NURS 5462 MSK Questions and Answers|Updated|
Guaranteed Pass
Taking the History
May or may not involve trauma, OLDCARTS
Associated symptoms—warning signs
- History of substantial trauma—fracture, major soft tissue injury - Hot swollen
joint—infection, RA, gout - Constitutional symptoms [fever, malaise, weight loss,
fatigue]—infection, sepsis - Focal neurological weakness—radiculopathy - Diffuse
weakness—degenerative, neoplastic disease, toxins - Neurogenic pain [burning,
numbness, paresthesia, asymmetric]—radiculopathy, entrapment, neuropathy -
Claudication—peripheral arterial/vascular, stenosis, arteritis 4/8/201
Taking the History 2
CHD - Medications: NSAIDS, Rx or OTC, HRT, calcium - LMP, menstrual cycles,
menopause: female athletes, post-menopausal • PMH - Previous injury or
trauma—fracture, surgeries, arthroscopy - Cancer, arthritis, sickle cell,
osteoporosis, renal or neurologic disease
Taking the History 3
,• FH - Congenital abnormalities of hip, foot - Scoliosis or back problems -
Arthritis—RA, degenerative, ankylosing spondylitis, gout - Genetic—osteogenesis
imperfecta, hypercalciuria ▪ Personal/Social - Work, exercise, hobbies 4/8/2018-
Tobacco, alcohol, drug use
Physical Exam
▪ Height ▪ Weight ▪ Uncover and examine both sides ▪ Observe gait if weight
bearing joint involved ▪ Inspection - Skin—injuries or contusions - Swelling,
deformities, bruising, erythema ▪ Palpation—one finger point tenderness -
Compare non-injured to injured area - Palpate all surfaces—bones, joints, soft
tissue - Examine above and below area of injury
▪ Range of motion
—active and passive - Examine above and below area of injury - Internal and
external rotation - Abduction and adduction - Document ROM in degrees!!!
Traditional Management
▪ Rest ▪ Ice ▪ Compression/immobilization ▪ Elevation (RICE) ▪ Acetaminophen,
NSAIDs, muscle relaxants - Oral steroids may be considered in some cases ▪
Physical therapy, exercise ▪ The tincture of time ▪ Manipulation, acupuncture,
other [ESI, TENS, etc], conservative Rx x4-6 weeks
,NSAIDs
Inhibit cyclooxygenase (COX) enzyme—provide anti-inflammatory/analgesic
effects - Dose dependent - NSAIDs differ in analgesic and anti-inflammatory effec
NSAIDs
- Gastritis, ulceration, bleed - Impaired renal function—NSAIDs inhibit renal
prostaglandins, affecting regulation of renal blood flow and glomerular filtration -
Hypertension/Edema - Platelet inhibition and bleeding - CV risk—potential
damage to arterial wall, possible arterial clotting - Drug interaction with ASA—
they ↓ cardioprotective benefits and ↑ risk of GI bleed 4/8/2018
Evidence: BMJ Clinical Evidence 2007; 12: 1108
- Plateau for effectiveness; SE ↑ with dose ↑ - COX-2 ↓ risk for PUD but ↑ risk
for MI/CV events - Paracetamol similar to NSAIDs for acute MSK pain but ↓
effective than NSAIDs for OA [Paracetamol not used in US 2nd to risk of GU
malignancy] - **PPI > H2 antagonists ↓ GI SE - Insufficient evidence whether
topical NSAIDs beneficial
NSAIDs ▪ Adverse effects:
- Gastritis, ulceration, bleed - Impaired renal function—NSAIDs inhibit renal
prostaglandins, affecting regulation of renal blood flow and glomerular filtration -
Hypertension/Edema - Platelet inhibition and bleeding - CV risk—potential
damage to arterial wall, possible arterial clotting - **Drug interaction with ASA—
they ↓ cardioprotective benefits and ↑ risk of GI blee
, NSAIDs ▪ Recommendations:
- GI risk in general—nonacelated aspirin products lowest risk [Disalsid, Trilisate];
Ibuprofen/Naproxen intermediate risk, Diclofenac/Piroxicam/Ketorolac greatest
risk ▪ Use lowest dose possible , risk ↑ with dose ▪ Short course best ▪ Use
acetaminophen when possible - Avoid in patients > 65 yrs., H/O PUD, on steroids,
anticoagulants, ASA ▪ AGS, May, 2009: NSAIDs considered rarely and with extreme
caution; Acetaminophen, opioids best for elderly
Osteoarthritis
▪ Also referred to as Degenerative Joint Disease [DJD] ▪ Factors that influence DJD -
Age - Heredity - Repetitive stress - Prior joint disease - Diabetes - Weight, ▪
Common above 65 ▪ Decrease in the repair process of the body ▪ Maximal stress
to articular cartilage ▪ Worse over weight bearing joints and large joints
Osteoarthritis 2
▪ Go slow, no cure ▪ Water aerobics are wonderful ▪ Use of cane, crutches, walker
when needed ▪ Physical Therapy: heat, exercise, stretching ▪ Rest as needed ▪ Ice ▪
Stay off limb if possible ▪ TENS unit ▪ Analgesics / Anti-inflammatory ▪ May need
joint replacement
Sprain
Guaranteed Pass
Taking the History
May or may not involve trauma, OLDCARTS
Associated symptoms—warning signs
- History of substantial trauma—fracture, major soft tissue injury - Hot swollen
joint—infection, RA, gout - Constitutional symptoms [fever, malaise, weight loss,
fatigue]—infection, sepsis - Focal neurological weakness—radiculopathy - Diffuse
weakness—degenerative, neoplastic disease, toxins - Neurogenic pain [burning,
numbness, paresthesia, asymmetric]—radiculopathy, entrapment, neuropathy -
Claudication—peripheral arterial/vascular, stenosis, arteritis 4/8/201
Taking the History 2
CHD - Medications: NSAIDS, Rx or OTC, HRT, calcium - LMP, menstrual cycles,
menopause: female athletes, post-menopausal • PMH - Previous injury or
trauma—fracture, surgeries, arthroscopy - Cancer, arthritis, sickle cell,
osteoporosis, renal or neurologic disease
Taking the History 3
,• FH - Congenital abnormalities of hip, foot - Scoliosis or back problems -
Arthritis—RA, degenerative, ankylosing spondylitis, gout - Genetic—osteogenesis
imperfecta, hypercalciuria ▪ Personal/Social - Work, exercise, hobbies 4/8/2018-
Tobacco, alcohol, drug use
Physical Exam
▪ Height ▪ Weight ▪ Uncover and examine both sides ▪ Observe gait if weight
bearing joint involved ▪ Inspection - Skin—injuries or contusions - Swelling,
deformities, bruising, erythema ▪ Palpation—one finger point tenderness -
Compare non-injured to injured area - Palpate all surfaces—bones, joints, soft
tissue - Examine above and below area of injury
▪ Range of motion
—active and passive - Examine above and below area of injury - Internal and
external rotation - Abduction and adduction - Document ROM in degrees!!!
Traditional Management
▪ Rest ▪ Ice ▪ Compression/immobilization ▪ Elevation (RICE) ▪ Acetaminophen,
NSAIDs, muscle relaxants - Oral steroids may be considered in some cases ▪
Physical therapy, exercise ▪ The tincture of time ▪ Manipulation, acupuncture,
other [ESI, TENS, etc], conservative Rx x4-6 weeks
,NSAIDs
Inhibit cyclooxygenase (COX) enzyme—provide anti-inflammatory/analgesic
effects - Dose dependent - NSAIDs differ in analgesic and anti-inflammatory effec
NSAIDs
- Gastritis, ulceration, bleed - Impaired renal function—NSAIDs inhibit renal
prostaglandins, affecting regulation of renal blood flow and glomerular filtration -
Hypertension/Edema - Platelet inhibition and bleeding - CV risk—potential
damage to arterial wall, possible arterial clotting - Drug interaction with ASA—
they ↓ cardioprotective benefits and ↑ risk of GI bleed 4/8/2018
Evidence: BMJ Clinical Evidence 2007; 12: 1108
- Plateau for effectiveness; SE ↑ with dose ↑ - COX-2 ↓ risk for PUD but ↑ risk
for MI/CV events - Paracetamol similar to NSAIDs for acute MSK pain but ↓
effective than NSAIDs for OA [Paracetamol not used in US 2nd to risk of GU
malignancy] - **PPI > H2 antagonists ↓ GI SE - Insufficient evidence whether
topical NSAIDs beneficial
NSAIDs ▪ Adverse effects:
- Gastritis, ulceration, bleed - Impaired renal function—NSAIDs inhibit renal
prostaglandins, affecting regulation of renal blood flow and glomerular filtration -
Hypertension/Edema - Platelet inhibition and bleeding - CV risk—potential
damage to arterial wall, possible arterial clotting - **Drug interaction with ASA—
they ↓ cardioprotective benefits and ↑ risk of GI blee
, NSAIDs ▪ Recommendations:
- GI risk in general—nonacelated aspirin products lowest risk [Disalsid, Trilisate];
Ibuprofen/Naproxen intermediate risk, Diclofenac/Piroxicam/Ketorolac greatest
risk ▪ Use lowest dose possible , risk ↑ with dose ▪ Short course best ▪ Use
acetaminophen when possible - Avoid in patients > 65 yrs., H/O PUD, on steroids,
anticoagulants, ASA ▪ AGS, May, 2009: NSAIDs considered rarely and with extreme
caution; Acetaminophen, opioids best for elderly
Osteoarthritis
▪ Also referred to as Degenerative Joint Disease [DJD] ▪ Factors that influence DJD -
Age - Heredity - Repetitive stress - Prior joint disease - Diabetes - Weight, ▪
Common above 65 ▪ Decrease in the repair process of the body ▪ Maximal stress
to articular cartilage ▪ Worse over weight bearing joints and large joints
Osteoarthritis 2
▪ Go slow, no cure ▪ Water aerobics are wonderful ▪ Use of cane, crutches, walker
when needed ▪ Physical Therapy: heat, exercise, stretching ▪ Rest as needed ▪ Ice ▪
Stay off limb if possible ▪ TENS unit ▪ Analgesics / Anti-inflammatory ▪ May need
joint replacement
Sprain
