N6647 Musculoskeletal Disorders Clinical Evaluation and Management
Examination: Osteoarthritis Degenerative Joint Disease Pathophysiology and
Risk Factors Including Aging Obesity and Joint Trauma, Rheumatoid Arthritis
Autoimmune Synovial Inflammation with Pannus Formation and Systemic
Manifestations, Osteoporosis Bone Mineral Density Loss Screening Prevention
and Pharmacologic Management, Fibromyalgia Chronic Widespread Pain
Syndrome with Sleep Disturbance and Central Pain Processing Dysfunction,
Gout Hyperuricemia Pathogenesis with Urate Crystal Deposition and Acute
Inflammatory Arthritis, and Chronic Low Back Pain Etiologies Including Disc
Herniation Spinal Degeneration Spinal Stenosis and Axial Spondyloarthritis
Diagnostic and Therapeutic Strategies Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
Osteoarthritis
Degenerative breakdown of articular cartilage that lines the joint surfaces
Degenerative joint disease or "wear and tear"
Risk factors: history of joint trauma, aging, obesity, overuse, genetics
OA continued
Most common articular disorder in people over age 45
Leading cause of disability in older adults
Prevalence equal among men and women
Affects approximately 60 million Americans
Primarily noninflammatory. Biomechanical and biochemical changes in the articular cartilage and
synovial membrane
Erosion and fibrillation of the cartilage, joint space narrowing and osteophyte formation
OA clinical presentation
,Gradual onset of joint pain that increases with use
Early morning stiffness < 30 minutes
Stiffness and pain may increase after prolonged activity
May have crepitus, joint tenderness and limited range of motion
Effects primarily weight bearing joints
OA physical exam
Observe gait, assess functional status
Look for joint swelling, tenderness (may have none)
Look for atrophy of muscles surrounding the joint
Assess joint stability and ROM
Assess for crepitus. Reduced passive and active ROM
OA assess
hands (DIP, PIP CMC joints for enlargement)
Feet (swelling of the big toe)
Knees/hips (ROM, crepitus)
Spine (ROM, stiffness, bone spurs at facet joints)
Typically affect distal interphalangeal (DIP) and proximal interphalangeal (PIP), joints , knees, hips, spine
MCP joint is usually not seen with OA unless at the base of the thumb Often seen with RA
OA differential diagnosis
RA
Gout, pseudogout
Inflammatory arthritis
Autoimmune arthritis
, Finbromyalgia
Tendinitis/bursitis
Ankylosing spondylitis
Lupus
Lyme disease
Neuromuscular disease
OA diagnostics
Can usually make the diagnosis based on history and physical exam alone
Diagnostic Testing:
CBC, sed rate, uric acid, RF
The blood work ordered depends on physical exam and history
X-Ray for baseline- may find narrow joint space and bony cysts. Rule out other conditions
OA treatment
Goal: maximize function and mobility, control pain, preserve quality of life
Low impact exercise example: example knee and quad strengthening
Glucosamine chondroitin 1500 QD
Tumeric: small studies have shown reduction in inflammation and pain
Analgesics: tylenol usually first line - 2000 mg max with chronic use, NSAIDs and COX2 NSAIDS, creams -
voltaren, pennsaid, or compounding pharmacy
OA other treatment
hyaluronic acid (viscosupplementation) - lubrication/ cushioning
Examination: Osteoarthritis Degenerative Joint Disease Pathophysiology and
Risk Factors Including Aging Obesity and Joint Trauma, Rheumatoid Arthritis
Autoimmune Synovial Inflammation with Pannus Formation and Systemic
Manifestations, Osteoporosis Bone Mineral Density Loss Screening Prevention
and Pharmacologic Management, Fibromyalgia Chronic Widespread Pain
Syndrome with Sleep Disturbance and Central Pain Processing Dysfunction,
Gout Hyperuricemia Pathogenesis with Urate Crystal Deposition and Acute
Inflammatory Arthritis, and Chronic Low Back Pain Etiologies Including Disc
Herniation Spinal Degeneration Spinal Stenosis and Axial Spondyloarthritis
Diagnostic and Therapeutic Strategies Exam Questions Verified and Provided
with Complete A+ Graded Rationales Latest Updated 2026
Osteoarthritis
Degenerative breakdown of articular cartilage that lines the joint surfaces
Degenerative joint disease or "wear and tear"
Risk factors: history of joint trauma, aging, obesity, overuse, genetics
OA continued
Most common articular disorder in people over age 45
Leading cause of disability in older adults
Prevalence equal among men and women
Affects approximately 60 million Americans
Primarily noninflammatory. Biomechanical and biochemical changes in the articular cartilage and
synovial membrane
Erosion and fibrillation of the cartilage, joint space narrowing and osteophyte formation
OA clinical presentation
,Gradual onset of joint pain that increases with use
Early morning stiffness < 30 minutes
Stiffness and pain may increase after prolonged activity
May have crepitus, joint tenderness and limited range of motion
Effects primarily weight bearing joints
OA physical exam
Observe gait, assess functional status
Look for joint swelling, tenderness (may have none)
Look for atrophy of muscles surrounding the joint
Assess joint stability and ROM
Assess for crepitus. Reduced passive and active ROM
OA assess
hands (DIP, PIP CMC joints for enlargement)
Feet (swelling of the big toe)
Knees/hips (ROM, crepitus)
Spine (ROM, stiffness, bone spurs at facet joints)
Typically affect distal interphalangeal (DIP) and proximal interphalangeal (PIP), joints , knees, hips, spine
MCP joint is usually not seen with OA unless at the base of the thumb Often seen with RA
OA differential diagnosis
RA
Gout, pseudogout
Inflammatory arthritis
Autoimmune arthritis
, Finbromyalgia
Tendinitis/bursitis
Ankylosing spondylitis
Lupus
Lyme disease
Neuromuscular disease
OA diagnostics
Can usually make the diagnosis based on history and physical exam alone
Diagnostic Testing:
CBC, sed rate, uric acid, RF
The blood work ordered depends on physical exam and history
X-Ray for baseline- may find narrow joint space and bony cysts. Rule out other conditions
OA treatment
Goal: maximize function and mobility, control pain, preserve quality of life
Low impact exercise example: example knee and quad strengthening
Glucosamine chondroitin 1500 QD
Tumeric: small studies have shown reduction in inflammation and pain
Analgesics: tylenol usually first line - 2000 mg max with chronic use, NSAIDs and COX2 NSAIDS, creams -
voltaren, pennsaid, or compounding pharmacy
OA other treatment
hyaluronic acid (viscosupplementation) - lubrication/ cushioning
