MSK_UPPER_LOWER_EXT_MS2

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soren101
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119368
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MSK_UPPER_LOWER_EXT_MS2
Updated:
2011-11-28 14:48:11
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MUSCULOSKELETAL UPPER LOWER EXTREMITIES MS2
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MSK U&L EXT MS2
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  1. OTTOWA ANKLE RULES
    DETERMINE OF X-RAY NEEDED

    • ANKLE
    • --PAIN IN MALLEOLAR ZONE
    • --EITHER MEDIAL OR LATERAL POSTERIOR EDGE OR TIP
    • --CAN'T BEAR WEIGHT (4 steps) IMMEDIATELY AFTER AND AT ER

    • FOOT
    • --PAIN IN MID-FOOT ZONE
    • --PAIN AT EITHER BASE OF 5TH METATARSAL OR NAVICULAR
    • --CAN'T BEAR WEIGHT
  2. LATERAL ANKLE PAIN
    DX -- LAT ANKLE SPRAIN

    H&P -- INVERSION OF FOOT w ACUTE LAT PAIN & SWELLING. TTP OVER LAT LIGs. PAIN w PASSIVE INVERSION AND ACTIVE EVERSION

    IMAGING -- OTTAWA ANKLE RULES

    Tx -- RICE
  3. MEDIAL ANKLE PAIN
    • Dx
    • -- DELTOID LIG SPRAIN
    • --UNCOMMON, DON'T MISS HIGH ANKLE SPRAIN OR MALLEO FRACT

    • H&P
    • --EVERSION OF FOOT w MEDIAL PAIN AND SWELLING

    • IMAGING
    • --OTTAWA

    • Tx
    • --RICE
  4. POSTERIOR HEAL PAIN and/or MORNING STIFFNESS
    ACHILLES TENDONITIS

    • H&P
    • --EXAMINE w ANKLE DORSIFLEXED AND FLEX/EXT AT KNEE
    • --EXAMINE ARCHES

    • IMAGING
    • --LATERAL WT-BEARING HEAL RAD

    • Tx
    • --ACUTE: RICE, NSAIDs, MAYBE HEAL LIFTS
    • --CHRON or UNRESPONSIVE: SURG EVAL
  5. ACUTE ONSET POSTERIOR HEAL PAIN w SWELLING IN TENDON AREA and CAN'T PLANTARFLEX
    ACHILLES RUPTURE

    • H&P
    • --OFTEN A GAP PALPATED ALONG BACK OF LEG

    • IMAGING
    • --NOT NEEDED IF GAP PALP
    • --US or MRI if SURG ANTICIPATED

    • Tx
    • --NON OPERATIVE (dm, transplant): BOXER BOOT
    • --OPERATIVE: wi 3 WEEKS
  6. ANTERIOR HIP PAIN THAT RADIATES TO GROIN. SLOWLY PROGRESSIVE w ACTIVITY
    OSTEOARTHRITIS

    • H&P
    • --PAIN w ACTIVITY
    • --SLOWLY PROGRESSIVE
    • --RROM
    • --RADIATES TO GROIN

    • Tx
    • --ANALGESICS
    • --MOIST HEAT
    • --STRENGTHENING EXER
    • --JOINT REPLACE
  7. ANTERIOR HIP PAIN w NUMBNESS IN WELL DEFINED AREA OF THIGH
    MERALGIA PARASTHETICA

    • H&P
    • --NUMBNESS IN WELL DEFINED AREA OF ANT THIGH
    • --CAN CAUSED BY TIGHT CLOTHING
    • --OBESITY
    • --CONSTANT FLEXION AT HIP

    • Tx
    • --REASSURANCE
    • --WT LOSS
    • --LOOSE CLOTHING
    • --IF PAIN, CAN REFER FOR NERVE BLOCK
  8. LATERAL HIP PAIN & CAN'T LAY ON SIDE
    TROCHANTERIC BURSITIS

    • H&P
    • --CAN'T LAY ON SIDE
    • --PAIN CROSSING LEGS
    • --POINT TENDERNESS OVER TROCH
    • --RADIATES ONLY TO KNEE

    • Tx
    • --95% CAUSED BY GAIT ABN
    • --AVOID DIRECT PRESSURE
    • --STRETCH
    • --STEROID INJ INTO BURSA
  9. POSTERIOR HIP PAIN w PAIN IN UPPER BUTTOCK REGION
    SACROILIITIS

    • H&P
    • --PAIN IN U.BUTTOCK REGION
    • --TTP OVER SI JOINT
    • --PAIN w PATRICK'S TEST (flex knee of affected side and place foot on other knee. hold hip in place while pushing down on knee)

    • Tx
    • --CORRECT ANY GAIT ABN
    • --SI BELT to prevent joint rub
    • --PT FOR STRETCHING
    • --ANTI-INFLAM MEDS
    • --MOIST HEAT
  10. ANTERIOLATERAL HIP PAIN w Hx OF TRAUMA OR OSTEOPOROSIS
    HIP FRACTURE

    • H&P
    • --Hx OF TRAUMA or OP
    • --UNABLE TO BEAR WT
    • --WON'T PASSIVELY ROTATE HIP

    • Tx
    • --SURG
  11. SLOW PROGRESSIVE PAIN IN MEDIAL OR LATERAL KNEE. WORSE w ACTIVITY
    OSTEOARTHRITIS

    • H&P
    • --SLOW PROG PAIN
    • --WORSE WHEN ACTIVE
    • --RELIEVED BY REST
    • --JOINT LINE TENDERNESS
    • --VARUS DEFORMITY (inward angulation of distal bone or joint seg. valgus is outward)

    • Dx TESTS
    • --WT BEARING PLAIN FILMS

    • Tx
    • --ANALGESICS
    • --PT
    • --WT CONTROL
    • --POSS INTRA-ARTIC STEROID INJ
    • --TOTAL JOINT REPLACE
  12. MEDIAL OR LATERAL KNEE PAIN w KNEE LOCKING
    MENISCAL TEAR

    • H&P
    • --AFTER TWISTING MOTION
    • --Hx OF OA
    • --EFFUSION OCCURS hrs LATER
    • --JOINT LINE TENDERNESS
    • --KNEE LOCKING / CATCHING

    • Dx TESTS
    • --MRI ONLY IF ABN FUNC AND SURG IS A CONSIDERATION

    • Tx
    • --PT
    • --ANALGESICS
    • --KNEE BRACE
    • --LOCKING: ORTH EVAL FOR SURG
  13. LOCALIZED TENDERNESS OVER MEDIAL TIBIAL PLATEAU
    ANSERINE BURSITIS

    • H&P
    • --TENDERNESS OVER MEDIAL TIB PLATEAU
    • --POSS ASSOC w OA or LARGE EFFUSION

    • Dx TESTS
    • --NONE

    • Tx
    • --ANTI INFLAMMs
    • --ICE
    • --AVOID DIRECT PRESSURE
    • --CONSIDER STEROID INJ IN CHRON
  14. LOCALIZED KNEE PAIN w VALGUS STRESS
    MCL STRAIN

    VALGUS -- OUTWARD ANGULATION OF DISTAL BONE OR JOINT

    • H&P
    • --LOCALIZED PAIN w VALGUS STRESS

    • Dx TESTS
    • --USUALLY NOT NEEDED

    • Tx
    • --RICE
    • --BRACE
    • --ANTI INFLAMs
    • --IF UNSTABLE: GRADE 3 ORTHO CONSULT
  15. ANTERIOR KNEE PAIN WHEN CLIMBING STAIRS AND RETROPATELLAR PAIN ON EXAM
    PATELLOFEMORAL PAIN SYND

    • H&P
    • --PAIN WHEN CLIMBING STAIRS
    • --WALKING UP HILL
    • --RISING FROM SEATED POSITION
    • --RETROPATELLAR PAIN ON EXAM
    • --PAIN w COMPRESSION OF PAT ON FEMUR

    • Dx TESTS
    • --PLAIN FILM

    • Tx
    • --PT FOR QUAD STRENGTH
    • --ANALGESICS
    • --PAT STABILIZING BRACE
  16. ANTERIOR KNEE PAIN w Hx OF KNEELING AND SWELLING ON TOP OF PATELLA
    PREPATELLAR BURSITIS

    "HOUSMAID'S KNEE"

    • H&P
    • --Hx OF KNEELING
    • --SWELLING ON TOP OF PAT
    • --ROM PRESERVED
    • --GOUT
    • --INFECTION

    • Dx TESTS
    • --NONE

    • Tx
    • --ASPIRATE TO DETERMINE ETIOLOGY
    • --COMPRESSION
    • --ANTI INFLAMs
    • --AVOID DIRECT PRESSURE
  17. FULLNESS IN POSTERIOR KNEE AND CAN'T FULLY FLEX
    POPLITEAL CYST

    "BAKER'S CYST"

    • H&P
    • --FULLNESS IN KNEE
    • --CAN'T FULLY FLEX
    • --UNDERLYING OA

    • Dx TESTS
    • --US

    • Tx
    • --TREAT UNDERLYING DISORDER
  18. ACUTE ONSET, WARM, PAINFUL KNEE. WORSE w ACTIVITY AND ERYTHEMATOUS
    SEPTIC ARTHRITIS

    • Dx TESTS
    • --JOINT ASPIRATION

    • Tx
    • --ANTI BIOTICS
    • --JOINT WASHOUT BY ORTHO
  19. EXQUISITELY TENDER, SWOLLEN, RESTRICTED KNEE
    GOUT / PSEUDOGOUT

    • H&P
    • --SELF LIMITED
    • --WARM
    • --EXQUISITELY TENDER
    • --SWOLLEN
    • --RROM DURING FLARE

    • Dx TESTS
    • --JOINT ASPIRATION

    • Tx
    • --COLCHICINE
    • --STEROIDS
    • --ALLOPURINOL ONCE RESOLVED
  20. RAPID SWELLING AFTER TRAUMA OF KNEE w SEVERE INSTABILITY
    LIGAMENTOUS TEAR

    • H&P
    • --RAPID SWELLING
    • --TRAUMA USUALLY
    • --SEVERE INSTABILITY

    • Dx TESTS
    • --MRI

    • Tx
    • --ORTHO EVAL
  21. DIFFERENTIAL FOR KNEE EFFUSION
    SEPTIC ARTHRITIS

    GOUT / PSEUDOGOUT

    LIG TEAR

    MENISCAL TEAR
  22. SHARP FOOT PAIN w FIRST STEP OF THE DAY. LOCAL POINT TENDERNESS ANLONG BOTTOM OF FOOT.
    PLANTAR FASCIITIS

    • H&P
    • --SHARP PAIN w FIRST STEP OF DAY
    • --LOCAL POINT TENDERNESS ALONG BOTTOM

    • IMAGING
    • --NONE

    • Tx
    • --OFTEN RESOLVES SPONT
    • --STRETCHES
    • --ORTHOTICS
    • --ICE
    • --CUSHIONED SHOES
  23. PAIN TO LAT SHOULDER AND ARM w OVERHEAD ACTIVITY. CAN'T SLEEP ON THAT SIDE. TTP OVER LAT HUMERAL HEAD
    IMPINGEMENT SYNDROME

    • aka
    • --SUBACROMIAL BURSITIS
    • --SUPRASPINATUS BURSITIS
    • --TENDINITIS

    • H&P
    • --PAIN TO LAT SHOULDER & ARM w OVERHEAD ACT
    • --CAN'T SLEEP ON SIDE
    • --TTP OVER LAT HUMERAL HEAD
    • --PAINFUL ARC
    • --HAWKINS & NEER TEST

    • Tx
    • --ICE
    • --AVOID OVERHEAD ACT
    • --PT
    • --ANTI INFLAM
    • --STEROID INJ
  24. SHOULDER STIFFNESS and CAN'T MOVE ARM FULLY. ABN PASSIVE ROM
    ADHESIVE CAPSULITIS

    aka FROZEN SHOULDER

    • H&P
    • --STIFFNESS
    • --ABN PASSIVE ROM
    • --SIMILAR TO IMPINGEMENT SYND BUT ABN PASSIVE ROM

    • Tx
    • --18 months PT
    • --STEROID INJ
    • --POSS SURG IF REFRACTORY
  25. FALLING DIRECTLY ONTO SHOULDER w ANTERIOR PAIN, POPPING OR GRINDING. TTP OF AC JOINT
    ACROMIAL-CLAVICULAR SEPARATION

    • Tx
    • --UP TO GRADE 3 SEPARATION: ANALGESICS AND PT
    • -- > GRADE 3: POSS SURGERY
  26. ANTERIOR SHOULDER PAIN w LIFTING AND OVERHEAD REACHING.
    BICEPS TENDINITIS

    • H&P
    • --PAIN w LIFTING
    • --OVERHEAD REACHING
    • --ANTERIOR PAIN
    • --TTP OF BICEPS GROOVE
    • --YERGASONS AND SPEEDS SIGN

    • Tx
    • --REST
    • --AVOID LIFTING
    • --ICE
    • --ANTI INFLAM
    • --PT
  27. VAGUE SHOULDER LOOSNESS w EXCESSIVE ROM esp ROTATION
    SHOULDER INSTABILITY

    • H&P
    • --VAGUE LOOSNESS
    • --SWIMMERS & THROWERS
    • --YOUNG WMN w POOR MUSC MASS
    • --EXCESSIVE ROM esp ROTATION
    • --APPREHENSION TEST

    • Tx
    • --PT
    • --POSS SURGERY
  28. PAIN IN LATERAL ELBOW w TTP OF LATERAL EPICONDYLE. PAIN w WRIST DORSIFLEXION
    EPICONDYLITIS

    aka TENNIS ELBOW

    • H&P
    • --PAIN IN LAT ELBOW / ARM WHEN OPENING JARS, GRIPPING, LIFTING
    • --TTP OVER LAT EPICONDYLE
    • --PAIN w WRIST DORSIFLEXION

    • Tx
    • --ELBOW STRAP
    • --ICE
    • --AVOID AGG ACT
  29. PAIN IN MEDIAL ELBOW AND TTP OVER MEDIAL EPICONDYLE
    EPICONDYLITIS

    aka GOLFER'S ELBOW

    PAIN w VOLAR WRIST FLEXION

    MEDIAL EPICONDYLE TTP

    PAIN IN ELBOW / ARM WHEN OPENING JARS, GRIPPING, LIFTING

    • Tx
    • --ELBOW STRAP
    • --ICE
    • --AVOID AGG ACT
  30. PAIN WHEN LEANING ON ELBOW. OLECRANON SWELLING
    OLECRANON BURSITIS

    • Tx
    • --ASP FOR CRYSTALS OR INFECTION
    • --AVOID PRESSURE
  31. NUMBNESS AND TINGLING IN FINGERS 1-3.5. AGGRAVATED IN WRIST FLEXION
    CARPAL TUNNEL SYND

    • H&P
    • --SHAKES HANDS TO RESTORE FEELING
    • --MORE COMMON IN DM, PREGOs, OBESITY, HYPOTHYROIDISM
    • --PHALEN (flex wrists and push together & TINEL (tap ventral wrist) TESTS
    • --THENAR ATROPHY
    • --DEC 2-POINT DESCRIMINATION
    • --DEC THUMB OPPOSITION

    • Dx TESTS
    • --EMG/NCS
    • --DM, THYROID Dz

    • Tx
    • --COCK UP WRIST SPLINTS
    • --ANTI INFLAMS
    • --CARP TUN INJ
    • --SURG
  32. PAIN IN RADIAL WRIST w TENDERNESS IN SNUFF BOX
    DE QUERVAINS TENOSYNOVITIS

    • H&P
    • --REPETITIVE MOV OF WRIST
    • --RADIAL SIDE PAIN
    • --TTP OVER SNUFF BOX
    • --FINKELSTEINS SIGN (thumb in fist then actively stretch)

    • Tx
    • --SPICA SPLINT
    • --ICE
    • --AVOID AGG ACT
    • --ANTI INFLAM
    • --STEROID INJ
  33. BLUNT TRAUMA TO WRIST w TTP OVER ULNAR SIDE
    TRIANGULAR FIBROCARTILAGE COMPLEX INJURY (TFCC)

    • H&P
    • --BLUNT TRAUMA TO WRIST
    • --TTP OVER ULNAR SIDE

    • TESTS
    • --MRI IN INTRACTABLE

    • Tx
    • --SPLINT
    • --ICE
    • -ANTI INFLAMs
  34. FALL ONTO OUTSTRETCHED HAND w TTP OF DISTAL RADIUS
    DISTAL RADIAL FRACTURE

    • H&P
    • --FOOSH
    • --TTP +/-
    • --DEFORMITY OF DISTAL RADIUS

    • Dx TESTS
    • --XRAY

    • Tx
    • --IMMOBILIZATION
    • --SURG IF DISPLACED
  35. FOCAL, DORSAL, USUALLY NON-TENDER SWELLING OF WRIST
    DORSAL WRIST GANGLION

    • H&P
    • --USUALLY NONTENDER SWELLING
    • --FOCAL DORSAL SWELLING

    • Tx
    • --LEAVE ALONE UNLESS CAUSING MECH PROBS
    • --SURG

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