ECR Joint Pain Flashcards
What is the process of RA
inflammation of synovial membranes, secondary erosion of adjacent cartilage and bone, damage to ligament and tendons
What are common locations of RA
PIP, MCP joints, feet (metatarsophlangeal joints),
wrists, knees, elbows, angles
What is the pattern of spread for RA
symetrically additive
progreses to other joings while peristing in initial ones
What is the onset of RA
Usually insidiuous
What is the progression and duration of RA?
Often CHRONIC, with remissions and exacerbations
Is tehre swelling in RA?
frequent swelling of synovial tissue in joints or tendon sheats; also subuctaneous nodules
Is there redness, warmth, and tenderness in RA?
tender, often warm, but seldom red
Is there stiffness in RA
prominent, often for an hour or more int eh mornings, also after inactivity
limited ROM in RA?
often develops
Generalized symtoms of RA
low fever
weakness, fatigue, weight loss
process of osteoarthritis (degenerative disc disease)
Degeneration and progressive loss of CARTLAGE within teh joints
damage to underlying bone, formation of new bone at the margins of the cartilage
common locations of osteoarthritis
usually DIP, sometimes PIP, knees, hips, hands, ccervical and lumbar spine, and wrists (firstcarpometacarpal joint); also joints previously injured or diseased
Pattern of spread for osteoarthritis
Additive, however only ONE JOINT invovled (not symmetrical)
Onset osteoarth
usually insiduous
progression and duration of osteoarthritis
slowly progressive, with temp exacerabtiosn after periods of overuse
Swelling in osteoarthritis?
small effusions in the joints may e present, esp in the knees’ also bony enlargement
Redness, warmth, tenderness in osteoarth?
possible tender, seldom warm and rarely red
Stiffness in osteoarthitis?
frequent but brief (10-15 mins); in the morning or after inactivity
Limited ROM in osteoarthritis?
often develops
Generalized symptoms of osteoarthriis
usually absent
Process of Acute Gout
inflammatory reaction to microcystals of sodium urate
Common locatios of acute gout
Base of the big toe (1st metatarsophalangeal joint) the instep or dorsa of feet, ankels, knees, and elbows
Pattern of spread for acute gout
Early attacks usually confined to one joint
Onset of acute gout
Sudden, often at night, often after injury, surgery, fasting, or excesive food or alcohol intake
progression and duration of acute gout
Occasioanl isolated attaks lasing days to two weeks; may get more frequent and severe with perissitn gysmptms
Is there swelling associated with gouty arthritiis (acute)
present,withtina nd around the involved joint
Warmth, redness, endernes acute gout
exquisiley tender, hot, and red
acute gout stiffness?
not evident
acute gout limitation of motion?
motion is limited primarly by pain
generalized symptoms of acute gout?
fever may be present
Chronic Tophaceous Gout
Multiple local accumulations of sodium urate in teh joints and other tissues, with or wihtout inflammation
Location of Tophaceous gout
Feet, ankels, wrists, fingers, and elbows
Pattern of spread of tophaceous gout
Additive, not so symmetric as RA
Onset of Toph Gout
gradual develpmetn of chronicity with repeated attacks
generalized symptoms of toph gout
possibly fever; patient may also dvelop sysmptoms of renal failture and renal stones
Polymyalgia Rhematica proces
disease of unclear etiiology >50 , espe in women; may be associated with giant cell arterititis
Common location of polymyalgia rheumatica
muscles of hip girdle, and should girdle
symmetric
Onset of PR
Insiduous or abrupt, even appearing overnight
Progression and duration or PR
chronic bu ultimately self-limiting
stffness in PR
prominent, esp int eh morning
Generalized symptoms of PR
Malaise, sense of depression, possible anorexia, weight loss adn fever, but no true weakness
Fibroymyalgia syndrome process
widespread MC pain and tender points. May accompany other diseases. Mechanisms unclear
Comon location of fibro
all over but esp in neck, shoulder,shands, low back and knees
Pattern of spread of fibro
shifts unpredictabley or worsens in response to immobility, execessive use, or chilling
stiffness with fibro?
present, esp in teh morning
Limitation of motion with fibro
Absent thoguht stiffness i sgreater in extremes of movemnt
generalized symptoms of fibro
disturbance of sleep, usually assocaited ith morning fatigue
What are causes of painful shoulder (7)
rotator cuff tendinitis rotator cuff tears Calcific tenditinits bicipital tendinitis adhesive capuslitis (frozen shoulder) acromioclaviclualr arthritis anterior dislocation of humerus
Rotator cuff tendinitis
repeated shoulder motion, as in throwing or swimming, can cause edema and hemorrhage followed by inflammatin, most commoly involveing supraspinatus tendon
sympsoms of rotator cuff tendinitis
patients report sharp catches of pain, grating, and weakenss when lifting
when supraspinatus tendon is invovled, tenderness is maximal just below the tip of the acromion
rotator cuff tears cause
when arm is raised, in forward flexion, rotator cuff may impinge against the unersurface of the acromion and the coracoacromial ligament. injury from fall or repeated impingement ay weaken the rotator cuff, causing a partial or repeated impingment usualy after age 40
symptoms of rotator cuff tear
weakness, atrophy, and infraspinatorus muscles, pain and tendernuess
In complete tera of supraspinaturs tendon, active abduction and forward flexion at the glenohumeral joing are severely impaired, producing a characteristic shrugging of shoulder and positieve “drop arm” test
what is bicipital tendinitis?
inflammation of the long head of the biceps tendon sheath causes anterior shoulder pain resesmbling and often coexisint giwht rotator cuff tendinitis
How do you separate biciptial tendinitis from supraspinatus tendinitis?
externally rotate and abduct arm `
Adhesive Capsulitis (frozen shoulder)
adhesive, capsulitis refers to fibrosis of glenohumeral joint capsule, manifested by diffuse, dull, aching pain in the shoulder and progressive restriction of active and apssive range of motion, but usually no localized tenderness
condition is usually unilaterla and cocurs in peopel aged 50-70
there is often a painful disorder of teh shoulder or another condition (such as MI) that has decresed shoulder oments
course is chronic lasting months to years. The disorder may resolve spontaneously, at least partilaly
Acromioclavicular arthritis
uncommon, susually arising from direct injury to the shoulder girdle wth resulting degeneratie changes
what is painful motion in AC arthritis?
glenohumeral joint otion is not painful, but movement of hte scapula, as in shoulder shrugging is painful
Anterior Dislcoation of the Humerus
positive apprehension sign
What are causes of swollen or tender elbows? (4)
olecranon bursitis
arthritis of the elbow
rheumatoid nodules
epicondylitis
What is olecranon bursitits
swelling and inflammation of the olecranon bursa may result from trauma or may be associated with rheumatoid or gouty arthritis
swelling is superficial to olecranon
what is arhtritis of the elbow
synovial inflammation or fluid is felt best in teh grooves between the olecranon process and the epicondyles on eitehr side.
palpate for boggy, soft, or fluctuant swelling and for tenderness
what are rheumatoid nodules
sucutaneous nodules may develop at pressure points along the extensor surface of the ulna in patients with rheumatoid arthritis or acute rheumatic fever
they are firm and nontender, and are not attached to teh overlying skin
they may or may not be atttacheds to udnerlyign periosteum.
they may dvelop in teh area of the olecranon bursa, but often occur more distally
What is lateral epicodnylitis>
how to test for it
Tennis elbow!!
follows repetitive extension of wrist or pronatino-supination of the forearm.
Pain and tenderness develop 1 cm distal to the lateral epicondyle and possibly in the extensor muscle close to it
when patient tries to extend the wrist against resistance, pain increaeses
what is medial epicondylitis
pitcher’s, golfer’s, or Little League elbow
follows repetitive wrist flexion , as in throwing
tenderness is maximial just lateral and distal to teh medial epicondyle.
Wrist felxion against resistance incerases the pain .
what are the four types of arthritis in the hand
Acute rheumatoid arthritis
Chronic Rheumatoid Arthritis
Osteoarthritis (Degenerative Joint Disease)
Chronic Tophaceous Gout
What is Acute RA
tender, painful, stiff joints in RA, usually iwth SYMMETRIC involvement on both sides of teh body.
The PIP , MCP, and wrist joints are the most frequently affected. Fusiform or SPINDLE SHAPED SWELLING of the PIP joints in acute disease
What is Chronic RA
swellign and thickenign in MCP and PIP joints
fingers deviate towards ulnar side
interosseous uscle satrophy
fingers show
SWAN NECK derformaties (hyperextension of the PIP with fixed flexion onf the DIP)
BOUTONNIERE DEFORMITY- persistent flexion of PIP with hypextension of DIP
Rheumatoid nodules
Osteoarthritis in the hands
HEBERDEN’s NODES on dorsolateral aspects of DIP from bony overgrowth of osteoarthritis
usually hard and painelss, they affect middle-aged or elderly
often ass with arthritic changes in other joints
flexion and deviation deformities may develop.
Bouchard’s nodes of PIP are less common,
MCP are spared
Radial deviation of distal phalanx
Herberden’s node
ont eh dorsolateral aspect of DIP from bony overgrowth of OSTEOARTHRITIS
hard and paintless, affectmiddle-aged or elderly, often associated with arthritic changes in other joints
Flexion and deviation deformities may develop
Bouchard’s Nodes
on PIP are less common
MCP are spared
Chronic Tophaceous Gout
deformities of long-standing chronic tophaceous gout can mimic rheumatoid arthritis and osteoarthritis
joint involvement isn’t as symmetric as rheumatoid arthritis ; acute inflammation may be present
Knobby swelligna roudn the joint ulcerate and disarchge white chalklike urates
What is the first joint involved in acute gouty arthritis
The Metatarsalphalangeal (MTP) joint of the great toe
acute gouty arhtritis
characterized by a very painful and tender, hot, dusky red swelling that extends beyond the margin of the joint
easily mistaken for CELLULITIS
acute gout may also inovle the dorsu of the foot
Flat feet
signs of flat feed apparent only when patient stands, or they ay become permenent. THe longitudinal arch flattens so tha the sole approaches or touches the floor. The normal concavity on the medial side of the foot becoms CONVEX. Tenderness may be present from teh medial malleolus down along the medial-plantar surface of the foot. Sweelling may develop anterior to teh malleoli. Inspec shoes for excess wear on teh inner sides of the soles and heels
What is Hallux Valgus
A bunion is when your big toe points toward the second toe. This causes a bump to appear on the outside edge of your toe.
The great tow is abnormally abducted in relaionship to the first metatarsal, which itself is deviated medially. The head of the first metatarsal may enlarge on its medial side, and a bursa may form at teh pressure point. The bursa may become inflamed
What is Morton’s Neuroma
Tenderness over the plantar surface, third and 4th metatarsal heads, from probable ENTRAPMENT OF MEDIAL AND LATERAL PLANTAR NERVES. Symptoms inclue hyperthesia, numbness, aching, and burning fro the metarsal heads into the third and fourth toes
where is there tenderness with FLAT FEET. Where is there swelling
tenderness from medial malleolus down along the medial-plantar surface of foot
Swelling may develop anterior to the malleoli
What are symptoms of Morton’s Neuroma
Hyperestheisa, numbness, aching, and burnign from teh metatarsal heads into teh 3rd and 4h toes
What is Ingrown toenail
sharp edge of toenail may dig into and injure the lateral nail fold, resulting in inflammation and infection
what are signs of ingrown toenail
tender, reddened, overhanging nail fold, sometimes with granulation tissue and purulent discharge, results . Great toe is most often affected
What is Hammer Toe?
most commonly invovling the second toe, a hammer toe is characterized by HYPEREXTENSION AT TEH METATARSOPHALANGEAL JOINT with FLEXION at teh PIP joint. A corn frequently develops at pressure point over PIP
What is a corn
Painful conical thickening of skin that results from recurrent prssure on normally thin skin . Apex of cone points inward sand causes pain
Where do corns characterisically occur
occur over bony prominences such as 5th toe. When located in moist areas such as pressure points between 4th and 5th toes , they are called SOFT CORNS
What is a Callus ?
like a corn, a callus is an area of grealty thickened skin that develops in a region of recurrent pressure. Unlike a corn, callus invovles skin that is normally thick, sucha s the sole, and is suually painless.
What do you suspect if a callus is painful
underlying plantar wart
What is a Plantar Wart
is a common wart, VERRUCA VULGARIS, located in the thickened skin of the sole. It may look lik ea callus or even be covered by one. Small dark pots that give a stippled appearance to a wart.
Normal skin lines stop at the wart’s edge
Neuropathic ulcer
When pain sensation is diminished or absent, as in diabetic neuropahty, neuropathic ulcers ay develop at pressure poings on teh feet. Although often deep, infected, and indolent, theya r painless. Results from chronic pressure
What do you suspect if a callus is painful
underlying plantar wart
What is a Plantar Wart
is a common wart, VERRUCA VULGARIS, located in the thickened skin of the sole. It may look lik ea callus or even be covered by one. Small dark pots that give a stippled appearance to a wart.
Normal skin lines stop at the wart’s edge
Neuropathic ulcer
When pain sensation is diminished or absent, as in diabetic neuropahty, neuropathic ulcers ay develop at pressure poings on teh feet. Although often deep, infected, and indolent, theya r painless. Results from chornic pressure
