Regional Pain Syndromes Flashcards
Olecranon bursitis
- inflammation of bursa that lies on posterior aspect of elbow
- presents as fluid-filled mass
- causes: repetitive trauma, infection, systemic inflammatory conditions
- no pain or movement restriction with range of motion
- aspirate bursa to assess for crystals or infection
- treatment: NSAIDs and rest
Cauda equina syndrome
Urinary retention or incontinence, diminished perineal sensation, bilateral motor deficits
Indications for back imaging
If pain is severe
Progressive neurologic deficits
Red flag symptoms, ie cauda equina syndrome
When underlying condition is suspected
Signs of herniated disk
- positive straight leg test
- weakness of ankle and great toe dorsiflexion(L5)
- loss of ankle reflexes(S1) and sensory loss in feet
- loss of knee reflex(L4), not common
Features of spinal stenosis
- neurogenic claudication: radiating back pain, LE numbness
- symptoms exacerbated by walking and spinal extension but improved with leaning forward and sitting
- wide based gait and abnormal Romberg test are highly specific for spinal stenosis
- diagnose with MRI
- surgical intervention has greater improvement in pain at 2 yrs compared to medical management
Patellofemoral syndrome
-most common cause of knee pain in patients
Prepatellar bursitis
- anterior knee pain and swelling anterior to the patella
- caused by trauma or repetitive kneeling
- always perform joint aspiration to rule out infection if warm and red
Anserine bursitis
- located medically and 6 cm below the joint line
- knee pain worse with activity and at night
- common in patients with osteoarthritis
Iliotibial band syndrome
- knife-like lateral knee pain that occurs with vigorous flexion-extension activities of the knee such as running
- treat with rest and exercise
Trochanteric bursitis
- lateral point tenderness and full range of motion except for abduction
- manage with local steroid injection and stretching exercises
Hip osteonecrosis
- continuous groin, thigh and butt pain
- high risk groups: SLE, sickle cell disease, steroid use
- diagnosis: MRI hip
- treatment: hip replacement
When to image the ankle
- patient cannot bear weight
- pain localized to medial or lateral malleoli
- base of 5th metatarsal pain
- navicular bone pain
2 most common causes of foot pain
- plantar fasciitis
- Morton neuroma
De Quervian tenosynovitis
-positive finkelstein test is characteristic- patient folds fingers over the thumb to make a fist then examiner rotates the hand, stretching the tendon which reproduces the pain
Carpal tunnel syndrome
- pain and parasthesias, worse at night, localized to thumb, first 2 fingers, and radial half of ring finger
- secondary causes: hypothyroid, diabetes, pregnancy, RA of wrist
- treatment: NSAIDs and splinting at night
Familial Mediterranean fever
- findings include recurrent, self-limited attacks of fever, serositis, arthritis, rashes that last 3 to 4 days
- lab findings: elevated ESR and CRP, positive amyloid A protein, proteinuria and MEFV gene
- treatment: colchicine to prevent attacks and development of amyloidosis
Adult onset still disease
- quotidian fever in which temp spikes once daily and returns to subnormal
- fatigue, malaise, arthralgia, myalgia
- proteinuria, serositis
- evanescence pink rash
- elevated ferritin above 2500 is highly specific and reflect disease activity
- treatment: NSAIDs, are first line; steroids may be helpful if refractory to NSAIDs; MTX, TNF-alpha inhibitor, interleukin-1 receptor antagonists may be helpful for refractory disease
Common autoimmune serologies
- CREST syndrome/limited cutaneous systemic sclerosis->anticentromere
- SLE->anti-dsDNA
- autoimmune hepatitis->anti smooth muscle ab
- anti-La/SSB->sjogren syndrome, neonatal lupus
- anti-RNP: mixed connective tissue disease
- anti-Scl-70: scleroderma/diffuse cutaneous sclerosis
- antihistone: drug induced lupus
- anti-Ro/SSA: sjogren, neonatal heart block, subacute cutaneous lupus
- c-ANCA: wegeners
- p-ANCA: churg Strauss, microscopic polyangiitis
- anti-Jo-1 ab: polymyositis
- anti-CCP: RA
2 most common causes of elbow pain
Olecranon bursitis
Epicondylitis
