Básico

Question 1

What rheumatic disorders, other than rheumatoid arthritis, may exhibit subcutaneous
nodules?

Answer 1

Systemic lupus erythematosus Multicentric reticulohistiocytosis
Rheumatic fever Sarcoidosis
Tophaceous gout Vasculitis
Juvenile idiopathic arthritis Panniculitis
Systemic sclerosis (calcinosis) Lupus profundus
Erythema nodosum

Question 2

Describe the examination of a patient with suspected median nerve entrapment of the wrist
(carpal tunnel syndrome [CTS]).

Answer 2

Thenar atrophy is a reliable sign of CTS but occurs only as a consequence of chronic disease with damage to
the motor nerve. Acute or subacute CTS symptoms are typically sensory (the median nerve supplies sensory
innervation to the palmar surface of the thumb, index finger, middle finger, and radial half of the ring finger). Its
symptoms may be reproduced by provocative tests. Tinel’s test is best performed with the wrist in extension.
The full width of the transverse carpal ligament is then percussed using a broad-headed, reflex hammer or the
examiner’s long finger. In contrast, Phalen’s test is performed by gently positioning the wrist at full volar flexion
for 60 seconds. N

Question 3

What is Finkelstein’s test?

Answer 3

Finkelstein’s test is a useful adjunct to direct palpation in the clinical diagnosis of wrist tenosynovitis (de
Quervain’s), involving the abductor pollicis longus and extensor pollicis brevis tendons. Performance of this
maneuver can help differentiate pathology secondary to de Quervain’s from conditions involving nearby structures
such as osteoarthritic involvement of the carpometacarpal joint.

Question 4

In the evaluation of shoulder pain, what single maneuver can best differentiate
glenohumeral joint involvement from that of the periarticular tissues?

Answer 4

Significant glenohumeral joint pathology can usually be excluded if passive external rotation of the shoulder is
unrestricted and pain-free.

Question 5

How do you diagnose “tennis elbow” (lateral epicondylitis)?
In addition to direct palpation, tennis elbow may be diagnosed by stressing the wrist extensor muscles at their
origin, the lateral epicondyle. This provocation maneuver requires the patient to form a fist and maintain the wrist
in extension. The examiner then flexes the wrist against resistance, while supporting the patient’s forearm. Pain
arising from the lateral epicondyle confirms the diagnosis. See Chapter 62 (Regional Musculoskeletal Disorders)
for additional information on the diagnosis and treatment of lateral epicondylitis.