Noninflammatory Causes of MSK pain Flashcards
Benign syndrome of hyper-mobility
- need 2 major, 1 major and 2 minor, or 4 minor (2 minor if 1st degree relative)
1. Major criteria - Beighton of 4/9 or greater
- Arthalgia >3months in > or = to 4 joints
2. Minor - Beighton score less than 4
- Arthalgia in less than 4 joints, back pain, or spondylolysis, spondylolisthesis
- > 1 joint dislocation
- 3 or more soft tissue lesions (epicondylitis, tenosynovitis, bursitis)
- Marfanoid habitus
- Skin striae, hyperextensibility, thin skin, or abnormal scarring
- Eye signs: drooping eye lids, myopia, antimongoloid slant
- Varicose veins, hernia, or uterine/rectal prolapse
Risk factors for mobile flat foot
- Male
- Fam hx
- Generalized ligamentous laxity
- shoe wearing before age 6
- Obesity
- developmental coordination disorder
What is genu Recurvatum associated with?
- Adolescent females (esp obese)
- Popiteal pain and increased ACL injury
Symptoms associated with PFS
- Difficulty descending stairs and squatting
- Theater sign (need to sit with legs straight)
- Dull, achy peripatellar or retropatellar pain and stiffness
- give way sensation though no true instability
- Painful grind and patellar compression test
Sx associated with plica syndrome
- Medial knee pain, patellar snapping, catching during flexion
- Localized tenderness at medial and inferior patellar border
RIsk factors for stress fractures
- Low vitamin D
- Female athlete triad (eating disorder, amenorrhea, and osteoporosis)
First degree ligament injury
Fibers of ligament stretched but intact
Second degree ligament injury
Tear of part of the ligament
Third degree ligament injury
Complete rupture of the ligament, sometimes avulsing a piece of bone
Shin splints
- Periostitis and fasciitis caused by repetitive traction at origin of muscle fascia attachment along middle and distal posterior middle tibia
Little leg elbow
Valgus compressive injury to lateral elbow –> causes decreased blood supply to capitellum, leading to Panner osteochrondrosis
Koelher disease
- Tarsal navicular
- Ages 6-9
- Can be b/l
- May complain of midfoot pain with weight bearing
- Localized swelling, erythema, tenderness over navicular
Freiberg disease
- Osteonecrosis of metatarsal heads
- Common in athletic females
- Forefoot pain and focal tenderness over affected meta tarsals
Thiemann disease
- Rare
- Osteochrondosis of phalangeal epiphyses
- PIPs of fingers and toes, may also affect DIPs
- Fusiform swelling and tenderness
Neuralgic amytrophy
- Brachial plexus neuritis
- Rare peripheral nerve disorder
- Acute episodes of extreme pain in upper extremities, neck and or trunk
- Lasts typically four weeks followed by shooting pains to the arms or trunk that disspirate over weeks to months
Primary Fibromyalgia Syndrome
Need all 4 major and 3/10 minor
Major
- Generalized MSK aching in at least 3 sites for at least 3 months
- Absence of underlying condition or cause
- Normal tests
- 5 tender points
Minor
- Chronic anxiety or tension
- Fatigue
- Pain with PE
- Pain with weather
- Pain with stress
- Subjective soft tissue swelling
- IBS
- Headaches
- Poor sleep
Chronic fatigue syndrome
All 3 below
- Substantial reduction or impairment in ability to engage in pre illness levels of occupational, educational, social or personal activities that persists for more than 6 months and is accompanied by extreme fatigue (new or definite onset, not lifelong) and is not the result of ongoing excessive exertion and is not alleviated by rest
- Post exertional malaise
- Unrefreshing sleep
At least 1/2 below
- Cognitive impairment
- Orthostatic intolerance
Complex regional pain syndrome
- Pain out of proportion to history/PE
- Allodynia
- Typically single lower extremity but can be both
- Conversion symptoms, sleep disturbances, eating disorders
- XR may show osteoporosis in later stages
- Bone scan usually shows decreased uptake but may show spotty increased pattern
- MRI may show bony edema and small joint effusion
Complications of CRPS
Osteoporosis
muscle atrophy of unused limb
Relapse
Other stress related disorders
OI
- Problem with connective tissue due to lack of Type 1 Collagen
- Mutations in COL1A1 and COL1A2
Type I OI
Most mild, collagen is normal in quality but insufficient in quantity
Key Findings: Blue sclera, fractures, hearing loss
Type II OI
- Severe and usually lethal
- Collagen is poor quality and quantity
Type III OI
- Collagen is enough quantity but defective quality
- Progressive deforming
Type IV OI
- Enough quantity but poor quality
- Fractures
- Mild to moderate deforming
Type V and VI
Like type IV but different histology
Type VII and VIII
different gene mutations
Type I/II EDS
- Col5A1 and COL5A2
- Severe skin fragility, joint hyper-extensibility and easy bruising
Type III EDS
- Painful joints that sublux or dislocate
- Molecular diagnosis not currently possible
Type IV EDS
- CoL3A1 mutation
- Thin translucent skin with prominent subq veins, acrogenic hands, pinched facial features
Type VI EDS
- Musculocontractual
- Digit contractures, hypermobility, scoliosis, thin lax skin ocular abnormalities
Marfan syndrome
- Dominant mutation of fibrillin 1
- Tall stature with wing span>height
- Arachnodactylt
- Wrist and thumb sign
- Pectus carinatum
- Hindfoot deformity with pes planus
- Protusio acetabuli
- Kyphoscoliosis
- Reduced elbow extension
- High arched palate, hypotonia, joint paint, hybermobilty and effusion
- Upward dislocation of lens of eye
- CV: aortic root dilatation, anererysm, MVP, sudden death
Homocystinuria
- Downward dislocation of the lens
- Stiff rather than hyperextensible joints
- Thrombosis
- Mental retardation
Tumoral calcinosis
- Familial condition with painless large periarticular massess
- Most common in hips, shoulders and elbow
- May also have eye abnormalities, dental abnormalities, hyperostosis
- Associated with hyperphosphatemia and mutations in FGF23, GALNT3, or KL–> all involved in phosphate homeostatsis
Trichorhinophalangeal syndrome
- Craniofacial and skeletal abnormalities
- Bulbous nose, short stature, sparse hair, enlarged interphalageal joints, cone shaped epiphyses, short metacarpals and metatarsals
- Small, flat fragmented capital epiphyses suggestive of Legg, Calve Perthes
Nail-patella syndrome
- Abnormalities of nails, knees, elbows and pelvis
- Can also have vasculitis and renal disease
Camptodactyly-arthopathy-coxa vara-pericarditis (CACP)
- Frequently born with camptydactyly
- Develop large and small non inflammatory arthropathy with synovial hypertrophy
- Pericarditis and pleuritis
- Bony deformities including coxa vara (hip deformity) and large synovial cysts
- NO effective treatment other than rehab
