Diseases Week 5 Flashcards
Prepatellar buristis
AKA “housemaid’s knees” busitis of prepatellar bursa common in people who work on their knees i.e. roofers, floorers, housemaids
Osgood-Schlatter Syndrome
Tenderness and swelling at the site of the infrapatellar tendon insertion into the tibial tubercle. Common.
Symmetric INFLAMMATORY arthritis w/ insidious (sudden) onset, erosive, chronic progressive, disabling disease. Can have systemic comorbidities: sq nodules, pericarditis, inflammatory eye disease, vasculitis. These are well controlled w/ new RA treatments. Serologies: Positive rheumatoid factor (RF) and anti CCP antibody (ACPA’s) (ACPA is more sensitive and specific), elevated CRP and ESR Prevalence: 1% of adult population. Higher in women, whites, and natives. Age of onset: 30-50 Risk factors: smoking, periodontal disease Clinical presentation: Swollen joints (not hips or DIPS), painful, red, immobile, systemic problems, morning stiffness >1hr. Swelling in > 3 joints, Swelling in hands, Symetric swelling, erosions (late), nodules (late), positive serologies, ulnar drift. Therapy: Patient Ed, PT/OT, Exercise/Rest (exercise when swelling is low; rest when high), NSAIDS, Steroids, DMARD’s (Disease Modifying Anti-Rheumatic Drugs), Biological DMARD’s
Rheumatoid Arthritis
Rheumatoid Arthritis
Symmetric INFLAMMATORY arthritis w/ insidious (sudden) onset, erosive, chronic progressive, disabling disease. Can have systemic comorbidities: sq nodules, pericarditis, inflammatory eye disease, vasculitis. These are well controlled w/ new RA treatments. Serologies: Positive rheumatoid factor (RF) and anti CCP antibody (ACPA’s) (ACPA is more sensitive and specific), elevated CRP and ESR Prevalence: 1% of adult population. Higher in women, whites, and natives. Age of onset: 30-50 Risk factors: smoking, periodontal disease Clinical presentation: Swollen joints (not hips or DIPS), painful, red, immobile, systemic problems, morning stiffness >1hr. Swelling in > 3 joints, Swelling in hands, Symetric swelling, erosions (late), nodules (late), positive serologies, ulnar drift. Therapy: Patient Ed, PT/OT, Exercise/Rest (exercise when swelling is low; rest when high), NSAIDS, Steroids, DMARD’s (Disease Modifying Anti-Rheumatic Drugs), Biological DMARD’s
Hallix rigidis
bone spur on first metatarsal. Causes turf toe like symptoms. Need lateral x-rays.
Description: Inflammatory back pain w/ sudden onset before 40. Duration > 3 months. Pain decreases w/ exercise (vs. other low back pain = opposite) Fusion of spine/ bamboo spine. Sacroiliitis/ fusiton. Notable Back inflexibility M>F Positive HLA B27 (90%)
Ankylosing Spondylitis
Most common benign bone neoplasm in children/young adults.
Osteoid Osteoma
Osteoporosis
A type of osteopenia due to bone atrophy caused by an imbalance in bone remodeling process (overactive osteoclasts). Normal lab values. Often a diagnosis of exclusion. Bone density below 2.5. Decreased trabecular bone. “trivial trauma” can cause fractures: hip, colles, wedge after dowager’s hump. Most common in post-menopausal white women. Treat by proper calcium and vitamin d intake in bone building years (up to 30). Weight bearing exercise! Two types: Type 1 = postmenopausal Type 2 = Senile (both sexes) Associations: Excess steroids, hyper parathyroidism, hyperthyroidism, poor nutrition/malabsorbtion, immobilization, hypogonadism. Kidney problems, diminished PTH secretion, increased oc, decreased ob (Be sure to screen treatable causes strictly!) Treatment: bisphosphonates –> decrease oc activity
Overuse injury that is very painful of the plantar fascia. Self healing, long term. Diagnose by pressing anterior calcaneus.
Plantar Fasciitis
Stages: I Mild AC separation II AC disruption III AC and CC disruption
Shoulder seperation
most common primary malignant neoplasm of children/ young adults Destructive neoplasm favoring metaphyseal regions of large long bones. Multiple variants : high grades have high mortality May be linked to paget’s, irradiation, bone infarcts, and retinoblastoma gene defect.
Osteosarcoma / Osteogenic Sarcoma
Plantar Fasciitis
Overuse injury that is very painful of the plantar fascia. Self healing, long term. Diagnose by pressing anterior calcaneus.
Autoimmune (Type III hypersensitivity). Production of antibodies to nucleus. Positive ANA in 95% of pts. (Positive ANA doesn’t mean lupus!!!, but negative likely means no lupus.) Peak incidence: 15-40. Females. Blacks. Clinical symptoms: DIVERSE. Acronym = I’M DAMN SMART: Immunoglobulin, Malar (butterfly) rash, Discoid rash, Ana, Mucositis, Neurologic disorders, Serositis, Hematologic disorders, Arthritis, Renal disorders, Photosensitivity. Tests: positive ANA (sensitive not specific) positive ds DNA ( very specific poor prognosis), positive smith (specific and not prognostic), positive antihistone (drug induced lupus) Therapy: patient ed, NSAIDs, steroids, hydroxychloroquine, methotrexate, Avoid TNF biologics
Systemic Lupus Erythematosus
Presentation: bruising, tenderness, palpable defect, painful limp, weak plantar flexion. Risk factors: Age, previous injury, sedentary, comorbidities, certain activities (tennis, jumping) Treatment: Acute (1-10 days): PRICEMM plus knee brace to limit extension. Subacute (up to 10 days) : ROM exercise, Estim, Ice/heat. Initiate cross training. Remodeling phase (up to 3-4 months) Isotonic then eccentric exercise. Consider brace/sleeve.
Gastrocnemius injuries
Most common are big football players and out of shape older pts. playing explosive sports. Test by squeezing gastroc and observing plantarflexion. Palpation. Partial tears will heal, full tears need surgery.
Torn Achilles Tedon
Ankle inversion sprain
Presentation: swollen, bruised. Pain w/ weight bearing, tendor at injured ligament/tendon. Positive anterior ankle drawer. Anterior Talo-Fibular ligament most common. Calacaneofibular ligament next then posterior talofibular. Fibularis/Peroneous tendons often involved. Treatment: Grade 1/2 Brace, ROM, Strengthening, Proprioception (PT) Grade 3: Consider surgery. Follow Ottowa Ankle rules: get x ray if pain over: posterior tip of medial/lateral malleolus, base of 5th metatarsal, or navicular bone. Be sure there isn’t tibio=talar seperation on x-ray.
Osteromalacia
Decreased bone mineralization w/ excess osteiod. Due to interference w/ calcium, phoshate, or vit. D. Osteopenic Childhood = rickets (widened distorted growth plates, bowed legs, fractures) Intestinal malabsorbtion is the most common cause of Vit. D defeciency in USA –> Celiac’s disease! Can be caused by renal vit. d metab prob too. BioChem profile: high ALP, low Ca or P, Increased PTH, Decrease Vit. D
Decreased bone mineralization w/ excess osteiod. Due to interference w/ calcium, phoshate, or vit. D. Osteopenic Childhood = rickets (widened distorted growth plates, bowed legs, fractures) Intestinal malabsorbtion is the most common cause of Vit. D defeciency in USA –> Celiac’s disease! Can be caused by renal vit. d metab prob too. BioChem profile: high ALP, low Ca or P, Increased PTH, Decrease Vit. D
Osteromalacia
JIA Systemic Onset
Boys = Girls; 1-6yrs old. Symptoms: daily spiking fevers accompanied by an evanescent (quick clearing)salmon colored rash. Systemic features including: lymphadenopaty, hepatosplenomegaly, pericardial/pleural effusions, fatigue, muscle atrophy, weight loss, leukocytosis, anemia –> leukemia is main differential. RA and ANA negative. 20-50% ultimately have severe, chronic arthritis.
PCL prevents the femur from sliding Anterior on tibia and hyperflexion of the knee. Main stabilizer of femur when walking downhill. Positive posterior drawer test. Toughest to find clinically. Remember tendons named for where they attach on tibia. Use finger cross and hold over knees to remember orientation. Index finger is PCL. Inside capsule, but outside synovial membrane
Torn PCL
Tenosynovitis of APL and EPB. Test w/ Finkelstein’s test.
De Quervain’s Tenosynovitis
Psoriatic Arthritis.
7-10% of psoriasis (westra said 33%?). Skin and nail pits, inflammatory eye dises, peripheral arthritis - DIPs, Dactylitis/sausage toes, achilles tendinitis, sacroiliitis, arthritis mutilans (very aggressive and mutitlating form of arthritis) Low % positive HLA B27
Tuberculous osteomyelitis
Secondary to hematogenous spread from lungs. Prefers spine (Pott’s disease) and long bones.
Positive Varus test.
Torn LCL