MSK

#Rhabdomyolysis 

CK level 5x ULN in setting of recent exercise 

High risk markers: CK>20k, potential compartment syndrome, AKI per KDIGO criteria, metabolic abnormality (hyperK, hyperphos, acidemia), sickle cell trait carrier, limited followup 

Patients without the above can generally be treated as outpatient with PO hydration, limited physical activity, and follow up q24 hours 

McMahon score:

Avoid nephrotoxins; discontinue possible inciting medications

#Lower limb amputation 

5 stages: pre-op, post-op, rehab, prosthetic training, long term follow-up 

-many patients require 12-18 months 

#Lower back pain 

OLDCARTS:

Better or worse with use?  (inflammatory)

Acute = <6 weeks, chronic = >3 months

Red flag symptoms (if positive, in BOLD): recent significant trauma, mild trauma at age > 50 years, unexplained weight loss, recent infection, unexplained fever, immunosuppression, previous or current cancer, intravenous drug use, osteoporosis, chronic corticosteroid use, focal neurological deficit, unable to control bladder or bowels, saddle anesthesia

Straight leg test?

Pes anserine bursitis is worst at night; reproducible  

At sleep, pes anserine worse on sleeping side due to weight of knees 

Can treat with steroid injection at site 

Meniscal tear: lock, pain, click 

McMurray test: torque Bent knee to catch cartilage 

Get MRI 

Greater trochanteric bursitis 

Treat with steroids injected 

Does not radiate to the groin 

Treatment: stretching, heat, NSAIDs 

Hip osteonecrosis 

Worse with weight bearing, better with rest 

If early, X-ray doesn’t catch it, needs MRI 

Carpal tunnel: 

Splint at night and when doing agitating exercise 

Steroid injection if not better 

Carpal tunnel release if not better 

EMG if weakness or palmar atrophy