Nurs 623-624 Exam 4 Questions With Complete
Solutions latest 2024
Anterior drawer test has a low sensitivity and high specificity for confirming
ACL pathology, so a positive test strongly suggests a problem but a negative
test does not rule out an ACL tear.
A positive test strongly suggests a problem but a negative test does not rule out an
ACL tear.
When assessing the patient with musculoskeletal problems, it is important to
determine if the problem is:
acute or chronic, articular or nonarticular, inflammatory or noninflammatory, and
localized or systemic in distribution. Acute (less than 6 weeks duration) or chronic
(more than 6 weeks duration), Flammatory or inflammatory
Articular structures
• synovium, • synovial fluid, • articular cartilage, • intra-articular ligaments, • joint
capsule, • juxta-articular bone
Articular problems are characterized by
deep or diffuse pain, • deep or diffuse pain, • limited ROM (passive & active), •
swelling, • crepitation,
• instability, • 'locking', • Deformity
Nonarticular (or periarticular) structures
• identified as supportive extra-articular ligaments,
• tendons, • bursae, • muscle, • fascia, • bone, • nerve,
• overlying skin •
Nonarticular disorders are characterized by
painful active, but not passive ROM,
• demonstrated point or focal ternderness in regions distinct from articular structures,
• physical findings far from the joint capsule.
• Usually do not find crepitus, instability or deformity
History
· Chronology of complaint gives important diagnostic clues
· onset, or did it develop over some time
· evolution of the problem, such as chronic, intermittent,
· migratory and duration of the problem.
Physical Examination
· Distinguish between mechanical problems, soft tissue disease, and
noninflammatory and inflammatory joint disease.
· Inspecting the involved site and observe for side to side symmetry
· The uninvolved side should be examined first and compared with the involved side
(this will mean the painful portion of the exam will be last)
· evaluate for warmth over the joint, joint effusion, and pain on joint motion.
, You should have the patient perform as much active ROM as possible during the
exam,
Low Back Pain
· Also called low back strain or lumbar strain
· Injury to paravertebral spinal muscles, ligamentous injuries, disc herniation or
leaking of substances from nucleus pulposus
· Back pain associated with neurological deficit, decreased or absent pulses, or
bowel or bladder dysfunction is potentially life threatening & warrants immediate
referral.
· Low back pain is a common complaint seen in primary care.
· Pain may be caused by a herniated disc or from leaking of substances from the
nucleus pulposus that can induce inflammation and cause irritation.
· often difficult to localize an injury to a specific structure.
Chronic low back pain is
pain that lasts longer than 3 months.
Symptoms associated with chronic low back pain are
typically recurrent and episodic, but may be unremitting.
Treatment for injury to muscle and ligamentous structures is similar.
Acute vs. chronic
Acute LBP will often spontaneously resolve and the patient may be back to
functioning normally within a month
Factors to consider in diagnosing cause of pain:
• Age, pain onset (acute or insidious),
• Pain location as unilateral or bilateral can help differentiate among these
differentials.
• Pain increases. Pain decreases, Straight-leg raising
Younger patients, under 50 years of age, are more likely to have
spondylolisthesis, • muscle strain, • scoliosis, • herniated disc.
Older than 50 are more likely to have pain
related to arthritis, • spinal stenosis, Pain onset, insidious
• acute
a herniated disk or leaking substances from the nucleus pulposus can induce
·inflammation and cause irritation.
Acute Lumber Radiculopathy
Herniated disc, acute lumbar radiculopathy, Sciatica
sciatica
• cause unilateral radicular pain.
• The pain may extend below the knee and the leg pain may be equal to that of the
back pain.
• often acute in onset, pain increases when sitting or bending, decreases when
standing, straight leg raise will be positive. xray will be negative with a herniated
disc, so further diagnostic testing may be indicated.
Treatment for back pain includes:
Meds and non-pharmacological treatment
Solutions latest 2024
Anterior drawer test has a low sensitivity and high specificity for confirming
ACL pathology, so a positive test strongly suggests a problem but a negative
test does not rule out an ACL tear.
A positive test strongly suggests a problem but a negative test does not rule out an
ACL tear.
When assessing the patient with musculoskeletal problems, it is important to
determine if the problem is:
acute or chronic, articular or nonarticular, inflammatory or noninflammatory, and
localized or systemic in distribution. Acute (less than 6 weeks duration) or chronic
(more than 6 weeks duration), Flammatory or inflammatory
Articular structures
• synovium, • synovial fluid, • articular cartilage, • intra-articular ligaments, • joint
capsule, • juxta-articular bone
Articular problems are characterized by
deep or diffuse pain, • deep or diffuse pain, • limited ROM (passive & active), •
swelling, • crepitation,
• instability, • 'locking', • Deformity
Nonarticular (or periarticular) structures
• identified as supportive extra-articular ligaments,
• tendons, • bursae, • muscle, • fascia, • bone, • nerve,
• overlying skin •
Nonarticular disorders are characterized by
painful active, but not passive ROM,
• demonstrated point or focal ternderness in regions distinct from articular structures,
• physical findings far from the joint capsule.
• Usually do not find crepitus, instability or deformity
History
· Chronology of complaint gives important diagnostic clues
· onset, or did it develop over some time
· evolution of the problem, such as chronic, intermittent,
· migratory and duration of the problem.
Physical Examination
· Distinguish between mechanical problems, soft tissue disease, and
noninflammatory and inflammatory joint disease.
· Inspecting the involved site and observe for side to side symmetry
· The uninvolved side should be examined first and compared with the involved side
(this will mean the painful portion of the exam will be last)
· evaluate for warmth over the joint, joint effusion, and pain on joint motion.
, You should have the patient perform as much active ROM as possible during the
exam,
Low Back Pain
· Also called low back strain or lumbar strain
· Injury to paravertebral spinal muscles, ligamentous injuries, disc herniation or
leaking of substances from nucleus pulposus
· Back pain associated with neurological deficit, decreased or absent pulses, or
bowel or bladder dysfunction is potentially life threatening & warrants immediate
referral.
· Low back pain is a common complaint seen in primary care.
· Pain may be caused by a herniated disc or from leaking of substances from the
nucleus pulposus that can induce inflammation and cause irritation.
· often difficult to localize an injury to a specific structure.
Chronic low back pain is
pain that lasts longer than 3 months.
Symptoms associated with chronic low back pain are
typically recurrent and episodic, but may be unremitting.
Treatment for injury to muscle and ligamentous structures is similar.
Acute vs. chronic
Acute LBP will often spontaneously resolve and the patient may be back to
functioning normally within a month
Factors to consider in diagnosing cause of pain:
• Age, pain onset (acute or insidious),
• Pain location as unilateral or bilateral can help differentiate among these
differentials.
• Pain increases. Pain decreases, Straight-leg raising
Younger patients, under 50 years of age, are more likely to have
spondylolisthesis, • muscle strain, • scoliosis, • herniated disc.
Older than 50 are more likely to have pain
related to arthritis, • spinal stenosis, Pain onset, insidious
• acute
a herniated disk or leaking substances from the nucleus pulposus can induce
·inflammation and cause irritation.
Acute Lumber Radiculopathy
Herniated disc, acute lumbar radiculopathy, Sciatica
sciatica
• cause unilateral radicular pain.
• The pain may extend below the knee and the leg pain may be equal to that of the
back pain.
• often acute in onset, pain increases when sitting or bending, decreases when
standing, straight leg raise will be positive. xray will be negative with a herniated
disc, so further diagnostic testing may be indicated.
Treatment for back pain includes:
Meds and non-pharmacological treatment
