupture of growth plate at tibial tuberosity due to stress on the patellar tendon
AKA tibial apopyseal traction injury
S/S: painful limp with pain below knee cap can be in one or both legs pain exacerbated with running, jumping, climbing swelling from mild to severe
Diagnostics: PE x-ray to rule out other conditions
Management RICE NSAIDS or tylenol rare cases refer for surgery |
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Costochondritis |
inflammation of cartilage that connects rib to sternum
Caused by: injury physical strain URI Infection Fibromyalgia
S/S: pain and tenderness where ribs attach pain with deep breath or coughing
Diagnostics: PE x-ray to rule out other conditions
Management: usually resolves on its own local heat or ice may be helpful NSAIDS |
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Polymyalgia Rhematica |
Inflammatory disorder involving pain and stiffness in the shoulder and usually the hip
May be associated with temporal arteritis Usually over 50 years old
S/S: stiff neck, shoulders, and hips loss of ROM in affected area fatigue, anemia, mild fever
Diagnostics ESR x-ray PRN to rule out other condition
Management: corticosteroids symptomatic management |
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Physical changes in gerontology musculoskeletal |
Sarcopenia (decrease muscle mass and strength) loss of lean body mass lean body mass replaced by fat redistribution of fat low bone mass intervertebral disc degeneration kyphosis and height reduction increased % adipose tissure degeneration of cartilaginous tissue
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Possible musculoskeletal findings in gerentology |
increased risk of disability and falls unstable gait increased body fat % height reduction osteoporosis osteoarthritis limited ROM joint instability |
