MSK/Rheumatology Flashcards
What is rheumatology?
Medical management of MSK disease. Prevalence increases with age. Mainly inflammatory joint pain.
What is inflammation?
Reaction of the microcirculation. Movement of fluid and white blood cells into extravascular tissues due to pro inflammatory cytokines.
What are the 4 pillars of inflammation?
Rubor (redness)
Calor (heat)
Dolor (painful)
Tumour (swollen)
How can an inflamed joint present?
- Hot, painful, red, swollen joint
- Deformity
- Stiffness
- Poor mobility/function
Give the main differences between inflammatory and degenerative joint pain.
- Pain - in inflammatory, pain eases with use whereas degenerative pain gets worse with use
- Stiffness - inflammatory stiffness is significant (>60mins) whereas degenerative generally less than 30 mins. Degenerative stiffness is generally morning and evening and inflammatory stiffness generally morning and at rest.
- Hot and red - only inflammatory
- Joint distrubution - inflammatory generally hands and feet whereas degenerative - carpometacarpel joint, distal interpharangeal joints, and knees.
- Swelling - inflammatory = synovial+/- bony. Degenerative = bony
Which type of joint pain generally responds to NSAIDs?
Inflammatory joint pain
Typically patient that presents with inflammatory joint pain vs one that presents with degenerative joint pain?
Inflammatory - often younger, with family history of inflammatory joint pain. May have psoriasis
Degenerative - older, prior occupation/sport
What is the relationship between work and mortality?
Higher mortality if don’t work
What are the Bradford Hill criteria?
Guidelines useful for providing evidence of a causal relationship between an apparent cause and effect.
Name 6 of the Bradford-Hill criteria?
- Strength of association (high and significant odds ratio)
- Consistency in association
- Exposure-response relationship
- Temporal relationship (effect after cause)
- Specificity
- Coherence
Name some high risk activities for MSK issues.
- Heavy manual handling
- Lifting above shoulders
- Lifting below knees
- Incorrect manual handling technique
- Forceful repetitive work
- Poor postures
What type of disease is carpal tunnel syndrome?
Entrapment neuropathy
Carpal tunnel syndrome is a result of pressure on what nerve?
Median nerve
What factors are associated with carpal tunnel syndrome?
Diabetes, obesity, pregnancy, OCP, hypothyroidism, RA, acromegaly
What is Tinel’s sign and what does it test for?
Tapping over carpel tunnel in attempt to elicit paraesthesia in median nerve distrubution
What is Phalen’s test and what does it test for?
Maximal wrist flexion for one min. May elicit symptoms of carpal tunnel syndrome, equally can be unreliable.
Typical clinical features of carpal tunnel syndrome?
- Aching pain in hand and arm - especially at night
2. Paraesthesia in thumb index and middle finger - relieved by hanging over end of bed and shaking ‘wake and shake’
What muscles does the median nerve supply?
LOAF
Lumbricals, opponens pollicis, abductor pollicis brevis, flexor pollicis brevis
What is the difference between Raynaud’s phenomenon and Raynaud’s disease?
Raynaud’s disease, the cause of the Raynaud’s is unknown and arises spontaneously. Whereas Raynaud’s phenomenon there is an underlying cause..
What is Raynaud’s?
Peripheral digital ischaemia due to paraoxysmal vasospasm, precipitated by cold or emotion.
What precipitates Raynaud’s?
Cold or emotion
What are some of the underlying causes of Raynaud’s phenomenon?
- Connective tissue disorders
- Occupational (vibrating tools)
- Obstructive e.g. atheroma
- Blood condition (cold agglutinin disease, monoclonal gammopathy)
- Drugs (B-blocker)
- Hypothyroidism
What drugs can cause Raynaud’s phenomenon?
Beta blockers
What is the colour change in Raynaud’s?
Yellow –> Blue –> Red
What are the symptoms of Raynaud’s?
- Fingers and toes ache
- Fingers and toes change colour
- Tingling, numbness and loss of dexterity
What is the management of Raynaud’s?
- Keep warm
- Stop smoking
- Nifedipine (CCB)
Why is Nifedipine used to treat Raynaud’s?
Is a CCB and so relaxes blood vessels
Differential of Raynaud’s?
Hypothenar hammer syndrome (occlusion of ulnar artery)