PESA Spring Diagnosis

Musculoskeletal: Neck & Upper Extremity - Rotator Cuff Impingement

1. Diagnosis Overview and Risk Factors

Compression of rotator cuff tendons between humeral head and acromion

Common in middle-aged adults, overhead athletes, and manual laborers

Risk factors include repetitive overhead activity, poor posture, acromial spurs

2. Patient Presentation

Lateral shoulder pain worsened with overhead motion or at night

Decreased active range of motion due to pain

Positive Neer and Hawkins-Kennedy tests

3. Diagnosis & Workup

Primarily a clinical diagnosis: X-ray may show acromial morphology or spurs, MRI if concern for rotator cuff tear

4. Management

Activity modification and physical therapy

NSAIDs or acetaminophen Subacromial corticosteroid injection

Surgery for refractory cases

5. Complications

Progression to rotator cuff tear, Chronic pain and loss of shoulder function

Musculoskeletal: Neck & Upper Extremity - Osteoarthritis

1. Diagnosis Overview and Risk Factors

Degenerative joint disease with cartilage breakdown

Increased prevalence with age, obesity, joint overuse, prior injury

2. Patient Presentation

Joint pain worse with activity and relieved by rest

Morning stiffness lasting less than 30 minutes

Crepitus and decreased range of motion

3. Diagnosis & Workup

Clinical diagnosis supported by imaging

X-ray shows joint space narrowing, osteophytes, subchondral sclerosis

4. Management

Weight loss and exercise NSAIDs or topical analgesics Intra-articular steroid injections, Joint replacement for severe disease

5. Complications

Progressive functional decline, Chronic pain and disability

Musculoskeletal: Back & Lower Extremity - Ankylosing Spondylitis

1. Diagnosis Overview and Risk Factors

Chronic inflammatory spondyloarthropathy affecting the spine

Typically affects young adult males

Associated with HLA-B27

2. Patient Presentation

Inflammatory back pain improving with activity

Morning stiffness lasting over 30 minutes

Limited spinal mobility

3. Diagnosis & Workup

Elevated ESR/CRP X-ray or MRI showing sacroiliitis

HLA-B27 supportive but not diagnostic

4. Management

NSAIDs as first-line therapy TNF-alpha or IL-17 inhibitors Physical therapy and posture training

5. Complications

Spinal fusion and kyphosis, Restrictive lung disease

Musculoskeletal: Back & Lower Extremity - Osteoporosis

1. Diagnosis Overview and Risk Factors

Systemic skeletal disease with low bone mass Common in postmenopausal women and older adults Risk factors include steroid use, smoking, low BMI

2. Patient Presentation

Often asymptomatic until fracture occurs Back pain or height loss from vertebral fractures

3. Diagnosis & Workup

DXA scan showing T-score ≤ -2.5 Evaluate secondary causes with labs if indicated

4. Management

Calcium and vitamin D supplementation Bisphosphonates or other antiresorptive agents Fall prevention strategies

5. Complications

Fragility fractures, Increased morbidity and mortality

Peripheral Nervous System - Carpal Tunnel Syndrome

1. Diagnosis Overview and Risk Factors

Median nerve compression at the wrist Associated with repetitive wrist use, pregnancy, diabetes

2. Patient Presentation

Numbness and tingling in thumb, index, and middle fingers Symptoms worse at night Positive Phalen and Tinel signs

3. Diagnosis & Workup

Clinical diagnosis Nerve conduction studies for confirmation or surgical planning

4. Management

Wrist splinting NSAIDs or corticosteroid injection Surgical decompression if severe

5. Complications

Permanent median nerve damage Thenar muscle atrophy

Peripheral Nervous System - Guillain-Barré Syndrome

1. Diagnosis Overview and Risk Factors

Acute inflammatory demyelinating polyneuropathy - Often follows viral or gastrointestinal infection

2. Patient Presentation

Ascending symmetric weakness, Areflexia

3. Diagnosis & Workup

Clinical diagnosis, LP for CSF showing inc proteins, EMG

4. Management

IVIG or plasmapheresis Supportive care and respiratory monitoring

5. Complications

Respiratory failure Autonomic dysfunction

Central Nervous System - Febrile Seizure

1. Diagnosis Overview and Risk Factors

Seizure associated with fever in children aged 6 months to 5 years Often triggered by viral infections

2. Patient Presentation

Generalized tonic-clonic seizure with fever Rapid return to baseline neurologic status

3. Diagnosis & Workup

Clinical diagnosis No routine imaging or EEG for simple febrile seizures

4. Management

Parental reassurance Antipyretics for comfort No chronic anticonvulsants

5. Complications

Recurrence Low risk of epilepsy

Central Nervous System - Hyperprolactinemia

1. Diagnosis Overview and Risk Factors:

Elevated prolactin levels due to pituitary adenoma or medications

Associated with dopamine antagonist use

2. Patient Presentation

Galactorrhea Amenorrhea or infertility Decreased libido

3. Diagnosis & Workup

Elevated serum prolactin level Pituitary MRI if persistent elevation

4. Management

Dopamine agonists (cabergoline, bromocriptine) Surgery for refractory macroadenomas

5. Complications

Hypogonadism

Bone loss