Non-articular Rheumatism Flashcards Preview

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Flashcards in Non-articular Rheumatism Deck (97):
1

Diagnosis?
Pain with abduction 60-120 degrees
-Pain increased when add resistance
- Impingement sign positive
less pain with passive than active motion

impingement/tendonitis
(rotator cuff)

2

Diagnosis?
+ drop arm test = cannot hold arm abducted at 90 degrees for very long

rotator cuff tear

3

what causes a rotator cuff tear?

trauma or gradual degradation

4

shoulder injury more common in younger pts and more likely to be assc with a calcific deposit at the insertion of the supraspinatius tendon

impingement/tendonitis
(rotator cuff)

5

Seen with prolonged immobilization of arm
Severe loss of active and passive ROM in ALL places

Adesive Capsulitis (Frozen shoulder)

6

Adesive Capsulitis (Frozen shoulder) is assc with what condition

DM

7

Diagnosis?
Yergason’s sign: supination against resistance elicits pain
Speed test: shoulder flexion against resitance elicits pain

Bicipical Tendonitis:

8

What can prolonged bicipical tendoniti lead to?

rupture --> popeye sign

9

What happens if you paplate the long head of the biceps tendon when a pt has bicipical tendonitis

it hurts

10

Numbness and parathesis in dermatomal pattern

pain in a dermatomal pattern

numb: Nerve Entrapment Syndromes

pain: cervical radiculopathy

11

median N entrapment syndrome name

carpel tunnel

12

Nerve is compressed at suprascapualr notch by suprascapular ligament or the spinoglenoid notch by the transverse ligament

Suprascapular N entrapment syndrome

*due to overhead activities

13

ulnar N entrapment syndrome name

cubital tunnel

14

axillary N entrapment syndrome name

quadralateral space syndrome

15

diagnosis
SWELLING, pain, increased vascularity and XR evidence of demineralization
--> atrophy of SKIN and muscles (skin my become cool and shiny)
--> irreversible flexion CONTRACTURES with pale, cool extremity

Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

*follows minor trauma

16

cervical radiculopathy, normal or abnormal EMG?

abnormal

17

May be assc with viral infection, post viral syndrome, or vaccination

Brachial Neuritis:

18

Long term hemodialysis pts with shoulder pain, weakness, loss of ROM, functional limitation

Dialysis Shoulder Arthropathy

19

Diagnosis (2 diff)

1. pain then atrophy of muscles

2. swelling and pain then atrophy of skin and muscles --> flexion contractures

1. brachial neuritis

2. Reflex Sympathetic Dystrophy/Complex Regional Pain Syndrome

20

What muscles will atrophy in brachial neuritis

Deltoid, supraspinatus, infraspinatus, biceps, triceps, DIAPRAGM

BT SIDD

21

Neoplasms that could cause shoulder pain in a younger pt? What part of the bone would they involve?

Chondroblastoma (epiphysis)
Osteogenic Sarcoma (metaphysis)

22

Neoplasms that could cause shoulder pain in an older pt?

METASTASES
Multiple Myeloma
Pancoast
Apical Ling tumor

Mets MAP

23

Fractured anatomical neck of Humerus can lead to...

osteonecrosis

24

Long term steroid use, SLE, hemaglobinopathies, pancreitis, hyperbarism all pre-dispose a person to

osteonecrosis

25

Numbness and parasthesia of the little finger and adj side of 4th digit

Ulnar N entrapment
(medial side of elbow)

26

Ulnar N entrapment is diagnosed with...

EMG

27

1. Due to degeneration od the common EXTENSOR tendon (extensor carpi radialis brevis)

2. Due to degeneration od the common FLEXOR tendon (flexor carpi radialis)

1. lateral epicondylitis (tennis elbow)

2. Medial epicondylitis (golfer's elbow)

28

"Golfball on the elbow"

olecranon bursitis

29

causes of olecranon bursitis

septic/infective, due to gout, or trauma

30

Pain with Forced forearm pronation and resisted wrist flexion

Medial epicondylitis (Golfer’s Elbow)

31

Localized tenderness anteriorly to lateral epicondyle. What muscle inserts here?

lateral epicondylitis
extensor carpi radialis brevis

32

Overuse injury of the elbow

lateral and medial epicondylitis
and ulnar N entrapment (kinda)

33

Localized tenderness anteriorly to medial epicondyle. What muscle inserts here?

Medial epicondylitis
flexor carpi radialis

34

Nocturnal parathesis (of affected digits)
Intermittent pain and parasthesia during the day → clumsiness

carpal tunnel

35

Pain in the palm of hand, mainly with flexion of digits

Flexor Tenosynovitis:

36

mucous filled cysts arising from a joint or tendon sheath

Ganglion

37

wrist pain
+ finkelstein test = tumb war position then ulnar deviate … elicits pain

deQuervain’s Tenosynovitis

38

Caused by thickening of the A1 retinacular pully in the palm

Treated with CCS and splining

Trigger fingers

39

Tender over “volar tendon sheath”

Flexor Tenosynovitis:

40

Postive Tinel: pins and needles in fingers with percussion of flexor retinaculuim

Carpel Tunnel

41

What lines the mucous filled cysts in "ganglion"

synovium

42

Positive Phalen: forced flexion of both wrists and hold them together with dorsal side

carpel tunnel

43

Where does ganglion commonly present

dorsum of the wrist

44

Tx for ganglion

corticosterioids then surgery

45

Pain and tenderness of medial flexor surface of wrist and sometimes elbow and shoulder pain with physical activity

carpel tunnel

46

Flexor tenosynovitis is inflammation of the tendon sheaths of what muscles?

deQuervain’s tenosynovitis is inflammation of the tendon sheaths of what muscles?

FT: flexor digitorum superficialis and profundus

dT: extensor pollicis brevis and abductor pollicis brevis

47

assc with triggering of the fingers

Flexor Tenosynovitis

48

What is thought to cause ganglion?

trauma

49

Whats systemic conditions are assc with carpel tunnel?

CHF
multiple myeloma
TB
pregancy
DM
RA
gout
Obesity

50

What N is being compressed in carpal tunnel?

median

51

Tx for carpel tunnel?

night splints, corticosteriod injections

surgery release only for pts with failed conservative therapy and sensory loss or thenar atrophy

52

Painful OA involving carpometacarpal joint of the thumb can often be treated successfully with

splinting

53

Lateral thigh pain that stops at the knee

trocanteric bursitis

54

Diffuse lateral thigh pain (burning or numbness)

Meralgia perasthetica (entrapment of lateral femoral cutaneous N)

55

What structures compress the nerve in meralgia perasthetica (lat fem cut N)

inguinal ligament or psoas inserion

56

What are common causes of Meralgia perasthetica

pregnancy
obesity
DM

57

Cystic swelling or discomfort behind the knee

Popliteal Cysts (Baker’s cyst)

58

Swelling superficial to kneecap

Prepatellar bursitis (Housemaid’s knee)

59

pain (esp when climbing stairs), tenderness and swelling on medial side of knee

Anserine Bursitis

60

What muscles insert on the pes anserinus

SGT pes anserinus

Sartorius
Gracilis
SemiTendinosis

61

Pain/discomfort seeming to originate from the contact of the posterior surface of the patella with the femur

Patellar tendonitis

62

What causes Patellar tendonitis

frequent jumping
aka jumper's knee

63

Rubor, calor, dolor over patellar and adjacent tissue but non-tender

septic prepatellar bursitis

64

+ Thompson’s sign: squeeze gastromenius and foot does NOT plantar flex

achillies tendon rupture

65

1. diagnosis?
Pain, swelling, and tenderness over Achilles tendon

2. What intensifies this pain?

achillies tendonitis

dorsiflexion

66

Follows chronic foot strain or improper footwear (cramped toes or pointed shoes)
+ Pain at MTP joints

Metatarsalgia

67

Sesamoiditis is...
Damage to articular surface between sesamoids and __________ --> pain and inflammation

1st metatarsal head

68

aching or burning that radiates from web to affected toes

morton's neuroma

69

flexion of PIP joint + tip of toe points downward

hammertoe

70

Characteristic pain worse with first step in the morning

plantar fascitis

71

What is a bunionette? What is it assc with?

prominence of metatarsal head; hammertoe

72

What is cavus feet?

high arches (hereditary)

73

What is Morton’s Neuroma

entrapment of interdigial plantar N in the web space between the 3rd and 4th toes

74

Also assc with poliomyelitis, Friedreich’s ataxia, spina bifida

cavus feet

75

Calcaneus is everted and out toeing is seen on ambulation

flat feet (pes planus)

76

Pain on the undersurface of heal with weight bearing

plantar fasciitis

77

A tendon swelling behind the ankle with bulging on both sides of the tendon

Achillies Bursitits

78

Localized tenderness (without swelling) on the anteriomedial portion of the plantar surface of the calcaneus

plantar fasciitis

79

dorsiflexion will make the pain worse with

plantar fasciitis and achillies tendonitis
achillies bursitis if passive

80

What is the cause/pathophys of plantar fasciitis?

repetitive microtrauma → tearing and stretching of the fibers of the plantar fascia and its narrow calcaneal attachment

81

Loss of longitudinal arch on medial side of foot

flat feet (pes planus)

82

rupture of the tibilais tendon can cause this

flat feet

83

chronic irritation → neuroma in foot

morton's neuroma

84

can lead to chondromalacia or OA in the foot

seasmoiditis

85

Diagnosis:
Non-restorative sleep pattern; tender points, widespread pain for > 3 mos, athralgias, burning and parathesias in extremeties, IBS, migraanes, medicanion sensitivities, depression/anxiety

fibromyalgia

86

Neuroimaging in fibromyalgia pts shows

increased gray matter and dysfunction of hypocampus

87

Causes of lumbar spinal stenosis

Idiopathinc
Congenital (achondroplasia)
Hypertrophy of ligamentum flavium or facet joint
Disk herniation
Spondylolisthesis
Scoliosis
Pagets, ankylosing spondylitis

88

noctournal pain
Unexplained weight loss

infection or cancer (in spine i guess)

89

Urinary retention
Outflow incontinence
Fecal incontinence
Bilateral or progressive motor deficit
Saddle anesthesia

cauda equina

90

Severe morning stiffness
Pain that improves with exercise not rest
Pain during 2nd half of night
Alternanting buttock pain

Spondyloarthritis

91

Fecal incontinence

cauda equina

92

Pain that improves with exercise not rest

Spondyloarthritis

93

Saddle anesthesia

cauda equina

94

Outflow incontinence

cauda equina

95

noctournal pain

infection or cancer (in spine i guess)

96

Severe morning stiffness

Spondyloarthritis

97

Alternanting buttock pain

Spondyloarthritis