Notes in 06 Joint pain

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Published	11/02/2024	When assessing for shoulder pain, it is first important to rule out {{c1::referred pain from the heart, mediastinal pleura, pericardium, diaphragm, an…
Published	11/02/2024	Rotator cuff tendinopathy (a major cause of shoulder {{c1::impingement}}) typically presents in patients {{c1::30-60}} years of age, is worse {{c1::at…
Published	11/02/2024	Adhesive capsulitis (aka {{c1::frozen}} shoulder) typically presents in patients {{c1::40-60}} years of age, is worse {{c1::at night}}, and is charact…
Published	11/02/2024	What is the primary function of each rotator cuff muscle?Supraspinatus - {{c1::abduction from 0-15°}}Infraspinatus - {{c1::external rotation}}Teres mi…
Published	11/02/2024	The static stabilizers of the shoulder joint include:{{c1::glenoid labrumjoint capsuleglenohumeral ligamentsinherent negative pressure in the joint::4…
Published	11/02/2024	The dynamic stabilizers of the shoulder joint include:{{c1::the rotator cuff musclesthe long head of the biceps tendonscapulothoracic motionshoulder g…
Published	11/02/2024	The most commonly dislocated joint (45% of all dislocations) is the {{c1::glenohumeral}} joint
Published	11/02/2024	{{c1::Cervical radiculopathy}} can be assessed for by the cervical compression test. This test is positive when {{c1::compression of the neck reproduc…
Published	11/02/2024	Cervical radiculopathy can also be assessed for using the {{c1::Spurling}} maneuver. In this maneuver, the patient's {{c1::neck is extended and rotate…
Published	11/02/2024	In addition to the compression test and spurling maneuver, {{c1::MRI}} and {{c1::CT myelography}} are two imaging modalities that can be used to asses…
Published	11/02/2024	Shoulder impingement syndromes refers to a narrowing of the space between the {{c1::acromion}} and {{c1::humeral head}}. Pain is felt between {{c1::60…
Published	11/02/2024	In the Neers test, {{c1::shoulder impingement syndrome}} is assessed for by placing the patient's arm into {{c1::internal rotation}} and {{c1::flexion…
Published	11/02/2024	In the Hawkins-Kennedy test, {{c1::shoulder impingement syndrome}} is assessed for by placing the patient's arm and elbow into {{c1::90° flexion}} and…
Published	11/02/2024	In rotator cuff tendinopathy, pain is elicited by {{c1::movement of the rotator cuff muscles}} and is assessed for by {{c1::resisted movement}} tests
Published	11/02/2024	The most common injury to the rotator cuff is {{c1::supraspinatus tendinopathy}}
Published	11/02/2024	An inability to touch the contralateral shoulder is called a positive {{c1::Dugos}} test and is indicative of {{c1::shoulder dislocation}}
Published	11/02/2024	The most common shoulder dislocations are {{c1::anterior}}, followed by {{c1::posterior}} (which are subtle in the {{c1::elderly}}), followed by {{c1:…
Published	11/02/2024	Atraumatic dislocation is the result of joint {{c1::laxity}} acquired from {{c1::recurrent subluxations (microtraumas)}}
Published	11/02/2024	The {{c1::popeye}} sign refers to bunching of the anterior brachium and is indicative of {{c1::tearing of the common tendon of the biceps brachii}}
Published	11/02/2024	Lateral epicondylitis ({{c1::tennis elbow}}) is caused by an overuse of forearm {{c1::extensors}} and is treated with {{c1::the RICE method}}
Published	11/02/2024	Medial epicondylitis ({{c1::golfers elbow}}) is caused by overuse of the forearm {{c1::flexors}} and can be treated with {{c1::the RICE method}}
Published	11/02/2024	Nursemaid's elbow refers to {{c1::radial head subluxation}} secondary to tearing of {{c1::the annular ligament}} following a pull on the {{c1::pronate…
Published	11/02/2024	A nursemaid's elbow is typically {{c1::not particularly painful}}, held in {{c1::pronation}} and slight {{c1::flexion}} with {{c1::no}} swelling or br…
Published	11/02/2024	A delay in surgical intervention of a proximal scaphoid bone fracture can lead to {{c1::avascular necrosis and nonunion}}
Published	11/02/2024	Carpal tunnel syndrome will cause pain in the {{c1::lateral 3.5 digits and their nailbeds}}, especially at {{c1::night}}
Published	11/02/2024	The most sensitive test for carpal tunnel syndrome is {{c1::weakened thumb abduction}}
Published	11/02/2024	{{c1::Tinel's}} sign is tingling in the distribution of the median nerve with tapping over the flexor retinaculum
Published	11/02/2024	{{c1::Phalen's}} sign is tingling in the distribution of the median nerve with the backs of the hands pressed together in acute flexion for {{c1::60 s…
Published	11/02/2024	{{c2::Finkelstein's}} test is used to assess for {{c1::De Quervain's tenosynovitis}} and requires the patient to {{c1::clasp the thumb with the other …
Published	11/02/2024	{{c1::Tendinopathy}} is the progressive degernation of a tendon due to chronic overuse that involves {{c1::fraying/tearing}} of the fibrous tissue acc…
Published	11/02/2024	Tendinopathy is characterized by {{c1::minimal}} inflammation
Published	11/02/2024	Tendinopathy frequently occurs at the {{c1::tendon-periosteum}} junction
Published	11/02/2024	Tendinitis refers to {{c1::inflammation or irritation}} of a tendon
Published	11/02/2024	The position of the arm in which most shoulder dislocations occur can be remembered by the {{c1::90-90-90}} rule
Published	11/02/2024	A mild loss of bone proteins/minerals is termed {{c1::osteopenia}} whereas a more severe loss is called {{c1::osteoporosis}}
Published	11/02/2024	Osteopenia is typically the result of {{c1::inadequate bone replacement secondary to lysis}}
Published	11/02/2024	{{c1::Hypo}}gonadism leads to an increase in osteoclast survival and an increase in osteoblast apoptosis
Published	11/02/2024	Primary osteoporosis type I is seen in {{c1::post-menopausal women}} and affects {{c1::trabecular}} bone. Primary osteoporosis type II is seen in {{c1…
Published	11/02/2024	Type 1 primary osteoporosis is most likely to cause fracture of the {{c1::vertebral bodies and distal forearm}}
Published	11/02/2024	Type 2 primary osteoporosis is most likely to cause fracture of the {{c1::femoral neck and proximal humerus}}
Published	11/02/2024	The risk factors for osteoporosis can be remembered with the mneumonic {{c2::ACCESS}}{{c2::Alochol use}}{{c2::Corticosteroid use}}{{c2::Calcium low}}{…
Published	11/02/2024	Women of {{c1::northern European}} and {{c1::Asian}} descent are at an increased risk for osteoporosis
Published	11/02/2024	A BMI of {{c1::<22}} increases one's risk for osteoporosis
Published	11/02/2024	Osteoporosis is frequently observed in diseases that alter The immune system ({{c1::HIV, rheumatoid arthritis, lupus}})Endocrinology ({{c1::diabetes, …
Published	11/02/2024	Medications that can lead to osteoporosis include:{{c1::Aluminum}}-containing agents{{c1::Chemotherapy (methotrexate)}} drugs{{c1::Loop diuretics (fur…
Published	11/02/2024	Screening for osteoporosis is recommended in {{c1::all women over 65 or postmenopausal women with modifiable risk factors}}
Published	11/02/2024	Diagnosis of primary osteoporosis can be made with the following criteria:Loss of {{c1::height (>1.5 inches since age 25)}}Incidental finding on {{…
Published	11/02/2024	Via DEXA scan, osteopenia can be diagnosed if the T-score or Z-score is {{c1::1-2.5 stdevs below the mean}}
Published	11/02/2024	Via DEXA scan, osteoporosis can be diagnosed if the T-score or Z-score is {{c1::>2.5 stdevs below the mean}}
Published	11/02/2024	The T-score of a DEXA scan relies on the average bone density of {{c1::pre-menopausal women}} for comparison
Published	11/02/2024	The Z-score of a DEXA scan relies on the average bone density of individuals {{c1::of similar demographics}} for comparison
Published	11/02/2024	It is recommended that postmenopausal women with osteoporosis take {{c1::1200mg}} of supplemental calcium daily. All other adults with osteoporosis sh…
Published	11/02/2024	The recommended vitamin D dose for postmenopausal women with osteoporosis is {{c1::800IU}} daily. All other adults should take {{c1::600IU}}
Published	11/02/2024	What tests can be used to assess for acromioclavicular arthritis?{{c1::Scarf test (cross arm test)}}
Published	11/02/2024	What tests can be used to assess for shoulder impingment?{{c1::Jobe's test, Hawkins-Kennedy, Neers}}
Published	11/02/2024	What tests can be used to assess for shoulder instability?{{c1::Drawer laxity testSulcus testApprehension test}}
Published	11/02/2024	What tests can be used to assess for bicipital tendinitis?{{c1::Speed's testsYergason's test}}
Published	11/02/2024	Shoulder impingement could be the result of {{c1::subacromial bursitis or rotator cuff tendonitis/tear}}
Published	11/02/2024	The infraspinatus is best tested by {{c1::externally rotating the upper arm with the elbow flexed to 90 degrees}}.
Published	11/02/2024	{{c2::Yergason's}} test is used to test for biceps tendon pathology such as {{c1::biceps tendonitis}} and unstable {{c1::superior labral AP lesion (SL…
Published	11/02/2024	Yergason's test is performed by applying traction to the {{c1::elbow}} with the arm {{c1::externally rotated}}. The patient will attempt to {{c1::inte…
Published	11/02/2024	The "empty can" (Jobe's) test is used to isolate the {{c1::suprasinatus}} muscle
Published	11/02/2024	{{c1::Speed's}} test is used to assess for bicep's tendinitis and is performed by having the patient {{c2::flex their externally rotated arm against r…
Published	11/02/2024	The {{c1::drawer}} test is used to assess for the direction of shoulder laxity
Published	11/02/2024	The {{c1::Sulcus}} sign test is used to assess for {{c1::inferior}} glenohumeral instability. It is accomplished by pulling the patients arm inferiorl…
Published	11/02/2024	{{c1::Apprehension}} sign is defined as a fear of imminent glenohumeral dislocation and is accomplished by {{c1::external rotation with 90 degrees of …
Published	11/02/2024	Patients undergoing a DEXA scan should not have had a recent {{c1::barium/radioisotope/IV contrast study}} and should {{c1::avoid calcium supplements,…
Published	11/02/2024	what are the musculoskeletal (orthopedic) differential diagnoses of shoulder pain?{{c1::macrotrauma and/or microtrauma (overuse)cervical referred pain…
Published	11/02/2024	Pain arising from the {{c1::C5}} nerve root can cause pain that appears to originate from the shoulder
Published	11/02/2024	what is a subluxation?{{c1::partial dislocation}}
Published	11/02/2024	glenohumeral capsule injuries and tears typically occur after {{c1::multiple dislocations }}
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Published	11/02/2024	when evaluating a joint for pain, one should always {{c1::evaluate a joint or region above and below}}
Published	11/02/2024	{{c2::cervical radiculopathy}} occurs when there's {{c1::nerve compression}} and produces symptoms of neck and radiating arm pain, numbness, sensory d…
Published	11/02/2024	what are the 4 tendons of the shoulder?{{c1::biceps brachiitriceps brachiicoracobrachialisbrachialis}}
Published	11/02/2024	describe the jobe's test{{c1::}}
Published	11/02/2024	the best combination to diagnose shoulder impingement is:{{c1::positive hawkins }}{{c1::neers sign}}{{c1::weakness w/external rotation with arm a…
Published	11/02/2024	describe the cross arm (scarf) test{{c1::patient raises arm to 90 degrees and then adducts it. pain in the area of the AC joint suggests a disorder}}
Published	11/02/2024	describe the drawer test for shoulder laxity{{c1::patient lays supine. the physician holds the patient's scapula with his left hand while grapsing the…
Published	11/02/2024	{{c1::acromioclavicular joint and rotator cuff calcification}}
Published	11/02/2024	a FRAX test asseses {{c1::fracture}} risk one should consider treatment if the 10-year risk is {{c1::>3%}} hip or {{c1::>20%}} major osteoporoti…
Published	11/02/2024	what are the 5 non-musculoskeletal (non-orthopedic) differentials for shoulder pain?{{c1::CholecystitisDiaphragmatic irritationMyocardial infarctionPa…
Published	11/02/2024	GI issues can cause referred pain to the shoulder thorugh the {{c1::phrenic}} nerve
Published	11/02/2024	some common GI causes of shoulder pain are (7):{{c1::Gallbladder diseasePancreatitisLiver diseaseDiaphragmatic irritationPeptic ulcer disease with per…
Published	11/02/2024	a ruptured spleen can cause referred pain to the left shoulder, known as {{c1::Kehr's sign}} and will manifest as {{c1::LUQ pain radiating to the shou…
Published	11/02/2024	Heart pathology can cause shoulder pain, particularly on the {{c1::left}} side
Published	11/02/2024	Common heart-related conditions that may cause shoulder pain (5):{{c1::AnginaMyocardial infarction (heart attack)PericarditisAortic dissectionHeart va…
Published	11/02/2024	{{c1::agina}} is chest pain due to reduced blood flow to the heart (ischemia) that can radiate to the left shoulder, arm, neck, or jaw
Published	11/02/2024	angina pain often occurs during {{c1::physical exertion}} or {{c1::stress}}
Published	11/02/2024	minimal occlusion of heart vessels without necrosis: {{c1::angina}}severe occlusion of heart vessels with necrosis: {{c1::NSTEMI }}complete occlu…
Published	11/02/2024	Pulmonary conditions that can cause referred pain to the shoulder typically involve the {{c1::diaphragm}}, {{c1::pleura}}, or {{c1::nearby structures…
Published	11/02/2024	lung conditions that can cause shoulder referred pain are (6):{{c1::Pleuritis/pleurisyPneumoniaPulmonary embolismPneumothoraxLung tumorsDiaphragmatic …
Published	11/02/2024	{{c1::horner's syndrome}} is a neurological condition that affects the sympathetic nerve pathway
Published	11/02/2024	stemi vs non stemi?STEMI is a {{c1::complete}} block w ST {{c1::elevation}}NSTEMI is a {{c1::partial}} blockage w/ ST {{c1::depression}}
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