Musculoskeletal Word Associations

Shoulder pain after repetitive activity, point tenderness at anterior humerus or AC joint. + drop arm test or apprehension test

Rotator cuff injury (SITS muscles)

Football player with burning pain, numbness, tingling from shoulder to hand which resolves

Brachial plexus neurapraxia, "stinger". Caused by stretching of brachial plexus

FOOSH, Radial fracture w/ dorsal displacement, dinner-fork deformity

Colle's Fx; Tx = volar splint

Typing, secretary wrist pain and numb/tingling from wrist to hand. New mothers, pregnant may worsen

Carpal Tunnel syndrome

Pain at base of thumb, distal radial styloid. Pain reproduced with ulnar deviation of clenched fist.

deQuervain's tenosynovitis

Hand injury after a punch

Boxer's fracture. Ulnar gutter w/ intrinsic plus positioning. ORIF if angulation > 40 degress

Female exam, asymmetric posterior chest wall or uneven scapula height with forward bending

Scoliosis (> 25 degree Cobb angle = surgery)

Tibial pain after running (military recruits), athletic activity (running sports)

Shin splints, stress fracture. Get bone scan if negative x-ray

Knee injury during football game

ACL (look for description of lachman or drawer test)

8 - 10yo male with limp, knee pain

Legg-Calve-Perthes Disease

12 - 15yo overweight male knee pain, limp, hip pain (knee XR normal)

SCFE

Adolescent male with knee pain, tenderness over tibial tuberosity

Osgood-schlatter disease

Retropatellar knee pain esp. in females

Patellorfemoral pain syndrome - increased Q angle, strengthen quadriceps

"Pain on plantar foot @ 2 - 3rd metatarsal. Associated w/ tight shoes, relieved by removing shoes. Palpable painful mass"

Morton's neuroma; Tx w/ NSAIDs, wide shoes, then steroid injections

Pain after tx of fracture w/ cast

Compartment syndrome

HLA-B27

Ankylosing spondylitis, Reiter's syndrome

Acute joint pain. Swollen, warm, erythema.

Septic arthritis (synovial fluid = leukocytosis, low glucose)

Large joint pain. Knees w/ medial joint space narrowing, osteophytes. No erythema or warmth.

Osteoarthritis. Acetaminophen #1 choice

Enlarged PID, DIP

Osteoarthritis - Heberden's nodes are hard or bony swellings that can develop in the distal interphalangeal joints (DIP); Bouchard - (PIP)

Female morning joint pain & stiffness esp. hand/wrists. MCP joint swelling, ulnar deviation

Rheumatoid arthritis. Methotrexate (DMARDs) #1.

Acute swollen big toe

Gout

Proximal symmetric muscle pain & stiffness esp. shoulder, neck, pelvic girdle

Polymyalgia rheumatica

"Male w/ low back pain, stiffness. Pain worse wakening, improve during day. Decreased ROM at spine. Plain films show sacroiliac abnormality. HLA-B27 positive"

Ankylosing spondylitis; Tx = NSAIDs (Indomethacin)

Conjunctivitis, iritis, arthritis, cervicitis, urethritis

Reiter's syndrome

Erythema nodosum

Systemic autoimmune diseases (RA, IBD), OCP

"Female with Arthralgias, malar rash, +ANA, + anti-double stranded DNA antibodies, +anti-phospholipid antibodies"

SLE

dusky red, well localized single or multiple papules or plaques usually of face

Discoid lupus

Female, fatigue, general aching, pain at neck, upper shoulders, sleeping problems, tender points

Fibromyalgia (exercise program good management)

Cold induced pain at extremities with color change as they warm up

Raynaud's phenomenon

Osteomyelitis after stepping on nail wearing sandals or tennis shoes

Pseudomonas aeruginosa (foam padding in shoes)

Teenage female with long bone pain without trauma or injury. XR w/ lytic mass, multi-laminated periosteal reaction

Ewing sarcoma - periosteal "onion skin" reaction

Painless bony mass. Plain films = stalky or broad-based projection from bone surface

Osteochondroma

Lytic lesions in the back or skull

Multiple myeloma