Internal Medicine

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

Musculoskeletal Problems 1023

tests

Lab Tests

■Blood studies only to detect underlying cause (eg, thyroid tests for

carpal tunnel syndrome)

■Synovial fluid analysis for infection (WBC >1,000/mm3, culture pos-

itive), crystals; may be important in olecranon bursitis in particular

■Nerve conduction studies for carpal or tarsal tunnel syndrome

Imaging

■Radiographs useful only to rule out underlying joint & bony pathol-

ogy in selective situations (persistent back, shoulder, foot, knee

pain)

■MRI or ultrasound in refractory shoulder rotator cuff symptoms

■MRI or CT for persistent back pain w/ sciatica for herniated disc

differential diagnosis

■For local syndromes

➣Arthritis, fracture or other bony lesion

■For low back pain

➣Ankylosing spondylitis (young male, chronic symptoms, morn-

ing stiffness)

➣Fracture (trauma history, known or risk for osteoporosis)

➣Septic disc or bone lesion (fever, immunocompromised)

➣Malignancy (older, rest pain, weight loss)

management

What to Do First

■Search for generalized medical illness, history of injury, underlying

articular process

General Measures

■Local ice for acute symptoms, heat for more chronic symptoms

■Range-of-motion exercises, local support (splint, elastic)

■Strengthening exercises during recovery

■Analgesics, NSAIDs

specific therapy

Indications

■Pain interfering w/ function, sleep