Flashcards in Semiology Deck (335)
synovium, synovial fluid, articular cartilage, intraarticular ligaments, joint capsule and juxtaarticular bone
Deep or diffuse pain
Pain on active and passive movement
Limited range of motion on active and passive movement
include supportive extraarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve, overlying skin
Painful on ACTIVE range of motion
Focal tenderness in regions adjacent to articular structures
Have physical exam findings remote from joint capsule
Rare to have swelling, crepitus, instability, deformity
*Most common MSK condition*
Crepitus with active motion: crunchy
*Knee, hip, wrist (carpometacarpal squaring), hand carpometacarpal, DIP, PIP *(no synovitis, erythema, warmth), *only RA involves the MCP*), spine, shoulder (NFL touchdown sign is positive
Chronic pain, loss of function
*-Morning stiffness < 30 min*
Diagnose with history and physical
Xray: insensitive test, absence of findings does not rule out disease
*-asymmetric joint space narrowing*
-cortical bone thickening
Pes Anserine Bursitis
Pain just below knee at ateromedial aspect of tibia that occurs when exercising or climbing
Pain usually occurs acutely and is associated with trauma
Buckling and locking of knee
Tenderness over joint line
McMurray: clicking felt when knee compressed and rotated during varus and valgus; point knee towards shoulders while flexing
Pain and tenderness over greater trochanter
Pain can radiate down thigh in some cases
Should do Xray to insure no other contributions
results from impingement or instability
Pain aggravated by lifting, pulling or repetitive overhead movements
Tenderness on palpation of biceps tendon with arm slightly externally rotated
ROM limited on active and passive motion
Present with patient with chronic shoulder problems, seen in Parkinson's patients
Physically cannot raise arm
-should be able to get arm to T7-T8
Rotator Cuff Tendonitis
Pain is worsened activity and night
*Most common shoulder pain: 29%*
Usually no history of trauma
Should not have weakness (if weakness = tear)
Carpal Tunnel Syndrome
Nocturnal aching wrist
-pain with squaring of the palm
-bilateral hand numbness and tingling: *helps with shaking it out
-worse at night
-numbness along middle finger*
Tinel's = taping test
Phalen's = funny; 1 min; fingers pointed down, wrists facing each other
Exercise related involving extensive wrist and thumb action
-gripping/grasping like carry small children
Tenderness at anatomic snuff box
Finkelsteins maneuver to aid diagnosis
Women 30-50 yo
Need to check RF, anti-ccp, Xrays (periarticular osteopenia, erosion, *symmetric joint space narrowing*)
*Involves the MCP and PIP joints bilaterally*
*Symmetric polyarthritis with prolonged morning stiffness*
30% have normal labs
*Dactylitis: finger like a sausage
Pencil in cup deformity on Xray*
Nail pitting is specific
Can precede skin findings by up to 10 years
refers to any joint disease of the vertebral column. As such, it is a class or category of diseases rather than a single, specific entity. It differs from spondylopathy, which is a disease of the vertebra itself
Acral lentiginous melanoma
with nail bed involvement the nail plate may have dark brown discoloration (due to melanin).
transverse grooved (e.g. depressed) lines parallel to lunula occurring after serious *medical illness, post-surgical and/or severe infections*.
produced by soft tissue growth at the nail bed and identified by noting a greater anterior-posterior distance at the nail bed as compared to the same distance at the distal interphalangeal joint (also creates a nail-finger angle >180 degrees).
typically occurs in response to *thoracic disease, including cyanotic congenital heart disease, cystic fibrosis, pulmonary fibrosis, lung cancer, and severe hepatic cirrhosis* (with hepato-pulmonary syndrome). Although reported in severe *COPD, other pathology (e.g. lung cancer)* must be excluded before accepting COPD as the sole cause.
(aka spooning of nail) - the nail curves upward away from nail bed (concave instead of the normal convex appearance). This is a classic finding in *iron deficiency anemia/malnutrition.*
also termed half-and-half nails, the proximal portion of the nail is pale/whitish while the distal 20-60% of the nail is brown, pink or reddish.
*Associated with renal failure and hyperkalemia (abnormal heart rhythms, peaked T waves with QRS widening*
transverse white band parallel to the lunula.
Originally described with arsenic intoxication, may also be seen with thallium as well as after acute medical conditions such as lymphoma and malaria.
Most common etiology is following *cancer chemotherapy (a poison of sorts) and arsenic poisoning*
two or more paired transverse white bands associated with severe *hypoalbuminemia* (usually < 2.2 g/dL).
small depressions in nail that are present in up to 50% of patients with *psoriasis* (usually more severe cases).
irregular separation of the nail plate from the hyponychium. Can be traumatic in origin, but also seen in *psoriasis and hyperthyroidism/Graves's*
(aka Koenen tumor) - flesh-colored papule of nail folds (toes > hands) seen in ~50% of patients with tuberous sclerosis (see below under skin).
heavy cigarette smoking leads to orange-brown discoloring of the nails and fingers holding the cigarette. A normal proximal nail with distal discoloration indicates smoking cessation - chronicity of abstinence can be estimated by understanding that nail growth is 0.8 - 1.0 mm per week.
small brown or red streaks perpendicular to the lunula, and often involving the distal nail. These are most commonly traumatic in origin, but classically a consequence of *microembolism from infectious endocarditis*. They are also reported in scleroderma and trichinosis.
proximal paleness of nail with only 1-2 mm of preserved pink distal border (appears dark).
-originally described with *liver cirrhosis, TB, heart failure,* but can also be seen in other severe medical conditions (e.g. heart failure, poorly controlled diabetes, hepatitis).
Arachnodactyly (aka spider fingers)
long fingers that are associated with Marfan syndrome. The wrist circumference is less than the distance encompassed by the subject's 5th finger and thumb.
bony protuberance of proximal IP joint without findings of inflammation - this is a finding in osteoarthritis.