Skip to Main Content

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

Image not available.

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

Favorite Table | Download (.pdf) | Print
Substances that can ↓ bone density Risk factors ≥ 3 factors = ↑ risk
  • Aluminum

  • Antiseizure meds

  • Corticosteroids

  • Cytotoxic meds

  • ↑ Thyroxine

  • Heparin

  • Caffeine

  • Tobacco

  • Caucasian

  • Female

  • > 65 years old

  • Substance abuse (smoking, alcohol)

  • Lactose intolerance or low Ca++ intake

  • Inactivity

  • Thyroid, NSAIDs, steroids

  • Family hx

  • Kidney disease

  • Thin stature/low body weight

  • Early menopause

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

Image not available.

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

Arthritic Changes

Favorite Table | Download (.pdf) | Print
...
OA RA Gout
• Asymmetrical involvement • Symmetrical jt swelling • Affects only a few joints
• Large wt-bearing joints • Small jts–hands, feet, wrist • Most common: 1st MTP, knee, wrist
• Loss of jt surface integrity • Erythema & fever

Pop-up div Successfully Displayed

This div only appears when the trigger link is hovered over. Otherwise it is hidden from view.