NR511 iFinal iExam iStudy iGuide
1. iSigns iand isymptoms iand Signs iand isymptoms iand imanagement iof imusculoskeletal
imanagement iof imusculoskeletal isprains/strains/dislocations
isprains/strains/dislocations iKara
iIrvin Sprains: istretching ior itearing iof iligaments ithat ioccurs iwhen ia ijoint iis iforced
ibeyond iits inormal ianatomical irange
First idegree- istretching iof iligamentous ifibers
Second idegree- itear iof ipart iof ithe iligament iwith ipain iand iswellingiThird
idegree- icomplete iligamentous iseparation
Sprain- isudden iinjury ior ifall ithat icaused iacute ipain iand iswelling ithat igotiworse
iover ia ifew ihours, iredness iand ibruising, iactive iand ipassive iROM idecreased.
iRadiography ito irule iout ifx.
Strain: imuscle iinjury icaused iby iexcessive itensile istress iplaced ion ia imuscleithat
iresults iin istiffness iand idecreased ifunction
-effects imuscle ior itendon ithat iconnects ia imuscle ito ia ibone, icomplain
iof i“pulled imuscle,” isevere icases icause iinflammation, iswelling, iweakness iand
iloss iof ifunction-surgery imay ibe ineeded
Management: iPRICE i(protect, irest, iice, icompression, ielevation), ilimitation iof
iactivity, iphysical itherapy, iNSAIDS, ireferral ito iortho
Dislocation- icomplete iseparation iof i2 ibones ithat iform ia ijoint
Very ipainful iand icause iimmobility, ineed iimmediate imedical iattention
iReferral ito iorthopedics ifor ipossible isurgery ior ireduction iwith
application iof icast ior isplint.
2. iSigns iand isymptoms iand Cervical iSpondylosis- ineck istiffness, imild iaching idiscomfort iwith iactivity. iPain
imanagement iof ispinal idisorders iand ilimited iROM ioccur iwith ilateral irotation iand ilateral iflexion iof ithe ineck
i(spondylosis, istenosis, ietc.) iSandra itoward ithe iaffected iside. iWeakness ishoulder iabduction- iC5. iBicep iweakness-
iOkonkwo iThank iyou iAshley iL ifor iC6. iTricep iweakness-C7.Myelopathy- ileg iweakness, igait idisturbance, ibalance
icompleting!!! iproblems, idifficulty iperforming ifine imotor itasks, iloss iof ibowel iand ibladder.
Treatment- icervical itraction, iPT, ipain irelievers.iSurgery ifor iMyelopathy.
Low iback ipain-Tenderness iand idecreased irange iof imotion. iPositive istraightileg
itest. iTreatment-NSAIDS, imuscle irelaxants, iopioids, isurgical, iself-care, ispinal
imanipulation
Stenosis-pseudoclaudication icausing iradicular ipain iin ithe icalves, ibuttocks, iand
iupper ithighs iof ione ior iboth ilegs. iSymptoms iprogress ifrom ia iproximal ito idistal
idirection. iWalking ior iprolonged istanding icauses ipain iand iweakness iin
ibuttocks iand ilegs. iStooping iover ihelps irelieve ipain. iPositive iRomberg.
Reflexes idiminished. iManagement- isurgical idecompression. iNSAIDS, ifolic iacid,
vitamin ib12. iPT-flexing ithe ispine.Bicycling.
, NR511 iFinal iExam iStudy iGuide
3. iRecognition iand iimmediate Immediate imanagement iof icauda iequina isyndrome. i(P. i829)
imanagement iof icauda iequina Cauda iequina isyndrome iis ia imedical iEMERGENCY iand irequires iimmediate
isyndrome iDanie iMolly idecompression.
If iCauda iequina iis iconfirmed, isurgical ilumbar idecompression iis inecessary ito
ihalt ineurological ideterioration iunless isurgery iis icontraindicated ifor iother
imedical ireasons.
*Rational ion iDavis iEdge iquestion: iLow iback ipain iaccompanied iby iacute ionsetiof
iurinary iretention ior ioverflow iincontinence, iloss iof ianal isphincter itone ior ifecal
iincontinence, iloss iof isensation iin ithe ibuttocks iand iperineum, iand imotor
iweakness iin ithe ilower iextremities iis ia ired iflag ifor icauda iequina isyndrome ior
severe ineurologic icompromise
4. iManeuvers iand iexpected ifindings Neck ipain-Spurling’s. iShoulder ipain-Apley iscratch itest(reaching ithe iscapula).
iwith ijoint ipain i(knee, ishoulder, iwrist, iInternal iand iexternal iflexion. iInternal iand iexternal iabduction. iPain iwith
ietc.) iDeanna iMorrison iThank iyou iabduction= iearly isupraspinatus itendinitis iand isubacromial ibursitis=early
iAshley iL!! irotator icuff iinjuries. iWrist iand ihand-allen’s itest= iradial iand iulnar iarteries.
Phalens itest=median inerve icompression. iTinel’s isign iassess ifor icompression
ineuropathy. iFinkelsteins itest- ide iQuervains idisease. iKnee iPain= iMcmurray,
apprehension isign, ibulge isign, iinspect/palpate ito iassess ieffusion.
5. iInitial iassessment iof iFOOSH iinjury FOOSH: iFalling iOn ian iOut iStretched iHand. iAfter ifalling ion ian ioutstretched
iin icorrelation ito ianatomical ilocation ihand ipatients ipresent iafter itrauma iwith ipain iand iswelling iin ithe idistal iforearm
iof iradial ihead ibone iLisa iCallahan ior iwrist. iNumbness imay ibe ipresent iif ithe imedial inerve iis iaffected. iThe
imechanism iof iinjury iwill ioften iprovide iimportant iclues ito ithe idiagnosis. iThe
iexamination ibegins iwith igentle ipalpation ito ilocate ithe iarea iof ipoint
itenderness iand iincludes ia ithorough ineurovascular iassessment. iA iradiograph
iof ithe iwrist i(including ian ioblique iview) imay ibe inecessary ito irule iout ifracture.
iCommon ifractures iare ithe iColles ifracture iof ithe idistal iradius iand ithe inavicular
i(scaphoid) ifracture iof ithe ianatomical isnuffbox. iIt iis inot iunusual ito ihave ia
inavicular ifracture imissed ion iradiography, iso ian iorthopedic ireferral ishould ibe
iprovided iwhen ithe ipresenting icomplaint iis ipain iand itrauma ito ithe isoft-tissue
area iof ithe ianatomical isnuffbox.
6. iAssessment iand imanagement iof Trigger ipoints iwithin ia imuscle. iCommon icause iof inonarticular irheumatic ipain.
iMyofascial ipain iJenna iLara iThank iInjections ia ithe itrigger ipoint iwith isaline, ian ianesthetic, ior icorticosteroid, idry
iyou iAshley iL ineedling, imuscle irelaxant itizanidine, iNSAIDS, ior icyclooxygenases-2 iinhibitors.
Tricyclic iantidepressants.
7. iHealth ipromotion iactivities ito Protection imay irefer ito ipreventing ithe iinjury ifrom ioccurring ior imaking iit iless
iprevent isport irelated isevere iby iwearing iprotective igear, isuch ias ihelmets, iwrist ipads, iand ikneepads.
imusculoskeletal iinjuries iMelissa iMaintain iadequate ihydration iand iproper idiet iwhile iplaying isports. iStretch
Schaf before ithe iactivity. iStop iwhen iyou iare iinjured, ido inot i“tough iit iout”.
8. iOsteopenia iHelena iLongfellow Osteopenia:
• Is ithe iprecursor ito iosteoporosis. iOsteopenia iis icategorized iby ithe ilevel
iof iT-scores iin irelation ito ithe iresults iof ia idual-energy ix-ray iabsorptiometry
iscan ior i(DXA iScan), iwhich imeasures ithe imineral icontent iof ibone. iA iT-score
ranging ifrom i-1 ito i-2.5 iwould ibe iclassified ias iosteopenia.
, NR511 iFinal iExam iStudy iGuide
Pathophysiology:
• It ioccurs isecondary ito iuncoupling iof iosteoclast-osteoblast iactivity,
iresulting iin ia iquantitative idecrease iin ibone imass. iPeak ibone imass iis itypically
iachieved iby imales iand ifemales ijust iprior ito, ior iearly-on iin ithe i3rd idecade iof
ilife.
• Beyond iage i30, ibone iresorption igradually ibecomes ifavored ias
idynamic ibone iremodeling icontinues iinto ilater idecades iof ilife.
• Histologic ispecimens idemonstrate imarkedly ithinned itrabeculae,
idecreased iosteon isize, iand ienlarged ihaversian iand imarrow ispaces.
Osteopenia iPrevention:
• Certain ihabits ican iaccelerate ithe iprocess isuch ias:io
Smoking
o Not igetting ienough icalcium iand ivitamin iD
o Drinking itoo imuch iETOH
o Use iof icertain imedications i(i.e.: icorticosteroids iand ianticonvulsants)
o Not igetting ienough iweight-bearing iexercise i(at ileast i30 imins ion imost
idays). iIf iyour ifeet itough ithe iground iduring ian iexercise, iit’s iprobably iweight
ibearing. iRunning iand iwalking iare iweight ibearing. iSwimming iand ibiking iare
inot
o Falls
• Women iare imore ilikely ito ihave ilow ibone idensity ithan imen, ibut iit’s ino
ilonger iviewed ias isolely ia iwomen’s icondition.
• Approx. ia ithird iof iwhite iand iAsian imen iover iage i50 iare iaffected.
• Percentages ifor iHispanics i(23%) iand iblacks i(19%) iare ilower, ibut istill
isizable.
Current iNational iOsteoporosis iFoundation i(NOF) irecommends itesting ifor:
• Women i65 iand iolder
• Postmenopausal iwomen iyounger ithan i65 iwho ihave ione ior imore irisk
ifactors, iwhich iinclude ibeing ithin
• Postmenopausal iwomen iwho ihave ihad ia ifracture
• For imen: itesting iis idone imore ion ia icase-by-case ibasis.
Osteopenia iTreatment:
Can ibe itreated iwith iexercise iand inutrition ior iwith imedications.
• If iT-score iis iunder i-2, ineed ito iensure iyou iare idoing iregular iweight-
ibearing iexercise, iand igetting ienough ivitamin iD iand idietary icalcium.
• If iT-score iis icloser ito i-2.5, ia imedication imay ibe iconsidered ito ikeep
ibones istrong.
• Bisphosphonates iare imost icommonly iprescribed imedication iclass ifor
itreatment. iProlonged iuse ihas ibeen ilinked iwith i2 imajor iclinical iside ieffects:
iosteonecrosis iof ithe ijaw i(ONJ) iand ithe iatypical isubtrochanteric ifemur
fracture.
1. iSigns iand isymptoms iand Signs iand isymptoms iand imanagement iof imusculoskeletal
imanagement iof imusculoskeletal isprains/strains/dislocations
isprains/strains/dislocations iKara
iIrvin Sprains: istretching ior itearing iof iligaments ithat ioccurs iwhen ia ijoint iis iforced
ibeyond iits inormal ianatomical irange
First idegree- istretching iof iligamentous ifibers
Second idegree- itear iof ipart iof ithe iligament iwith ipain iand iswellingiThird
idegree- icomplete iligamentous iseparation
Sprain- isudden iinjury ior ifall ithat icaused iacute ipain iand iswelling ithat igotiworse
iover ia ifew ihours, iredness iand ibruising, iactive iand ipassive iROM idecreased.
iRadiography ito irule iout ifx.
Strain: imuscle iinjury icaused iby iexcessive itensile istress iplaced ion ia imuscleithat
iresults iin istiffness iand idecreased ifunction
-effects imuscle ior itendon ithat iconnects ia imuscle ito ia ibone, icomplain
iof i“pulled imuscle,” isevere icases icause iinflammation, iswelling, iweakness iand
iloss iof ifunction-surgery imay ibe ineeded
Management: iPRICE i(protect, irest, iice, icompression, ielevation), ilimitation iof
iactivity, iphysical itherapy, iNSAIDS, ireferral ito iortho
Dislocation- icomplete iseparation iof i2 ibones ithat iform ia ijoint
Very ipainful iand icause iimmobility, ineed iimmediate imedical iattention
iReferral ito iorthopedics ifor ipossible isurgery ior ireduction iwith
application iof icast ior isplint.
2. iSigns iand isymptoms iand Cervical iSpondylosis- ineck istiffness, imild iaching idiscomfort iwith iactivity. iPain
imanagement iof ispinal idisorders iand ilimited iROM ioccur iwith ilateral irotation iand ilateral iflexion iof ithe ineck
i(spondylosis, istenosis, ietc.) iSandra itoward ithe iaffected iside. iWeakness ishoulder iabduction- iC5. iBicep iweakness-
iOkonkwo iThank iyou iAshley iL ifor iC6. iTricep iweakness-C7.Myelopathy- ileg iweakness, igait idisturbance, ibalance
icompleting!!! iproblems, idifficulty iperforming ifine imotor itasks, iloss iof ibowel iand ibladder.
Treatment- icervical itraction, iPT, ipain irelievers.iSurgery ifor iMyelopathy.
Low iback ipain-Tenderness iand idecreased irange iof imotion. iPositive istraightileg
itest. iTreatment-NSAIDS, imuscle irelaxants, iopioids, isurgical, iself-care, ispinal
imanipulation
Stenosis-pseudoclaudication icausing iradicular ipain iin ithe icalves, ibuttocks, iand
iupper ithighs iof ione ior iboth ilegs. iSymptoms iprogress ifrom ia iproximal ito idistal
idirection. iWalking ior iprolonged istanding icauses ipain iand iweakness iin
ibuttocks iand ilegs. iStooping iover ihelps irelieve ipain. iPositive iRomberg.
Reflexes idiminished. iManagement- isurgical idecompression. iNSAIDS, ifolic iacid,
vitamin ib12. iPT-flexing ithe ispine.Bicycling.
, NR511 iFinal iExam iStudy iGuide
3. iRecognition iand iimmediate Immediate imanagement iof icauda iequina isyndrome. i(P. i829)
imanagement iof icauda iequina Cauda iequina isyndrome iis ia imedical iEMERGENCY iand irequires iimmediate
isyndrome iDanie iMolly idecompression.
If iCauda iequina iis iconfirmed, isurgical ilumbar idecompression iis inecessary ito
ihalt ineurological ideterioration iunless isurgery iis icontraindicated ifor iother
imedical ireasons.
*Rational ion iDavis iEdge iquestion: iLow iback ipain iaccompanied iby iacute ionsetiof
iurinary iretention ior ioverflow iincontinence, iloss iof ianal isphincter itone ior ifecal
iincontinence, iloss iof isensation iin ithe ibuttocks iand iperineum, iand imotor
iweakness iin ithe ilower iextremities iis ia ired iflag ifor icauda iequina isyndrome ior
severe ineurologic icompromise
4. iManeuvers iand iexpected ifindings Neck ipain-Spurling’s. iShoulder ipain-Apley iscratch itest(reaching ithe iscapula).
iwith ijoint ipain i(knee, ishoulder, iwrist, iInternal iand iexternal iflexion. iInternal iand iexternal iabduction. iPain iwith
ietc.) iDeanna iMorrison iThank iyou iabduction= iearly isupraspinatus itendinitis iand isubacromial ibursitis=early
iAshley iL!! irotator icuff iinjuries. iWrist iand ihand-allen’s itest= iradial iand iulnar iarteries.
Phalens itest=median inerve icompression. iTinel’s isign iassess ifor icompression
ineuropathy. iFinkelsteins itest- ide iQuervains idisease. iKnee iPain= iMcmurray,
apprehension isign, ibulge isign, iinspect/palpate ito iassess ieffusion.
5. iInitial iassessment iof iFOOSH iinjury FOOSH: iFalling iOn ian iOut iStretched iHand. iAfter ifalling ion ian ioutstretched
iin icorrelation ito ianatomical ilocation ihand ipatients ipresent iafter itrauma iwith ipain iand iswelling iin ithe idistal iforearm
iof iradial ihead ibone iLisa iCallahan ior iwrist. iNumbness imay ibe ipresent iif ithe imedial inerve iis iaffected. iThe
imechanism iof iinjury iwill ioften iprovide iimportant iclues ito ithe idiagnosis. iThe
iexamination ibegins iwith igentle ipalpation ito ilocate ithe iarea iof ipoint
itenderness iand iincludes ia ithorough ineurovascular iassessment. iA iradiograph
iof ithe iwrist i(including ian ioblique iview) imay ibe inecessary ito irule iout ifracture.
iCommon ifractures iare ithe iColles ifracture iof ithe idistal iradius iand ithe inavicular
i(scaphoid) ifracture iof ithe ianatomical isnuffbox. iIt iis inot iunusual ito ihave ia
inavicular ifracture imissed ion iradiography, iso ian iorthopedic ireferral ishould ibe
iprovided iwhen ithe ipresenting icomplaint iis ipain iand itrauma ito ithe isoft-tissue
area iof ithe ianatomical isnuffbox.
6. iAssessment iand imanagement iof Trigger ipoints iwithin ia imuscle. iCommon icause iof inonarticular irheumatic ipain.
iMyofascial ipain iJenna iLara iThank iInjections ia ithe itrigger ipoint iwith isaline, ian ianesthetic, ior icorticosteroid, idry
iyou iAshley iL ineedling, imuscle irelaxant itizanidine, iNSAIDS, ior icyclooxygenases-2 iinhibitors.
Tricyclic iantidepressants.
7. iHealth ipromotion iactivities ito Protection imay irefer ito ipreventing ithe iinjury ifrom ioccurring ior imaking iit iless
iprevent isport irelated isevere iby iwearing iprotective igear, isuch ias ihelmets, iwrist ipads, iand ikneepads.
imusculoskeletal iinjuries iMelissa iMaintain iadequate ihydration iand iproper idiet iwhile iplaying isports. iStretch
Schaf before ithe iactivity. iStop iwhen iyou iare iinjured, ido inot i“tough iit iout”.
8. iOsteopenia iHelena iLongfellow Osteopenia:
• Is ithe iprecursor ito iosteoporosis. iOsteopenia iis icategorized iby ithe ilevel
iof iT-scores iin irelation ito ithe iresults iof ia idual-energy ix-ray iabsorptiometry
iscan ior i(DXA iScan), iwhich imeasures ithe imineral icontent iof ibone. iA iT-score
ranging ifrom i-1 ito i-2.5 iwould ibe iclassified ias iosteopenia.
, NR511 iFinal iExam iStudy iGuide
Pathophysiology:
• It ioccurs isecondary ito iuncoupling iof iosteoclast-osteoblast iactivity,
iresulting iin ia iquantitative idecrease iin ibone imass. iPeak ibone imass iis itypically
iachieved iby imales iand ifemales ijust iprior ito, ior iearly-on iin ithe i3rd idecade iof
ilife.
• Beyond iage i30, ibone iresorption igradually ibecomes ifavored ias
idynamic ibone iremodeling icontinues iinto ilater idecades iof ilife.
• Histologic ispecimens idemonstrate imarkedly ithinned itrabeculae,
idecreased iosteon isize, iand ienlarged ihaversian iand imarrow ispaces.
Osteopenia iPrevention:
• Certain ihabits ican iaccelerate ithe iprocess isuch ias:io
Smoking
o Not igetting ienough icalcium iand ivitamin iD
o Drinking itoo imuch iETOH
o Use iof icertain imedications i(i.e.: icorticosteroids iand ianticonvulsants)
o Not igetting ienough iweight-bearing iexercise i(at ileast i30 imins ion imost
idays). iIf iyour ifeet itough ithe iground iduring ian iexercise, iit’s iprobably iweight
ibearing. iRunning iand iwalking iare iweight ibearing. iSwimming iand ibiking iare
inot
o Falls
• Women iare imore ilikely ito ihave ilow ibone idensity ithan imen, ibut iit’s ino
ilonger iviewed ias isolely ia iwomen’s icondition.
• Approx. ia ithird iof iwhite iand iAsian imen iover iage i50 iare iaffected.
• Percentages ifor iHispanics i(23%) iand iblacks i(19%) iare ilower, ibut istill
isizable.
Current iNational iOsteoporosis iFoundation i(NOF) irecommends itesting ifor:
• Women i65 iand iolder
• Postmenopausal iwomen iyounger ithan i65 iwho ihave ione ior imore irisk
ifactors, iwhich iinclude ibeing ithin
• Postmenopausal iwomen iwho ihave ihad ia ifracture
• For imen: itesting iis idone imore ion ia icase-by-case ibasis.
Osteopenia iTreatment:
Can ibe itreated iwith iexercise iand inutrition ior iwith imedications.
• If iT-score iis iunder i-2, ineed ito iensure iyou iare idoing iregular iweight-
ibearing iexercise, iand igetting ienough ivitamin iD iand idietary icalcium.
• If iT-score iis icloser ito i-2.5, ia imedication imay ibe iconsidered ito ikeep
ibones istrong.
• Bisphosphonates iare imost icommonly iprescribed imedication iclass ifor
itreatment. iProlonged iuse ihas ibeen ilinked iwith i2 imajor iclinical iside ieffects:
iosteonecrosis iof ithe ijaw i(ONJ) iand ithe iatypical isubtrochanteric ifemur
fracture.
