Non-articular Rheumatism Flashcards
Characteristics of Non-articular joint pain
overuse related or idiopathic;
Tenderness/pain localized away from joint spaces and increases in certain motions;
May be in systemic/infectious diseases
BOTH passive and active tests are positive
What provides diagnosis of most causes of shoulder pain on clinical exam?
comprehension of functional anatomy
What provides the best Tx for shoulder pain?
Hx and clinical exam along with ancillary tests
What is the most common cause of shoulder pain?
rotator cuff tendinitis secondary to impingement syndrome
What is the key finding of rotator cuff tendinitis during PE?
pain w/in RC w/ active abduction between 60-120’ along with increase in pain w/ active abduction against resistance
Less pain on passive ROM
What is the etiology for RCT?
50% involved in trauma while other are associated with degeneration
What are the clinical manifestations differences of complete vs partial RCT?
complete=> positive arm drop test w/ inability to maintain 90’ of passive shoulder abduction
partial=> weakness, pain, loss of ABD
Define bicipital tendinitis, tests and clinical manifestations
Anterior pain from LHB and painful to palpate;
Yergasons and Speeds
Popeye can form on rupture
Define adhesive capsulitis and clinical manifestations
idiopathic but generally 2ndary to other pathology or prolonged immobilization of arm;
High association to diabetes;
Loss of active/passive ROM in all planes
What are 3 extrinsic or regional factors causing shoulder pain?
Cervical radiculopathy (referred pain); Brachial neuritis; nerve entrapment syndrome (SSc nerve-trxn lesion) Reflex sympathetic dystrophy; neoplasms Dialysis shoulder arthropayy Osteonecrosis
What is olecranon bursitis?
swelling of elbow from infection, trauma, gout
Define lateral epicondylitis along with clinical manifestations
overuse leading to degeneration of common extensor tendon=> extensor carpi radialis brevis;
Phys exam: tenderness on palpation, forced supination and resisted wrist extension
Define medial epicondylitis along with clinical manifestations
overuse injury of the flexor carpi radialis
Phys exam: local tenderness and pain on forced pronation and resisted wrist flexion
Define ulnar nerve entrapment
aching medial pain at elbow causing numbness and paresthesia of 4th and 5th digits
many causes
Carpal tunnel patients typically have manifestations when?
nocturnal paresthesias associated with intermittent pain or paresthesia during day
Define ganglion cysts
mucin filled cysts arising from joint capsules or tendon sheaths and symptomatic
What tendon is very susceptible to rupture in the hand and wrist?
extensor pollicis longus tendon => careful w/ tendinitis
Define DeQuervain’s disease
inflammation of extensor pollicis brevis and abductor pollicis longus tendons in 1st dorsal extensor compartment
common in women and those w/ repetitive hand activities
+ Finklestein test
How should CMC osteoarthritis pain be initially treated?
splinting (thumb)
Define trigger finger and treatment
thickening of A1 retinacular pulley in palm
Tx: corticosteroid injections and splinting
Define flexor tenosynovitis and clinical manifestations
inflammation of tendon sheaths of flexor digitorum superficialis and profundus with pain in palm of hand mainly arising in finger flexion
Triggering may be present over sheath along with nodules
What is the most commonly diagnosed compression neuropathy? Epidemiology?
Carpal tunnel syndrome
3x more common in women usually bw 40-60yr
What are the stages of Tx for carpal tunnel syndrome?
Night splinting;
Corticosteroid injection;
Surgical release
Define trochanteric bursitis
lateral thigh pain ending at the knee that is reported as hip pain
define meralgi paresthetica
Non-articular=> lateral femoral cutaneous nerve (L2-L3) entrapment causing diffuse lateral thigh pain
Sites: inguinal ligament and psoas insertion
Causes: pregnancy, obesity, diabetes
Define prepatellar bursitis
swelling superficial to patella with many causes but must keep sepsis on DDx
How will septic prepatellar bursitis present?
rubor, calor, dolor over patella and adjacent tissue with LACK OF JOINT INVOLVEMENT =>nontender suprapatellar pouch and popliteal area
Define popliteal cyst (Baker’s cyst)
common as most popliteal bursas communicate w/ joint and presents w/ swelling/discomfort posterior to joint that may rupture
Define achilles tendinitis
inflammation of achilles tendon associated w/ inflammation causing pain, swelling and tenderness at attachment that is prone to rupture
Test: Thompson test
Define plantar fascitis
pain in plantar area of heel associated with idiopathic or spondyloarthropathy causes with pain in AM and tender at origin of plantar fascia
Define pes planus
loss of longitudinal arch on medial foot with the calcaneus everted;
hereditary to some degree;
monitor rupture of posterior tibialis tendon causing it
Define morton’s neuroma
entrapment neuropathy of interdigital plantar nerves occurring in web spaces bw 3rd and4th toes but can affect other spaces as well
Chronic irritation of nerve may lead to neuroma
What is the clinical manifestations of morton’s neuroma?
aching/burning pain radiating distally to affected toes and irritated by jogging/standing and worsens on hard surfaces, wearing tight shoes, heels
What is the Tx for Morton’s neuroma?
padding metatarsal area, loose shoes, injection
surgical resection if conservative Tx fails
Define hammertoe
flexion of PIP joint and tip of toe points down commonly seen in 2nd toe
Define bunionette
prominence of metatarsal head
How should hammertoe and bunionettes be managed?
avoid aggravating activities; stretch; splint
What is the most common cause of low back pain?
degenerative changes of lumbar spine
How does lower back pain typically resolve?
pain free w/in 8 weeks
What is critical on initial eval of low back pain?
identify neurologic involvement or suspicion of systemic disease=> without systemic disease then imaging is rarely needed
What is the major indication for back surgery?
presence of a serous or progressive neurologic deficit
What is the best therapy for the lower back pain?
exercise but no other Tx is supported by evidence of efficacy
Define fibromyalgia
widespread pain > 3 months with nonrestorative sleep pattern associated w/ point tenderness
What does fibromyalgia patient have on advanced neuroimaging?
dysfunctioning hippocampus and other cerebral abnormalities along with gray matter loss
What is key in treating a patient with fibromyalgia?
caring, comprehensive care (exercise, sleep) is key but pharm Tx is of limited value
