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ECR 2012 > ECR Joint Pain > Flashcards

ECR Joint Pain Flashcards

1
Q

What is the process of RA

A

inflammation of synovial membranes, secondary erosion of adjacent cartilage and bone, damage to ligament and tendons

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2
Q

What are common locations of RA

A

PIP, MCP joints, feet (metatarsophlangeal joints),

wrists, knees, elbows, angles

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3
Q

What is the pattern of spread for RA

A

symetrically additive

progreses to other joings while peristing in initial ones

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4
Q

What is the onset of RA

A

Usually insidiuous

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5
Q

What is the progression and duration of RA?

A

Often CHRONIC, with remissions and exacerbations

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6
Q

Is tehre swelling in RA?

A

frequent swelling of synovial tissue in joints or tendon sheats; also subuctaneous nodules

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7
Q

Is there redness, warmth, and tenderness in RA?

A

tender, often warm, but seldom red

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8
Q

Is there stiffness in RA

A

prominent, often for an hour or more int eh mornings, also after inactivity

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9
Q

limited ROM in RA?

A

often develops

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10
Q

Generalized symtoms of RA

A

low fever

weakness, fatigue, weight loss

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11
Q

process of osteoarthritis (degenerative disc disease)

A

Degeneration and progressive loss of CARTLAGE within teh joints
damage to underlying bone, formation of new bone at the margins of the cartilage

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12
Q

common locations of osteoarthritis

A

usually DIP, sometimes PIP, knees, hips, hands, ccervical and lumbar spine, and wrists (firstcarpometacarpal joint); also joints previously injured or diseased

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13
Q

Pattern of spread for osteoarthritis

A

Additive, however only ONE JOINT invovled (not symmetrical)

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14
Q

Onset osteoarth

A

usually insiduous

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15
Q

progression and duration of osteoarthritis

A

slowly progressive, with temp exacerabtiosn after periods of overuse

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16
Q

Swelling in osteoarthritis?

A

small effusions in the joints may e present, esp in the knees’ also bony enlargement

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17
Q

Redness, warmth, tenderness in osteoarth?

A

possible tender, seldom warm and rarely red

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18
Q

Stiffness in osteoarthitis?

A

frequent but brief (10-15 mins); in the morning or after inactivity

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19
Q

Limited ROM in osteoarthritis?

A

often develops

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20
Q

Generalized symptoms of osteoarthriis

A

usually absent

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21
Q

Process of Acute Gout

A

inflammatory reaction to microcystals of sodium urate

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22
Q

Common locatios of acute gout

A

Base of the big toe (1st metatarsophalangeal joint) the instep or dorsa of feet, ankels, knees, and elbows

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23
Q

Pattern of spread for acute gout

A

Early attacks usually confined to one joint

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24
Q

Onset of acute gout

A

Sudden, often at night, often after injury, surgery, fasting, or excesive food or alcohol intake

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25
Q

progression and duration of acute gout

A

Occasioanl isolated attaks lasing days to two weeks; may get more frequent and severe with perissitn gysmptms

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26
Q

Is there swelling associated with gouty arthritiis (acute)

A

present,withtina nd around the involved joint

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27
Q

Warmth, redness, endernes acute gout

A

exquisiley tender, hot, and red

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28
Q

acute gout stiffness?

A

not evident

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29
Q

acute gout limitation of motion?

A

motion is limited primarly by pain

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30
Q

generalized symptoms of acute gout?

A

fever may be present

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31
Q

Chronic Tophaceous Gout

A

Multiple local accumulations of sodium urate in teh joints and other tissues, with or wihtout inflammation

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32
Q

Location of Tophaceous gout

A

Feet, ankels, wrists, fingers, and elbows

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33
Q

Pattern of spread of tophaceous gout

A

Additive, not so symmetric as RA

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34
Q

Onset of Toph Gout

A

gradual develpmetn of chronicity with repeated attacks

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35
Q

generalized symptoms of toph gout

A

possibly fever; patient may also dvelop sysmptoms of renal failture and renal stones

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36
Q

Polymyalgia Rhematica proces

A

disease of unclear etiiology >50 , espe in women; may be associated with giant cell arterititis

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37
Q

Common location of polymyalgia rheumatica

A

muscles of hip girdle, and should girdle

symmetric

38
Q

Onset of PR

A

Insiduous or abrupt, even appearing overnight

39
Q

Progression and duration or PR

A

chronic bu ultimately self-limiting

40
Q

stffness in PR

A

prominent, esp int eh morning

41
Q

Generalized symptoms of PR

A

Malaise, sense of depression, possible anorexia, weight loss adn fever, but no true weakness

42
Q

Fibroymyalgia syndrome process

A

widespread MC pain and tender points. May accompany other diseases. Mechanisms unclear

43
Q

Comon location of fibro

A

all over but esp in neck, shoulder,shands, low back and knees

44
Q

Pattern of spread of fibro

A

shifts unpredictabley or worsens in response to immobility, execessive use, or chilling

45
Q

stiffness with fibro?

A

present, esp in teh morning

46
Q

Limitation of motion with fibro

A

Absent thoguht stiffness i sgreater in extremes of movemnt

47
Q

generalized symptoms of fibro

A

disturbance of sleep, usually assocaited ith morning fatigue

48
Q

What are causes of painful shoulder (7)

A 
rotator cuff tendinitis
rotator cuff tears
Calcific tenditinits
bicipital tendinitis
adhesive capuslitis (frozen shoulder)
acromioclaviclualr arthritis
anterior dislocation of humerus
49
Q

Rotator cuff tendinitis

A

repeated shoulder motion, as in throwing or swimming, can cause edema and hemorrhage followed by inflammatin, most commoly involveing supraspinatus tendon

50
Q

sympsoms of rotator cuff tendinitis

A

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

51
Q

rotator cuff tears cause

A

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

52
Q

symptoms of rotator cuff tear

A

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

53
Q

what is bicipital tendinitis?

A

inflammation of the long head of the biceps tendon sheath causes anterior shoulder pain resesmbling and often coexisint giwht rotator cuff tendinitis

54
Q

How do you separate biciptial tendinitis from supraspinatus tendinitis?

A

externally rotate and abduct arm `

55
Q

Adhesive Capsulitis (frozen shoulder)

A

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

56
Q

Acromioclavicular arthritis

A

uncommon, susually arising from direct injury to the shoulder girdle wth resulting degeneratie changes

57
Q

what is painful motion in AC arthritis?

A

glenohumeral joint otion is not painful, but movement of hte scapula, as in shoulder shrugging is painful

58
Q

Anterior Dislcoation of the Humerus

A

positive apprehension sign

59
Q

What are causes of swollen or tender elbows? (4)

A

olecranon bursitis
arthritis of the elbow
rheumatoid nodules
epicondylitis

60
Q

What is olecranon bursitits

A

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

61
Q

what is arhtritis of the elbow

A

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

62
Q

what are rheumatoid nodules

A

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

63
Q

What is lateral epicodnylitis>

how to test for it

A

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

64
Q

what is medial epicondylitis

A

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 .

65
Q

what are the four types of arthritis in the hand

A

Acute rheumatoid arthritis
Chronic Rheumatoid Arthritis
Osteoarthritis (Degenerative Joint Disease)
Chronic Tophaceous Gout

66
Q

What is Acute RA

A

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

67
Q

What is Chronic RA

A

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

68
Q

Osteoarthritis in the hands

A

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

69
Q

Herberden’s node

A

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

69
Q

Bouchard’s Nodes

A

on PIP are less common

MCP are spared

70
Q

Chronic Tophaceous Gout

A

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

70
Q

What is the first joint involved in acute gouty arthritis

A

The Metatarsalphalangeal (MTP) joint of the great toe

71
Q

acute gouty arhtritis

A

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

71
Q

Flat feet

A

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

72
Q

What is Hallux Valgus

A

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

73
Q

What is Morton’s Neuroma

A

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

74
Q

where is there tenderness with FLAT FEET. Where is there swelling

A

tenderness from medial malleolus down along the medial-plantar surface of foot

Swelling may develop anterior to the malleoli

75
Q

What are symptoms of Morton’s Neuroma

A

Hyperestheisa, numbness, aching, and burnign from teh metatarsal heads into teh 3rd and 4h toes

76
Q

What is Ingrown toenail

A

sharp edge of toenail may dig into and injure the lateral nail fold, resulting in inflammation and infection

77
Q

what are signs of ingrown toenail

A

tender, reddened, overhanging nail fold, sometimes with granulation tissue and purulent discharge, results . Great toe is most often affected

78
Q

What is Hammer Toe?

A

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

79
Q

What is a corn

A

Painful conical thickening of skin that results from recurrent prssure on normally thin skin . Apex of cone points inward sand causes pain

80
Q

Where do corns characterisically occur

A

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

81
Q

What is a Callus ?

A

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.

82
Q

What do you suspect if a callus is painful

A

underlying plantar wart

83
Q

What is a Plantar Wart

A

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

84
Q

Neuropathic ulcer

A

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

85
Q

What do you suspect if a callus is painful

A

underlying plantar wart

86
Q

What is a Plantar Wart

A

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

87
Q

Neuropathic ulcer

A

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

ECR 2012 (16 decks)

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