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Cuccurullo 3rd Edited > Ch 3 - Rheumatology: Pain and tendon disorders > Flashcards

Ch 3 - Rheumatology: Pain and tendon disorders Flashcards

1
Q

What is fibromyalgia?

A

Diffuse aching stiffness and fatigue with multiple tender points in specific area

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2
Q

Who is affected by fibromyalgia?

A

Females—20 to 60 years old

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3
Q

What can exacerbate fibromyalgia symptoms?

A

– Physical activity
– Inactivity
– Sleep disturbance
– Emotional stress

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4
Q

What can fibromyalgia be associated with?

A

IBS
RA
Lyme
Hyperthyroidism

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5
Q

What is required for the diagnosis of fibromyalgia?

A
  • 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
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6
Q

What are the tender points for fibromyalgia?

A 
Occipital
Lower cervical
Trapezius
Supraspinatus
2nd rib
Lateral epicondyle
Gluteal
Greater trochanter
Knee
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7
Q

What are non-medicine treatments for fibromyalgia?

A
  • Patient education and reassurance
  • Biofeedback, tender point injections
  • Acupuncture
  • Low-impact, graded aerobic exercise
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8
Q

What are FDA approved medications for treatment of fibromyalgia?

A

Pregabalin (Lyrica)
Duloxetine (Cymbalta)
Milnacipran (Savella)

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9
Q

What are non-FDA approved medications for treatment of fibromyalgia?

A

– TCA (amitriptyline, nortriptyline)
– Muscle relaxants (cyclobenzaprine, tizanidine)
– Tramadol

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10
Q

What is myofascial pain syndrome?

A

Local pain and tender points that resolve with local treatment, but may recur

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11
Q

What is chronic fatigue syndrome?

A
  • Disabling fatigue at least 6 months

* Often preceded by a viral syndrome

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12
Q

What are other names for CRPS type I?

A

Reflex sympathetic dystrophy
Sudeck’s atrophy
Algodystrophy
Shoulder hand syndrome

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13
Q

What is the onset of CRPS type I?

A

Occurs after a traumatic injury and without a specific nerve injury

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14
Q

What is CRPS type II?

A

Causalgia

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15
Q

What is the onset of CRPS type II?

A

Seen after a specific nerve injury

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16
Q

What is seen during the acute stage of CRPS?

A

Few weeks to 6 months:
– Allodynia, hyperpathia, hypersensitivity, swelling, and vasomotor changes
– Inc blood flow creating temp and skin-color changes
– Hyperhidrosis

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17
Q

What is seen during the dystrophic stage of CRPS?

A

3 to 6 months:
– Persistent pain, disability, and atrophic skin changes
– Dec blood flow/temp
– Hyperhidrosis

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18
Q

What is seen during the atrophic stage of CRPS?

A

– Atrophy and contractures

– Skin glossy, cool, and dry

19
Q

What is seen on x-ray of CRPS?

A

Sudeck’s atrophy—patchy osteopenia, ground-glass appearance

20
Q

What is seen on triple phase bone scan in CRPS?

A

– First two phases are nonspecific

– Third: enhanced uptake in the periarticular structures

21
Q

What should be advised to patients with CRPS?

A

Continue activities as tolerated to avoid disuse atrophy

22
Q

What procedure can be done for CRPS?

A

Cervical sympathetic ganglia block for UE

Lumbar ganglion block for the LE

23
Q

What surgery can be done for CRPS?

A

Surgical sympathectomy if block is beneficial but transient

24
Q

Where does CRPS typically present in children?

A

Lower extremity

25
Q

Where does CRPS typically present in adults?

A

Upper extremity

26
Q

What is the prognosis of CRPS in children?

A

Good

27
Q

What is the prognosis of CRPS in adults?

A

Poor

28
Q

What tests are used to determine if CRPS is sympathetically mediated?

A
  1. Sympathetic block with local anesthesia
  2. Guanethidine test
  3. Phentolamine test
  4. Ischemia test
29
Q

What is blocked in a sympathetic block test?

A

Stellate ganglion (UE) or the lumbar paravertebral ganglion (LE)

30
Q

What ensures a proper stellate ganglion block?

A 
Ipsilateral Horner’s syndrome
Anhidrosis
Conjunctival injection
Nasal congestion
Vasodilation
Increased skin temperature
31
Q

How is a Guanethidine test performed?

A

Injection of guanethidine into the extremity distal to a suprasystolic cuff

32
Q

What indicates a positive Guanethidine test?

A

Test is positive if the pain is reproduced after injection and is immediately relieved after the cuff is released

33
Q

What is a Phentolamine test?

A

IV phentolamine will reproduce the pain

34
Q

What is an Ischemia test?

A

Inflation of the suprasystolic cuff decreases the pain

35
Q

What is Dupuytren’s contracture?

A

ABN fibrous hyperplasia and contracture of the palmar fascia, causing a flexion contracture at the MCP and PIP joint

36
Q

Who is affected by Dupuytren’s contracture?

A

Men 50-70 yo

37
Q

What is Dupuytren’s contracture associated with?

A

Epilepsy
Pulmonary TB
Alcoholism
DM

38
Q

What digits are most commonly affected by Dupuytren’s contracture?

A

4th and 5th digits

39
Q

What is stenosing flexor tenosynovitis?

A

TENOSYNOVITIS (FIGURE 3–7)

• Thickening of the flexor tendon sheath causes increased friction through normal movement

40
Q

Where can nodules develop in stenosing flexor tenosynovitis?

A

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

41
Q

What happens with finger flexion in stenosing flexor tenosynovitis?

A

Nodule moves proximally, and re-extension is prevented

42
Q

What causes mallet finger?

A

Rupture of the extensor tendon into the distal phalanx secondary to forceful flexion

43
Q

What is the finger position of mallet finger?

A

DIP drops remain in a flexed position and cannot be actively extended

44
Q

What is the treatment of mallet finger?

A

DIP splint immobilizes the distal phalanx in hyperextension

Cuccurullo 3rd Edited (91 decks)

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