ANP Certification Musculoskeletal Flash Cards.txt

Soda, Smoking, menopause, caffeine

Aerobic exercise

DEXA scan at age 65, unless high risk factors

Obesity

Uric acid, tophaceous, in joints, SubQ and Connective tissues

3 Liters /day

Avoid chilled, do ROM, stop smoking

Hot showers may exacerbate s/s.

Be sure to rest in between and flexibility exercises are good

Lumbar extensions worsen radiculopathy by increasing laxity of ligaments

Shoulder, Hip

Elbow, and IP joints of hands/feet

Knee, TMJ

Gelling. Seen in Rheumatoid Arthritis

The Anterior Drawer Test is used to assess for instability of the ankle. Laxity upon anteriorly moving heel is typically due to a sprain of the anterior talofibular ligament.

Arm goes across chest, assesses acromioclavicular joint

Put arm behind back and try to touch shoulder blade from above and then below. Difficulty suggests rotator cuff disorder

Patient is in prone position, bend up knee. Pushing down on foot. Positive test indicates meniscus damage. Pain, click, or knee lock.

Assesses tear of rotator cuff (supraspinatus) have patient abduct arm out to side at 90 degrees and then slowly lower. Positive test will have non-smooth motion.

Rotator cuff tear

Lateral epicondylitis

Medial epicondylitis

Heberden's nodes on DIP (D in node and DIP) Bouchard's nodes are in PIP joint. These are found in osteoarthritis

IP, MCP and wrist joint with ulnar deviation, typically symmetrical

Thenar eminence atrophy

Flexion contractures of 3rd, 4th and/or 5th fingers due to nodular thickening of the palmar fascia

Reveals tenderness of the distal radius

Tenderness over the extensor and abductor tendons of the thumb at the radial styloid. An inflammation. Also, when bending thumb in ROM, it may be jerky motion

Finkelstein's test. Make fist over thumb and then bend wrist in ulnar deviation. Positive test is pain in wrist (extensor pollicis brevis and abductor pollicis longus tendons)

With age

Muscle spasm of neck

Restricts internal rotation of the hip, especially sensitive indicator in arthritis

Suggests partial or complete tear of the patellar tendon

Can be seen if effusion in knee joint. Elicited by moving over the bursa then looking for bulge or fluid wave.

Compress the patellar pouch and ballotte (push) the patella sharply against femur and watch for fluid.

Abductor (valgus) stress test. Hold knee in medially while pulling ankle laterally. Pain equals positive partial tear of MCL

Adductor (Varus) stress test. Hold knee laterally while pushing the ankle medially.

By performing the Anterior Drawer Sign.

Supine position. Knees bent with feet flat on table. Cup hands around the knee and draw the tibia forward (anteriorly). A forward movement or jerking movement is positive for ACL tear.

Lay flat. Knee flexed and externally rotated. One hand on femur other on tibia and move tibia forward and femur back. Forward excursion indicates ACL tear. Better diagnostic test than the anterior drawer test.

Posterior Cruciate Ligament tear. Bend leg out laterally and push on tibia posteriorly and look at degree of femur posterior movement.

Meniscus. Checks for ligamental damage of medial meniscus and lateral meniscus

If a click is felt in join line during flexion and extension of knee. Or if tenderness is noted along joint line. Perform test by bending leg out laterally, and then grasp heel and flex knee. Rotate lower leg internally and then externally to assess medial and lateral meniscus.

Evaluates Hip function and ROM

Cannot plantar flex the foot. Also, may have flat footed gait.

Focal heel pain on palpation

Thumb weakness on abduction

Numbness and pain of ventral surface of first three digits of hand. Worse at night. Suggestive of median nerve compression.

Tinel's-TAP median nerve and will complain of electric or tingling sensation in area of nerve distribution

Hold patients hand in acute flexion, or alternatively have patient hold own hands with dorsal surfaces together in acute flexion. Hold either test for 60 seconds. This compresses median nerve and causes numbness and tingling along median nerve.

Sharp pain radiation down back of leg in L5-S1 distribution is highly suggestive of compression of nerve root, HNP. And dorsiflexing foot will further increase pain.

Pain in affected leg when opposite leg is raised.

Chronic inflammation of synovial membranes with secondary erosions of adjacent cartilage and bone with damage to ligaments and tendons

RA has warm, tender joints. OA is rarely warm, rarely tender

RA

Inflammatory reaction to microcrystals of sodium urate

Finger of someone with chronic RA. Persistent flexion of the PIP join with hyperextension of DIP.

Chronic RA, hyperextension of PIP with fixed flexion of DIP

On PIP joints in acute RA disease

Presence of 4 indicators, which can include: +ANA, +Antiphospholipid antibody, malar rash, arthritis with inflammation, hematological disorder, renal disease, pleuritis, pericarditis, etc.

Exocrine glands.

Biopsy of salivary gland for positive presence of mononuclear cell infiltration

Pregnancy, untreated hypothyroidism, repetitive motion

Waking at night with pain and numbness of fingers

Straightening of LS curve, paraspinal tenderness, spasm, decreased LS flexion, decreased lateral bending,

NSAID. Indomethacin 50 to 75mg load, then 25-50mg Q8h x 10 days or Naproxen 750mg load then 250 mg q8h x 10 days. And Colchicine

Colchicine, must be given within first 48 hours of first attack.

0.5mg tablets q1hour until diarrhea. Two tablet loading dose.

Wait 4-6 weeks after initial attack prior to starting maintenance therapy.

Allopurinol given once daily for over producers. Probenecid is given for under excretors.

Psoriasis, lympho or myeloproliferative disorder, chronic hemolytic anemia.

CBC, affects bone marrow function

Excessive production or decreased excretion of uric acid.

Byproduct of protein metabolism

Thiazide diuretic, niacin, ASA, ETOH, cyclosporine

Takes weeks to start working. Decreased uric acid production

Men and women are equally prone, men just get it later in life.

Colles fx (distal radius) vertebral fx, and hip fx

Trabecular bone(cancellous bone)

Causes bone loss to be greater than bone replacement.

Peaks during 1st week. Gone by 3-6 months.

Peaks after had HAV x 1 months, but will stay elevated for years

During growth spurt. Knee pain. Worsens with squatting, walking up/down stairs. Tender swollen tibial tuberosity. Pain upon knee extensive and passive hyperflexion.

Effusion

Poly arthritis, conjunctivitis, urethritis Cant see, Cant pee, Cant climb a tree

Acute diarrhea from shigella, Salmonella, Campylobacter or STD Chlamydia.

Neuro exam WNL. Muscle spasm and stiffness. No dx tests needed. Keep moving.

Typically due to L5-S1, L4-L5 disk bulges causing irritation or damage of nerves.

Abnormal Neuro findings. Altered DTRs, sensory loss, pain with straight leg raise test. Burning, electric shock pain.

Conservative, most resolve 4-6 weeks when disk moves back

Knee Jerk. Foot dorsiflexion. Sensation medial calf

No reflex check. Great Toe dorsiflexion. Sensation Medial foot.

Ankle Jerk. Foot eversion. Sensation lateral foot

Improvement of symptoms when bending forward. Radiating leg pain, can be bilateral. Pseudoclaudication. If s/s greater than one month- start imaging, MRI, EMG.

PT, NSAIDS, Epidural steroid injection

Not routinely. But, if suspected: major trauma age <50, minor trauma age >50, malignancy, Paget's, scoliosis, infection.

Evaluate persistent low back pain with s/s of radiculopathy or spinal stenosis.

BMD is 1.0 to 2.5 SD below norm. (T score -1 to -2.5)

BMD is >2.5 SD Below norm. (T score at or below -2.5)

Postmenopausal women <65 Men 50-70

Women age >65 without risks Men >70 without risks

Female. Advancing age. FHx of osteoporosis. Small and thin. Low estrogen levels. Poor Calcium/Vit D intake. Excessive odium, protein, caffeine. Inactivity. Tobacco use. ETOH abuse.

Long Term corticosteroid use. Some anticonvulsants.

Anorexia nervosa, RA, GI diseases

Femoral neck, total hip, or spine

Joint space narrowing. Becomes bone-on-bone

Due to fall forward onto wrist. Pain with deep palpation of anatomical snuff box

Anterior groin and thigh pain which may radiate to knee. Fx leg is shorter. Leg will be abducted, externally rotated

Difficulty walking, pain with hip movement, and bladder/fecal incontinence

For 48 hours post injury. No ROM, no heat, no exercise. If done too early, will cause increased inflammation and joint damage

Glucosamine effect seen after 2weeks to 3 months. Side effect of bronchospasm. Chrondroitin has synergistic effect

Fingers most common. Then Knee and Hip and spine

Age, joint overuse, + FHx, contact sports, obesity

In sulfa allergy patient

Pain and stiffness gets worse as day progresses

Smooth, cool joints, course crepitus

Knee join effusions

Osteophytes, bone cysts, joint space narrowing.

Tylenol, NSAIDS, Cox2 inhibitors, steroid injection, or surgery

Pain and stiffness is worst in morning, better as day goes on.

Systemic autoimmune disorder

Generalized aching joints, especially fingers, hands, and wrists.

Rheumatoid arthritis

RA, hands, PIP,MCP, wrists, elbows, ankles, shoulders.

RA

OA

Bony erosions and joint space narrowing

Want to treat early to preserve function, limit deformity, and decrease inflammation and pain.

Systemic oral corticosteroids for short course of 2-8 wks only. Plaquinil. Methotrexate.

Early use of DMARDs- Disease modifying agent for rheumatoid arthritis disease. Methotrexate. Minocycline, hydroxychloroquine, monoclonal antibodies. Occasional steroid injections.

3 injections/joint/year

A chronic inflammatory disease affecting spine and SI joint causing severe arthritic changes. Can also affect hips, feet, shoulders

Unable to have full ROM of lower spine

Bamboo spine.

Spinal stenosis

Acute pressure on sacral nerve root with results in pain, inflammation and ischemic nerve changes.

Pain on straight leg raise

Pain or numbness noted in upper extremity when examiner pushes on the top of the head

Loss of bowel and bladder sphincter tone.

Micro tears in tendon which result in inflammation and pain. Usually due to repetitive injury. RICE

Sprain is a LIGAMENT damage partial or complete. Grade I to III.

Grade III is complete rupture of ligaments, complete instability. TX is orthopedic consult,

Ankle. Due to Inversion injury. Jumping, running.

Edema, bruising, pain

One of the main tendons in rotator cuff. Common cause of shoulder pain due to inflammation. Causes pain with elevation and abduction. Local point tenderness over tendon of anterior shoulder.

Bursitis often occurs with tendinitis

Extensor tendon of lateral epicondyle is affected.

Extensor tendon of medial epicondyle is affected

Weakness and tenderness. Requires conservative treatment of NSAIDS and spot or short cast to stop movement to rest

Joint locks up, pop sound and cannot kneel or squat

RICE, NSAIDS, arthroscopic repair if not better in 4-6 weeks

Quadriceps straight leg raises to strengthen

Pain pressure or asymptomatic ball-like mass in popliteal fossa that

Resembles cellulitis appearance. Rupture of baker's cyst causes leakage of synovial fluid, inflammation, tenderness, swelling

Subdeltoid, olecranon, trochanter, prepatellar

Pain limited ROM only.

Joint overuse, trauma, infection, arthritis

Inhibit COX 1 and COX 2.

C5-C6

Nipple Line

Umbilicus

Inguinal

Thumb

Knee, Quadriceps

Fingers 2 and 3

Fingers 4 and 5

Foot, sole and ankle

Scrotum

Perineal

C5, C6

C6, C7

L2, L3, L4

S1

L5, S1

CNS lesion

Decrease risk of exercise inducted cardiac death and decrease the progression of CV function caused by exercise

Often occurs during team sport. Congenital Heart malformations, HCM, congenital Coronary artery abnormalities

Due to atherosclerosis

Prior chest pain, syncope, SOB, hx murmur, HTN, + FHx of Sudden death, Marfans, Long QT, cardiomyopathy, arrhythmias.

Check for murmurs supine and then standing.

Vibratory, Innocent Murmur

Murmur that become more faint with standing

Exercise can cause outflow obstruction

1200 to 1500 mg daily for women. 1000 mg daily for men

600 � 900 IU daily

Safe alternative to Estrogen supplement, does not adversely affect breast or uterus

Inhibits osteoclast activity and increases bone mass and decreases bone fracture

Full glass of Water, Empty stomach x1 hour, erect x 1 hour

Central Pain Syndrome

Sensitization of CNS, causing diffuse hypersensitivity to pain. Also noted to see low serotonin.

Need presence of tender Points specific to certain diagnostic locations, pectoral muscle at 2nd rib, shoulder, trapezius, piriformis area. Need pain in axial skeleton plus 4 other quadrants, more than 3 months. Need 11 out of 18 spots positive. (9 pairs)

Cognitive changes, constipation or diarrhea, altered moon

Physical activity, trigger point injection, topical capsaicin,

Pregabalin (Lyrica) and Duloxetine (Cymbalta) FDA approved for Fibromyalgia pain. Trazodone for sleep, TCAs. Antiepileptics Gabapentin.

Softening, rubbery deposit in bone causes an abnormal collagen matrix. Due to Vitamin D Deficiency.

Increased Alkaline phosphatase and decreased serum calcium, serum phosphorus, creatinine, and urinary calcium.

Dilantin and Phenobarbital. Need 2-5x recommended Vitamin D Supplement

Gastric Bypass, Liver and Renal disease

50,000 IU Vitamin D once a week x 8 weeks. Then 50,000 IU twice monthly plus daily lose dose supplements

Place can on side of GOOD leg. Move it in conjunction with affected leg. Cane should be at height of greater trochanter.

Age related increase in convexity of T spine

Pregnancy or obesity related increase in lumbar concavity

Tests of Achilles tendon rupture by squeezing calf. If positive rupture, absent foot movement is noted

RNS test. Repetitive nerve stimulation test.

Bone fragments in many pieces

Broken ends of bone poke through skin

Even break, but no skin involvement

Crushed bone

More common. Unable to shoulder shrug, positive pain and arm lengthening

Knee

No

Partial joint location