Ch 3 - Rheumatology: Pain and tendon disorders Flashcards
What is fibromyalgia?
Diffuse aching stiffness and fatigue with multiple tender points in specific area
Who is affected by fibromyalgia?
Females—20 to 60 years old
What can exacerbate fibromyalgia symptoms?
– Physical activity
– Inactivity
– Sleep disturbance
– Emotional stress
What can fibromyalgia be associated with?
IBS
RA
Lyme
Hyperthyroidism
What is required for the diagnosis of fibromyalgia?
- Widespread pain in all four body quadrants
- Sx for at least 3 mo
- No other medical disorder to explain the pain
- 11 of 18 Tender points
What are the tender points for fibromyalgia?
Occipital Lower cervical Trapezius Supraspinatus 2nd rib Lateral epicondyle Gluteal Greater trochanter Knee
What are non-medicine treatments for fibromyalgia?
- Patient education and reassurance
- Biofeedback, tender point injections
- Acupuncture
- Low-impact, graded aerobic exercise
What are FDA approved medications for treatment of fibromyalgia?
Pregabalin (Lyrica)
Duloxetine (Cymbalta)
Milnacipran (Savella)
What are non-FDA approved medications for treatment of fibromyalgia?
– TCA (amitriptyline, nortriptyline)
– Muscle relaxants (cyclobenzaprine, tizanidine)
– Tramadol
What is myofascial pain syndrome?
Local pain and tender points that resolve with local treatment, but may recur
What is chronic fatigue syndrome?
- Disabling fatigue at least 6 months
* Often preceded by a viral syndrome
What are other names for CRPS type I?
Reflex sympathetic dystrophy
Sudeck’s atrophy
Algodystrophy
Shoulder hand syndrome
What is the onset of CRPS type I?
Occurs after a traumatic injury and without a specific nerve injury
What is CRPS type II?
Causalgia
What is the onset of CRPS type II?
Seen after a specific nerve injury
What is seen during the acute stage of CRPS?
Few weeks to 6 months:
– Allodynia, hyperpathia, hypersensitivity, swelling, and vasomotor changes
– Inc blood flow creating temp and skin-color changes
– Hyperhidrosis
What is seen during the dystrophic stage of CRPS?
3 to 6 months:
– Persistent pain, disability, and atrophic skin changes
– Dec blood flow/temp
– Hyperhidrosis
What is seen during the atrophic stage of CRPS?
– Atrophy and contractures
– Skin glossy, cool, and dry
What is seen on x-ray of CRPS?
Sudeck’s atrophy—patchy osteopenia, ground-glass appearance
What is seen on triple phase bone scan in CRPS?
– First two phases are nonspecific
– Third: enhanced uptake in the periarticular structures
What should be advised to patients with CRPS?
Continue activities as tolerated to avoid disuse atrophy
What procedure can be done for CRPS?
Cervical sympathetic ganglia block for UE
Lumbar ganglion block for the LE
What surgery can be done for CRPS?
Surgical sympathectomy if block is beneficial but transient
Where does CRPS typically present in children?
Lower extremity
Where does CRPS typically present in adults?
Upper extremity
What is the prognosis of CRPS in children?
Good
What is the prognosis of CRPS in adults?
Poor
What tests are used to determine if CRPS is sympathetically mediated?
- Sympathetic block with local anesthesia
- Guanethidine test
- Phentolamine test
- Ischemia test
What is blocked in a sympathetic block test?
Stellate ganglion (UE) or the lumbar paravertebral ganglion (LE)
What ensures a proper stellate ganglion block?
Ipsilateral Horner’s syndrome Anhidrosis Conjunctival injection Nasal congestion Vasodilation Increased skin temperature
How is a Guanethidine test performed?
Injection of guanethidine into the extremity distal to a suprasystolic cuff
What indicates a positive Guanethidine test?
Test is positive if the pain is reproduced after injection and is immediately relieved after the cuff is released
What is a Phentolamine test?
IV phentolamine will reproduce the pain
What is an Ischemia test?
Inflation of the suprasystolic cuff decreases the pain
What is Dupuytren’s contracture?
ABN fibrous hyperplasia and contracture of the palmar fascia, causing a flexion contracture at the MCP and PIP joint
Who is affected by Dupuytren’s contracture?
Men 50-70 yo
What is Dupuytren’s contracture associated with?
Epilepsy
Pulmonary TB
Alcoholism
DM
What digits are most commonly affected by Dupuytren’s contracture?
4th and 5th digits
What is stenosing flexor tenosynovitis?
TENOSYNOVITIS (FIGURE 3–7)
• Thickening of the flexor tendon sheath causes increased friction through normal movement
Where can nodules develop in stenosing flexor tenosynovitis?
A nodule in the tendon sheath may develop, causing the tendon to “catch” at the A1 pulley system and not glide through, limiting finger movement
What happens with finger flexion in stenosing flexor tenosynovitis?
Nodule moves proximally, and re-extension is prevented
What causes mallet finger?
Rupture of the extensor tendon into the distal phalanx secondary to forceful flexion
What is the finger position of mallet finger?
DIP drops remain in a flexed position and cannot be actively extended
What is the treatment of mallet finger?
DIP splint immobilizes the distal phalanx in hyperextension
