Other MSK MDT Flashcards
The following describes what injury:
- Major cause of chest pain in the ambulatory setting
- Causes of this syndrome poorly studied and documented
- Likely secondary to viral illness and other causes of inflammation
- Other rheumatic diseases such as fibromyalgia a common cause of chest wall pain
- Chest pain is said to “reproducible”
Costochondritis
What must you r/o before dx of Costochondritis
- Myocardial ischemia
- Infarction
- Pulmonary embolism
- Aortic dissection
- Pneumothorax
Pt presents with:
- Chest pain is said to “reproducible”
- Able to exacerbate pain with palpation on physical exam
Costochondritis
Treatment of Costochondritis
- Most cases improve course of few weeks:
- NSAIDS
- Home stretching program
- Activity modification
- Refer all patients in which the diagnosis is unclear
The following describes what injury:
- Knee joint accounts for approximately 80% of cases
- Also affects:
Hand
Spine
Hip
Osteoarthritis
The following are risk factors for what condition
- Age: more common in older population
In general population age over 50
-Gender: greater risk in females
1.7 times as likely as males
-Family history
-Joint injuries
-Chronic inflammation
-Obesity
-Occupation
Heavy workload
Osteoarthritis
Common sites of osteoarthritis
- Hips
- Knees
- Spine
- Hands
Pt presents with:
- Joint Pain that is exacerbated with use, alleviated with rest
- Joint Pain is aching, deep in later stages
- Sharp joint pain in beginning stages
Osteoarthritis
Plain films show the following:
- Joint space narrowing
- Osteophytes
- Subchondral sclerosis
- Cysts
Osteoarthritis
Treatment of Osteoarthritis
- Control Pain
- NSAIDs
- Tylenol
- Activity/lifestyle modification
- Weight reduction
- Loss of 10% body weight associated with 50% reduction in pain over 18 months
- Rehabilitation
- Aerobic and strengthening exercises
The following describes what injury:
- Unknown etiology
- Autoimmune disorder
- Insidious onset, distal joints first (DIPJ of hands are spared)
- Extra-articular manifestations (pulm, CV, eyes)
- Mostly small joints and bilateral: hands, finger, wrists, feet, ankle
Rheumatoid Arthritis
Pt presents with:
4 of 7 ACR criteria:
- Morning stiffness (1 hour for 6 weeks)
- Arthritis (>/= 3 joints for 6 weeks)
- Swelling of hand joints (6 weeks)
- Symmetrical joint swelling (6 weeks)
- Rheumatoid nodules
- Positive RF factor
- Erosions or osteopenia in hand XR
- May have myelopathy with C1-C2 involvement
Rheumatoid arthritis
Pt PE:
- Nodules (elbow mostly)
- Swelling/hypertrophy (esp PIP early sign)
- Swan neck deformity
- Lateral drift of toes
- Boggy sensation
- ROM Diminished and painful
Rheumatoid arthritis
Treatment of Rheumatoid arthritis
- MEDAVICE with GMO or refer to Internal Medicine
- Typical medications used:
NSAID/Tylenol
DMARD (Disease-Modifying Anti-Rheumatic Drug)
-ab, , etanercept, methotrexate, hydroxychloroquine, cyclosporine - Physical Therapy/Surgery
The following describes what injury:
- preceeded and precipitated by infection in the body
- Urinary Tract Infection
- Diarrheal illness
- Sexually Transmitted Infections
- Incidence estimated around 10 per 1,000
Interval of days to weeks between infection and onset of pain
Reactive arthritis
Pt presents with:
- Acute onset of joint pain 1-4 weeks after infection
- Peripheral arthritis
Knees
Small joints of hands/wrists
Enthesitis
- Inflammation of insertion sites of ligaments, tendons, fascia
- Achilles tendon commonly involved
- Dactylitis (“sausage digits”)
- Lower back pain
- Extra articular manifestations
Reactive arthritis
Treatment of reactive arthritis
- Treat infection if active
- Symptoms self limited
- May last up to 6 months
- NSAIDs for pain
- Severe cases
- Refer to specialist
DMARDs/steroids considered
The following describes what injury:
- Common inflammatory skin disease
- Most common manifestation: well-demarcated erythematous plaques with silver scale
- Other presentations: guttate, pustular, erythrodermic, inverse, nail psoriasis
- Affects women and men equally
- 1 to 2 per 1000 people affected in general population
Psoriatic arthritis
Pt presents with:
- Pain and stiffness in affected joints
- Stiffness sometimes alleviated by physical activity
- Asymmetric distribution of joint pain
SI joint, large joints (such as knee), small joints (such as DIP)
- Majority have skin lesions prior to pain
- Pain may precede lesions
- Soft tissue inflammation: enthesitis, dactylitis, tenosynovitis
- Nail lesions
- Ocular involvement
Psoriatic arthritis
Pt presents with:
- Back pain in almost all patients
-“Bamboo spine”: severe restriction in back mobility seen in about half of patients in later stages of disease progression
- Large joints involved:
Sacroiliac joint, spine, hip, shoulder
Peripheral arthritis common
Chest wall inflammation
Enthesitis
Dactylitis
Ankylosing Spondylitis
Pt presents with:
- Mostly monoarticular (80% of the time)
- Common sites of involvement
1st toe, ankle, knee, wrist, fingers, elbow
- Intense pain, redness, swelling,
- Occurs in hours to days
Gout
Pt PE:
- Big toe Swelling, erythema; tophi
- Severe tenderness even to light touch
- Limited and guarded
Gout
How is Pseudogout and gout differentiated
Analysis of joint aspiration reveals rhomboid shaped crystals confirms pseudogot
Bayonetted fracture definition
distal fragment overlaps proximal fragment
