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Rheumatology Exam > Regional MSK Pain Syndromes > Flashcards

Regional MSK Pain Syndromes Flashcards

1
Q

overuse syndromes - defined

A

*repetitive action causes chronic trauma / irritation
*trauma → inflammatory cascade → painful range of movement & swelling → disability

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2
Q

overuse syndromes - epidemiology

A

*fairly common in the general population
*increase in incidence in systemic diseases (diabetes, rheumatoid arthritis)
*increase in incidence in particular occupations

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3
Q

overuse syndromes - general treatment principles

A

*education & prevention are most important
1. treatment of active inflammation:
-NSAIDs, anti-inflammatories
-ice initially, heat later
2. RICE: rest, ice, compression, elevation
3. decrease causative movements/triggers: time off sport or work; braces
4. control pain: NSAIDs (oral, topical), aspirin
5. steroid injections: pain control, decrease inflammatory process

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4
Q

stenosing tenosynovitis - symptoms

A

*aka “trigger finger”
*“locking” of the digit of the finger in flexed position
*describe having to use their other hand to extend their finger
*may also click or catch

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5
Q

stenosing tenosynovitis - physical exam

A

*aka “trigger finger”
*nodule/thickening of flexor tendon
*may have inflammation of retinacular sheath
*diagnosed based on history & exam

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6
Q

stenosing tenosynovitis - treatment

A

*steroid injection
*NSAIDs for pain relief (oral or topical)
*surgery if refractory

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7
Q

Dupuytren’s contracture - pathophysiology

A

*fibroproliferative disease of the palmar fascia with resultant deformity (most commonly 4th and 5th digit)

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8
Q

Dupuytren’s contracture - epidemiology

A

*men > women
*age > 50
*risk factors: DM, EtOH, smoking

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9
Q

Dupuytren’s contracture - symptoms

A

*often painless
*contracture of the 4th and 5th digits
*difficulty extending fingers (even with the other hand) and grasping objects

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10
Q

Dupuytren’s contracture - physical exam

A

*flexion contractures of most commonly the 4th and 5th digits (MCP, PIP joints)
*diagnosis based on history and exam

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11
Q

Dupuytren’s contracture - treatment

A

*no great therapy (surgery? collagenase injections?)

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12
Q

carpal tunnel syndrome - overview

A

*aka median nerve entrapment syndrome
*carpal tunnel bound on dorsal and lateral surfaces by carpal bones; on volar surface by transverse carpal ligament
*numerous flexor tendons and median nerve pass through this canal
*pressure on median nerve causes the symptoms; may be intrinsic or extrinsic to tunnel

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13
Q

carpal tunnel syndrome - risk factors

A

*aka median nerve entrapment syndrome
*risk factors include:
-pregnancy
-rheumatoid arthritis
-repetitive tasks involving wrist flexion (hairdresser, typist, receptionist)

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14
Q

carpal tunnel syndrome - symptoms

A

*aka median nerve entrapment syndrome
*symptoms include:
-paresthesia, pain, and numbness in the median nerve distribution: palmar side thumb, index, and middle fingers
-often worse at night

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15
Q

carpal tunnel syndrome - physical exam

A

*aka median nerve entrapment syndrome
* Tinel’s sign: percussion over median nerve reproduces the symptoms
*Phalen’s maneuver: wrist in complete flexion; pushing the dorsal surface of both hands together for 30-60 seconds; reproduces the symptoms
*diagnosis based on history and physical exam

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16
Q

carpal tunnel syndrome - treatment

A

*aka median nerve entrapment syndrome
*splints to keep wrist extended (night time)
*NSAIDs for pain control, if needed
*treat underlying cause, if present
*consider steroid injection
*surgery to remove transverse carpal ligament if conservative measures fail

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17
Q

important board information for carpal tunnel syndrome

A

*associated with:
1. acromegaly
2. hemodialysis-related amyloidosis

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18
Q

De Quervain’s tenosynovitis - overview

A

*noninflammatory thickening of abductor pollicis longus & extensor pollicis brevis tendons → pain or tenderness at radial styloid
*EPB (extensor pollicus brevis) and APL (abductor pollicus longus) tendons pass through a synovial sheath

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19
Q

De Quervain’s tenosynovitis - epidemiology

A

*women > men
*often seen post-partum

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20
Q

De Quervain’s tenosynovitis - symptoms

A

*pain on radial aspect of the wrist
*wrist pain
*difficulty grabbing objects, pinching

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21
Q

De Quervain’s tenosynovitis - physical exam

A

*Finkelstein test: fingers wrap around thumb and ulnar deviate the hand sharply; pain at the base of the thumb
*diagnosis = clinical

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22
Q

De Quervain’s tenosynovitis - treatment

A

*SPICA splint to rest thumb
*NSAIDs, rest
*injection if severe

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23
Q

lateral epicondylitis - pathophysiology

A

*aka tennis elbow
*inflammation/micro-trauma of extensor tendons at insertion on lateral epicondyle

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24
Q

lateral epicondylitis - risk factors

A

*aka tennis elbow
*age > 50
*non-professional tennis players
*gardeners
*carpenters

25
Q

lateral epicondylitis - symptoms

A

*aka tennis elbow
*pain on lateral aspect of the elbow
*pain worsens with activity
*difficulty lifting up heavier objects

26
Q

lateral epicondylitis - physical exam

A

*aka tennis elbow
*localized tenderness 1.5 cm distal to the origin of the extensor carpi radialis brevis (ECRB)
*painless ROM at the elbow
*restricted wrist extension with elbow in full extension reproduces pain

27
Q

lateral epicondylitis - treatment

A

*aka tennis elbow
*stop activities that aggravate, correct improper techniques
*NSAIDs for pain control
*counter-force brace
*steroid injections

28
Q

medial epicondylitis - pathophysiology

A

*aka Golfer’s elbow
*inflammation/micro-trauma of flexor tendons at insertion on medial epicondyle

29
Q

medial epicondylitis - epidemiology

A

*aka Golfer’s elbow
*age 45-55
*seen in golfing / throwing sports

30
Q

medial epicondylitis - symptoms

A

*aka Golfer’s elbow
*aching pain over the medial elbow
*ulnar nerve symptoms possible

31
Q

medial epicondylitis - physical exam

A

*aka Golfer’s elbow
*pain with resisted wrist flexion with the elbow in full extension

32
Q

medial epicondylitis - treatment

A

*aka Golfer’s elbow
*stop activities that aggravate
*correct improper techniques
*NSAIDs for pain control
*physical therapy

33
Q

olecranon bursitis - epidemiology

A

*ages 40-50 yo
*male > female
*50% with preceding trauma
*associated with repetitive trauma or systemic disease (RA, gout), can be infectious

34
Q

olecranon bursitis - symptoms

A

*pain, redness, swelling over bursa of olecranon (elbow)
*can have asymptomatic swelling

35
Q

olecranon bursitis - physical exam

A

*erythema and swelling at bursa
*tenderness to area
*may have decreased ROM

36
Q

olecranon bursitis - treatment

A

*aspirate the bursa to rule out infection, other causes
*aspiration improves pain (decreases swelling)
*elbow protection (if repetitive trauma)
*consider steroid injection if persistent (and not infected)

37
Q

trochanteric bursitis - pathophysiology

A

*acute or repetitive trauma leads to inflammation of the trochanteric bursa and surrounding tendons (sac surrounding the hip joint)

38
Q

trochanteric bursitis - symptoms

A

*lateral hip pain, localized but may radiate
*worsens with ambulation, standing, climbing stairs, or inclines
*patient complains that they cannot lie on that side (may keep them up at night)

39
Q

trochanteric bursitis - physical exam

A

*point tenderness over trochanteric bursa

40
Q

trochanteric bursitis - treatment

A

*short course of NSAIDs
*rest, stretching (especially IT band)
*physical therapy for stretching
*consider steroid injection if conservative therapy does not help

41
Q

pes anserine bursitis - pathophysiology

A

*area on medial aspect of knee joint where tendons of 3 muscles (semitendinosus tendon, gracilis tendon, sartorius tendon) joint to form a common insertion point

42
Q

pes anserine bursitis - risk factors

A

*obese
*females
*osteoarthritis

43
Q

pes anserine bursitis - symptoms

A

*painful medial knee
*exacerbated by activities such as rising from a chair or going up and down the stairs, walking up inclines (hills)

44
Q

pes anserine bursitis - physical exam

A

*painful palpation around pes anserine (medial knee)
*erythema

45
Q

pes anserine bursitis - treatment

A

*NSAIDs
*rest
*RICE therapy
*physical therapy
*consider steroid injection

46
Q

popliteal (Baker’s) cyst - pathophysiology

A

*caused by distention of connecting gastrocnemius and semi-membranous bursae
*often from underlying joint pathology (causes swelling)

47
Q

popliteal (Baker’s) cyst - symptoms

A

*may be asymptomatic
*posterior leg edema/mass at back of knee (can look like DVT)
*discomfort, potentially decreased ROM if big enough

48
Q

popliteal (Baker’s) cyst - treatment

A

*rest, ice, NSAIDs
*ultrasound-guided drainage
*treat underlying causes (arthritis of the knee)

49
Q

plantar fasciitis - pathophysiology

A

*plantar fascia connects MTPs to calcaneus
*insertion sites and the fascia itself can become inflamed

50
Q

plantar fasciitis - risk factors

A

*peak incidence 40-60yo
*obesity, excessive standing, runners, military recruits

51
Q

plantar fasciitis - symptoms

A

*inferior heel pain
*worse with movement (first few steps in the morning very painful)

52
Q

plantar fasciitis - physical exam

A

*pain with dorsiflexion of the toes
*palpation along fascia from heel to forefoot elicits pain

53
Q

plantar fasciitis - treatment

A

*NSAIDs, rest, RICE therapy
*stretching exercise
*rolling cold coke can/frozen water bottle along fascia
*consider steroid injection

54
Q

Morton’s Neuroma - pathophysiology

A

*entrapment neuropathy of an interdigital nerve
*more common in females > males

55
Q

Morton’s Neuroma - symptoms

A

*burning pain in third intermetatarsal space that can radiate towards the toes
*numbness or pain that increases with activity

56
Q

Morton’s Neuroma - physical exam

A

*Mulder’s sign: clicking sensation upon palpation of the involved interspace while squeezing the metatarsal joints
*tenderness to palpation

57
Q

Morton’s Neuroma - diagnosis

A

*clinical
*MRI and ultrasound are options if diagnosis is questionable

58
Q

Morton’s Neuroma - treatment

A

*mechanical (inserts in shoes, proper shoe fit)
*consider injection

Rheumatology Exam (20 decks)

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