Adults

Musculoskeletal Pathology

Ottawa Knee Rules

X-ray series of the knee is only required if the patient presents with any of the following criteria:

• > 55 years old

• Isolated tenderness of the patella

• Tenderness of the head of the fibula

• Inability to flex > 90 degrees

• Inability to bear weight (4 steps) both immediately after injury & in emergency department (regardless of limping)

Ottawa Ankle Rules

X-ray series of the ankle is only required if the patient presents with any of the following criteria:

• Bone tenderness at posterior edge of the distal 6 cm of the medial malleolus

• Bone tenderness at posterior edge of the distal 6 cm of the lateral malleolus

• Totally unable to bear weight both immediately after injury & (for 4 steps) in the emergency department

Source: Gulick D (2005).

Ottawa Foot Rules

X-ray series of the foot is only required if the patient presents with any of the following criteria:

• Bone tenderness is at navicular

• Bone tenderness at the base of 5th MT

• Totally unable to bear weight both immediately after injury & (for 4 steps) in the emergency department

Osteoporosis

Signs & Symptoms

• Severe & localized T-L-spine pain

• ↑ Pain with prolonged posture

• ↑ Pain with Valsalva

• ↓ Pain in hook-lying

• Loss of ht > 1"

• Kyphosis

• Dowager's hump

Source: Boissonnault WG (2005).

Systemic Causes of Carpal Tunnel Syndrome

• DM

• Hormonal imbalance

• Pregnancy

• Gout

• Graves' disease (hyperthyroidism)

• Hyperparathyroidism

• Hypothyroidism

• Liver disease

• Oral contraceptives

• Obesity

Source: Goodman C & Snyder T (2000).

Fibromyalgia Syndrome

• Widespread pain for > 3 months

• Myalgia & AM stiffness

• Fatigue & sleep disturbance 2° ↓ GH released @ night

• Soft tissue swelling

• Headache, dyspnea, dizziness

• Hypersensitivity to light

• Dry eyes & mouth

• Presence of 11 of 18 tender points

Source: Adapted from Goodman CC & Boissonnault WG (1998).

Arthritic Changes