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Flashcards in ECR Joint Pain Deck (90):

What is the process of RA

inflammation of synovial membranes, secondary erosion of adjacent cartilage and bone, damage to ligament and tendons


What are common locations of RA

PIP, MCP joints, feet (metatarsophlangeal joints),
wrists, knees, elbows, angles


What is the pattern of spread for RA

symetrically additive
progreses to other joings while peristing in initial ones


What is the onset of RA

Usually insidiuous


What is the progression and duration of RA?

Often CHRONIC, with remissions and exacerbations


Is tehre swelling in RA?

frequent swelling of synovial tissue in joints or tendon sheats; also subuctaneous nodules


Is there redness, warmth, and tenderness in RA?

tender, often warm, but seldom red


Is there stiffness in RA

prominent, often for an hour or more int eh mornings, also after inactivity


limited ROM in RA?

often develops


Generalized symtoms of RA

low fever
weakness, fatigue, weight loss


process of osteoarthritis (degenerative disc disease)

Degeneration and progressive loss of CARTLAGE within teh joints
damage to underlying bone, formation of new bone at the margins of the cartilage


common locations of osteoarthritis

usually DIP, sometimes PIP, knees, hips, hands, ccervical and lumbar spine, and wrists (firstcarpometacarpal joint); also joints previously injured or diseased


Pattern of spread for osteoarthritis

Additive, however only ONE JOINT invovled (not symmetrical)


Onset osteoarth

usually insiduous


progression and duration of osteoarthritis

slowly progressive, with temp exacerabtiosn after periods of overuse


Swelling in osteoarthritis?

small effusions in the joints may e present, esp in the knees' also bony enlargement


Redness, warmth, tenderness in osteoarth?

possible tender, seldom warm and rarely red


Stiffness in osteoarthitis?

frequent but brief (10-15 mins); in the morning or after inactivity


Limited ROM in osteoarthritis?

often develops


Generalized symptoms of osteoarthriis

usually absent


Process of Acute Gout

inflammatory reaction to microcystals of sodium urate


Common locatios of acute gout

Base of the big toe (1st metatarsophalangeal joint) the instep or dorsa of feet, ankels, knees, and elbows


Pattern of spread for acute gout

Early attacks usually confined to one joint


Onset of acute gout

Sudden, often at night, often after injury, surgery, fasting, or excesive food or alcohol intake


progression and duration of acute gout

Occasioanl isolated attaks lasing days to two weeks; may get more frequent and severe with perissitn gysmptms


Is there swelling associated with gouty arthritiis (acute)

present,withtina nd around the involved joint


Warmth, redness, endernes acute gout

exquisiley tender, hot, and red


acute gout stiffness?

not evident


acute gout limitation of motion?

motion is limited primarly by pain


generalized symptoms of acute gout?

fever may be present


Chronic Tophaceous Gout

Multiple local accumulations of sodium urate in teh joints and other tissues, with or wihtout inflammation


Location of Tophaceous gout

Feet, ankels, wrists, fingers, and elbows


Pattern of spread of tophaceous gout

Additive, not so symmetric as RA


Onset of Toph Gout

gradual develpmetn of chronicity with repeated attacks


generalized symptoms of toph gout

possibly fever; patient may also dvelop sysmptoms of renal failture and renal stones


Polymyalgia Rhematica proces

disease of unclear etiiology >50 , espe in women; may be associated with giant cell arterititis


Common location of polymyalgia rheumatica

muscles of hip girdle, and should girdle


Onset of PR

Insiduous or abrupt, even appearing overnight


Progression and duration or PR

chronic bu ultimately self-limiting


stffness in PR

prominent, esp int eh morning


Generalized symptoms of PR

Malaise, sense of depression, possible anorexia, weight loss adn fever, but no true weakness


Fibroymyalgia syndrome process

widespread MC pain and tender points. May accompany other diseases. Mechanisms unclear


Comon location of fibro

all over but esp in neck, shoulder,shands, low back and knees


Pattern of spread of fibro

shifts unpredictabley or worsens in response to immobility, execessive use, or chilling


stiffness with fibro?

present, esp in teh morning


Limitation of motion with fibro

Absent thoguht stiffness i sgreater in extremes of movemnt


generalized symptoms of fibro

disturbance of sleep, usually assocaited ith morning fatigue


What are causes of painful shoulder (7)

rotator cuff tendinitis
rotator cuff tears
Calcific tenditinits
bicipital tendinitis
adhesive capuslitis (frozen shoulder)
acromioclaviclualr arthritis
anterior dislocation of humerus


Rotator cuff tendinitis

repeated shoulder motion, as in throwing or swimming, can cause edema and hemorrhage followed by inflammatin, most commoly involveing supraspinatus tendon


sympsoms of rotator cuff tendinitis

patients report sharp catches of pain, grating, and weakenss when lifting

when supraspinatus tendon is invovled, tenderness is maximal just below the tip of the acromion


rotator cuff tears cause

when arm is raised, in forward flexion, rotator cuff may impinge against the unersurface of the acromion and the coracoacromial ligament. injury from fall or repeated impingement ay weaken the rotator cuff, causing a partial or repeated impingment usualy after age 40


symptoms of rotator cuff tear

weakness, atrophy, and infraspinatorus muscles, pain and tendernuess

In complete tera of supraspinaturs tendon, active abduction and forward flexion at the glenohumeral joing are severely impaired, producing a characteristic shrugging of shoulder and positieve "drop arm" test


what is bicipital tendinitis?

inflammation of the long head of the biceps tendon sheath causes anterior shoulder pain resesmbling and often coexisint giwht rotator cuff tendinitis


How do you separate biciptial tendinitis from supraspinatus tendinitis?

externally rotate and abduct arm `


Adhesive Capsulitis (frozen shoulder)

adhesive, capsulitis refers to fibrosis of glenohumeral joint capsule, manifested by diffuse, dull, aching pain in the shoulder and progressive restriction of active and apssive range of motion, but usually no localized tenderness

condition is usually unilaterla and cocurs in peopel aged 50-70

there is often a painful disorder of teh shoulder or another condition (such as MI) that has decresed shoulder oments

course is chronic lasting months to years. The disorder may resolve spontaneously, at least partilaly


Acromioclavicular arthritis

uncommon, susually arising from direct injury to the shoulder girdle wth resulting degeneratie changes


what is painful motion in AC arthritis?

glenohumeral joint otion is not painful, but movement of hte scapula, as in shoulder shrugging is painful


Anterior Dislcoation of the Humerus

positive apprehension sign


What are causes of swollen or tender elbows? (4)

olecranon bursitis
arthritis of the elbow
rheumatoid nodules


What is olecranon bursitits

swelling and inflammation of the olecranon bursa may result from trauma or may be associated with rheumatoid or gouty arthritis

swelling is superficial to olecranon


what is arhtritis of the elbow

synovial inflammation or fluid is felt best in teh grooves between the olecranon process and the epicondyles on eitehr side.

palpate for boggy, soft, or fluctuant swelling and for tenderness


what are rheumatoid nodules

sucutaneous nodules may develop at pressure points along the extensor surface of the ulna in patients with rheumatoid arthritis or acute rheumatic fever

they are firm and nontender, and are not attached to teh overlying skin

they may or may not be atttacheds to udnerlyign periosteum.

they may dvelop in teh area of the olecranon bursa, but often occur more distally


What is lateral epicodnylitis>

how to test for it

Tennis elbow!!
follows repetitive extension of wrist or pronatino-supination of the forearm.

Pain and tenderness develop 1 cm distal to the lateral epicondyle and possibly in the extensor muscle close to it

when patient tries to extend the wrist against resistance, pain increaeses


what is medial epicondylitis

pitcher's, golfer's, or Little League elbow

follows repetitive wrist flexion , as in throwing

tenderness is maximial just lateral and distal to teh medial epicondyle.

Wrist felxion against resistance incerases the pain .


what are the four types of arthritis in the hand

Acute rheumatoid arthritis
Chronic Rheumatoid Arthritis
Osteoarthritis (Degenerative Joint Disease)
Chronic Tophaceous Gout


What is Acute RA

tender, painful, stiff joints in RA, usually iwth SYMMETRIC involvement on both sides of teh body.

The PIP , MCP, and wrist joints are the most frequently affected. Fusiform or SPINDLE SHAPED SWELLING of the PIP joints in acute disease


What is Chronic RA

swellign and thickenign in MCP and PIP joints

fingers deviate towards ulnar side
interosseous uscle satrophy
fingers show

SWAN NECK derformaties (hyperextension of the PIP with fixed flexion onf the DIP)

BOUTONNIERE DEFORMITY- persistent flexion of PIP with hypextension of DIP

Rheumatoid nodules


Osteoarthritis in the hands

HEBERDEN's NODES on dorsolateral aspects of DIP from bony overgrowth of osteoarthritis

usually hard and painelss, they affect middle-aged or elderly

often ass with arthritic changes in other joints

flexion and deviation deformities may develop.

Bouchard's nodes of PIP are less common,

MCP are spared
Radial deviation of distal phalanx


Herberden's node

ont eh dorsolateral aspect of DIP from bony overgrowth of OSTEOARTHRITIS

hard and paintless, affectmiddle-aged or elderly, often associated with arthritic changes in other joints
Flexion and deviation deformities may develop


Bouchard's Nodes

on PIP are less common

MCP are spared


Chronic Tophaceous Gout

deformities of long-standing chronic tophaceous gout can mimic rheumatoid arthritis and osteoarthritis

joint involvement isn't as symmetric as rheumatoid arthritis ; acute inflammation may be present

Knobby swelligna roudn the joint ulcerate and disarchge white chalklike urates


What is the first joint involved in acute gouty arthritis

The Metatarsalphalangeal (MTP) joint of the great toe


acute gouty arhtritis

characterized by a very painful and tender, hot, dusky red swelling that extends beyond the margin of the joint

easily mistaken for CELLULITIS
acute gout may also inovle the dorsu of the foot


Flat feet

signs of flat feed apparent only when patient stands, or they ay become permenent. THe longitudinal arch flattens so tha the sole approaches or touches the floor. The normal concavity on the medial side of the foot becoms CONVEX. Tenderness may be present from teh medial malleolus down along the medial-plantar surface of the foot. Sweelling may develop anterior to teh malleoli. Inspec shoes for excess wear on teh inner sides of the soles and heels


What is Hallux Valgus

A bunion is when your big toe points toward the second toe. This causes a bump to appear on the outside edge of your toe.

The great tow is abnormally abducted in relaionship to the first metatarsal, which itself is deviated medially. The head of the first metatarsal may enlarge on its medial side, and a bursa may form at teh pressure point. The bursa may become inflamed


What is Morton's Neuroma

Tenderness over the plantar surface, third and 4th metatarsal heads, from probable ENTRAPMENT OF MEDIAL AND LATERAL PLANTAR NERVES. Symptoms inclue hyperthesia, numbness, aching, and burning fro the metarsal heads into the third and fourth toes


where is there tenderness with FLAT FEET. Where is there swelling

tenderness from medial malleolus down along the medial-plantar surface of foot

Swelling may develop anterior to the malleoli


What are symptoms of Morton's Neuroma

Hyperestheisa, numbness, aching, and burnign from teh metatarsal heads into teh 3rd and 4h toes


What is Ingrown toenail

sharp edge of toenail may dig into and injure the lateral nail fold, resulting in inflammation and infection


what are signs of ingrown toenail

tender, reddened, overhanging nail fold, sometimes with granulation tissue and purulent discharge, results . Great toe is most often affected


What is Hammer Toe?

most commonly invovling the second toe, a hammer toe is characterized by HYPEREXTENSION AT TEH METATARSOPHALANGEAL JOINT with FLEXION at teh PIP joint. A corn frequently develops at pressure point over PIP


What is a corn

Painful conical thickening of skin that results from recurrent prssure on normally thin skin . Apex of cone points inward sand causes pain


Where do corns characterisically occur

occur over bony prominences such as 5th toe. When located in moist areas such as pressure points between 4th and 5th toes , they are called SOFT CORNS


What is a Callus ?

like a corn, a callus is an area of grealty thickened skin that develops in a region of recurrent pressure. Unlike a corn, callus invovles skin that is normally thick, sucha s the sole, and is suually painless.


What do you suspect if a callus is painful

underlying plantar wart


What is a Plantar Wart

is a common wart, VERRUCA VULGARIS, located in the thickened skin of the sole. It may look lik ea callus or even be covered by one. Small dark pots that give a stippled appearance to a wart.

Normal skin lines stop at the wart's edge


Neuropathic ulcer

When pain sensation is diminished or absent, as in diabetic neuropahty, neuropathic ulcers ay develop at pressure poings on teh feet. Although often deep, infected, and indolent, theya r painless. Results from chronic pressure


What do you suspect if a callus is painful

underlying plantar wart


What is a Plantar Wart

is a common wart, VERRUCA VULGARIS, located in the thickened skin of the sole. It may look lik ea callus or even be covered by one. Small dark pots that give a stippled appearance to a wart.

Normal skin lines stop at the wart's edge


Neuropathic ulcer

When pain sensation is diminished or absent, as in diabetic neuropahty, neuropathic ulcers ay develop at pressure poings on teh feet. Although often deep, infected, and indolent, theya r painless. Results from chornic pressure