Ortho/Rheum 4 Flashcards
In Rotator cuff impingement or tendinopathy…
- What two maneuvers cause pain?
- Palpation of what area cause pain?
3 What two impingement tests/maneuvers are helpful in diagnosis?
- Pain w ABduction and External rotation.
- Subacromial tendernes.
- NEER TEST = examiner passively flexes shoulder by raising arm up to maximal elevation while stabilizing scapula. +ve = pain with elevation.
HAWKINS TEST = elevate patient’s arm forward 90 degrees and forcibly INTERNALLY rotate shoulders. +ve = pain on internal rotation.
Rotator cuff tear presents similar to impingement, but with what other finding?
WEAKNESS OF EXTERNAL ROTATION.
- What is the classic presentation of adhesive capsulitis “Frozen Shoulder Syndrome”?
- What is the classic PE finding?
- How do you dx?
- TRX?
Begins with shoulder pain worse at night. Then gradually the shoulder becomes stiff in ALL directions. Stiffness > pain;
DECREASE in PASSIVE and ACTIVE ROM in all directions of shoulder.
DX= Clinical with decreased passive/active ROM in >2 planes.
TRX = Range of motion exercises +/- steroid injections if ROM is severely limited.
When do you consider EMG/NCS for Carpal Tunnel Syndrome?
Patient who are failing conservative treatment (wrist splinting), worsening symptoms, in preparation for SURGERY.
OR Diagnosis unclear.
What are the DEXA values:
Normal?
Osteopenia?
Osteoporosis?
Normal = > -1 Osteopenia = -2.5 to -1 Osteoporosis = < -2.5
What are the two indications for Bisphosphonate therapy?
1) Osteoporosis (DEXA < -2.5)
(OR)
2) At least 1 Fragility fracture (fracture from standing), regardless of DEXA.
What is the pathophysiology of Scleroderma Renal Crisis?
How do you treat HTN in Scleroderma Renal Crisis?
Abnormal collagen deposition in renal vessels causing renal ischemia –> Activation of RAS –> malignant HTN.
TRX = ACEI (especially captopril) - because it reverses angiotensin induced vasoconstriction.
Systemic Scleroderma Presents with what three main symptoms?
What symptoms can you see in these other organ systems:
Lungs?
GI?
Heart?
Renal?
- Tight, fibrous, thickening of skin.
- Raynaud’s phenomenon
- Joint pain (mild/symmetrical)
Lungs –> Pulmonary fibrosis and pulmonary HTN
GI –> GERD, esophageal dysmotility, PBC (15%)
Heart –> Restrictive Cardiomyopathy
Renal –> Malignant hypertension
What are the three important clinical findings for diagnosis of Ankylosing Spondylitis?
- lower back pain/stiffness for >3 months that improves with activity.
- Limited ROM of lumbar spine.
- Limited chest expansion.
If you suspect Ankylosing Spondylitis, what is the best first step in work up?
How do you monitor for disease progression in Ankylosing Spondylitis?
What is prognosis?
XR of sacroilliac joint –> need to show sacroilliitis in order to diagnose.
Monitor disease progression by –> XR of lumbar spine, cervical spine and hip, every several months. Can also follow acute phase reactants -ESR.
Prognosis - normal life expectancy.
What are the five main extra-articular findings in Ankylosing Spondylitis?
- Acute anterior uveitis
- Aortic Regurg
- Apical pulmonary fibrosis
- Restrictive lung disease
- IgA nephropathy
What is the pathophysiology of Developmental Dysplasia of HIP?
A baby with DDH may show what signs?
Adolescence with DDH can present with these two PE findings.
DDH caused by abnormal acetabular development –> Shallow his socket and inadequate support for femoral head –> Causing accelerated wearing of cartilage and osteoarthritis in adolescence.
Baby - asymmetric leg fold creases and “hip clunk” (dislocation of femoral head from acetabulum)
Adolescence:
- Trandelenburg gait (contralateral hip drop when standing on ipsilateral foot)
- Length discrepancy of legs.
What is the classic presentation of Polymyositis?
- PROXIMAL muscle weakness (stair climbing or getting up from chair). little to no muscle pain.
- Joint pain
- Muscle inflammation (increased CPK and aldolase)
- Increased inflammatory markers (CRP and ESR)
(etiology is unclear –> inflammatory myopathy, possibly after viral infection)
What ab is associated with polymyositis and dermatomyositis?
What is the single best test for diagnosis?
What is the mainstay of TRX?
Anti-jo-1 (both)
Anti - Mi-2 (DM»_space;PM)
definitive DX = muscle biopsy, but if proximal weakness + increased CPK + Serum AB +ve then don’t necessarily need bx.
TRX = Steroids.
Dermatomyositis presents similarly to Polymyositis. What additional skin findings define Dermatomyositis?
- Gottron’s paules - purple papules over MCP joints.
- Heliotrope rash - periorbital purple lesion around eyes “raccoon eyes”
- Shawl Sign- shoulder and neck erythema.
