Ortho-Differential diagnosis

Question	Answer
Sign of the Buttock	Limited/painful SLR; Limited/painful passive hip flexion with knee bent; Non-capsular pattern
Pancoast Tumor	Men >50 with hx of smoking; Nagging pain in shoulder/vertebral scapular border; Pain progression nagging->burning & extends down arm in ulnar distribution
After how many visits should you refer if no improvement?	3-4 treatments
S/sx of neurommskeletal impairments typically related to what?	Changes in posture or movement
Stoddard #1	Back ache, having hx of malignancy during previous 2 yrs, must be assumed to have 2ndary malignant deposits in spine
Stoddard #2	Onset of back pain late in life w/o any previous hx of back s/sx, it is more than likely osteoporosis or 2ndary deposits
Stoddard #3	Serious loss of spinal fxn or shock or vomiting after trivial spinal injury/strain, pt likely to have pathological fx of spine
Stoddard #4	Intense pain requiring morphine >48 hrs may indicate serious disease
Stoddard #5	Severe pain, derofmity & mm spasm in areas of spine other than lower cervical/lower lumbar, should arouse suspicion of disease
Stoddard #6	Constitutional signs like fever, loss of wt, malaise & excessive wkness suggest disease
Stoddard #7	Loss of power too widespread to be accountable by single nerve root lesion suggests neurological disease
Stoddard #8	Loss of sphincter control is never due to simple mechanical causes
Stoddard #9	Continuous pain unrelated to posture is unlikely to be mechanical in origin
Stoddard #10	Normal ESR doesn't exclude disease entirely
Cyriax Normal End Feels	Capsular; Bone-on-bone; Tissue approximation
Cyriax Abnormal End Feels	Empty; Springy Block; Spasm
MMT Strong & Painful	Minor Lesion
MMT Weak & Painless	Neurological/Rupture
MMT Weak & Painful	Gross Lesion
MMT All Painful	Psychogenic/Highly irritable
MMT Painful on repetition	Vascular
MMT Strong & Pain-free	Normal
DTR Biceps; Brachioradialis; Triceps	Biceps/Brachioradialis = C5-6; Triceps = C6-7
S/sx Cervical Radiculopathy	Neck pain, radicular pain with numbness/paresthesia in UE; Mm spasms/fasciculations; Occipital HA; Radiating pain; Wkness, lack of coordination, decreased grip strength
Presentation of Cervical Radiculopathy	Decreased ROM (extension/rotation reproduce radicular s/sx); Myotomes, Dermatomes, DTRs; UMN (rule out cord compression)
Study with ULTT, Spurling, Distraction Tests; Rotation <60 degrees	2 s/sx = 21% have cervical radiculopathy; 3 s/sx = 65%; 4 s/sx = 90%
Diff Dx of Cervical Radiculopathy	Adhesive capsulitis (AROM/PROM); Demyelinating condiiton (s/sx vary); Myocardial ischemia (ECG/stress tests); Peripheral n entrapment (+ Tinel/Phalen's test); RTC (impingement/RTC s/sx); TOS (decreased radial pulse)
Cervical Spondylosis s/sx	Decreased ROM; Chronic neck pain; HA; Radicular s/sx; Irritability, fatigue, sleep disturbances, decreased work tolerance
Presentation of Cervical Spondylosis	Diffuse non-sepcific neck pain exacerbated by neck mvmts
Presence of joint dysfunction with cervical spondylosis	Limited ROM; Palpable tenderness; dermatomes; myotomes; reflexes
Diff Dx of Cervical Spondylosis	Metastatic tumor (night pain); Cervical HNP (younger population); SC tumor (diagnostic studies); Syringomyelia (loss of superficial b reflexes/insensitivity to pain); Vertebral subluxation (advanced spondylosis; RA; trauma)
Cervical Myelopathy s/sx	Palmar paresthesia; Decreased UE dexterity; Subtle gait disturbances; abnormal urinary fxn; Loss of vibration/position sense; UE radiculopathy; May not experience pain
Key Findings with Cervical Myelopathy	Long tract signs (Hoffman's; Babinski; Clonus); Gait disturbances; Decreased UE dexterity
RTC Tear S/sx	Recurrent shoulder pain triggered by specific injury; Night pain; Weakness; Catching; Grating
Presentation of RTC Tear	Supra/infra atrophy; Limited AROM; Drop arm; Tenderness over greater tuberosity
Diff Dx of RTC Tear	AC jt arthritis (localized pain/tenderness, normal ROM); C-spondylosis (neck stiff, myo/dermatomes/DTRs); GH jt arthritis (radiographs); Adh Caps (AROM/PROM); Impingement; Pancoast tumor; TOS (ulnar n distribution; worse with TOS testing)
What is TOS?	Compression of brachial plexus &/or subclavian vessels as they exit b/t shoulder girdle & 1st rib; may be due to congenital anomalies; Fibromuscular bands in thoracic outlet; Post-traumatic fibrosis of scalenes
TOS s/sx	Vague & variable; Aching pain/paresthesias from neck to shoulder, arm, medial forearm, fingers; Intermittent swelling/discoloration of arm, decreased radial pulse, coldness; Aching, fatigue & wkness exacerbated by overhead activity
Presentation of TOS	Female, late teens to 40s; Must reproduce neuro/vascular s/sx; Fwd head, rounded shoulders; (+) ANTT; Motor/sensory intact
TOS Diff Dx	Brachial neuritis (sudden onset, pain, prox wkness); CTS (radial s/sx; Phalen); HNP (neck involvement; radicular pattern); Impingement (+ tests with localized pain); Pancoast tumor (venous congestion; radiographs); Ulnar n entrapment (Tinel, no prox s/sx)
Medial/Lateral Epicondylitis S/sx	35-50 yo; gradual onset in lateral elbow/forearm during wrist ext; medial presents with medial pain exacerbated with wrist flexion/pronation
Presentation of Med/Lat Epicondylitis	Local tenderness 1 cm distal to lat epicondyle (common extensor origin); Medial epicondylitis tender just distal to med epicondyle
Diff Dx of Med/Lat Epicondylitis	Cubital tunnel sx (ulnar n compression with parasthesias in 4th/5th fingers); Radial tunnel sx (PIN compression; tender 5 cm distal to lat epicondyle)
What nerve compression is the 2nd most common nerve entrapment?	Ulnar nerve compression
Where is ulnar n usually compressed?	Cubital Tunnel
PIN Compression	No sensory, innervates wrist, thumb, fingers extensors
Which nerve is compressed in pronator syndrome?	Median Nerve
S/sx of ulnar n compression	Medial elbow aches w/ N/T in 4th/5th fingers; Rdiate proximal into shoulder/neck; Mm wasting in late stages
S/sx of Radial n compression	Pain 4-5 cm distal to lateral epicondyle; No N/T; Mm weakness in late stages
S/sx of Median n compression	Forearm pain that can radiate proximally into arm; Numbness may affect all/part of median n distribution
Diff Dx of elbow compression syndromes	CTS (numb thumb, index, middle fingers; thenar wasting); HNP; Med/Lat epicondylitis; TOS; Ulnar n entrapment at wrist
Ulnar Nerve supply	FCU; FDP; Superficial sensory; Deep motor; Ulnar lumbricals; IO; Adductor pollicis; FPB
What is the most common compression neuropathy in the UE?	CTS
What occurs most in middle-aged/pregnant females?	CTS
CTS S/Sx	Vague aching radiating into thenar area; Presthesia/numbness in median distribution; Worse at night; Dropping objects/wkness; Need to shake/rub hands
Presentation of CTS	Thenar atrophy; decreased sensory; Phalen test; Tinel sign; Carpal compression; ULTT; Opposition strength
Diff Dx of CTS	CMC arthritis (pain w/ motion); Cervical radiculopathy of C6 (neck pain; C6 dist); Diabetes; Hypothyroid; Median n compression at elbow; Ulnar neuropathy
Median N. supply	FCR; PT; PL; FDS; AI branch = FPL; Radial 1/2 of FDP; PQ; Superficial sensory; Terminal = APB; OP; FPB; Radial lumbricals; Sensory
DeQuervain Tenosynovitis is what?	Swelling/stenosis of sheath surrounding APL & EPB
DeQuervain's is common in what population?	Middle-aged women
S/sx of DeQuervain's	Pain, swelling, triggering resulting in locking/sticking of tendon with thumb motion; Swelling over radial styloid & pain aggravated by moving thumb/making fist
DeQuervain's Presentation	Swelling/tenderness over tendons of 1st dorsal compartment; Crepitus with thumb flex/ext; (+) Finkelstein
Diff Dx of DeQuervain's	CMC arthritis (painful compression); Dorsal wrist ganglion (palpable mass); Scaphoid fx (snuffbox tender); Superficial radial n (cheralgia paresthetic; dog handler's sx)