DIFFERENTIAL DIAGNOSIS AND PRIMARY CARE PRACTICUM
MUSCULOSKELETAL
•Lachman maneuver: anterior cruciate ligament (ACL injury) (knee
... [Show More] exam)
•McMurray sign: injury to the meniscus (knee exam)
oCause: Suddenly planting leg on the ground and twisting
▪Immediate pain in the planted leg and inability to bear weight
▪Can lock up when trying to straighten it
•Phalen’s test: numbness and tingling in the first 3 digits when pressing the dorsal surface of both hands together in a forced wrist flexion for at least 1 minute (wrist exam)
•Radial head fracture: palpate for tenderness, swelling, and crepitus just distal to the lateral epicondyle (wrist exam)
•Articular and non-articular musculoskeletal complaint – differentiation between the two is that non- articular complaints involves a point or focal tenderness
•Bulge test: use when checking for joint effusion (knee)
•Carpal Tunnel Syndrome – inflammation of the median nerve
-Tx: wrist splint and NSAIDs
Herniated Disk – most common is L4-L5 (weakness in the great toe)
-Evaluate by doing a straight leg test: supine position, elevate affected leg, if this elicits back and sciatic nerve pain = positive for herniated disk
Shoulder Dislocation – pain noted when shrugging shoulders d/t excessive pressure put on the shoulders
Muscle Strain –
1st degree: ligaments are stretched but not torn
2nd degree: most common; partial tearing of the ligament 3rd degree: most severe; ligament is torn completely
Strain – can be due to not warming up prior to exercise
Educate: stretching and warm-up exercise prior to the full exercise routine
Strain? Example: acute low back pain strain, low back pain that is not associated with sciatica – alleviated with rest, pain locally on palpitation and muscle spasms are felt
Tx: NSAID and low back strengthening exercises
Cauda Equine Syndrome – occurs when bundle of nerves below the end of the spinal cord called cauda equina is damaged
-S/S: low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control
-Should be referred to the ER for eval requires surgery (laminectomy) [Show Less]