Approach to Musculoskeletal Pain Flashcards

1
Q

Articular vs. nonarticular

A

Articular comes from within the joint…can be from many different things

Nonarticular from outside the joint

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2
Q
Articular 
Pain 
ROM 
Swelling 
Others
A

Constant deep or diffuse…worse with mo[vement

Limited on active and passive

Often prominent

Joint instability, crepitus, popping, clikcing, locking

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3
Q

Nonarticular
Pain
ROM
Swelling

A

Intermittent localized…only with movement

Limited on active only

Usually minimal

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4
Q

Synovium and synovitis

A

CT lining inner surface and produces synovial fluid

Inflammation of synovial membrin…results in synovial hypertrophy or collection of fluid which leads to joint swelling…most common in RA

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5
Q

Articular cartialge

A

Covering the ends of bone to help absorb force and allows smooth motion

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6
Q

Degneration of articular cartilage and menisacal injury

A

Either signifanct event or result of injury from years of trauam and eventual matrix degradation…primary mech of OA

Meniscal - can be injured

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7
Q

Intra-articular ligaments and sprain/rupture

A

Dense collagenous that connect bones within the joint capsule…provides stability and ROM

Forces against the joint overload the intra-articular ligament leading to strain or rupture

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8
Q

Joint capsule and capsulitis

A

Envelope of tissues surrounding the joint consisting of innner synovial membrane and outer fibrous

Chornic inflammation of joint cpasule leading to adhesions and fibrosis of the inner synovial layer (frozen shoulder)

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9
Q

Dislocation and subluxation

A

No longer in contact…focal pain at joint without inflammation

Partial contact…focal pain without inflamation

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10
Q

Non-articular characteristics

A

Pain located outside of the joint itself…pain with active rather than passive and ROM can be preserved…tenderness and signs of inflamm away from joint line

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11
Q

Bursae and bursitis

A

Connective tissue sac with a potential space filled with synovial fluid…allows motion of one tissue over another

Inflammation of bura

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12
Q

Tendon and extra-art ligament pain

Sprain

A

Less severe than bone apin…often described as sharp…worse with stretch or movement

Tearing injyr due to stretching

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13
Q

Tendinitis and enthesisi

A

Inflammation of tendon due to overuse (think rotator cuff from throwing or swimming)

Inflammation of parts that insert into bone (think AI like spondyloarthropathy)

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14
Q

Bone pain and fracture

A

Deep, dull, constant, progressive and occurs at night

Force overcomes the strength of bone

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15
Q

Osteomyelitis and malignancy

A

Infection of bone…usually insidous onset

Cancer

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16
Q

Muscle pain and strain

A

Less intense than bone pai…may have spasms or cramps

Injury due to overuse or excessive force…normally get acute focal pain

17
Q

Myositis and myalgia

A

Inflammation of muscle…can be seen afrer viral illness…may have ummune mediated without pain…can cause weakness

Widespread chonric muscle pain without inflammation like in fibromyaglia

18
Q

INflammatoru

Timing
Morning
Duration
Exam
Labs 
Radio
A

Worse after rest and in the morning

MOre than 60 minutes

More acute

Swollen, tender, erythematous, warm

Evleated ESR and CRP

Erosions and joint space narrowing

19
Q

Noninflam

Timing 
Morning
Joint exam
Labs
Radio
A

Worse after activity and worse in the evening

Less than 30 minutes

More chronic

Bony swelling possible with crepitus

Normal ESR and CRP

OSteophytes and space narrowing

20
Q

ESR

A

Measure of aggregation of erythrocytes

Accumulation of positive proteins (in inflalmation) with incresase aggregation

Basically indirct measure of fibrinogen levels

Peak 2 weeks after systemic inflammation and declines in about 2 weeks

21
Q

CRP

A

Producd by liver in response to inflam….IL6, IL1 and TNF alpha induce

CRP is much more direct as it peaks 48 horus

22
Q

Chronic vs acute

A

Acute less thjan 4 weeks and oftne infection, trauam, or crystal arthropathies

Chronic from arthritis, RA, or another AI joint dz

23
Q

IMportant other tests to run

A

Anemia, leukopenia, and thrombocytopenia

Liver and kidney function

24
Q

ANA

A

Test is positive in almost every with SLE…great test to exclude SLE when neg

25
Anti-dsDNA and anti-smith Abs
Specific tests for SLE, but negative does not exclude
26
Antiribonucleoprotein ABs
Strongly associated with mixed conn tissue dz, but can be positive in SLE
27
Anti-SSa and anti-SSB antibodies (anti-ro and la)
NOt sensitive or specific enough to really diagnose...but can help with Sjorgens
28
RF
RF positive not specific for only RA...also associated wiht other AI and HepC
29
joint aspirations and microscopy
WBC more than 2000 with neutrophils is inflammation WBC over 50000 with neutrophil predom could be septic arthritis Cna distinguish between gout and pseudogout
30
Localized and acute Chronic and liocalized Non articular
Tendinitis, bursitis, plantar fascitis, fracture, ligament spriand Osteomyelitis, structural diusorder
31
Diffuse and acute SDiffuse and chronic Non articular pain
Myositis (viral) Plymyalgia rheumatic, polymyositis/dermatomyositis, fibromyalgai
32
Noninflam vs inflam non artciular
Inflam will be worse with movement, have local signs of swelling and redness, and lab signs Non is constant that might be not worse with movement
33
POlymyalagia rhematica
Proximal muscle groups over the age of 50 Inflammatory May have systemic sx as well
34
Fibromyalgia
Non inflam widesrpeaad pain under 50 y/o