Musculoskeletal & CT Disorders (Week 4)

Question 1

Monoarticular (list common causes of pain)

Answer 1

Affecting 1 joint. In young adults usu from injury/infection. In older adults usu osteoarthritis & crystal-induced injuries. Less common causes include hemarthrosis, avascular necrosis, and tumors.

Question 2

Oligoarticular (aka pauciarticular)

Answer 2

Affecting 4 or fewer joints

Question 3

Polyarticular

Answer 3

Affecting many joints

Question 4

Periarticular (give examples)

Answer 4

Affecting tissues around the joint (tendons, ligaments, bursa). Specific inflammations… Synovitis = synovial membrane. Tendonitis = tendon. Tenosynovitis = tendon and its enveloping sheath. Enthesitis = insertion points of ligaments or tendons. Bursitis = bursa.

Question 5

Symmetric

Answer 5

Involving same joints bilaterally (common in autoimmune conditions)

Question 6

Inflammatory

Answer 6

Due to infection, crystals, immune dysfunction

Question 7

Noninflammatory

Answer 7

Due to traume or other mechanical derangements (osteoarthritis is usu classified as noninflammatory arthritis)

Question 8

What do we ask about onset & chronology?

Answer 8

When, acute v insidious, trauma, progressive v static, periodicity or diurnal pattern, how long do episodes last?

Question 9

What do we ask about location?

Answer 9

Which joints, symmetric or asymmetric, polyarticular or monoarticular?

Question 10

What do we ask about Palliation/provocation?

Answer 10

Better use v rest, affect of therapeutics

Question 11

What do we ask about Quality?

Answer 11

Aching (most myalgias & arthritis) v burning (neuropathies)

Question 12

What do we ask about Severity?

Answer 12

Pain scale, impacted ADLs, Deformity

Question 13

General sxs that can help with a dx

Answer 13

fever, wt loss, fatigue

Question 14

Skin sxs that can help with a dx

Answer 14

Rash, Raynaud’s, nodules, nail changes

Question 15

Eye sxs that can help with a dx

Answer 15

irritation, pain, photosensitivity

Question 16

Respiratory sxs that can help with a dx

Answer 16

cough, SOB

Question 17

Cardiac sxs that can help with a dx

Answer 17

chest pain, palpitations

Question 18

GI sxs that can help with a dx

Answer 18

oral ulcers, bowel changes, hx of GI dz

Question 19

GU sxs that can help with a dx

Answer 19

vaginal ulcers, STI history

Question 20

What is Osteoarthritis?

Answer 20

Degenerative disorder due to mechanical stress involving articular cartilage in synovial joints. Erosion of cartilage continues until underlying bone is exposed. The subchondral bone then thickens in areas of pressure, forming cysts and irregular outgrowths of new bone (osteophytes). It is classified as noninflammatory.

Question 21

Etiology/Risk Factors for Osteoarthritis

Answer 21

Advancing age (most over 65 show arthritis on xray), Mechanical stress (repetitive use, obesity), Genetics, Joint trauma.

Question 22

SSx Osteoarthritis

Answer 22

Gradual onset. Deep, aching pain worse with use & better with rest. Decreased ROM and crepitus. Morning stiffness of

Question 23

Joints most often involved in Osteoarthritis

Answer 23

Hand: (mostly DIPs, some PIPs, base of thumb)
Cervical & Lumbar vertebrae: (can lead to spinal stenosis, which then leads to myelopathy or radiculopathy)
Foot: (First metatarsophlangeal joint)
Hip: (worse with wt bearing, may refer to knee)
Knee

Question 24

Dx Osteoarthritis

Answer 24

Labs (not useful): Normal ESR & CRP, RF negative, Synovial fluid WBCs

Question 25

Prognosis for Osteoarthritis

Answer 25

Depends on joints involved & severity. Joint replacement has good prognosis, prosthesis lasts only 10-15 years.