NR511 Final Exam Review 2022

I. Musculoskeletal disorders A. The Musculoskeletal Exam 1. Lachman maneuver: for ACL injury 2. McMurray sign: injury to the meniscus a) Cause is suddenly planting leg on ground and twisting, which can cause immediate pain in the planted leg and the inability to bear weight. b) It will lock up when trying to straighten. c) Think basketball injury 3. Phalen’s test: Numbness and tingling in the first three digits when pressing the dorsal surface of both hands together in a forced wrist flexion for 1 min 4. Radial head fracture: palpate for tenderness, swelling just distal to the lateral epicondyle. 5. Articular versus non-articular musculoskeletal complaints a) The non-articular complaints involve a point of focal tenderness 6. Bulge Test: use to check for knee going effusion B. Carpal Tunnel Syndrome 1. Inflammation of the medial nerve 2. Initial treatment is wrist splint and NSAIDs C. Herniated Disk 1. Most common area is L4-L5 (weakness in the big toe) 2. Evaluation a) Straight leg test: with patient in supine position, elevate affected leg, if this elicits back and sciatic nerve pain, then the test is positive D. Shoulder Dislocation 1. Assessment: pain noted when shrugging shoulders 2. Due to excessive pressure put on the shoulders E. Muscle Strains 1. Degree of ankle sprains a) First: ligaments are stretched but not torn b) Second: most common; partial tearing of ligament c) Third: most severe; ligament torn completely 2. Strain: can be due to not warming up properly before exercise. a) This is a teachable moment when the patient presents with starin. Suggest stretching and warm-up exercises before working out 3. How do you know? Look at the location a) Acute low back strain: back pain not associated with sciatica, aggravated by sitting, standing, and movement (1) Treat with NSAIDs and recommend back strengthening exercises F. Cauda Equine Syndrome 1. Occurs when bundle of nerves below end of spine is damaged 2. Signs and Symptoms: low back pain, pain that radiates down the leg, numbness around anus, and loss of bladder and bowel control 3. Send to the ER immediately for laminectomy G. Spinal Fracture 1. Low back pain 2. Consider red flags in the patient’s history like trauma, prolonged corticosteroid use, osteopenia, and osteoporosis H. Lumbar Spinal Stenosis 1. Often radicular pain in legs (with or without back pain) 2. Symptoms progress from proximal to distal direction and walking or prolonged standing causes pain and weakness in the legs and buttocks 3. Patient reports short term relief with leaning forward and often leans on counters when standing or grocery carts when shopping I. Cervical Spondylosis versus Cervical Myelopathy