Podcast
Questions and Answers
What type of pain is primarily associated with the fibrous layer due to trauma or overstretching?
What type of pain is primarily associated with the fibrous layer due to trauma or overstretching?
Which condition is indicated by abdominal pain, appetite loss, and jaundice?
Which condition is indicated by abdominal pain, appetite loss, and jaundice?
What is a common presenting symptom of Guillain-Barré Syndrome (GBS)?
What is a common presenting symptom of Guillain-Barré Syndrome (GBS)?
Which of the following is NOT typically associated with diabetic conditions?
Which of the following is NOT typically associated with diabetic conditions?
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What symptom is commonly linked to multiple sclerosis (MS)?
What symptom is commonly linked to multiple sclerosis (MS)?
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What is a common symptom of lateral epicondylitis?
What is a common symptom of lateral epicondylitis?
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What factor does NOT contribute to carpal tunnel syndrome?
What factor does NOT contribute to carpal tunnel syndrome?
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Which of the following is a complication associated with diabetes?
Which of the following is a complication associated with diabetes?
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Which statement correctly describes the symptoms of Dupuytren's contracture?
Which statement correctly describes the symptoms of Dupuytren's contracture?
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What criteria is NOT included in the Wells score for DVT diagnosis?
What criteria is NOT included in the Wells score for DVT diagnosis?
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Which condition is characterized by a thickening of fascia due to chronic inflammation and repetitive stress?
Which condition is characterized by a thickening of fascia due to chronic inflammation and repetitive stress?
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What is a typical sign of PVD rather than PAD?
What is a typical sign of PVD rather than PAD?
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Which of the following symptoms corresponds with IBS diagnostic criteria?
Which of the following symptoms corresponds with IBS diagnostic criteria?
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Which symptom is least likely to be associated with knee osteoarthritis?
Which symptom is least likely to be associated with knee osteoarthritis?
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What condition is indicated by bilateral joint swelling and stiffness predominantly in smaller joints?
What condition is indicated by bilateral joint swelling and stiffness predominantly in smaller joints?
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What finding is commonly associated with cervical spondylotic myelopathy?
What finding is commonly associated with cervical spondylotic myelopathy?
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Which spinal condition is characterized by a 'step-off deformity'?
Which spinal condition is characterized by a 'step-off deformity'?
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Which of the following muscles is primarily affected in calcific tendinopathy?
Which of the following muscles is primarily affected in calcific tendinopathy?
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What is the main symptom associated with Tarsal Tunnel Syndrome?
What is the main symptom associated with Tarsal Tunnel Syndrome?
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Which sign is indicative of radiculopathy at the level of C5?
Which sign is indicative of radiculopathy at the level of C5?
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In patients with degenerative scoliosis, which symptom is most likely observed?
In patients with degenerative scoliosis, which symptom is most likely observed?
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Which condition is characterized by sharp, localized knee pain primarily on stair climbing or bending?
Which condition is characterized by sharp, localized knee pain primarily on stair climbing or bending?
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What test is specific to assessing for infrapatellar fat pad syndrome?
What test is specific to assessing for infrapatellar fat pad syndrome?
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What symptom is classically associated with temporomandibular joint dysfunction?
What symptom is classically associated with temporomandibular joint dysfunction?
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Which of the following is a common sign of adhesive capsulitis?
Which of the following is a common sign of adhesive capsulitis?
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In which condition would you expect to find tenderness and swelling specifically around the medial joint line of the knee?
In which condition would you expect to find tenderness and swelling specifically around the medial joint line of the knee?
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Which underlying condition is most commonly linked to posterior knee pain aggravated by sitting for long periods?
Which underlying condition is most commonly linked to posterior knee pain aggravated by sitting for long periods?
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Study Notes
Osteoarthritis (OA)
- Articular cartilage loss, osteophytes, and joint space narrowing
- Hypertrophy of articular processes and ligamentum flavum bulging
- Common sites: knee, hand, hip
- Symptoms: stiffness, pain, grinding, swelling
Cervical Spine (Csp)
- Osteoarthritis: headaches, unilateral radiculopathy
- Herniation: neck and arm pain, paresthesias (C5, 6, 7)
- Stenosis: neck pain, numbness, tingling, weakness, decreased balance and function; alleviated by leaning forward or sitting
- Facet syndrome: neck pain, stiffness, radiculopathy, headaches
Thoracic Spine (Tsp)
- Osteoarthritis: radiculopathy
- Herniation: chest wall, epigastric, and arm pain; sometimes groin and lower extremity pain
- Stenosis:
- Facet syndrome:
Lumbar Spine (Lsp)
- Osteoarthritis: Neurogenic claudication - low back pain (LBP), numbness, and weakness aggravated by standing and walking
- Herniation: LBP
- Stenosis: Heavy feeling in legs, cramping, worse with standing and walking
- Facet syndrome: LBP, stiffness, radiculopathy
Sacroiliac Joint (SIJ)
- Osteoarthritis:
- Herniation:
- Stenosis:
- Facet syndrome:
Hip
- Osteoarthritis: Groin pain
- Herniation:
- Stenosis:
- Facet syndrome:
Tibiofemoral Joint
- Osteoarthritis: Pain with walking, stairs, standing, and weight bearing
- Herniation:
- Stenosis:
- Facet syndrome:
Patellofemoral Joint
- Osteoarthritis: Bending pain, compression pain, reduced quad strength, pain under or around knee
- Herniation:
- Stenosis:
- Facet syndrome:
Ankle
- Osteoarthritis:
- Herniation:
- Stenosis:
- Facet syndrome:
Acromioclavicular (AC) Joint
- Osteoarthritis:
- Herniation:
- Stenosis:
- Facet syndrome:
Glenohumeral (GH) Joint
- Osteoarthritis:
- Herniation:
- Stenosis:
- Facet syndrome:
Sternoclavicular (SC) Joint
- Osteoarthritis:
- Herniation:
- Stenosis:
- Facet syndrome:
Radioulnar Joint
- Osteoarthritis:
- Herniation:
- Stenosis:
- Facet syndrome:
Radiocarpal Joint
- Osteoarthritis:
- Herniation:
- Stenosis:
- Facet syndrome:
Carpometacarpal Joint
- Osteoarthritis:
- Herniation:
- Stenosis:
- Facet syndrome:
Herniation
- Spurling's test and distraction test are positive
- Pain worse in flexion
- Central herniation leads to myelopathy
- Lateral herniation leads to radiculopathy
Stenosis
- Caused by OA, disc disease, spinal cysts, fractures, and tumors
- Csp: Neck pain, numbness, tingling, weakness, decreased balance and function; alleviated by leaning forward or sitting
- Lsp: Heavy feeling in legs, cramping, worse with standing and walking
Facet Syndrome
- Positive Spurling's and Distraction tests, Kemp's test
- Can be caused by spondylitis, spondylosis, microtrauma, or trauma
- Pain worse with extension and sidebending/rotation
Radiculopathy
- Symptoms: sensory loss, pain, and weakness
- C5: Shoulder, abduction weakness
- C6: Arm, elbow flexion, wrist extension weakness
- C7: Down arm, elbow extension, wrist flexion weakness
- C8: Lower arm, finger grip, thumb extension weakness
- T1: Medial arm and forearm, thumb abduction weakness
- T: Torso, weak intercostal muscles
- L1: Groin, flexion weakness
- L2: Anterior thigh, flexion and adduction weakness
- L3: Thigh, weak knee extension and dorsiflexion
- L4: Thigh and medial leg, weak toe extension, medial leg and foot weakness
- L5: Lateral leg, dorsum of foot weakness
- S1: Posterior leg, plantar flexion weakness, lateral foot weakness
- S2: Posterior leg, weak knee flexion, posterior thigh and medial leg weakness
- S3-5: Perineum, bladder, weak pelvic floor muscles
Myelopathy
- Upper motor neuron (UMN) signs: spasticity, hyperreflexia, Babinski's sign, weakness
Vertebrobasilar Insufficiency (VBI)
- Symptoms: dizziness, dysphagia (difficulty swallowing), diplopia (double vision), dysarthria (difficulty speaking), drop attacks, nausea, nystagmus (involuntary eye movement), numbness, ataxia (lack of coordination)
Rheumatoid Arthritis (RA)
- Autoimmune inflammatory disease where antibodies attack the synovium
- Smaller joints are affected first (hands then knees)
- Symptoms: swelling, stiffness, warmth, muscle wasting, bilateral involvement
Ankylosing Spondylitis
- Characterized by synovitis, fibro-osseous inflammation, and ossification of the annulus fibrosis
Spondylolisthesis
- Five grades based on severity, with causes including congenital, spondylolysis, degenerative, traumatic, pathological, and post-surgical
- Symptoms: pain, radiculopathy, numbness, weakness, stiffness, postural changes
- Physical exam: Step-off deformity, hamstring tightness, muscle spasms
Tendinopathy
- Can be caused by overuse, age, diabetes, posture, and alignment issues
- Tendinitis: Acute inflammation
- Tendinosis: Degeneration
- Insertional tendinopathy: Localized to tendon insertion
- Non-insertional tendinopathy: Diffuse along the tendon
- Symptoms: slow onset, pain increases with activity, stiffness, swelling, tenderness, crepitus, weakness
- Patellar tendinopathy: Pain and weakness with knee extension
- Weakness without pain might indicate nerve or muscle involvement
Calcific Tendinopathy
- Most commonly affects the supraspinatus tendon
- Sudden onset, constant and severe pain
- Symptoms: Sharp/burning pain in the front/top of the shoulder, night pain, sporadic patterns
Degenerative Scoliosis
- Symptoms: Pain, radiculopathy, postural changes, fatigue, muscle imbalance, decreased range of motion (ROM), migraines
Lumbar Spine (LS) Strain
- Graded 1-3 based on severity
Sacroiliac Joint (SIJ) Dysfunction
- Causes: trauma, repetitive stress, posture, pelvic instability
- Aggravated by flexion and side bending
Thoracic Outlet Syndrome (TOS)
- Vascular TOS: Subclavian artery involvement, symptoms: swelling, discoloration, coldness, pain/cramping with activity, blood clots
- Neurogenic TOS (95%): Nerve involvement, symptoms: numbness, tingling, weakness, pain, muscle wasting
- Causes: Csp rib, posture, trauma, pregnancy, repetitive trauma
Intercostal Neuralgia
- Caused by rib compression during inhalation
- Symptoms: radiculopathy, numbness, tingling, decreased appetite
Tietze Syndrome
- Inflammation at the costochondral junction
- Symptoms: Pain with inhalation, shortness of breath (SOB), decreased rotation and sidebending
Precordial Catch Syndrome
- Caused by chest nerve compression due to pleura irritation
- Symptoms: Pain between the 6th and 12th ribs, below the nipple
Herpes Zoster (Shingles)
- Reactivation of dormant varicella zoster virus
- Symptoms: Maculopapular rash
Costovertebral Joint Syndrome
- Derangement or partial dislocation of the costovertebral joint
Post-Herpetic Neuralgia
- Pain lasting longer than 3 months after shingles
- Symptoms: Hyperalgesia (increased sensitivity to pain), allodynia (pain from non-painful stimuli), burning, itching, unilateral
Pancreatitis
- Often triggered by gallstones and alcohol
- Symptoms: Abdominal pain, vomiting, which can lead to organ failure
Osteitis Pubis
- Overuse injury, pain in the anterior/medial groin
- Pain worsens with activity
Iliopsoas Bursitis
- Affects the anterior hip, symptoms include snapping, pain with extending the leg, possible radicular pain due to femoral nerve entrapment
Ischiogluteal Bursitis
- Pain related to prolonged sitting, possible radiation of pain
Trochanteric Bursitis
- Affects the greater trochanter, pain worsens when lying on the affected side
Meralgia Paresthetica
- Compression of the lateral femoral cutaneous nerve by the inguinal ligament
- Risk factors: obesity, diabetes, older age
- Symptoms: Dysesthesia (abnormal sensation), pain, numbness, tingling
Coccydynia
- Abnormal mobility of the coccyx leads to inflammation and degeneration
- Aggravated by pregnancy
Piriformis Syndrome
Gluteal Tendinopathy
- Pain localized around the greater trochanter
Femoroacetabular Impingement (FAI)
- Head of the femur pinches on the socket and labrum
- Types:
- WoPINCER:
- MeCAM
- Symptoms: Groin pain, pain after activity, stiffness
Iliotibial (IT) Band Syndrome
- Often triggered by running on hills
- Tightness and pain between Gerdy's tubercle and the lateral epicondyle
- Varum or valgus alignment can contribute
- Pain at rest and can lead to patellofemoral pain syndrome (PFPS)
Knee
Meniscal Tear
- Bucket-handle tear: The most serious type, characterized by locking of the knee
Meniscal Cyst (Usually Lateral)
- Often the result of trauma
Patellofemoral Pain Syndrome (PFPS)
- Dull ache, generalized pain around the kneecap
- Cinema sign: Pain with prolonged sitting
Osteochondritis Dissecans
- Avascular fragment of bone under cartilage separates
- Most common in ages 15-20
- Symptoms: Giving away sensation, locking, tender condyle, quadriceps wasting
- Can affect the patella and talus
Chondromalacia
- Caused by stress, malalignment, trauma, wear and tear, muscle imbalance, and obesity
- Localized, sharp pain
- Breakdown of hyaline cartilage in the trochlear groove
- Other factors: Abnormal patellar shape, malalignment, dislocation, weak vastus medialis muscle
- Symptoms: Anterior knee pain, quadriceps wasting, pain aggravated by climbing stairs, cinema sign, crepitus
Pes Anserine Bursitis
- Pain located medially, just below the joint line
- Sharp or aching pain, worse with activity, tenderness, swelling
- Aggravated by flexion and extension, night pain
- Less commonly, a catching sensation
Patellar Maltracking
- Imbalance between the patella and trochlea, leading to cartilage loss and osteoarthritis
- Contributing factors: Weak vastus medialis obliquus (VMO) muscle, instability, dislocations, genu valgum, patella alta, anteversion, dysplastic patella
- Symptoms: Anterior knee pain, sharp pain, worse with activity
Infrapatellar Fat Pad Syndrome
- Pain located inferior to the patella
- Symptoms: Swelling, tenderness, pain worsens with activity, night pain
- HOFFA's test: Pressure applied to the infrapatellar fat pad while the patient extends their leg from a seated position 90 degrees
Plantar Fat Pad Syndrome
- Pain under the heel
Ligament Strain
- Lateral:
- Medial:
- Anterior:
- Posterior:
Anterior Knee
- Prepatellar Bursitis: Often seen in carpet layers
- Infrapatellar Bursitis:
Posterior Knee
- Semimembranosus Bursa:
- Popliteal/Baker's Cyst:
- Popliteal Aneurysm:
Lateral Knee
- Meniscal Cyst:
Medial Knee
- Calcification of the Medial Collateral Ligament (MCL):
Synovial Chondromatosis
- Cartilaginous nodules form within the synovium and detach
- Symptoms: Deep, aching, intermittent, and progressive pain, locking, catching, instability, swelling, crepitus
Ankle
Tendinopathy
- Insertional: Localized to the tendon insertion
- Non-insertional: Diffuse along the tendon
Tendon Rupture
- Achilles:
- Tibialis Posterior:
- Tibialis Anterior:
Anterior Talofibular Ligament (ATFL) Sprain
Calcaneofibular Ligament (CFL) Sprain
Retrocalcaneal Bursitis
Calcaneal Bursitis
Metatarsalgia
Plantar Fasciitis
Interdigital Neuritis
Gout
- Triggered by diet and alcohol, leading to high uric acid levels
- Treatment: Allopurinol
Pseudogout
- Caused by calcium pyrophosphate dehydrate crystals
Tendinitis
- Achilles Tendinitis:
- Biceps Tendinitis:
- Supraspinatus Tendinitis:
- Calcific Tendinitis: More sudden onset, night pain
Tenosynovitis
- Ankle:
- Wrist:
Avascular Necrosis of the Talus
Sesamoiditis
Tarsal Tunnel Syndrome
- Compression of the posterior tibial nerve
Freiberg's Infraction
Stress Fracture
Shoulder
Subacromial Impingement
- Bursitis:
- Tendinitis:
Rotator Cuff Tear
- Sudden, sharp onset followed by dull pain that worsens with activity
Biceps Tear
- Long head pathology: Commonly related to shoulder flexion
- Short head pathology: Commonly related to elbow flexion and supination
Adhesive Capsulitis (Frozen Shoulder)
- Characterized by a contracted joint capsule
- Risk factors: Diabetes, immobility, thyroid disease, autoimmune disorders
-
Stages:
- Inflammatory: Onset of pain and increasing stiffness (2-9 months)
- Adhesive: Stiffness, pain may decrease (4-12 months)
- Resolution: Slow improvement (5-26 months)
Shoulder Instability
- Anterior instability: Most common type
- Aggravated by throwing or lifting
- Symptoms: Instability, weakness, dislocation, pain with specific movements
Capsular Tears
- Can be caused by trauma or degeneration
- Symptoms: Instability, weakness, dislocation, pain with specific movements
Capsular Contracture
- Abnormal shortening or tightening of the joint capsule
- Can occur after injury or immobility due to scar tissue formation
- Symptoms: Limitation in overhead activities, external rotation, and abduction
Glenohumeral Ligament
- Superior glenohumeral ligament (SGHL): Anterior instability, external rotation
- Middle glenohumeral ligament (MGHL): Anterior dislocation, mid-range motion
- Inferior glenohumeral ligament (IGHL): Abduction and external rotation; traumatic anterior dislocations
- Aggravated by overhead activities and throwing
- Symptoms: Pain, instability
Transverse Ligament
- Decompression of the ulna
SLAP Tear
- Four grades based on the extent of biceps tendon involvement
- Symptoms: Pain that may radiate, clicking, popping, instability, weakness, night pain
- Clunk, crank, and speed's test: May be positive
Epicondylitis
- Degenerative tendon aponeurosis
- Lateral epicondylitis: Affects the extensor carpi radialis brevis tendon
- Medial epicondylitis: Affects the flexor carpi radialis and pronator teres tendons
Olecranon Bursitis
- Caused by repetitive trauma, direct trauma, RA, or gout
- Pain with flexion
- Swelling on the dorsal side of the elbow
Carpal Tunnel Syndrome
- Compression of the median nerve
- Risk factors: Menopause, pregnancy, RA
- Symptoms: Night pain, numbness, tingling
- Flexor retinaculum and carpals are the usual sites of compression.
Cubital Tunnel Syndrome
- Compression of thee ulnar nerve
- Sites of compression:
- Flexor carpi ulnaris muscle:
- Olecranon:
- Osborne ligament:
- Medial epicondyle:
- Guyon's canal: Another common site of ulnar nerve compression
Triangular Fibrocartilage Complex (TFCC) Tear
Ulnocarpal Impaction Syndrome
Ganglion Cyst
Dupuytren's Contracture
- Nodules form in the palm, progressing to cords, leading to contracture
- Symptoms: Inability to straighten fingers, difficulty with daily tasks, progressive
Diabetes
- High glucose levels lead to the formation of advanced glycation end products (AGEs) which affect tendons, ligaments, and cartilage, reducing elasticity
- Microvascular damage restricts blood flow and healing
- Neuropathy is common
- Chronic inflammation
- Symptoms: Frequent urination, excessive thirst, weight loss, hunger, blurry vision, numbness, tingling, fatigue, dry skin, slow-healing sores, frequent infections
- Musculoskeletal complications: Adhesive capsulitis, carpal tunnel syndrome, Dupuytren's contracture, OA, osteoporosis, plantar fasciitis, bone spurs, gout, peripheral artery disease (PAD)
Irritable Bowel Syndrome (IBS)
- Key features:
- Symptoms related to defecation
- Changes in stool frequency
- Alterations in stool appearance
- Duration: Symptoms must be present for at least 6 months
- Abdominal pain must be present 1 day per week in the last 3 months
Deep Vein Thrombosis (DVT)
-
Wells criteria used to assess risk:
- Previous DVT
- Active cancer
- Immobilization
- Bedridden for 3 or more days
- Tenderness
- Leg swelling
- Calf swelling 3cm greater than the other leg
- Non-varicose veins
Anemia
- Iron-deficiency anemia: Commonly caused by gastrointestinal (GI) bleeding or NSAID use
- Anemia in rheumatoid arthritis (RA) and lupus: Due to chronic inflammation
- Neurologic anemia (pernicious anemia): Vitamin B12 deficiency
- Infectious anemia:
- Symptoms: Shortness of breath (SOB), fatigue, pale hands, brittle and concave nails
Peripheral Vascular Disease (PVD)
- A broad term encompassing all peripheral arteries and veins
- Peripheral artery disease (PAD): Narrowing or blockage of arteries, commonly affecting the legs
- PAD symptoms: Pain with activity (intermittent claudication), cold extremities, weak pulses, non-healing sores
- PVD symptoms: Swelling, varicose veins, skin changes, pain while standing, heaviness in legs, ankle ulcers
Contracture
- Permanent shortening or tightening of muscles, ligaments, or joint capsules
- Caused by immobility, scarring, neurological conditions, or trauma
- Example: Dupuytren's contracture
Fibrosis
- Excessive fibrous tissue formation
- Causes: Chronic inflammation, trauma, repetitive stress, immobilization, systemic conditions
Densification
- Thickened and rigid fascia
- Causes: Chronic inflammation, repetitive stress, posture, immobility
- Symptoms: Heaviness or tightness, muscular tension, discomfort with movement
Pain Above L4
- Abdominal aortic aneurysm (AAA): Pulsatile abdominal mass, bruit (abnormal heart sound), abdominal or back pain, syncope (fainting), pain radiating to the legs
- Femoral nerve compression (L2-3): Anterior thigh pain, knee extension weakness, decreased plantar reflex, numbness, and tingling
- Abdominal cancer: Weight and appetite loss, abdominal pain, change in bowel habits, fatigue, malaise, jaundice (yellowing), ascites (fluid buildup in the abdomen)
- Inguinal hernia: Groin bulge, fever, nausea, sharp pain, ache, burning
- Pelvic hematoma: Bruising, swelling, difficulty flexing the hip, rapid pulse, low blood pressure, dizziness, blood in urine/stool, possible nerve weakness or numbness
Pins and Needles
-
12VLS.SSSSHMMAGDK:
- 12: 12th cranial nerve palsy (hypoglossal)
- V: Vertebrobasilar insufficiency
- L: Lumbosacral radiculopathy
- S: Stroke/TIA
- SS: Spinal stenosis
- SH: Shingles
- MM: Multiple sclerosis (MS)
- A: Alcohol neuropathy
- G: GBS
- D: Diabetes
- K: Kidney disease
Other
- Stroke/TIA: Facial, speech, and visual changes, paralysis, weakness (upper extremity), headache
- MS: Lhermitte's sign (electric shock sensation in the back with neck flexion), optic neuritis, pain, numbness, weakness, fatigue, coordination problems, ataxia, spasms, cramping, urinary urgency, memory problems, Horner's syndrome
- Guillain-Barré syndrome (GBS): Ascending paresthesia and weakness, onset 2-3 weeks after an infection, can lead to respiratory involvement
- Spinal cord compression: Bilateral symptoms, gait changes, bowel and bladder dysfunction
- PAD/vascular disease: Decreased pulses, coldness, intermittent claudication
- Systemic lupus erythematosus (SLE): Skin and joint manifestations, butterfly rash
- Kidney disease: Swelling, appetite loss, urinary frequency (especially at night), confusion, nausea
- Peripheral neuropathy: Can be caused by alcohol, vitamin B12 deficiency, shingles, diabetes
- Diabetes: Increased thirst, increased urinary frequency, weight loss, hunger, blurry vision
- Vitamin B12 deficiency: Fatigue, weakness, appetite loss, dizziness, SOB, memory problems, confusion, GI issues
- Chronic alcohol use: Nerve damage
- Cervical myelopathy: Spinal cord compression, upper motor neuron and lower motor neuron (UMN & LMN) signs, wasting, pain, numbness, tingling; symptoms develop gradually
- Amyotrophic lateral sclerosis (ALS): UMN and LMN signs
- Primary lateral sclerosis (PLS): UMN signs
- Untreated hypothyroidism:
- Myasthenia gravis: (Less likely) Proximal weakness, facial weakness, diplopia, dysphagia (difficulty swallowing), dysarthria (difficulty speaking)
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Description
Test your knowledge on various medical conditions and their associated symptoms. This quiz explores topics including fibrous layer pain, Guillain-Barré Syndrome, diabetes complications, and more. Perfect for students in medical or health-related fields!
