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Symptoms of respiratory system > JOINTS > Flashcards

JOINTS Flashcards

1
Q

Synarthrosis

A

• Fibrous, permits little or no mobility (eg The Skull)

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2
Q

AMPHIARTHROSIS:

A

cartilaginous joints, permits slight mobility (eg.

Vertebrae)

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3
Q

DIARTHROSIS:

A
  • synovial joints (all diarthrosis)
  • permits a variety of movements.
  • (eg. Shoulder, Hip, Elbow, Knee etc)
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4
Q

OLIGOARTICULAR involvement

A

2- 4 joints groups affected
 located dominantly at distal joints
 generally asymmetrical

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5
Q

POLIARTICULAR involvement

A 
> 5 joints affected
 symmetrical /asymmetrical
 dominant at upper or lower limbs
 periarticular involvement associated
 ± systemic involvement associated
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6
Q

Symptoms description

A 
1. Symptoms description
Severity of symptoms
Sequence of symptoms
Patterns of
> Progression
 > Exacerbation
> Remission
  1. Functional impact of the disease
  2. Effects of therapy (current / previous) on the illness course
  3. Compliance to therapy assessment
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7
Q

Symptoms

A
  1. Pain
  2. Stiffness
  3. Limitation of Motion
  4. Swelling
  5. Weakness
  6. Fatigue
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8
Q

1.Pain

A

most common complaint
Definition:
=subjective sensation that is difficult to define,
explain, or measure.
Localization → anatomical description
• ask the patient to point the area with a finger

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9
Q

1.Pain

A

• between joints may suggest
• more accurately if localized in
• small joints of the hands or feet > pain in larger jnt
(shoulder, hip, or spine)

• Superficial tissues
• less focal if arising from deeper structures
• if diffuse, variable, poorly described, or unrelated to
anatomic structures →
- Malingering, or
- Psychological problems
- Fibromyalgia

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10
Q

1.Pain- Characteristics (description)

A
  1. Intensity :variable
    - Intense (↑”aching”) in a joint area suggests an
    inflammatory disorder (arthritis)
    - Sharp or “burning” (suggests neuropathy due to a
    compression, eg. carpal tunnel syndrome)
  2. Severity of pain: mild / moderate / severe
     scale from 1 to 10 (determined by the patient)
    !! If excessive, unbearable, in a patient who can otherwise perform usual activities is rather emotionally amplified
  3. Duration: variable (the patient is asked when it appeared, if it was continuous or had periods of activity alternating with periods of remission)
  4. Type of onset: sudden/ insidious
    Time of onset: the time of day when the pain begins / intensifies)
    → eg. nocturnal pain in gout (microcrystalline arthritis)
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11
Q

Durerea articulara- Caracteristici

A

Location
- ! Localized - joint pain is generally localized (felt
articular / periarticular)

or Iradiated (ex. A pain in the hip may cause also pain at the knee level on the same side)
 Monoarticular/ Poliarticular
 Symmetrical/ Asymmetrical
Example:
- symmetrical rheumatoid syndrome in rheumatoid arthritis
- asymmetric rheumatoid syndrome in reactive arthritis
Irradiate
 distal: nerve compression syndromes (tunnel / compartment
syndrome)
 referred pain

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12
Q

Pain assessment during activity/rest

A

inflammatory process→ Joint pain
• at Rest and

• with Movement (Activity)
- mechanical disorder (degenerative)
• Pain mainly during Activity

Persistence
- at the level of a certain joint or
- migratory character (moves from one joint
to another)

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13
Q

Stiffness

A
  • discomfort perceived by the patient attempting
    to move joints after a period of inactivity

Character
• develops after several hours of inactivity
• may resolve within a few minutes (Mild stiffness)
• may persist for many hours (RA or polymyalgia rheum.)
• usually transient

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14
Q

Morning stiffness

A

Inflammatory disease
- prodromal symptom of rheumatoid arthritis (RA)
- criterion for the diagnosis of RA (absence does not exclude)
NonInflammatory joint diseases
- short duration almost always (usually < 30 min)
- less severe than stiffness
- related to the extent of joint overuse (mechanical or
degenerative joint disease)
- resolve usually within a few days to limitation of the use of the affected joint

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15
Q

Limitation of Motion

A

Fixed
 NOT transient
 Does not vary

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16
Q

Limitation of Motion : important to detect

A

Type of onset
 Abrupt = suggestive of a mechanical problem (tendon rupture)
 Gradual = more common with inflammatory joint disease
The extent of limitation
 Degree of Active and Passive motion limitation

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17
Q

Swelling

A

Determine:
• Where and When occurs
 Information about
1. Factors that influence it
2. Onset and Persistence of the swelling
acutely developed →swelling is most painful
slowly developed is often much more tolerable
! Obese may interpret as swelling collections of adipose tissue over the elbow, knee, ankle

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18
Q

Weakness

A
  • Loss of motor power or muscle strength
  • Objectively demonstrable on physical examination
    Assessment:
    1.Distribution (distal / proximal)
    2.Duration of weakness
    3.Specific patterns
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19
Q

Patterns of weakness

A

musculoskeletal disorders
= Persistent > intermittent
 neuromuscular disorders (myasthenia gravis)
= Initially good strength with subsequent weakness
 inflammatory myopathies
= Weakness occurs in a Proximal distribution
(i.e., shoulders and hips rather than hands and feet)
 neurologic disorder = Significant Distal involvement

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20
Q

Fatigue

A

An inclination to rest even though pain and weakness are not limiting factors
- sense of exhaustion, not muscle weakness, not pain
common complaint of patients with M&S disease
may be prominent even without activity in rheumatic dis.

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21
Q

Fatigue : Differentiation from stiffness + weekness

A
  • Stiffness is a discomfort during movement
  • Weakness is an inability to move normally, especially
    against resistance
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22
Q

Fatigue : Differentiation from Malaise

A

Malaise

  • is an indefinite feeling of lack of health
  • occurs at the onset of an illness
  • often occurs with fatigue but is not a synonymous
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23
Q

Fatigue & malaise can be seen in

A

the absence of identifiable organic

disease, and anxiety, tension, stress, and emotional factors can play a role.

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24
Q

JOINTS- CLINICAL EXAMINATION

A 
Inspection
– Palpation of:
bony landmarks
related joint and soft-tissue structures
– Range of motion assessment
– Special maneuvers to test specific movements
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25
Q

JOINTS - INSPECTION

A
  • joint Symmetry
  • joint Alignment
  • bony Deformities
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26
Q

JOINTS

INSPECTION AND PALPATION

A

skin changes of surrounding tissues
– nodules
– muscle atrophy
– Crepitus = audible and/or palpable crunching during movement of tendons or ligaments over bone

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27
Q

JOINTS EXAMINATION

RANGE OF MOTION / MANEUVERS

A

Active mov. (i.e. movements performed by the patient on their own)
Passive mov. (i.e. movements performed by the examiner)
Resisted mov. (i.e. movements against resistance)
! always compare one side with the other

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28
Q

JOINTS EXAMINATION

RANGE OF MOTION

A 
General rule:
– muscular / tendon problems suggested by
reduced active movements,
that improve on passive movement
– intra-articular disease suggested by
reduced range of movements
both active and passive
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29
Q 
Temporomandibular Joint (TMJ)
INSPECTION + PALPATION
A

place the tips of your index fingers just
in front of the tragus of each ear and ask the
patient to open his or her mouth. The fingertips
should drop into the joint spaces as the mouth
opens

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30
Q 
Temporomandibular Joint (TMJ)
RANGE OF MOTION
A

– Opening / closing
– Protrusion / retraction
– Lateral / Side to side motion

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31
Q

Flexion

A

Normal range – usually 180 degrees

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32
Q

Extension

A

Normal range ~

usually 50 degrees

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33
Q

Abduction

A

(Normal range ~

usually 180 degrees)

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34
Q

Adduction

A

(Normal range ~

usually 45 degrees)

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35
Q

External rotation ( Shoulder )

A

(Normal range ~

usually 90 degrees)

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36
Q

Internal rotation ( Shoulder )

A

(Normal range ~

usually 50 degr)

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37
Q

PAINFUL SHOULDERS

A

1.Pain
2.Pinching
3.Stiffness →
Pain characters

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38
Q

Pain characters

A 
Location: upper arm
Radiation into the
- forearm
- hands
- fingers
Worsening at night, making sleeping a painful and difficult event
Pathology:
PAINFUL SHOULDERS

 when raising the arm

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39
Q

ELBOW

INSPECTION + PALPATION

A 
epicondyles (medial and lateral)
- olecranon process of the ulna
Identify:
- Tenderness (Press on the epicondyles)
- Displacement of the olecranon
- grooves between the epicondyles and the olecranon
Identify:
- tenderness
- swelling
- thickening
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40
Q

ELBOW

RANGE OF MOTION

A

Flexion / extension at the elbow

– Pronation / supination of the forearm

41
Q

The wrist and hand

INSPECTION for

A
  • Swelling over the palmar and dorsal surfaces of the wrist and hand
  • Deformities of the wrist, hand, or finger bones
  • Angulation from radial or ulnar deviation
  • Thickening of the flexor tendons
  • Flexion contractures in the fingers
  • Observe the thenar and hypothenar eminences
42
Q

The wrist and hand

PALPATION

A 
wrist / distal ulna and radius
• anatomic snuffbox
• 8 carpal bones
• each of the 5 metacarpals
• Phalanges (proximal, middle, and distal)
Look for:
 tenderness
 swelling
43
Q

WRIST

RANGE OF MOTIONS

A
  1. Flexion
  2. Extension
  3. Ulnar / radial deviation
44
Q

The wrist and hand
Pathologic finding
1. Dupuytren’s contracture

A

fixed flexion

contracture of the hand where the fingers bend towards the palm and cannot be fully extended (straightened)

45
Q 
The wrist and hand
Pathologic finding ( 2, 3)
A
  1. Herbeden’s nodes (distal Phalanges)

3. Bouchard’s nodes (interPhalangian)

46
Q

The wrist and hand
Pathologic finding
4. Rheumatoid Arthritis

A
  • swollen hand (early RA)

- ulnar deviation (late RA)

47
Q

The spine
INSPECTION
(From the side)

A 
spinal curvatures
→
1= Cervical lordosis
2=Thoracic kyphosis
3= Lumbar lordosis
4= Sacral kyphosis
48
Q

The spine
INSPECTION
From behind

A 
1="Vertebra prominens"
Spinous process of C7
2= 2nd Lumbar vertebra
3= L4-5 inter vertebral space
4= Iliac crests
5= Dimples of Venus (fossae lumbales lateralis) /
Sacroiliac joints
49
Q

The spine
PALPATION
tenderness

A

the spinous process /
the paraspinal muscles /
the sacroiliac joints

50
Q

The spine

Schober’s test

A

!!! measures the degree of flexion of the spine
Mark the spine at the lumbosacral junction, then 10 cm above and 5 cm below this point. A 4-cm increase between the two upper marks is
normally seen.
!!! Increases less < 4cm in ankylosing spondylitis

51
Q

Lasegue Maneuver

A
  • The sciatic nerve elongation maneuver performed in clinostatism
  • It involves raising the pelvic limb in extension to an angle of 90 degrees
  • If present, pain apear at an angle of less than 30 degrees
52
Q

HIP INSPECTION

A 
Assess
– level of the iliac crests
– leg length discrepancy
– muscle wasting
– scar
53
Q

HIP PALPATION

A
  • tenderness
  • heat
  • swelling ] ->
    around the inguinal areas and the greater trochanter
    area
    Measurement of legs length
    – between the anterior iliac spine to the tip of the medial mallous, with the anterior spines lying at the same transverse level
    ! compare one side to the other
54
Q

HIP FLEXION + EXTENSION

A

Normal range ~ 120 degree

55
Q

ADDUCTION

A

Normal range of movement

~ 30 degrees)

56
Q

ABDUCTION

A

Normal range of movement

~ 45 degrees

57
Q

HIP EXTERNAL ROTATION

A

Normal range of movement

~ 60 degrees

58
Q

HIP INTERNAL ROTATION

A

(Normal range of movement

~ 45 degrees)

59
Q

The knee and lower leg
INSPECTION
walking & standing (eg.walk with a limp)

A 
Asses for:
• muscle wasting
• bowing (varus) deformity
• knock-kneed (valgus) deformity
• sign of inflammation (eg.red or swollen)
60
Q

The knee and lower leg

INSPECTION

A
  • genu varum
    (Varus deformity of the knee)
  • scar & staples (recent) after a total knee replacement
61
Q

The knee and lower leg

PALPATION

A

– temperature
– Tenderness (Bend the knee to 90 degrees & feel around the medial & lateral joint lines)
• the patella
• quadriceps tendon
• prepatellar & collateral ligaments
– popliteal (Bakers) cyst: back of the knee

62
Q

The knee and lower leg
Special maneuvers
Assessment of fluid in the knee join (3 tests)

A

–1) The Bulge Sign (for minor effusions)
–2) The Balloon Sign (for major effusions)
Compress the suprapatellar pouch against the femur.
Feel for fluid entering (or ballooning into) the spaces next to the patella under your right thumb and index finger.
3) Ballotting the patella-large effusions
Compress the suprapatellar pouch and “ballotte” or push the patella sharply against the femur.
Watch for fluid returning to the suprapatellar pouch.

63
Q

Knee + lower leg

Range of motions

A

– Flexion/extension

– Internal/external rotation

64
Q

Crepitus is usually indicative of

A

degenerative knee disease (osteoarthritis)

65
Q

The ankle + foot

Range of motions

A

– Flexion / extension at the ankle (tibiotalar) joint

– In the foot: inversion / eversion

66
Q

The ankle + foot

A
  1. Arthritis , ligaments , injury or infection of the ankle
  2. Achilles tendinitis
  3. Bursitis
  4. Plantar fasciitis
  5. Rheumatoid arthritis
  6. Gout
67
Q

Arthritis, ligament injury, or infection of the ankle

A
  • localized tenderness

- pain on mobilization

68
Q

Achilles tendinitis

A
  • tenderness
  • partial tear from trauma
  • rheumatoid nodules in Achilles tendon
69
Q

Bursitis

A
  • tenderness
70
Q

Plantar fasciitis

A

pain over the plantar fascia

71
Q

Rheumatoid arthritis

A

tenderness on compression is an early sign

72
Q

Gout

A

acute inflammation of the first metatarsophalangeal joint (pain, decreased movements, edema, erythema)

73
Q

DIAGNOSIS

A

AGE
 young: SLE, rheumatic fever, and Reiter’s syndrome
 middle age: fibromyalgia
 old age: osteoarthritis, polymyalgia rheumatica
SEX
 men: Gout, spondyloarthropathies
 women: rheumatoid arthritis, fibromyalgia
RACE
 whites: giant cell arteritis, and Wegener disease
 blacks: sarcoidosis and systemic lupus erythematosus (SLE)
FAMILY HISTORY
 Familial aggregation:

 RA, ankylosing spondylitis, gout,

74
Q

JOINT- EXTRINSEC PAIN

A
  • Cellulitis - typical red streaks and swelling

- Bursitis

75
Q

JOINT PAIN – Intrinsic conditions

A

Degenerative disorders

Osteoarthritis

76
Q

JOINT DISEASES = ARTHRITIS

A
  1. Osteoarthritis
  2. Autoimmune diseases
    - rheumatoid arthritis
    - psoriatic arthritis
    - reactive arthritis
  3. Septic arthritis
  4. Gouty arthritis/ Pseudogout
77
Q

OSTEOARTHRITIS

DEFINITION

A
  1. Degeneration
  2. Progressive loss
    of cartilage within the joints
  3. Underlying Bone damage
  4. New Bone formation at the margins of the cartilage
78
Q

OSTEOARTHRITIS

A 
Pattern of Spread:
– Additive or only 1 joint may be involved
Onset: usually Insidious
Progression and duration
– Slowly progressive, with temporary
exacerbations after periods of overuse
Associated symptoms:
– Swelling: small effusions may be present, especially in the knees
– Redness  : rarely
– Warmth  : seldom
– Tenderness  : Possibly
Stiffness: After inactivity
Limitations of motions: often develops
Generalized symptoms: ABSENT
79
Q

RHEUMATHOID ARTHRITIS

A
  1. synovial membranes inflammation
  2. cartilage erosion
  3. bone erosion
  4. ligaments and tendons damage
  5. Systemic involvment
80
Q

Joint involvement pattern in

RHEUMATHOID ARTHRITIS

A
  1. Pattern of Spread:
    – Symmetrically
    – Additive: progresses to other joints while persisting in the initial ones
  2. Onset:
    – Insidious Usually
  3. Progression and duration:
    – Often chronic, with Remissions and Exacerbations

Associated symptoms
–Swelling of synovial tissue in joints or tendon
sheaths + Subcutaneous nodules
– Redness, Warmth and Tenderness:
seldom red, often warm, tender
–Stiffness: prominent, often for an hour or more in
the morning, also after inactivity
–Limitation of Motion: often develops
–Generalized Symptoms: weakness,
fatigue, weight loss,and increased fever

81
Q

Joint involvement pattern in

RHEUMATHOID ARTHRITIS

A 
– Hands (PIP / MCP joints)
– feet (MTP joints)
–Wrists
– Knees
–Elbows
– Ankles
82
Q

Early rheumatoid arthritis

A

MCP joints
Swollen
Warm
Red

83
Q

Late RA

A

Deformities present.
Swan neck deformity of the thumb.
Ulnar drift of the MCP joints.
Subluxation of the PIP joints.

84
Q

RHEUMATHOID ARTHRITIS

DIAGNOSIS CRITERIA

A
  1. Morning stiffness
  2. Arthritis of 3 or more joint areas
  3. Arthritis of hand joints
  4. Symmetric arthritis
  5. Rheumatoid nodules
  6. Serum RF
  7. Radiographic (erosions or bony decalcification on hand and wrist
85
Q

PSORIATIC ARTHRITIS findings

A 
10-30% of people suffering from
psoriasis
Inflammatory arthritis
Associated signs:
Psoriatic Nail lesions
splitting of nails → onycholysis
Tendinitis =‘sausage-like’
swelling of digits ~ dactylitis
86
Q

Reactive Arthritis

A

autoimmune condition that develops in
response to an infection in another part of the
body (genitourinary or gastrointestinal infections)

87
Q

Reiter ́s syndrome = 3 symptoms combination:

A

Arthritis (inflammatory) of large joints RTCD
 Eyes inflammation (Conjunctivitis and Uveitis)
 Urethritis

88
Q

Septic arthritis

A

DEFINITION joint infection
PATHOGENY:
 dissemination of pathogens by blood
abscesses or wound infections osteomyelitic focus
• dissemination by Contiguity (adjacent soft tissue infection)
 direct entry via penetrating trauma
iatrogenic means
ETIOLOGY
Bacteria commonly involved:
Staph. aureus, Streptococci, E coli, M. tuberculosis, Salmonella spp.

89
Q

Gout

A 
Caused by
Deposition of Uric Acid Crystals in the joint that
results in subsequent joint inflammation
Characterized by
– Pain: (burning) severe, sudden, unexpected D
– Swelling T
– Redness R
– Warmth C
– Stiffness
– Low-grade Fever may also be present
occurs commonly in Men in their toes
Longstanding
Hyperuricemia

Other sign
- Tophi = uric acid crystal deposits in other tissues
– Ear helix
– Knees, elbows, hands

90
Q

Arthritis in Rheumatic Fever

A 
systemic illness
- autoimmune
response group A β hemolytic streptococcal pharyngitis
- rheumatic heart disease, most serious complication
Clinical manifestation
Major diagnostic criteria
1. Carditis
2. Polyarthritis
3. Chorea
4. Subcutaneous nodules
5. Erythema marginatum

Minor diagnostic criteria

  1. Fever
  2. Arthralgia
  3. Prolonged PR interval on Ecg
  4. Elevated acute-phase reactants

2 M / 1 M+ 2

91
Q

Joint involvement pattern in

Rheumatic Fever

A

Polyarthritis
• earliest manifestation of RF (70-75%)
• begins in the large joints of the lower extremities
(ie, knees, ankles)

  • Migratory → migrates to other large joints in the lower or upper extremities (ie, elbows, wrists)
  • NOT Additive
  • Generally fully recover of joint
  • IF multiple attacks → destructive arthritis (Jaccoud arthritis)
92
Q

Joint involvement pattern in
Rheumatic Fever
Arthritis symptoms + signs

A 
Symptom
• Pain
out of proportion to clinical findings
reaches maximum severity in 12-24 hours
persists for 2-6 days
Signs
• Swelling
• Warmth
• Redness
• Limited range of motion
93
Q

Ankylosing Spondylitis

A 
chronic and Progressive form of Seronegative
arthritis
• autoimmune disease
- arthritis of the spine
- start 20 - 40 y
- Males >>> females
Risk factors
• Family history of AS
• Male gender
94
Q

Ankylosing Spondylitis

Symptoms

A

LOW BACK PAIN
• centered over the sacrum
• radiate to the groin and buttocks and down the legs
• comes and goes
• worse at night, in the morning, or when Pt are Not active
• Awake from sleep
• typically gets better with activity or exercise
• SUBSTRATE: bilateral sacroiliitis

95
Q

Ankylosing Spondylitis

less common symptoms

A
  • Eye inflammation or uveitis
  • Peripheral joint Pain, Heel pain, Hip pain and Stiffness
  • Fatigue
  • Slight Fever
  • Weight loss
  • Loss of appetite
96
Q

Ankylosing Spondylitis

Joint involved

A

axial skeleton particularly
• sacroiliac and spinal facet joints
+ Extraspinal involvement

97
Q

Ankylosing Spondylitis

Symptoms and Range of movement suggest diagnosis

A
  1. Low back pain: present for more than 3 months,
    improved by exercise but not relieved by rest.
  2. Limitation of lumbar spine motion (sagittal &
    frontal)
  3. Limitation of chest expansion relative to normal
    values for age and sex.
98
Q 
Ankylosing Spondylitis
Physical examination (signs)
A
  1. Spine & sacroiliac joints
    • Loss of lateral flexion of the lumbar spine early
    • tenderness response during percussion over the sacroiliac joints
    • pain response by springing the pelvis
2. Peripheral joints
• restriction of joint motion (Synovitis)
Entheses tenderness (entheses are sites of attachment to bone of ligaments, tendons, and joint capsules)
↓ Chest expansion → costovertebral joints involved
• Diaphragmatic breathing (ballooning of the abdomen during inspiration)
99
Q

Ankylosing Spondylitis

Tests to measure spinal restriction

A

1.Touching the toes (difficult)
2.Schober test (<4 cm)
3.Chest expansion measurement (↓)
in AS the spine
→ completely rigid
→ with loss of the normal curvatures and
→ reduced movement

Symptoms of respiratory system (8 decks)

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