Musculoskeletal Injuries and Disorders (McFalls)

Acute pain is categorized by pain lasting __________ than _______ ____________

Less than 4 weeks

Subacute pain is categorized by pain lasting _______ ___________ to _______ ___________

4 weeks to 3 months

Chronic pain is categorized by pain lasting longer than _______ ____________

3 months

_______________ attach muscle to bone, while ______________ attach bone to bone

Tendons, Ligaments

What are the main mediators of inflammation? (5)

Bradykinin

Histamine

Serotonin

Leukotrienes

Prostaglandins E

_________________ is inflammation of the bursa, which normally occurs in the knee, shoulder, and big toe

Bursitis

If someone has warmth, redness, and erythema around the area of their shoulder, what does this indicate?

Bursitis

(Inflammation of the bursa)

Which disorders are caused by chronic repetitive movements?

Bursitis, Strains, Tendonitis

Which disorder is characterized by constant pain that worsens with movement or application of external pressure over the joint?

Bursitis

HMG-CoA Reductase Inhibitors can be the cause of which injury/disorder?

Myalgia

Which disorder mainly occurs within the muscles?

Myalgia

_________________ is a dull, constant ache and can cause weakness and fatigue

Myalgia

If a person has a dull, constant ache and they have told you they are currently taking atorvastatin, what do they likely have?

Myalgia

Sprains occur within the _________________ within a joint

Ligaments

(Bone to bone)

True or False: sprains are involved with tendons

False: ligaments

(Sprains are involved with ligaments, strains are involved with tendons/muscles)

What are the three gradings of sprains?

I: Excess stretching

II: Partial tear

III: Complete tear

A twisted ankle or ACL tear are examples of which type of injury?

Sprain

A twisted ankle is an example of a _____________

Sprain

If someone has swelling and bruising around their ankle after twisting it, with pain that occurs with use but not when resting, what injury do they likely have?

Sprain

_____________ are characterized by initial severe pain, followed by pain particularly with joint use

Sprains

______________ occur within muscles or tendons

Strains

____________ involves muscles or tendons, while _____________ involve ligaments

Strains, Sprains

True or False: strains occur within ligaments

False: tendons and muscle

If someone has swelling and bruising, and they have recently pulled a muscle, what injury do they have?

Strain

Pulled muscles and hamstring strain are examples of __________________.

Strain

____________ can be characterized by swelling, bruising, and initial severe pain with continued pain upon movement and at rest

Strains

True or False: the pain felt with strains only occurs when there is movement

False: pain will be felt both when moving and at rest

____________ are characterized by swelling and bruising, and initial severe pain that is followed by pain particularly with joint use

Sprains

Tendonitis is inflammation of a _____________ ONLY

Tendon

Carpal tunnel syndrome, Tennis elbow, and Golfer's elbow are examples of ________________

Tendonitis

Which class of medications have a blackbox warning for tendon rupture?

Fluoroquinolones

(Ciprofloxacin)

If someone has warmth, swelling, and erythema, and they tell you that they are a frequent golfer and have pain after playing, what do they likely have?

Tendonitis

(Golfer's elbow.... repetitive movements also pain after use)

Systemic infections, such as influenza, can be cause of ______________

Myalgia

Which medications are known for causing tendonitits?

Fluoroquinolones

If someone has ______________ pain (>6) and pain that lasts more than ______ days, they are excluded from self-treatment

Severe, 10

True or False: a pregnant patient with a musculoskeletal injury/disorder can be self-treated

False

What is the age cut off for self treatment of musculoskeletal injury/disorders?

Less than 2 years can not be self treated

Which nonpharmacologic therapy would be best to reduce inflammation?

RICE

___________ therapy is used to relieve stiffness with pain of a non-inflammatory nature

Heat

True or False: chronic icing will help reduce inflammation faster

False

Explain the different parts of RICE therapy:

R

-Rest for 1-2 days

I

-ice 15-20 min increments

-3-4 times daily

C

-Compression

E

-Elevate at or above the level of the heart

TENS therapy can be used for ______-_____ minutes for up to ______ times a day

15-30, 3

Heat therapy can be used for _____-_____ minute increments _____-_____ times daily

15-20, 3-4

What is a main counseling point when recommending heat therapy?

Do not use on areas of broken skin

Who is TENS therapy NOT safe in?

Pediatrics, Pregnant, Pacemaker/Defibrillator

TENS therapy can be used for ______-______ minutes for up to _____ times a day

15-30, 3

TENS therapy will increase the productions of natural _________________

Endorphins

Which systemic analgesics can be used for treatment of musculoskeletal injuries/disorders?

Acetaminophen, Ibuprofen, Naproxen

Systemic analgesics should be used for ______-______ days on a scheduled basis, and use should be limited to ______ days

1-3, 10

True or False: systemic analgesics (APAP, Ibu, Naproxen) should be used on a schedule basis and not PRN

True

The use of systemic analgesics (APAP, Ibu, Naproxen) should be limited to ______ days

10

________________ work by producing a less severe pain to counter a more severe one

Counteirriatants

What are some of the ingredients contained within counteirritants? (5)

Methyl salicylate, Camphor, Menthol, Methyl nicotinate, Capsaicin

Which pharmacologic treatment should be used for the initial treatment of musculoskeletal injuries?

Systemic analgesics

What is the dosing of topical counterirritant products?

3-4 times daily

What are the three main instructions to follow when using a topical counterirritant?

1. Do not bandage the area where the product has been applied

2. Do not apply heat to the area where the product has been applied

3. Do not apply to wounded/broken skin

_____________ _______________ produces a HOT sensation, and redness of the skin

Methyl salicylate

_________________ and ________________ produce a cold followed by a warm sensation

Camphor and Menthol

Capsaicin produces a _________________ sensation

Burning

____________ ________________ produces a warm sensation

Methyl Nicotinate

Capsaicin causes a burning sensation and a depletion of __________________

Substance P

Capsaicin can produce pain relief within ______ days, but can be delayed as much as _____ to _____ weeeks

14, 4 to 6

Counterirritants are safe for patients older than _____ years of age

2

(The labeling on most products says 12 years of age and older)

True or False: capsaicin is safe for use in all populations

False: can not be used in anyone 18 and younger

Which two counterirritant products are safe for pregnant and lactating patients?

Camphor and Capsaicin

(In lactating, breastfeeding should be avoided on days when treating with capsaicin)

Bengay Relief Gel

Menthol 2.5%

Icy Hot

Menthol 16%

Mineral Ice

Menthol 2%

JointFlex Arthritis Relieving Cream

Camphor 3.3%

Capzasin

Capsaicin 0.1%

Zostrix

Capsaicin 0.1%

Diclofenac sodium is a ________________ NSAID, which will inhibit prostaglandins

Topical

Which treatment would you use for arthritis pain in the hand, foot, ankle, knee, or wrist?

Diclofenac sodium 1%

True or False: diclofenac is only safe for patients older than 18 years of age

True

Diclofenac should be discontinued after ______ days of treatment

21

What is the dosing for diclofenac?

Hand, Wrist, Elbow

-2.25in (2g) four times daily

Foot, Ankle, Knee

-4.45in (4g) four times daily

True or False: diclofenac is safe for use in geriatrics

True

Aleve Arthritis Gel, Salonpas Arthritis , Voltaren Arthritis

Diclofenac Sodium 1%

The patient should be referred on if pain from a musculoskeletal injury/disorder lasts over _______ days

10

____________ is a topical anesthetic which inhibits the conduction of nerve impulses

Lidocaine

Which type of product would be used for neuropathic pain or itching?

Topical Anesthetic

(Lidocaine)

True or False: lidocaine is safe for use in pediatrics

False: must be over 18 years

What is the dosing for a lidocaine topical?

Every 6 to 8 hours as needed (NTE 3 applications in 24 hours)

True or False: lidocaine is safe for use in BOTH pregnant and lactating patients

True

Aspercreme with Lidocaine Maximum Strength

Lidocaine Hydrochloride 4%

Lidocare Patch

Lidocaine 4%

Arthritis Hot Cream

Methyl salicylate 15%, Menthol 10%

Bengay Ultra Strength Cream

Methyl Salicylate 30%,Menthol 10%, Camphor 4%

Icy Hot Lidocaine Cream

Lidocaine HCl 4%, Menthol 1%

Salonpas Pain Relief Patch

Methyl salicylate 10% Menthol 3%