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FNP~MSK

Musculoskeletal Probs

QuestionAnswer
What % of gout is due to "uric acid overproduction"... ~10%
What % of gout is due to "urate under excretion"... ~90% with gout, made worse by renal insufficiency, ETOH abuse, use of diuretics, ASA, other meds
Allopurinol is used to... avoid gout...used as a gout prophylaxis
McMurray (+)... palpable popping/click on the joint line
Talar tilt... increase degree inversion
Spurling (+)... radiating pain when pressing on head
Tinel's (+)... pain and paresthesia w/ tapping on compressed nerve
Lachman (+)... like anterior drawer, but knee @20' excessive movement
Straight leg raising (Lasegue') (+)... lower back, sciatic pain
Drop arm test... passively abducting patients shoulder
McMurray shows what condtion... meniscal tear
Talar tilt shows what condition... ankle instability
Spurling shows what condition... cervical nerve root compression
Tinel's sign shows what condition... carpal tunnel
Lachman test shows what condition... anterior cruciate ligament tear (ACL)
Straight leg raising test shows what condition... lumbar nerve root condition
Drop arm test shows what condition... rotator cuff evaluation
Osgood~Schlatter disease... Growing pains below the knee and up the front of the thigh in adolescent children caused by the femur growing in length faster than the muscles that run along it
Prepatellar bursitis... Prepatellar bursitis, also known as Housemaid's knee, is a common cause of swelling and pain above the patella (kneecap), and is due to inflammation of the prepatellar bursa; no effusion
Patellar tendonitis... Patellar tendinitis (patellar tendinopathy, also known as jumper's knee and Sinding-Larsen-Johansson disease), is a relatively common cause of pain in the inferior patellar region in athletes.
Reactive arthritis (Reiter syndrome)... an autoimmune condition that develops in response to an infection in another part of the body; polyarthritis, with rash
Most common condition of causing lower back pain... lumbar-sacral strain
Lumbar-sacral strain is... spasm, irritation of LS spine supporting muscles
Lumbar-radiculopathy is... irritaion or damage of neural structures i.e. L4-L5, L5-S1, most common sites of disc buldge
Dicomfort characteristics of "LS strain"... spasm, ache, stiffnes. Position, activity, rest typically impacts pain
Discomfort characteristics of "lumbar rediculopathy"... sharp, burn, electricshock sensation; worse with spinal fluid pressure...sneeze, cough, straining
PE for "LS strain" shows... spinal muscle tenderness and spasm; neuro exam WNL
PE for "lumbar radiculopathy" shows... altered neuro exam: abnormal straight leg raising, sensory loss, altered DTR's
Spinal x-ray (***not routinely indicated for back pain) is helpful if suspecting... supspected: fx if major trauma <50yo or minor trauma >50yo, imflammatory bone dz, malignancy, Paget's dz, scoliosis or other anatomical probs, infection or other bony destructive dz
MRI or CT is done in LS strain or Radiculopathy if... done for persistent low back pain, potential candidate for surgery
MRI is good for what type of injury... soft tissue
Key features of "cauda equina syndrome".... urinary retention, motor deficits at multiple levels, fecal incontinence, saddle anesthesia
Testing indicated for "cauda equina syndrome"... MRI
Key features of "vertebral compression fx"... hx of osteoporosis, use of systemic corticosteroids, older age
Testing indicated for "vertebral compression fx"... LS x-ray
Key features of "ankylosing spondylitis" (chronic inflammatory dz of axial skeleton)... morning stiffness, improvement with exercise, alternating butock pain, awakening due to back pain during the second part of the night, younger age (20-30yo)
Testing indicated for "ankylosing spondylitis"... AP pelvis x-ray, consider ESR and/or CRP, HLA-B27
Key features of "spinal stenosis"... radiating leg pain, older age
Testing indicated for "spinal stenosis"... initially none, if sx's persist >1 mo consider EMG/NCV
Normal BMD... within 1 SD of a "young normal" adult
Low bone mass BMD ("osteopenia")... between 1.0-2.5 SD below that of a "young normal" adult
Osteoporosis BMD... 2.5 SD or more below that of a "young normal" adult
Location of "Heberden" nodes DIP
Location of "Bouchard" nodes PIP
Created by: KimmiNP