ch 16 Common MK problems Flashcards
when conducting an orthopedic exam, assess..
the entire person not just the MK problem
3 ortho q’s to ask…
- is the pt otherwise well? if no, condition limited to bone and/or joints (OA, osteoporosis)
- systemic systems and signs (fever, weight loss, anemia, rash, joint swelling)? yes think RA, lupus, PMR etc
- pt’s risk factors/predisposing factors? trauma, age, gender, obesity, autoimmune (RA), job (OA), sports, meds
monoarticular pain
affecting 1 joint
2 most common places to have gout
-metacarpophalangeal joint of
the great toe
-wrist
distal from body since uric acid need lower temp to ‘settle’ compared to internal body
when to start preventative therapy for gout with allopurinol?
6 months AFTER tx of acute gouty attack
avoid what type of foods to prevent future gout attacks?
purine rich foods = forms uric acid when metabolized like organ meats
-seafood
-alcohol
-fructose
risk factors for gout
-Obesity
-diabetes mellitus
-family history of gout
thiazide, niacin, aspirin, alcohol use, purine-rich diet (organ meats, seafood (sardines and anchovies, spinach, oatmeal),
-CKD(offloading uric acid isn’t as sufficient), renal failure
gout causes
-10% uric acid overproduction
-90% urate UNDER excretion esp with risk factors
prevention of acute gouty athritis attack (urate lowering therapy)
1st line: Allopurinol (Aloprim) - xanthine oxidase inhibitor (XOI) therapy OR
febuxostat (Uloric)
start 6 months after start of NSAID/colchicine treatment
knee pain after a twisting-type injury; has reduced ROM and reports the knee locks
& what test?
meniscus tear
Mc Murray test
history of multiple ankle sprains; feels ankle rolls inward more easily, ankle pain
& what test?
ankle instability
talar tilt
repeititve hand motions, who constantly uses a soldering iron throughout day; feels numbness,
tingling, weakness in dominant hand
& what test?
carpel tunnel syndrome (hand repeititve movements)
Tinel’s sign
18 year old soccer player experiences
sudden knee pain and swelling after changing direction rapidly, heard a “popping” noise, has reduced ROM
& what test?
ACL tear
lachmman test
A 62-year-old with history of spondylolisthesis and experiences low back pain that radiates to the legs and feet, with numbness and muscle
weakness
& what test?
lumbar nerve root compression/lumbar spinal stenosis (lower back pain)
straight leg raise test
A 32-year-old with neck pain following a motor vehicle accident; tingling and numbness runs down shoulder, arm, and to the thumb
& what test?
cervical nerve root compression
Splurling test
A 14-year-old baseball pitcher complaining of
pain and swelling on his throwing arm, clicking
sound heard when arm is raised, pain triggered
by raising or lowering arm
& what test?
rotator cuff evaluation
drop arm test
A 44-year-old drummer who complains of pain
and swelling at base of thumb, feels a “sticking”
sensation when trying to move thumb
& what test?
De quervains tenosynovitis
Finkelstein test
differential diagnosises of MK depends on
if it’s systemic issue or localized issue
-pay attention if the joints are affected are smaller joints (hands, wrist) or big joints (shoulders, hips)
rheumatoid arthritis vs polymyalgia rheumatica
both elevate ESR
RA affects smaller joints (fingers, wrists)
PMR affects larger joints (hips, shoulders)
polymyalgia rheumatica (PMR) etiology
> 50 years (white)
-unknown etiology
PMR clinical presentation
aches in shoulder (1st sx seen), neck, upper arms, lower back, hips, thighs
-worse in morning, better during day
PMR intervention
50% will have giant cell arteriitis so get rid of inflammation! give low dose corticosteroids (10-15 mg QD prednisone) until sx’s are relieved (2-3 wks) then taper dose to find lowest dose to suppress sx
tx up to 2-3 years
supplement with Ca & Vitamin D
-NSAIDS
PMR diagnosis
-no specific test
-CRP, ESR are elevated = inflammation
-MRI, U/S = inflammation
-CBC = mild anemia of chronic disease
RA, lupus, or both?
More common in women?
An autoimmune disorder?
Classic presentation of fever, joint pain, and
rash?
Anemia of chronic disease common at
diagnosis?
Elevation in ESR and CRP?
Treated with biologic and/or non-biologic
DMARDs?
Can present with subcutaneous nodules?
More common in women: both
An autoimmune disorder: both
Classic presentation of fever, joint pain, and butterfly rash: lupus
Anemia of chronic disease common at diagnosis: both (multip system and inflammatory condition)
Elevation in ESR and CRP: both
Treated with biologic and/or non-biologic
DMARDs: both
Can present with subcutaneous nodules: RA
osgood-schlatter disease affects mostly
adolescent during growth spurts in running/jumping sports
pain and/or swelling of knees, ankles, heels, toes or fingers
low back pain
conjunctivitis
urinary problems can also be present
reactive arthritis
reactive arthritis etiology
painful inflammatory arthritis seen days or weeks after acute bacterial diarrhea or STI
most common in men 20-50 years old