Back Pain
Sharp, burning, radiating pain to buttock, leg and foot along dermatomes
Sitting and knee extension produces radicular pain
H/o repetitive motion strain, strenuous lifting/twisting/bending
Sciatica
Result of nerve and vascular structures
h/o of reaching/working with arm raised, poor posture
Morning pain and paresthesia, when reaching overhead with arm
Thoracic Outlet Syndrome
Often a fall onto an outstretched arm or forced abduction and external rotation
Severe, often diffuse shoulder pain
anxiety and limited movement; patient often holds arm in a protective position
Dislocation
Limping after strenuous running may indicate a stress fracture
Ripping or tearing sound; can be acute or chronic, minimal to moderate pain 1-2 days post injury
If fractured will be a diffuse swelling and heard a "crack" sound--pain with weight bearing
Sprain/Strain/Fracture
H/o repetitive flexion of hip
Pain worse with movement and putting heel on opposite knee
Iliopsoas tendinitis
Often no precipitating event
Sudden, generalized pain
Alleviated with rest in supine position with hips and knees flexed, heat/ice,
Aggravated by sitting, walking, standing and certain motions
Strain/Acute Low Back Pain
Recent overuse, awkward sleeping position, localized muscle tenderness, pain with moveent
Negative: no neurological deficits, no significant midline bony tenderness
Cervical muscle strain
H/O sports or MVA or direct fall/impact onto lateral shoulder; stretching/tearing of clavicular ligaments
Pain and limited shoulder movement (especially adduction); localized to top of shoulder, directly over AC joint
May have obvious deformity
Acromioclavicular (AC) Joint Injury
h/o pivot, twist or extension injury
audible "pop" sound, rapid swelling, instability rotational/anterior
ACL tear
Boys age 3-11
Groin or medial thigh pain, limp
Legg-Calve-Perthes Disease
Family hx: crooked spine (Native Alaskans 40%)
Localized/chronic pain (L5-S1), onset at hyperextension (back hand spring, butterfly stroke, tennis serve
Spondylolisthesis
Neck pain radiating into arm, paresthesias, possible weakness
Cervical radiculopathy
Overuse of bicep bracchi muscle that ends at radial tuberosity (may be associated with impingement syndrome)
Kids with repeated trauma from swimming, volleyball, baseball or golf
Pain localized to intertubicular groove, improves with rest, aggravated with movement
Bicipital Tendinitis
twisting injury to knee
pain, difficulty flexing or bearing weight; "clicking or catching" of knee with movement
Meniscus Tear
Children younger than 10 w/h/o URI or other infection
Limp, pain in anteromedial thigh and knee, hip movement increases pain, low-grade fever
Transient synovitis of hip
Males more likely <30YO
chronic low back pain, relieved by exercise
morning stiffness that improves throughout the day
Ankylosing spondylitis
Positives: Gradual onset, older age, chronic stiffness, reduced ROM, pain with extension
Negatives: no acute trauma, fever, or systemic symptoms
Cervical spondylosis
Acute injury in children, young adult; usually chronic as aging
If acute: severe pain, unable to move arm sideways, if complete tear attempt to raise arm ends in shoulder shrug
If chronic: insidious onset of pain, made worse with arm over head, nocturnal pain and tenderness over AC joint
Rotator Cuff Tear
h/o valgus stress to knee joint (direct blow to lateral knee)
Pain localized to medial knee, swelling usually localized along innter knee, may feel unstable medially
Key finding: medial knee tenderness with pain or laxity during valgus stress testing
MCL sprain/tear
Gradual goin pain, morning stiffness <30 mins, decreased internal rotation, pain with weight bearing
Pertinent (-): No prominent groin pain or significant restriction of PROM
Hip Osteoarthritis
Adults over 50YO
Lower Back Pain with radioculapathy. Increased pain with walking, bending, hyperextension, standing, sneezing, coughing
Spinal Stenosis
(-): No dermatomal sensory loss, reflex changes, or objective weakness
Myofascial pain syndrome
!! Red Flag !!
Increased pressure in muscle compartment post injury
C/o severe burning and numbness
Acute Compartment Syndrome
Adolescent male (running/jumping sports); repetitive traction of the patellr tendon
Gradual onset; pain below patella with swelling to tibial tubercle, no instability, aggravated by activity, limp.
Osgood-Schlatter
repetitive (running, stairs, prolonged walking) overuse of hip abductor tendons, obesity, usually female 40-60YO
Lateral hip pain that worsens when lying on the affected side, climbing stairs, or walking, point tenderness over the greater trochanter. Does not have significant restriction of PROM,
Greater trochanteric pain syndrome
!! RED FLAG !!
H/O bacterial infection (secondary to DM2, AOM, laryngitis, IV drug use)
Nighttime back pain not relieved by laying down
May have an acute onset of fever, weight loss, general malaise
Infection/Sepsis
!! RED FLAG!!
(+) progressive bilateral arm or leg symptoms, hand clunsiness or difficulty with fine motor tasks, gait imbalance, hyperreflexia, clonus, or babinski sign, new bowel or bladder dysfunction in advanced cases
(-): No gait changes, normal strength and reflexes, no hand dexterity problems, no bowel or bladder changes
Cervical myelopathy (spinal cord compression causing progressive neurological impairment)
!! RED FLAG !!
Recent surgery, joint injection, prosthetic joint, immunosuppresion
Hot, swollen, painful joint with restricted passive ROM or to bear weight, significant pain with both active and passive ROM, fever or chills (although fever may not be present)
Septic Knee Joint
!! RED FLAG !!
Fall or trauma, particularly in older adults, h/o osteoporosis
severe groin/hip pain, inability to bear weight, shortened/externally rotated leg, pain with passive movement
Hip Fracture