Module 14: Musculoskeletal Disorders

Module Authors

Michael Burney, MS, PA-C
Chair, Masters of Science in Health Sciences.
Assistant Professor, Physician Assistant Education
Western University of Health Sciences, Pomona, CA

Tina M. Meyer, PA-C
Clinical Consultant and Adjunct Professor
Western University of Health Sciences, Pomona, CA

Review Concepts

By the end of this Review Concept you should be able to:

• Outline the various types of disorders that involve the musculoskeletal system
• Describe the incidence and mortality associated with common orthopedic injuries
• Define basic terms used to describe common orthopedic injuries
• Differentiate a closed fracture from an open fracture
• Classify open fractures using Gustilo and Anderson's scheme
• Differentiate special types of fractures based on distinguishing clinical characteristics

By the end of this Review Concept you should be able to:

• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common fractures of the clavicle and scapula
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common fractures of the humerus
• Explain why it is important to assess the neurovascular status of a patient with humerus fracture
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for supracondylar fractures of the humerus
• Describe complications that can arise secondary to supracondylar fractures of the humerus.
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for fractures of the olecranon
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for fractures of the radial head

By the end of this Review Concept you should be able to:

• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common forearm and wrist fractures
• Explain why it is important to assess the neurovascular status of a patient with a forearm or wrist fracture
• Differentiate common fractures of the wrist and forearm from special types of injuries such as Galeazzi fracture dislocation and Monteggia fracture-dislocation
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for special fractures such as Colles fracture, Smith's fracture, and Barton's fracture. Describe the mechanisms of injury, common clinical findings, and recommended treatment for scaphoid fractures
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common distal, middle, and proximal phalangeal fractures
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for special types of hand fractures such as Boxer's fracture, Bennett's fracture, and Rolando's fracture

By the end of this Review Concept you should be able to:

• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common pelvic fractures
• Explain why it is important to assess the neurovascular status of a patient with a pelvic fracture
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common fractures of the femoral neck.
• Explain how the Garden scheme is used to classify femoral neck fractures
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for intertrochanteric and femoral shaft fractures
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for supracondylar and intracondylar femur fractures
• Explain why it is important to assess the neurovascular status of a patient with an intracondylar femur fracture
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for fractures of the patella

By the end of this Review Concept you should be able to:

• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common fractures of the tibial plateau and tibial shaft
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common fractures of the fibular shaft
• Explain how the Lauge-Hansen scheme is used to classify fractures of the ankle
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common ankle fractures
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for metatarsal or march fractures
• Differentiate mechanisms of injury, common clinical findings, and recommended treatment for fractures of the fifth metatarsal (Dancer's fracture, Jones fracture)
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common phalangeal fractures of the foot.
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common calcaneal fractures

By the end of this Review Concept you should be able to:

• Describe the mechanisms of injury, common clinical findings, and recommended treatment for complete spinal cord syndrome
• Differentiate clinical findings observed in patients with anterior spinal cord syndrome and central spinal cord syndrome
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for Brown-Séquard syndrome
• Identify the vertebrae involved in various types of common cervical fractures
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for flexion/extension cervical spine injuries
• Differentiate the mechanisms of injury that produce various types of thoracolumbar injuries
• Explain how the stability of a spinal cord injury is determined
• Describe recommended radiography, management and treatment for patients with suspected spinal cord injuries

By the end of this Review Concept you should be able to:

• Describe the mechanisms of injury, common clinical findings, and recommended treatment for acromioclavicular joint injuries
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for anterior and posterior shoulder dislocations
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for rotator cuff tears and tendonitis
• Describe common clinical findings and recommended treatment for adhesive capsulitis, calcific tendonitis, and bicipital tendonitis
• Describe the mechanisms of injury, common clinical findings and recommended treatment for injuries of the elbow joint, including posterior elbow dislocation, radial head subluxation, and lateral epicondylitis

By the end of this Review Concept you should be able to:

• Describe the mechanisms of injury, common clinical findings, and recommended treatment for posterior hip dislocation
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for dislocations and other injuries of the knee joint
• Describe the mechanisms of injury, common clinical findings and recommended treatment for anterior cruciate injuries

By the end of this Review Concept you should be able to:

• Describe the mechanisms of injury, common clinical findings, and recommended treatment for common dislocations of the lunate, perilunate, and scapholunate carpal joints
• Describe common clinical findings, and recommended treatment for De Quervain's tenosynovitis
• Describe the causes, mechanisms of injury, common clinical findings, and recommended treatment for carpal tunnel syndrome
• Describe appropriate assessment priorities and treatment interventions for patients with tendon injuries to the hand
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for Boutonniere deformity and Gamekeeper's thumb
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for mild and acute ankle sprains
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for rupture of the Achilles tendon
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for tendonitis and tenosynovitis
• Describe the mechanisms of injury, common clinical findings, and recommended treatment for dislocations of the talus, tarsometatarsal, and phalangeal joints

By the end of this Review Concept you should be able to:

• Describe differential diagnoses, assessment priorities, and recommended treatment interventions for patients with low back pain
• Describe the epidemiology, diagnostic workup, complications, and clinical management for herniated nucleus pulposus
• Describe the epidemiology, diagnostic workup, and clinical management for spondylolisthesis
• Describe the epidemiology, diagnostic workup, and clinical management for ankylosing spondylitis and osteomyelitis
• Describe the epidemiology, diagnostic workup, and clinical management for spinal stenosis
• Explain why it is important to perform an abdominal exam on a patient presenting with new onset back pain
• Describe the epidemiology, diagnostic workup, and clinical management for scoliosis and kyphosis

By the end of this Review Concept you should be able to:

• Describe the epidemiology, diagnostic workup, and clinical management for the following infectious musculoskeletal disorders:
  • Osteomyelitis
  • Tenosynovitis
• Describe the epidemiology, diagnostic workup, and clinical management for the following deep skin conditions:
  • Scleroderma
  • Systemic lupus erythematous (SLE)
• Describe the epidemiology, diagnostic workup, and clinical management for:
  • Giant cell arteritis
  • Polymyalgia rheumatica

By the end of this Review Concept you should be able to:

• Define the clinical condition known as arthritis.
• List the major types of arthritic conditions
• Describe procedures for assessing, diagnosing, and treating patients with arthritic disorders
• Cite laboratory and radiographic findings associated with arthritic disorders
• Describe the epidemiology of rheumatoid arthritis (RA), including incidence, prevalence, and etiology
• Describe common sites, characteristic signs and symptoms, and typical clinical progression of RA.
• Outline common physical examination findings associated with RA
• Describe laboratory tests and expected results when performing a diagnostic workup of the RA patient
• List differential diagnoses for rheumatoid arthritis
• Describe general goals and types of interventions used in the management of the RA patient
• Outline pharmacotherapeutic regimens commonly used to treat patients with RA

By the end of this Review Concept you should be able to:

• Describe the incidence/prevalence and risk factors associated with osteoarthritis
• Describe findings from the physical exam and laboratory tests that support the diagnosis of osteoarthritis
• Differentiate the clinical presentation of osteoarthritis from that of rheumatoid arthritis
• Identify educational, pharmacological, and surgical interventions used in the clinical management of osteoarthritis
• Describe the epidemiology and clinical presentation of gouty arthritis
• Outline management protocols for acute and chronic gout
• Explain procedures and expected findings in the diagnostic workup of the patient with gouty arthritis
• Compare and contrast the clinical presentation and management of gouty arthritis and chondrocalcinosis (pseudogout)
• Describe the epidemiology, diagnostic workup, and clinical management of septic arthritis
• Describe the epidemiology, diagnostic workup, and clinical management of gonococcal arthritis

By the end of this Review Concept you should be able to:

• Identify the common etiology of the family of conditions known as spondyloarthropathies
• Describe the epidemiology, diagnostic workup, and clinical manifestations of ankylosing spondylitis
• Describe the epidemiology, diagnostic workup, and clinical manifestations of psoriatic arthritis
• Describe the epidemiology, diagnostic workup, and clinical manifestations of Reiter's syndrome

By the end of this Review Concept you should be able to:

• List orthopedic developmental milestones that are important in the health evaluation of pediatric patients
• Describe the epidemiology, diagnostic workup, and clinical management of congenital dysplasia of the hip
• Describe the epidemiology, diagnostic workup, and clinical management of Legg-Calve Perthes disease
• Describe the epidemiology, diagnostic workup, and clinical management of slipped capital femoral epiphysis
• Compare and contrast clinical features and management of genu varum (bowleg) and genu valgus (knock-knee)
• Describe the etiology and clinical management of talipes equinovarus (club foot)
• List three conditions that lead to intoeing in younger patients
• Compare and contrast the clinical features and management of metatarsus varus, tibial torsion, and femoral neck anteversion
• Compare and contrast clinical features and management of pes planus (flat foot) and pes cavus

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