MSK and Rheumatology

Question 1

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Describe the classic physical exam findings associated with rheumatoid arthritis?

What is a hallmark symptom associated with RA?

Answer 1

Classic physical exam findings in the hand and digits include ulnar deviation of the metacarpophalangeal joints, swan-neck contractures, and boutonnière deformities. Joints will often be swollen and may feel boggy. Additionally, grip strength may be decreased. Flexor tendon synovitis is another hallmark of rheumatoid arthritis that further decreases hand function.

Morning stiffness

Question 2

Describe the Phalen Test?

A positive Phalen test is associated with what diagnosis?

Answer 2

Passive wrist flexion with dorsal wrists against each other with the elbows flexed create parathesesias

Carpal Tunnel

Question 3

What nerve is affected in carpal tunnel syndrome?

Answer 3

The Median Nerve

Question 4

What other conditions could present similarly to carpal tunnel syndrome and would be discerned on nerve conduction testing?

Answer 4

Neuropathy or Cervical Rediculopathy

Question 5

A 25-year-old woman presents to your office with a bump over her right wrist, which she first noticed 6 months ago. It was not initially painful, and she saw her primary clinician, who recommended observation. Since that time, it has enlarged slightly, and she now has pain when she puts weight on her hand, such as when doing a push-up. On physical examination, there is a 1.5 cm subcutaneous mass over the dorsum of her right wrist at the scapholunate joint. It is well circumscribed, mobile, and slightly tender. She has pain with maximum dorsiflexion of her wrist. X-rays of the wrist are normal. Which of the following is the most appropriate intervention?

Answer 5

Aspiration of the Ganglian Cyst (a fluid filled mass)