Approach to Musculoskeletal Pain Flashcards
Articular vs. nonarticular
Articular comes from within the joint…can be from many different things
Nonarticular from outside the joint
Articular Pain ROM Swelling Others
Constant deep or diffuse…worse with mo[vement
Limited on active and passive
Often prominent
Joint instability, crepitus, popping, clikcing, locking
Nonarticular
Pain
ROM
Swelling
Intermittent localized…only with movement
Limited on active only
Usually minimal
Synovium and synovitis
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
Articular cartialge
Covering the ends of bone to help absorb force and allows smooth motion
Degneration of articular cartilage and menisacal injury
Either signifanct event or result of injury from years of trauam and eventual matrix degradation…primary mech of OA
Meniscal - can be injured
Intra-articular ligaments and sprain/rupture
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
Joint capsule and capsulitis
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)
Dislocation and subluxation
No longer in contact…focal pain at joint without inflammation
Partial contact…focal pain without inflamation
Non-articular characteristics
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
Bursae and bursitis
Connective tissue sac with a potential space filled with synovial fluid…allows motion of one tissue over another
Inflammation of bura
Tendon and extra-art ligament pain
Sprain
Less severe than bone apin…often described as sharp…worse with stretch or movement
Tearing injyr due to stretching
Tendinitis and enthesisi
Inflammation of tendon due to overuse (think rotator cuff from throwing or swimming)
Inflammation of parts that insert into bone (think AI like spondyloarthropathy)
Bone pain and fracture
Deep, dull, constant, progressive and occurs at night
Force overcomes the strength of bone
Osteomyelitis and malignancy
Infection of bone…usually insidous onset
Cancer
Muscle pain and strain
Less intense than bone pai…may have spasms or cramps
Injury due to overuse or excessive force…normally get acute focal pain
Myositis and myalgia
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
INflammatoru
Timing Morning Duration Exam Labs Radio
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
Noninflam
Timing Morning Joint exam Labs Radio
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
ESR
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
CRP
Producd by liver in response to inflam….IL6, IL1 and TNF alpha induce
CRP is much more direct as it peaks 48 horus
Chronic vs acute
Acute less thjan 4 weeks and oftne infection, trauam, or crystal arthropathies
Chronic from arthritis, RA, or another AI joint dz
IMportant other tests to run
Anemia, leukopenia, and thrombocytopenia
Liver and kidney function
ANA
Test is positive in almost every with SLE…great test to exclude SLE when neg
Anti-dsDNA and anti-smith Abs
Specific tests for SLE, but negative does not exclude
Antiribonucleoprotein ABs
Strongly associated with mixed conn tissue dz, but can be positive in SLE
Anti-SSa and anti-SSB antibodies (anti-ro and la)
NOt sensitive or specific enough to really diagnose…but can help with Sjorgens
RF
RF positive not specific for only RA…also associated wiht other AI and HepC
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
Localized and acute
Chronic and liocalized
Non articular
Tendinitis, bursitis, plantar fascitis, fracture, ligament spriand
Osteomyelitis, structural diusorder
Diffuse and acute
SDiffuse and chronic
Non articular pain
Myositis (viral)
Plymyalgia rheumatic, polymyositis/dermatomyositis, fibromyalgai
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
POlymyalagia rhematica
Proximal muscle groups over the age of 50
Inflammatory
May have systemic sx as well
Fibromyalgia
Non inflam widesrpeaad pain under 50 y/o
