Nonarticular Rheumatism Flashcards
Comprehension of functional anatomy of the shoulder allows what?
Diagnosis of most of the causes of shoulder pain on clinical examination
History and clinical exam are aided by what to provide what?
Aided by ancillary tests to guide application of the most appropriate treatment of shoulder pain
The DDx of shoulder pain includes what 2 things?
1) Common local disorders (tendon and adjacent structures)
2) Etiologies arising from distant anatomic sites arising by referred pain pathways
What are there a great disposal of to use for the diagnosis of shoulder pain?
Diagnostic Test (lame question…)
What are most causes of shoulder pain treated with?
Structured physical therapy program
What does a successful treatment program understand?
Potential surgical candidates including those who fail conservative treatment
Systemic arthoopathies occasionally present with what and what is essential for these patients?
Shoulder pain; early assessment
Patients with carpel tunnel syndrome generally present how?
With nocturnal paresthesias associated with intermittent pain or paresthesia during the day
What are ganglia?
Mucin-filled cysts arising from joint capsules or tendon sheaths
What can you treat symptomatic ganglia with?
Corticosteroid injections; surgical excision may be necessary to cure
Tendinitis of the extensor pollicis longus tendon can be dangerous because of what?
The risk of tendon rupture
DeQuervains Dz is what? and who is it common in?
Inflammation of the extensor pollicis brevis and abductor pollicus longus tendons in first dorsal extensor compartment; common in women + associated with repetitive hand activities (…lol) such as caring for an infant
Painful osteoarthritis involving what joint of the thumb can be treated with what?
Carpometacarpal joint of the thumb; treated with splinting
What are trigger fingers caused by and how are they treated?
Thickening of the A1 retinacular pulley in the palm; treated by corticosteroid injections and splinting
Up to what % of people experiences low back pain, and what is the MCC of that back pain?
80%; degenerative changes of the lumbar spine
More than % of patients with LBP are largely pain free within 8 weeks?
90%
What does initial evaluation of LBP entail?
Identify the few patients with neurologic involvement or systemic dz (infection, malignancy, spondyloarthritis) because they may need urgent or specific intervention
Psychosocial and other risk factors predict what for LBP?
They predict the risk of chronic disabling LBP
When is imaging rarely indicated for LBP?
In the absence of significant neurologic involvement or suspicion of systemic dz
Why must imaging abnormalities be carefully interpreted for LBP?
They are frequently present in asymptomatic individuals
A precise pathanatomic dx with identification of the pain generator may not be seen in up to what % of patients?
85%
Persistent LBP should be treated with?
An individually tailored program that includes analgesia, core strengthening, stretching, aerobic conditioning, loss of excess weight, and patient education
Intensive interdisciplinary rehab with an emphasis on what should be considered if LBP conservative measures fail?
Cognitive-behavioral therapy
What is there no evidence for in terms of the effectiveness in LBP patients without radiculopathy?
Epidural Corticosteroids
A large number of what 3 things lack evidence of efficacy for LBP?
1) injection technique
2) physical therapy modalities
3) nonsurgical interventional therapies
What is the major indication for back surgery?
Presence of a serious or progressive neurologic deficit.
If back surgery is performed in the absence of neurologic defects like spinal fusion or degenerative changes, what is the problem?
It is not clearly effective
What are the issues that surround fibromyalgia?
Not scientific ones - it is widely agreed the pain and suffering is real; but the primary issues are often social, political, and financial
Fibromyalgia lies at the end of a continuum of what?
Polysumptomatic distress rather than being a discrete disorder
Fibromyalgia can be diagnosed using what? Does clinical care require a diagnosis?
The American College of Rheumatology 2010 or 1990 criteria; No it does not
What is included in the ACR 2010 criteria for fibromyalgia that wasnt in the 1990? Why?
Changes in the sex ratio if patients because men have a higher tolerance for pain and are less likely to be diagnosed with having fibromyalgia than women when the 1990 criteria including tender points are used
Advanced neuroimaging techniques showed dysfunction in what part of the brain? As well as what loss?
Hypocampus dysfunction as well as other cerebral abnormalities; and greater grey matter loss
The regions in which objective changes are demonstrated may be functional inked to what in fibromyalgia?
Core features of the disorder including affective disturbances and chronic widespread pain
Pharmacologic treatment of fibromyalgia is or is not valuable?
Limited valuable; but it is shown that caring and comprehensive care can make a difference
