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MSK/Rheum path > Non-articular Rheumatism > Flashcards

Non-articular Rheumatism Flashcards

1
Q

Characteristics of Non-articular joint pain

A

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

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2
Q

What provides diagnosis of most causes of shoulder pain on clinical exam?

A

comprehension of functional anatomy

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3
Q

What provides the best Tx for shoulder pain?

A

Hx and clinical exam along with ancillary tests

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4
Q

What is the most common cause of shoulder pain?

A

rotator cuff tendinitis secondary to impingement syndrome

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5
Q

What is the key finding of rotator cuff tendinitis during PE?

A

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

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6
Q

What is the etiology for RCT?

A

50% involved in trauma while other are associated with degeneration

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7
Q

What are the clinical manifestations differences of complete vs partial RCT?

A

complete=> positive arm drop test w/ inability to maintain 90’ of passive shoulder abduction

partial=> weakness, pain, loss of ABD

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8
Q

Define bicipital tendinitis, tests and clinical manifestations

A

Anterior pain from LHB and painful to palpate;
Yergasons and Speeds
Popeye can form on rupture

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9
Q

Define adhesive capsulitis and clinical manifestations

A

idiopathic but generally 2ndary to other pathology or prolonged immobilization of arm;
High association to diabetes;
Loss of active/passive ROM in all planes

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10
Q

What are 3 extrinsic or regional factors causing shoulder pain?

A 
Cervical radiculopathy (referred pain);
Brachial neuritis; 
nerve entrapment syndrome (SSc nerve-trxn lesion)
Reflex sympathetic dystrophy;
neoplasms
Dialysis shoulder arthropayy
Osteonecrosis
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11
Q

What is olecranon bursitis?

A

swelling of elbow from infection, trauma, gout

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12
Q

Define lateral epicondylitis along with clinical manifestations

A

overuse leading to degeneration of common extensor tendon=> extensor carpi radialis brevis;
Phys exam: tenderness on palpation, forced supination and resisted wrist extension

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13
Q

Define medial epicondylitis along with clinical manifestations

A

overuse injury of the flexor carpi radialis

Phys exam: local tenderness and pain on forced pronation and resisted wrist flexion

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14
Q

Define ulnar nerve entrapment

A

aching medial pain at elbow causing numbness and paresthesia of 4th and 5th digits

many causes

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15
Q

Carpal tunnel patients typically have manifestations when?

A

nocturnal paresthesias associated with intermittent pain or paresthesia during day

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16
Q

Define ganglion cysts

A

mucin filled cysts arising from joint capsules or tendon sheaths and symptomatic

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17
Q

What tendon is very susceptible to rupture in the hand and wrist?

A

extensor pollicis longus tendon => careful w/ tendinitis

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18
Q

Define DeQuervain’s disease

A

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

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19
Q

How should CMC osteoarthritis pain be initially treated?

A

splinting (thumb)

20
Q

Define trigger finger and treatment

A

thickening of A1 retinacular pulley in palm

Tx: corticosteroid injections and splinting

21
Q

Define flexor tenosynovitis and clinical manifestations

A

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

22
Q

What is the most commonly diagnosed compression neuropathy? Epidemiology?

A

Carpal tunnel syndrome

3x more common in women usually bw 40-60yr

23
Q

What are the stages of Tx for carpal tunnel syndrome?

A

Night splinting;
Corticosteroid injection;
Surgical release

24
Q

Define trochanteric bursitis

A

lateral thigh pain ending at the knee that is reported as hip pain

25
Q

define meralgi paresthetica

A

Non-articular=> lateral femoral cutaneous nerve (L2-L3) entrapment causing diffuse lateral thigh pain
Sites: inguinal ligament and psoas insertion
Causes: pregnancy, obesity, diabetes

26
Q

Define prepatellar bursitis

A

swelling superficial to patella with many causes but must keep sepsis on DDx

27
Q

How will septic prepatellar bursitis present?

A

rubor, calor, dolor over patella and adjacent tissue with LACK OF JOINT INVOLVEMENT =>nontender suprapatellar pouch and popliteal area

28
Q

Define popliteal cyst (Baker’s cyst)

A

common as most popliteal bursas communicate w/ joint and presents w/ swelling/discomfort posterior to joint that may rupture

29
Q

Define achilles tendinitis

A

inflammation of achilles tendon associated w/ inflammation causing pain, swelling and tenderness at attachment that is prone to rupture

Test: Thompson test

30
Q

Define plantar fascitis

A

pain in plantar area of heel associated with idiopathic or spondyloarthropathy causes with pain in AM and tender at origin of plantar fascia

31
Q

Define pes planus

A

loss of longitudinal arch on medial foot with the calcaneus everted;
hereditary to some degree;
monitor rupture of posterior tibialis tendon causing it

32
Q

Define morton’s neuroma

A

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

33
Q

What is the clinical manifestations of morton’s neuroma?

A

aching/burning pain radiating distally to affected toes and irritated by jogging/standing and worsens on hard surfaces, wearing tight shoes, heels

34
Q

What is the Tx for Morton’s neuroma?

A

padding metatarsal area, loose shoes, injection

surgical resection if conservative Tx fails

35
Q

Define hammertoe

A

flexion of PIP joint and tip of toe points down commonly seen in 2nd toe

36
Q

Define bunionette

A

prominence of metatarsal head

37
Q

How should hammertoe and bunionettes be managed?

A

avoid aggravating activities; stretch; splint

38
Q

What is the most common cause of low back pain?

A

degenerative changes of lumbar spine

39
Q

How does lower back pain typically resolve?

A

pain free w/in 8 weeks

40
Q

What is critical on initial eval of low back pain?

A

identify neurologic involvement or suspicion of systemic disease=> without systemic disease then imaging is rarely needed

41
Q

What is the major indication for back surgery?

A

presence of a serous or progressive neurologic deficit

42
Q

What is the best therapy for the lower back pain?

A

exercise but no other Tx is supported by evidence of efficacy

43
Q

Define fibromyalgia

A

widespread pain > 3 months with nonrestorative sleep pattern associated w/ point tenderness

44
Q

What does fibromyalgia patient have on advanced neuroimaging?

A

dysfunctioning hippocampus and other cerebral abnormalities along with gray matter loss

45
Q

What is key in treating a patient with fibromyalgia?

A

caring, comprehensive care (exercise, sleep) is key but pharm Tx is of limited value

MSK/Rheum path (22 decks)

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