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Rheum Boards Studying > Noninflammatory Causes of MSK pain > Flashcards

Noninflammatory Causes of MSK pain Flashcards

1
Q

Benign syndrome of hyper-mobility

A
  • 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
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2
Q

Risk factors for mobile flat foot

A
  • Male
  • Fam hx
  • Generalized ligamentous laxity
  • shoe wearing before age 6
  • Obesity
  • developmental coordination disorder
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3
Q

What is genu Recurvatum associated with?

A
  • Adolescent females (esp obese)

- Popiteal pain and increased ACL injury

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4
Q

Symptoms associated with PFS

A
  • 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
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5
Q

Sx associated with plica syndrome

A
  • Medial knee pain, patellar snapping, catching during flexion
  • Localized tenderness at medial and inferior patellar border
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6
Q

RIsk factors for stress fractures

A
  • Low vitamin D

- Female athlete triad (eating disorder, amenorrhea, and osteoporosis)

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7
Q

First degree ligament injury

A

Fibers of ligament stretched but intact

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8
Q

Second degree ligament injury

A

Tear of part of the ligament

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9
Q

Third degree ligament injury

A

Complete rupture of the ligament, sometimes avulsing a piece of bone

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10
Q

Shin splints

A
  • Periostitis and fasciitis caused by repetitive traction at origin of muscle fascia attachment along middle and distal posterior middle tibia
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11
Q

Little leg elbow

A

Valgus compressive injury to lateral elbow –> causes decreased blood supply to capitellum, leading to Panner osteochrondrosis

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12
Q

Koelher disease

A
  • Tarsal navicular
  • Ages 6-9
  • Can be b/l
  • May complain of midfoot pain with weight bearing
  • Localized swelling, erythema, tenderness over navicular
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13
Q

Freiberg disease

A
  • Osteonecrosis of metatarsal heads
  • Common in athletic females
  • Forefoot pain and focal tenderness over affected meta tarsals
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14
Q

Thiemann disease

A
  • Rare
  • Osteochrondosis of phalangeal epiphyses
  • PIPs of fingers and toes, may also affect DIPs
  • Fusiform swelling and tenderness
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15
Q

Neuralgic amytrophy

A
  • 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
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16
Q

Primary Fibromyalgia Syndrome

A

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
17
Q

Chronic fatigue syndrome

A

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
18
Q

Complex regional pain syndrome

A
  • 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
19
Q

Complications of CRPS

A

Osteoporosis
muscle atrophy of unused limb
Relapse
Other stress related disorders

20
Q

OI

A
  • Problem with connective tissue due to lack of Type 1 Collagen
  • Mutations in COL1A1 and COL1A2
21
Q

Type I OI

A

Most mild, collagen is normal in quality but insufficient in quantity
Key Findings: Blue sclera, fractures, hearing loss

22
Q

Type II OI

A
  • Severe and usually lethal

- Collagen is poor quality and quantity

23
Q

Type III OI

A
  • Collagen is enough quantity but defective quality

- Progressive deforming

24
Q

Type IV OI

A
  • Enough quantity but poor quality
  • Fractures
  • Mild to moderate deforming
25
Q

Type V and VI

A

Like type IV but different histology

26
Q

Type VII and VIII

A

different gene mutations

27
Q

Type I/II EDS

A
  • Col5A1 and COL5A2

- Severe skin fragility, joint hyper-extensibility and easy bruising

28
Q

Type III EDS

A
  • Painful joints that sublux or dislocate

- Molecular diagnosis not currently possible

29
Q

Type IV EDS

A
  • CoL3A1 mutation

- Thin translucent skin with prominent subq veins, acrogenic hands, pinched facial features

30
Q

Type VI EDS

A
  • Musculocontractual

- Digit contractures, hypermobility, scoliosis, thin lax skin ocular abnormalities

31
Q

Marfan syndrome

A
  • 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
32
Q

Homocystinuria

A
  • Downward dislocation of the lens
  • Stiff rather than hyperextensible joints
  • Thrombosis
  • Mental retardation
33
Q

Tumoral calcinosis

A
  • 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
34
Q

Trichorhinophalangeal syndrome

A
  • 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
35
Q

Nail-patella syndrome

A
  • Abnormalities of nails, knees, elbows and pelvis

- Can also have vasculitis and renal disease

36
Q

Camptodactyly-arthopathy-coxa vara-pericarditis (CACP)

A
  • 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

Rheum Boards Studying (34 decks)

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