Ankle and Foot
L5-S1
Explain the difference between mechanical and non-mechanical back pain
Mechanical pain: caused by stress and strain on the spine, intervertebral discs, muscles, tendons, ligaments & other surrounding tissue
Non-mechanical pain: caused by neoplastic disorders, infection of the spine, chronic inflammatory disorders
most common cause of cauda equina
most commonly in large central disc herniations at L4/L5 level
what medications can increase risk of gout
diuretics** ASA, ETOH, nicotine
Goals of treatment in RA
‒remission, preventing functional decline, and halting progression of disease
Examination for achilles tendon injury
Thompson test
the 4 serious underlying disorders of low back pain
Cauda equina, spinal infections, metastatic cancer, tumors
stage CES suspected
Bilateral radicular pain in lower extremities
3 stages of gout
1) acute gouty arthritis 2) inter-critical gout 3) chronic/tophaceous gout
Extra-articular features
‒anemia, pleuropericarditis, neuropathy, myopathy, splenomegaly, Sjogren’s syndrome, scleritis, vasculitis, renal disease
Causes of forefoot problems
Bunion, Neuroma, Corns, Calluses, stress fracture
Absolute indications for surgical intervention
progressive neurological deficit, progressive weakness, and alterations in bowel/bladder function
Changes in bowel, bladder function (retention or incontinence), sensory changes to extremities, weakness/paresthesias to extremities
Diagnostics for gout
CBC (↑ WBC, ↑ ESR), uric acid (> 404umol/L), RF, X-ray or MRI to identify bony cysts or gout tophi
Characteristics of joint pain consistent with RA (timing location etc)
morning stiffness in joints lasting for at least 1 hour, present for more than 6 weeks, erythema/swelling in at least 3 joints x 6 weeks (wrists, hands, MCP, PIP joints most commonly)
Tenderness to palpation along the medial plantar border of the sole may indicate
Pes Planus (flat foot)
follow up for back pain
7-10 days, then q2-4 week until sx resolves
follow up as PCP in CES
Once surgical decompression has occurred, the patient may have residual neurological deficits (need for self-catheterization, mobility aids, sexual dysfunction, etc.) – important to follow-up closely and meet these needs in primary care
Dosing for colchicine and prednisone
1.2mg initial dose, followed by 0.6mg 1 hour later (needs renal/hepatic dosing)
Prednisone 30 to 40mg once daily until resolution begins, then taper over 7 to 10 days (avoid in HF, poorly controlled HTN, poorly controlled diabetes)
Screening you need to consider for patients with RA
Plantar Fasciitis causes ______ pain
Subcalcaneal pain, radiating to the arch of the midfoot while the person is running, walking, or standing
what would trigger you to order an XR to rule out fracture
history of trauma, osteoporosis, the individual is older, they have long-term steroids
PSEUDOGOUT:
Typical location and how to manage
‒Large joints (knees/shoulder) joint aspiration + glucocorticoid injection)
‒NSAIDs
Another term for pseudogout:
calcium pyrophosphate disease (CPPD)
3 specialities to refer to with RA dx
Rheumatologist, orthopedist, and ophthalmologist