Internal Medicine

0521779407-14 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:16

Muscular Dystrophies Musculoskeletal Problems 1021

complications and prognosis

■Depends on type of dystrophy; Duchenne dystrophy characterized

by rapid progression leading to disability & death; progression is

slow in Becker, FSH & distal dystrophies; prognosis more variable or

unclear in other varieties

MUSCULOSKELETAL PROBLEMS

CHRIS WISE, MD

history & physical

History

■Cervical spine (whiplash, strain): history of neck injury, pain on

motion

■Mechanical back pain: onset often after activity, heavy labor

➣Worse w/ activity

➣Radicular symptoms: herniated disc

■Shoulder (rotator cuff ) pain: middle-aged, overhead arm activities

➣Pain worse w/ reaching, lying on it in bed

■Chest wall pain: arm or extremity activities

➣Pain reproduced by pressure

■Elbow pain: lateral epicondylitis: lateral arm pain, worse w/ forearm

activities

➣Olecranon bursitis: local trauma, swelling

■Hand & wrist pain

➣Flexor tenosynovitis: palmar hand pain, fingers catching/

triggering

➣Carpal tunnel syndrome: repetitive use, diabetes, pregnancy, RA,

diffuse pain, tingling, median nerve distribution

➣DeQuervain’s tenosynovitis: repetitive use, radial wrist pain,

■Hip girdle pain

➣Trochanteric bursitis: lateral hip pain, worse lying on affected

side

➣Meralgia paresthetica: anterior upper thigh numbness, tight gar-

ment

■Knee & lower leg pain

➣Anserine bursitis: medial knee pain, worse in bed, associated

OA

➣Popliteal cyst: posterior knee pain, swelling, known joint dise-

ase