Joint Disorders Flashcards
Synovial fluid
Cartilage is most commonly the problem in a presenting patient. It does not have any blood supply and wears and tear with time and increased body mass. Synovium secretes nutrients (synovial fliuids) provides nutrients to cartilage and lubrication
Ligaments
connect bone to bone. Issue = lack of stability. Main purpose of ligament is stability.
Tendon
Tendons connect bone to the muscle. This main purpose is mobility. Tendon tear = lack of mobility, weakness.
Nerve (referred pain)
active and passive is normal, Poorly localized, “ burning”, parasthesia, numb, loss of sensation
Tendon, bursa
active is limited, passive is normal, localized pain
Muscle
active limited, passive is normal, Bilateral and proximal, Myalgia muscle pain is usually bilateral and proximal (shoulders, thighs) never localized
Joint
active and passive are limited, localized
Diagnostic approach to joint pain
History and physical: Distribution? Timing (acute vs. chronic)? Inflammatory pain? Distribution? Extra-articular manifestation?
Arthragia
pain
Arthritis
true joint inflammation
RA and Lupus
Same joints inflammed on both sides. Symmetrical small joints (wrists, hands) These are both chronic. > 6 weeks. Polyarticular
Viral (Hepatitis B&C, Epstein Barr, HIV, Parvovirus B19)–
symmetric, smaller joints more common Polyarticular
Polyarticular
> 4 joints. RA. Lupus. Viral.
Mono/ Olygoarticular
1-3 joints
Osteoarthritis
weight bearing joints (hips, knees, low spine)
Septic arthritis
monoarticular
Crystal arthritis (Gout/ pseudo-gout)
monoarticular, most common 1st metatarsophalangeal
Ankylosing spondylitis
(severe back pain in young patients < 40, more common in men)- spine joints
Other monoarticular causes
Lyme arthritis
Psoriatic arthritis (<10% of patients w/ psoriasis)
Arthritis w/ IBD ( in 20-30% )
Reactive arthritis ass with immune response to bacterial infections (usually 3 weeks after GI or GU infections)
Inflammation
Erythema
Warmth
Swelling
Stiffness (“gelling”) during period of inactivity > 1 h (better with exercise, hot shower, movement)
Examples of inflammation
RA, SLE, Ankylosing spondylitis, Gout, septic
No inflammation in this condition
OA
History of inflammation
Prolonged morning stiffness (> 1 hour), stiffness/ pain improves with activity
OA symptoms
No or minimal morning stiffness (< 30 min), pain worse with activity, Bony crepitus , mild tenderness, hard bony joint enlargement
NO redness, NO warmth, NO soft effusion, ESR, CRP normal