Rheumatology & Orthopedics Exam Review: Musculoskeletal Conditions for Physician Assistants

Prepare for your physician assistant certification exam with this focused review of musculoskeletal, rheumatologic, and orthopedic conditions from A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants by Claire Babcock O'Connell and Thea Cogan-Drew. This summary covers key concepts, diagnoses, and management strategies for common arthritic diseases, bone disorders, fractures, and regional musculoskeletal syndromes.

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Arthritis & Rheumatologic Conditions

• Osteoarthritis (OA): Degenerative disease of weight-bearing joints, presenting with pain, stiffness, and reduced range of motion. Managed with lifestyle changes, NSAIDs, steroid injections, and surgery.
• Rheumatoid Arthritis (RA): Autoimmune disorder with chronic synovitis and joint deformity; symmetric joint involvement and extra-articular features. Treat with DMARDs, biologics, and rehab.
• Gout & Pseudogout: Crystal-induced arthritis—gout (urate crystals, great toe), pseudogout (calcium pyrophosphate, knee). Treated with NSAIDs, colchicine, steroids.
• Systemic Lupus Erythematosus (SLE): Multisystem autoimmune disease, classic malar rash, arthritis, renal involvement. Managed with antimalarials, corticosteroids, immunosuppressants.
• Fibromyalgia: Chronic widespread pain, fatigue, tender points. Management includes exercise, antidepressants, CBT.

Bone & Joint Disorders

• Osteoporosis: Low bone density, high fracture risk. Diagnosed by DEXA scan. Treat with calcium, vitamin D, bisphosphonates.
• Tendinitis & Bursitis: Inflammation causing pain and movement restriction; rest, ice, NSAIDs, and sometimes injections help.
• Osteomyelitis: Infection of bone (often Staph aureus); requires prolonged antibiotics, possible surgery.

Fractures, Dislocations, Sprains & Strains

• Fractures: Treated with immobilization, pain control, surgery as needed. Pediatric fractures (greenstick, torus) need specific management.
• Dislocations & Subluxations: Common at shoulder, hip, patella—require reduction, immobilization, and rehab.
• Strains & Sprains: Strains = muscle/tendon; sprains = ligament. Treat with RICE and gradual activity resumption.

Regional Musculoskeletal Disorders

• Upper Extremity: Rotator cuff injuries, carpal tunnel syndrome, epicondylitis, and fractures (clavicle, humerus, wrist).
• Spine: Back pain, herniated discs, sciatica, spinal stenosis, scoliosis, ankylosing spondylitis.
• Lower Extremity: Hip, knee, and foot conditions: avascular necrosis, meniscal injuries, Osgood-Schlatter disease, plantar fasciitis.

Practice Questions & Clinical Pearls

• The chapter concludes with board-style practice questions and detailed explanations to reinforce exam knowledge and clinical reasoning.

Glossary of Key Terms

• Arthrocentesis: Joint fluid aspiration for diagnosis.
• DMARDs: Disease-Modifying Antirheumatic Drugs for RA and other rheumatologic diseases.
• Pseudogout: Calcium pyrophosphate crystal-induced arthritis.
• Osteophytes: Bony spurs in osteoarthritis.
• RICE: Rest, ice, compression, elevation—initial management for strains/sprains.
• ROM: Range of Motion—vital for musculoskeletal assessment.

Conclusion: Key Takeaways for the Musculoskeletal Exam

Mastering the core concepts in rheumatology and orthopedics is essential for success on the physician assistant certification exam and effective clinical practice. Review the common presentations, diagnostic criteria, and management strategies for arthritis, bone disease, fractures, and regional musculoskeletal conditions.

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