Week 7 MSK and Pain Flashcards

Question

What causes central neuropathic pain and what is an example?

Answer 1

Caused by lesion or dysfunction of brain or spinal cord Central sensitization – progressive repeated stimulation of group C neurons in the dorsal horn leads to increased sensitivity of central pain signalling neurons -> pathological changes in the CNS -> persistent pain Ex: brain or spinal cord trauma, tumours, multiple sclerosis, postherpetic neuralgia, phantom limb pain

Answer 2

Nociceptors are pain receptors. They are free nerve endings in the afferent PNS, their stimulation produces pain

Answer 3

Nociceptors can sense different types of stimuli: Mechanical (pressure or mechanical distortion) Thermal (extreme temperatures) Chemicals (acids or chemicals of inflammation)

Answer 4

Transduction, transmission, perception and modulation

Answer 5

Afferent (Ascending) Pathways – conduction of pain impulses to brain along A𝛿 and C fibres (these are the primary order neurons) -> dorsal horn of spinal cord, where synapse with excitatory or inhibitory interneurons (second order neurons) ->2 lateral spinothalamic tracts -> brain where they synapse with third-order neurons called projection neurons -> connections with the reticular formation, hypothalamus, thalamus (major relay station of sensory information) and the limbic system.

Answer 6

A𝛿 fibres: larger myelinated fibres; rapidly transmit sharp, well-localized “fast” pain sensations (ex. burn or pinprick on skin). Activation causes spinal reflex withdrawal of affected body part before pain sensation is perceived C fibres: most numerous; smaller and unmyelinated; located in muscle, tendons, body organs, skin. Slowly transmit dull, aching, burning sensations that are poorly localized and often constant Interpretive centres: The quality of pain associated with nociceptive and neuropathic pain Nociceptive: Pain associated transmitted via unmyelinated C fibres and myelinated A delta Neuropathic: Peripheral and Central

Answer 7

1) somatosensory cortex for location and intensity of pain 2) Other areas of the brain for an integrated response to pain Pain Matrix: Sensory-discriminative system: From the somatosensory cortex. Responsible for the identifying the presence, character, location, and intensity of pain Affective-motivational system: From the reticular formation, limbic system, and brainstem.Determines a person’s conditioned avoidance behaviours and emotional responses to pain Cognitive-evaluation system: From the cerebral cortex. Individual's learned behaviour concerning the experience of pain Can modulate perception of pain

Answer 8

Efferent (Descending) Pathways - inhibit or facilitate pain Brain stimulates the periaqueductal grey matter (PAG) and the rostral ventral medulla (RVM) in the midbrain -> stimulates efferent pathways which inhibit afferent pain signals in the dorsal horn of the spinal cord The RVM stimulates efferent pathways that facilitate or inhibit pain

Answer 9

1. Synovial – C. Freely moveable 2. Fibrous – A. generally do not move 3. Cartilaginous – B. Allow some movement

Answer 10

A fibrous joint connects bone directly to bone. Can also be known as synarthrosis or fixed joints.

Answer 11

Suture Fibrous Joint – A. Flat bones of skull in young children Syndesmotic fibrous joints – C. Radius/ulna or tib/fib Gomphosis fibrous joint – B. Teeth in maxilla

Answer 12

Allow some movement Connect two bones with pad of cartilage

Answer 13

Symphysis – fibro cartilage – ex. Symphysis pubis, intervertebral discs Synchondrosis – hyaline cartilage – joints between ribs and sternum (costal cartilage)

Answer 14

Most common Allow wide range of movements – flexion/extension, abduction/adduction, rotation (axis) Enclosed in joint (articular) capsule with synovial fluid

Answer 15

1. Hinge joint – B. Elbow joint 2. Pivot joint – D. Distal radial-ulnar joint 3. Plane (gliding joint) - F. Carpal bones joints 4. Ball & socket joint - E. glenohumeral joint 5. Condyloid (ellipsoid joint) - A. Metacarpophalangeal joint 6. Saddle joints – C. Sternoclavicular joint

Answer 16

Supraspinatus Infraspinatus Teres minor Subscapularis

Answer 17

Origin: Supraspinatus fossa of scapula and deep fascia Insertion: Greater tubercle of humerus

Answer 18

Origin: infraspinatus fossa of scapula and deep fascia Insertion: Greater tubercle of humerus

Answer 19

Origin: lateral border of scapula Insertion: Greater tubercle of humerus

Answer 20

Origin: subscapular fossa of scapula Insertion: Lesser tubercle of humerus

Answer 21

Primarily composed of types III, IV, V, and VI collagen and fibroblasts * Collagen & fibroblasts form fascicles, multiple fascicles form tendon or ligament

Answer 22

LIGAMENTS FOR BOTH: Fibroblasts less organized than in tendons (in tendons, form parallel rows) Fiberss in ligaments contains more elastin than tendons

Answer 23

* Both L&T can withstand significant stretch but tend to buckle with compressive force

Answer 24

Attach bone to bone, helping to form joints and stabilize them against excessive movement

Answer 25

1) Transfers forces from muscles to bone 2) acts as spring for muscles to provide stability during movement.

Answer 26

= Small sacs lined with synovial membrane and filled with synovial fluid that are located between bony prominences and soft tissues such as tendons, muscles, and ligament * Lie OUTSIDE the joints

Answer 27

to separate, lubricate, and cushion these structures (bones, ligaments, tendons) * When healthy, create a smooth, almost frictionless functional gliding surface making normal movement painless.

Answer 28

False - you can grow new ones! * Can either be constant (those formed during embryological development) or “adventitious” (bursae that develop as a result of chronic friction and degeneration of fibrous tissue between adjacent structures)

Answer 29

* Fibrous connective tissue that covers the ends of bones where they meet in a joint (A “sleeve” around the joint) * Sharpey fibres firmly attach the proximal and distal capsule to the periosteum & ligaments and tendons may reinforce the capsule * Composed of parallel, interlacing bundles of dense, which, fibrous tissue richly supplied with nerves, blood vessels, and lymph vessels

Answer 30

The joint capsule is vital to the function of synovial joints. It 1) seals the joint space, 2) provides passive stability by limiting movements 3) provides active stability via its proprioceptive nerve endings and 4) may form articular surfaces for the joint. Nerves in and around the joint capsule are sensitive to rate and direction of motion, compression, tension, vibration, and pain - Lined with synovial membrane, which makes synovial fluid

Answer 31

* Smooth, delicate inner lining of the joint capsule found in the NONPARTICULAR portion of the synovial joint & any ligaments or tendons that traverse this cavity * Composed of 2 layers: vascular subintima and thin cellular intima * Vascular subintima merges with joint capsule * Cellular intima = rows of synovial cells embedded in matrix and contains A cells (macrophages that ingest bacteria & debris) and B cells (fibroblasts, most numerous, secrete hyaluronate makes synovial fluid viscous) * Rich supply of blood and lymph. Can repair rapidly.

Answer 32

* Clears bacteria & debris * Makes hyaluronate (part of synovial fluid)

Answer 33

* Superfiltrated plasma from blood vessels * Contains hyaluronic acid, which gives it important biomechanical properties * Contains free-floating synovial cells & various leukocytes that phagocytose bacteria & debris

Answer 34

* Lubricates joint surfaces, nourishes pad of the articular cartilage, and covers the ends of the bones

Answer 35

The enthesis

Answer 36

1) Supraspinatus 2) Infraspinatus 3) Tenes minor 4) Subscapularis ACRONYM = SITS

Answer 37

Generally: Scapula to humerus More specifically... ORIGIN: 1. Supraspinatus: originates in Supraspinous fossa of scapula and deep fascia 2. Infraspinatus Originates in Infraspinous fossa of scapula and deep fascia 3. Teres Minor : originates from Lateral border of scapula 4. Subscapularis : originates from Subscapular fossa of scapula INSERTION: 1) 2) and 3) insert at greater tuberosity of humerus. 4) inserts at lesser tuberosity of the humerus **the term "spinatus" is referring to the spine of the scapula (the sticky outy linear part of bone that comes off the scapula). So "supra" means above this, and "infra" means below this.

Answer 38

1) Supraspinatus: ABduction until 15 degrees (then deltoid takes over) 2) Infraspinatus: external (lateral) rotation 3) Teres minus: external (lateral) rotation and ADDuction 4) Subscapularis: internal rotation (medial) and ADDuction

Answer 39

Dynamic Shoulder stability (hold humerus in glenoid fossa while the arm moves around) (The shoulder has HIGH mobility but LOW stability due to how the humerus head only sits partially in the glenoid fossa at any one time)

Answer 40

The subscapularis

Answer 41

One of the most common causes of working age individuals getting spinal surgery. High occurrence in men Highest occurrence is in men aged 30 to 50 years. Risk factors are repeated lifting, physically demanding jobs, weight-bearing sports and light weightlifting.

Answer 42

Most affected lumbosacral discs are L4-L5 and L5-S1. The most affected cervical region is C5-C6 and C6-C7. Lumbar disc herniation is more common than cervical disc herniation.

Answer 43

It is caused by the displacement of the nucleus pulposus or annulus fibrosus beyond the intervertebral disc space. The nucleus pulposus is hydrated and acts a “shock absorber” by compressing when lifting a load and relaxing when load is removed. With age nucleus pulposus weakens, becomes less dehydrated and more gelatinous --> more of the compression forces transferred to the annulus fibrosus. Overtime, the compression-relaxation cycle causes peripheral tears of the annulus fibrosus. The tear allows the nucleus pulposus to bulge and protrude through the annulus fibrosus and this can compress the nerve root.

Answer 44

The annulus fibrosus is the strong wrapping that makes up the outside portion of the intervertebral disc. Its job is to contain and protect the soft material located in the center of the disc. This soft center is called the nucleus pulposus.

Answer 45

Most commn = degenerative process as we age 2nd most common = trauma

Answer 46

Most disc herniations occur in the posteolateral direction where the annulous fibrous is thinner and is not well supported by the anterior or posterior longitudinal ligaments (I think posterolateral means back toward the spinal cord and off to the side a bit)

Answer 47

The combination of nerve root compression and release of local inflammatory cytokines causes localized back pain.

Answer 48

Cauda equina syndrome is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. Signs and symptoms include low back pain, pain that radiates down the leg, numbness around the anus, and loss of bowel or bladder control. Onset may be rapid or gradual.

Answer 49

Multiple nerve root compressions may be found at the L5-S1 level affecting the cauda equina and leading to the cauda equina syndrome.

Answer 50

“Over 85% of patients with symptoms associated with an acute herniated disc will resolve within 8 to 12 weeks without any specific treatments.” Most herniated disc resolve on their own and do not require surgery. Conservative treatments include NSAIDs, acetaminophen, therapeutic massage and physical therapy. May require neurosurgery consultation.

Answer 51

The location and size of the herniation into the spinal canal and amount of space in the canal determine clinical signs. It causes radiculopathy or pinched nerve - injury to nerve roots in the area where they leave the spine. Radiation of the pain follows distribution of the compressed nerve root. Lumbosacral area causes pain in the sacroiliac joint, buttocks, hip, posterior thigh, and leg. Cervical disc herniation causes shoulder and upper limb pain and hand. Pain increases with movements and straining. Range of motion is decreased in the lumbar spine or neck. Numbness, tingling, decreased sensation, decreased range of motion and motor weakness of the extremities may occur along the path of the nerve root.

Answer 52

X-rays, CT-scans and MRI. MRI is the most sensitive and preferred method if disc herniation is suspected. CT myelography can be used to visualize herniated discs if patients are unable to do MRI. The Straight Leg Raise (SLR) test is a commonly used test to identify an impairment in disc pathology or nerve root irritation. It have also specific importance in detecting disc herniation and neural compression. The straight leg raise test is more sensitive but less specific than the contralateral straight leg raise for the diagnosis of radiculopathy due to disc herniation [40]. It is most helpful in the evaluation of radiculopathy at the L5 and S1 levels. Contralateral leg raise test is relatively specific for radiculopathy due to disc herniation, but has poor sensitivity

Answer 53

The straight leg raise test: With the patient lying supine, the examiner slowly elevates the patient's leg at an increasing angle, while keeping the leg straight at the knee joint (movement must be PASSIVE). The test is positive if it reproduces the patient's typical pain and paraesthesia. The contralateral (crossed) straight leg raise test: As in the straight leg raise test, the patient is lying supine, and the examiner elevates the asymptomatic leg. The test is positive if the maneuver reproduces the patient's typical pain and paraesthesia.

Answer 54

= pinched nerve in the spine

Answer 55

80-90% of cases are women!

Answer 56

Chronic musculoskeletal syndrome characterized by diffuse pain, fatigue, increased sensitivity to touch, absence of systemic or localized inflammation, and the presence of fatigue and nonrestorative sleep, anxiety, depression. Can coincide with autoimmune diseases such as lupus and IBS

Answer 57

Genetic factors have a role- individuals with family members with FM have an increased risk Alterations in genes affecting serotonin, catecholamines, and dopamine. External stressors such as infection, psychosocial stress, physical or emotional trauma are proposed mechanisms that may precipitate FM. There is a lot more to discover about FM.

Answer 58

Most prominent symptom is diffuse persistent pain- present for more than 3 months. Pain often begins in one location such as neck and shoulders and then becomes more generalized. Describe pain as burning or gnawing. - Profound fatigue - Headaches - Memory loss - Poor sleep

Answer 59

Need to rule out other disorders such as rheumatic disorders. Diagnosis is based on assessment and the Canadian guidelines for the diagnosis and management of fibromyalgia syndrome: pain that has been present at similar level for at least 3 months with insidious onset, usually localized to a particular one area, pain might be neuropathic in nature, there is no other underlying pathology to explain the pain. AND other associated symptoms: fatigue, nonrestorative sleep, cognitive dysfunction, changes in mood. There is no other testing for fibromyalgia.

Answer 60

Should be individualized Mind-body interventions Movement therapies Relaxation techniques Medication: NSAIDs, opioids, cannabinoids, antidepressants. And anticonvulsants. Patient teaching: not caused by infection, not deforming, or deteriorating, not life threatening, assist the individual to use aerobic exercises to reduce stress and increase rapid eye movement, stress that illness is real and not imagined, discuss the role of sleep disturbances and the relationship of neurohormones to pain, fatigue, abnormal sleep, and mood, and that reassure that although the cause is unknown some information is known about the physiological changes responsible for symptoms.

Answer 61

a type of acute inflammatory arthritis of the joint, caused by uric acid crystals depositing in the joints and bones.

Answer 62

Men Ages 30 to 60 yrs most common but also common in elderly *Rare in children

Answer 63

Women become increasingly susceptible to gout after menopause; rare premenopausal (estrogen promotes uric acid excretion).

Answer 64

Uric acid is a natural byproduct of purine. Purines are produced in the body and also found in certain foods/drinks. Normally, uric acid is excreted out by kidneys in the form of urate.

Answer 65

Closely linked to purine metabolism and kidney function. If there is an imbalance between uric acid production and excretion, hyperuricemia may result. Uric acid crystals begin to form on joints and bones. Macrophages phagocytize these crystals, which initiates the inflammatory cascade → results in an acute gout attack. Chronic hyperuricemia occurs when the kidneys are unable to effectively excrete uric acid.

Answer 66

Chronic conditions: Hyperuricemia, kidney disease, hypertension, diabetes mellitus, ischemic cardiovascular disease, hyperlipidemia, obesity. Genetics → about 10% of population has a predisposing factor for excessive uric acid production. Gender → men older than 30 years. Medications that inhibit uric acid excretion by kidneys. E.g., Diuretics, ASA, nicotinic acid, ethambutol High-purine diet High intake of alcohol (especially beer) High intake of meat and certain seafoods (e.g., shrimp & oily fish).

Answer 67

1) High uric acid levels: Uric acid is building up in blood and starting to form crystals on joints. Asymptomatic. 2) Acute gouty arthritis: Acute attack exhibiting severe pain, redness, and swelling of a joint, which may last from days to weeks, even if left untreated. 3) Intercritical gout: Period without flares. 4) Chronic/tophaceous gout: Gout pain is frequent (3+ attacks per year) and tophi form in joints and soft tissues, potentially causing deformity and disability of joints.

Answer 68

Without treatment, gout attacks increase in length and frequency, and can eventually become chronic.

Answer 69

Erythema, swelling, warmth, and/or pain in the joint. Reduced joint range of motion. Monoarticular (affects one joint). Often big toe. Pain is likely to be most severe during the first 12-24 hours. Hx of severe joint pain with inflammation in other joints, followed by pain-free episodes. Other possible signs Tophi are seen from untreated gout. Fever may be present during acute stage (not always).

Answer 70

Deposits of uric acid crystals or tophi in joints and other tissues can be present years before an acute gout attack occurs. Timely identification allows for early treatment and ongoing support.

Answer 71

Joint fluid aspiration Gold standard in diagnosing gout. Inspect fluid with a polarized light microscopy to identify uric acid crystals.

Answer 72

WBC → Elevated. ESR → Elevated. CRP → elevated. Serum uric acid level: Uric acid >404.46 umol/L. Rheumatoid factor (RF) titre.

Answer 73

F: Serum uric acid level may be normal during acute attacks. Perform test at least 2 weeks after acute attack (or when flare has resolved).

Answer 74

Goal during a gout attack: Relieving pain and inflammation. General Interventions Rest the joint. Avoid heavy lifting or weight-bearing activities on that joint. Cold therapy on affected joint to relieve pain and inflammation. Discontinue ASA, if using. Pharmacology Analgesia for symptom control. NSAIDs – most effective if started within 48 hrs of presenting symptoms. Colchicine – an option for those who cannot take NSAIDs. However, colchicine comes with side effects that may not be tolerated. Corticosteroids – for patients who cannot tolerate either NSAIDs or colchicine

Answer 75

Patient Teaching Increase fluid intake → aim for 8+ glasses of water daily. Avoid alcohol intake. Avoid excessive meat and seafood products that trigger flares. Medication education and compliance → taking medication can be effective in preventing chronic gout stage.

Answer 76

For uric acid hypersecretion → need long-term therapy to decrease uric acid production. Allopurinol (first line of tx). For reduced excretion of uric acid Consider probenecid. Encourage increased fluid intake. If clients have 3 or more attacks per year, consider long-term therapy: low dose of NSAIDs, or Allopurinol

Answer 77

Septic arthritis is a potentially fatal infection of the joint space; usually bacterial, but occasionally fungal, viral, or mycobacterial. *Surgical emergency → The affected joint can be destroyed within 24 hours.

Answer 78

More prevalent in children and the elderly. Children: 5-12 cases per 1,000 Peaks around age 2-3 years. More prevalent in males. Incidences of septic arthritis has increased in recent years, due to: Increased prosthetic joint surgeries. Aging population. Increased use of immunosuppressive therapy.

Answer 79

Primary routes by which pathogens accumulate in joints: 1) Hematogenously (systemic infection) 2) Neighbouring soft tissue sepsis (e.g., osteomyelitis). 3) Trauma – direct inoculation of bacteria (e.g., open fracture, animal bite) 4)Iatrogenic events (e.g., joint surgery, arthrocentesis, steroid injections).

Answer 80

Staphylococcus aureus → most common; any age group. Group A streptococcus → from respiratory infection; usually children. Neisseria gonorrhoeae → STI; mainly young adults Methicillin-resistant S. aureus

Answer 81

Underlying joint disease (rheumatoid arthritis, osteoarthritis, gout). Recent joint surgery (prosthetic joints) Chronic diseases: diabetes mellitus, leukemia, cirrhosis, granulomatous diseases, cancer. Immunosuppressive therapy and/or glucocorticoids. Hemodialysis. HIV. Intravenous drug abuse. Cutaneous ulcers. Previous intra-articular corticoid injections. Low socioeconomic status.

Answer 82

Bacterial invasion into synovium and joint space via bloodstream, nearby infection, or directly. Bacteria release toxins (e.g., chondrocyte proteases) that destroy articular cartilage. Macrophages phagocytose bacteria, while releasing inflammatory cytokines which also mediate joint destruction. Mast cells release histamine → causes vasodilation & increased vascular permeability → blood enters area (red, swollen, warm joint) Increased intra-articular pressure due to fluid leaking out of capillaries → compresses & interrupts blood supply to the joint → necrosis of joint.

Answer 83

Osteomyelitis Chronic pain Osteonecrosis Length discrepancies Sepsis Death Aggressive physiotherapy after the acute phase is necessary to restore joint function.

Answer 84

Erythema, swelling, warmth, and/or pain in the joint. Reduced joint range of motion. (these are same as gout) “Pseudoparalysis” – or marked guarding to motion of the joint; inability to bear weight. Children appear quite ill: malaise, anorexia. Typically monoarticular, but assess for polyarticular septic arthritis. - More than one joint is affected in 22% of cases. Note: Fever is not a reliable indicator of an infected joint (a mild fever may be present). **Symptoms usually present for <2 weeks

Answer 85

Knee (adults) Hip (children) Ankles Elbows

Answer 86

Definitive Diagnosis Test Joint fluid aspiration Presence of bacteria in synovial fluid. May have elevated WBC in SF. Laboratory Findings WBC → elevated. ESR → elevated. CRP → elevated. Note: the absence of elevated ESR, CRP or WBC does not exclude dx of septic arthritis. Blood Cultures Isolate causative bacteria to tailor antibiotic treatment. Note: Blood cultures are only positive in 30-40% of cases.

Answer 87

There is a greater than 90% chance of a septic joint if 3 of the 5 following criteria are met: WBC greater than 12 x 109/L Inability to bear weight on the joint Fever greater than 38.5C ESR greater than 40mm/hr CRP greater than 0.190 mcmol/L

Answer 88

*Surgical emergency* Quick diagnosis and treatment is essential to reduce morbidity and mortality. Referral: If septic arthritis is suspected, immediate referral to an orthopedic surgeon is needed. Antibiotic Treatment → Prompt antibiotic treatment. Start on broad-spectrum antibiotics. Switch to specific antibiotics when culture results return. Joint Drainage → Prompt removal of any purulent material from joint space; achieved either surgically (open drainage) or via closed needle aspiration (arthrocentesis). Analgesia → NSAIDs, acetaminophen Splints to maintain correct positioning. During the acute phase of infection, optimal positioning of joint is essential to avoid subsequent deformities and contractures. Isotonic exercise → must be initiated to prevent muscular atrophy during the acute phase. Physiotherapy → after the acute phase, early physiotherapy and mobilization is important to ensure optimal recovery of joint.

Answer 89

Anterior (extensor) Medial (adductor) Posterior (flexor) Each component contains its own muscles, blood vessels and nerves.

Answer 90

Anterior compartment is the largest. Muscles are flexors of the hip and extensors of the knee.

Answer 91

The Iliopsoas (including the Psoas major and the Iliacus)

Answer 92

Quadriceps Femoris. Together these are among the largest and most powerful muscles in the body, they act on both the hip and knee joints.

Answer 93

The tendon of all four of the Quadricep Femoris muscles unites to form the quadriceps tendon (which then envelopes the patella, continues as the patellar ligament, with insertion on the tibial tuberosity.) Medical and Lateral vastus muscles also attach independently to the patella, increasing patellar stability and centering the patella.

Answer 94

Femoral Nerve (L2-L4)

Answer 95

Iliopsoas (Psoas Major, Iliacus) Sartorius Quadriceps (Vastus lateralis, vastus intermedius, vastus medialis and rectus femoris)

Answer 96

Adductor magnus, adductor longus, adductor brevis, obturator externus, gracilis

Answer 97

The adductor magnus. This is the largest muscle in the medial compartment, adducts thigh, composed of two parts: adductor (adducts) and hamstring (extends thigh)

Answer 98

Obturator Externus

Answer 99

Obturator nerve (L2-L4) (Exception: hamstring of adductor magnus is innervated by the tibial part of the sciatic nerve)

Answer 100

Semitendinosus, semimembranosus, biceps femoris Collectively called the hamstrings (except for the short head of the biceps femoris muscle) These muscles generally originate on the ischial tuberosity, insert on bones of the leg and extend the hip and flex the knee.

Answer 101

Semitendinosus

Answer 102

Semimembranosus

Answer 103

Biceps femoris – short head and long head

Answer 104

Sciatic Nerve (L5-S2) - tibial division for all, except the short head of the biceps femoris = fibular division of sciatic nerve

Answer 105

Anterior distal tibia and fibula, runs obliquely

Answer 106

Ligament tear

Answer 107

Lateral ankle sprain is most common and usually involves the ATFL. Ankle sprains are typically caused by inversion injuries – when the foot is plantarflexed – places stress on the components of the lateral collateral ligaments

Answer 108

-pain over lateral ankle -swelling hours after inciting event -inability to ambulate

Answer 109

Anterior drawer test: tibia is held steady while the heel is pulled anteriorly with the foot in about 10-20 degrees of plantarflexion. This will confirm the injury to the ATFL if the translation (laxity) of the foot anteriorly is excessive compared with that of the uninjured ankle.

Answer 110

Men are three times more likely

Answer 111

Age 20 peak start of symptoms. Although often delay in diagnosis

Answer 112

chronic systemic autoimmune inflammatory disease, characterized by stiffening/fusion (ankylosis) of primarily spine and sacroiliac joints, with excessive bone formation. Can also affect large peripheral joints Inflammation occurs at entheses (insertion site of ligaments and tendons on bones) Inflammatory cells invade the joint and erode the bone and fibrocartilage of the joints. Body then tries to repair the area and forms fibrous scar tissue. This is then replaced by ossified scar tissue, causing fusion

Answer 113

Fusion “Bamboo spine” Lumbar lordosis and kyphosis

Answer 114

Pain is usually improved by activity and aggravated by rest

Answer 115

Gradual onset of low back pain and stiffness during early 20’s Pain starts as insidious, becomes persistent. Worse with prolonged rest, improved by physical activity SI joint pain Joint pain occurring for more than 3 months with morning stiffness Dactylitis (sausage digits of the fingers/toes) Enthesitis (inflammation/pain at the insertion site of the tendon or ligament to the bone

Answer 116

Referral to rheumatology Education about the disease Continuous physical therapy program to maintain skeletal mobility and prevent progression of contractures NSAIDs/ analgesia medications to provide symptom relief and facilitate exercise Biological response modifying agents. Ex. Certolizumab, golimumab, rituximab Possible surgical procedures: osteomy, total hip replacement, cervical spinal fusion

Answer 117

Plantar Fasciitis

Answer 118

Shortening or contracture of calf muscles and plantar fascia the result of collagen degeneration of the plantar fascia at the origin, the calcaneal tuberosity of the heel

Answer 119

Risk factors for shortened calf muscles include a sedentary lifestyle, occupations requiring sitting, very high or low arches in the feet, and chronic wearing of high-heel shoes Common among runners and dancers and may occur in people whose occupations involve standing or walking on hard surfaces for prolonged periods Also associated with obesity, RA, reactive arthritis and psoriatic arthritis

Answer 120

Pain at bottom of heel. It is often worse when pushing off of the heel (the propulsive phase of gait) and after periods of rest. Some patients describe burning or sticking pain along the plantar medial border of the foot when walking. Dorsiflexion of patient’s pedal phalanges

Answer 121

Confirm the diagnosis by reproducing pain with calcaneal pressure exerted by the thumb during dorsiflexion

Answer 122

Treatment involves calf muscle and plantar soft-tissue foot-stretching exercises, night splints, orthotics, and shoes with appropriate heel elevation

Answer 123

Proximal radius

Answer 124

typically present within 48 hrs of fall onto outstretched (FOOSH) hand or direct elbow trauma Pain, tenderness or swelling over the lateral elbow or decreased elbow motion following any type of trauma Joint tenderness over the radial head

Answer 125

Distal radius Colles Fracture (extension) – dorsal displacement of distal radius fragment Smith Fracture (flexion) – palmar displacement of distal radius fragment

Answer 126

Most common mechanism is FOOSH injury Colles’ fall with hand outward, Smith’s fall with hand inward Pain of wrist and possibly edema and deformity

Answer 127

Supraspinatus.

Answer 128

Infraspinatus.

Answer 129

Subscapularis.

Answer 130

Teres Minor.

Answer 131

Supraspinatus tendon. *Most vulnerable to injury* Infraspinatus tendon Subscapularis tendon Teres Minor tendon

Answer 132

Subacromial Subdeltoid Subscapular

Answer 133

Brachial plexus.

Answer 134

Anterior part: Flexes and medially rotates arm at shoulder Middle part: Abducts arm at shoulder Posterior part: Extends and laterally rotates arem at shoulder

Answer 135

Biceps Brachii - Supinates flexed forearm; flexes forearm at elbow. Brachialis - Flexes forearm at elbow in all position. Coracobrachialis - Helps to flex and adduct arm at shoulder.

Answer 136

Triceps brachii - Extends forearm at elbow' is chief extensor of elbow; steadies head of abducted humerus (long head). Anconeus - Assists triceps in extending elbow; abducts ulna during pronation.

Answer 137

Can fully extend without difficulty. Full active or passive flexion of elbow is uncomfortable.

Answer 138

Pain and a "popping" sensation are typical complaints. Aggravating activities include repetitive movements such as working overhead, reaching up and forward, or doing pushups. Local tenderness and palpable crepitus are characteristic. An effusion or hemorrhage into the area may be seen on MRI.

Answer 139

Men aged 30-50 years. Common risk factors are repeated lifting, physically demanding jobs, weight-bearing sports and light weightlifting. Advancing age is in itself a significant risk factor.

Answer 140

Most affected lumbosacral discs are L4-L5 and L5-S1. The most affected cervical region is C5-C6 and C6-C7. (Lumbar disc herniation is more common than cervical disc herniation.)

Answer 141

Cauda equina syndrome.

Answer 142

The location and size of the herniation into the spinal canal and amount of space in the canal determine clinical signs. It causes radiculopathy or pinched nerve - injury to nerve roots in the area where they leave the spine. Radiation of the pain follows distribution of the compressed nerve root. - Lumbosacral area causes pain in the sacroiliac joint, buttocks, hip, posterior thigh, and leg. -Cervical disc herniation causes shoulder and upper limb pain and hand. Pain increases with movements and straining. Range of motion is decreased in the lumbar spine or neck. Numbness, tingling, decreased sensation, decreased range of motion and motor weakness of the extremities may occur along the path of the nerve root.

Answer 143

The straight leg raise test: With the patient lying supine, the examiner slowly elevates the patient's affected leg at an increasing angle, while keeping the leg straight at the knee joint. The test is positive if it reproduces the patient's typical pain and paraesthesia. You are testing for herniated disc in the lumbosacral region Note: the test can be performed with the unaffected leg and is called the contralateral leg raise test. This test has a 90% specificity if positive.

Answer 144

Most herniated disc resolve on their own and do not require surgery. Conservative treatments include NSAIDs, acetaminophen, therapeutic massage and physical therapy. May require neurosurgery consultation if ongoing or symptoms are not manageable.

Answer 145

Occurs equally in both biological sexes Age (onset usually between 20-55 years of age) Family history (40% of affected individuals have first degree relative with PsA) Genetic predisposition Psoriasis (especially those nail pitting or onycholysis). Majority present with psoriasis first. Median time between joint disease diagnosis is 7-8 years after psoriasis onset, in some patients can be up to 40 years Environmental triggers Physical trauma Infection

Answer 146

Cardiovascular disease, especially in those who aren’t on disease-modifying anti-rheumatic drugs (DMARDs) Metabolic syndrome (hypertension, diabetes etc.) Psychiatric morbidity – anxiety and depression Non-alcoholic fatty liver Anemia of chronic disease

Answer 147

Asymmetric/Oligoarticular PsA

Answer 148

Arthritis Mutilans/Destructive PsA

Answer 149

Decreased range of motion (ROM) in affected joints Dermatological psoriasis (red plaques/silver scales) Nail pitting, onycholysis and/or discoloration Uveitis Dactylitis (inflammation of fingers/toes “sausage” digits) Enthesopathy (inflammation/pain at insertion site of the tendon or ligament to the bone) commonly seen in the Achilles tendon, plantar fascia, or tibial tuberosity Tenosynovitis (inflammation of synovium) Limp secondary to heel tenderness

Answer 150

Serum Bloodwork: - Erythrocyte sedimentation rate (ESR) - elevated - C-reactive protein (CRP) - elevated - Leukocytosis - Rheumatoid Factor (RF) - usually negative (positive in up to 15% of clients) X-Rays of affected joint: shows joint erosion and classic feature of pencil-in-cup radiographic sign (DIP joint malformation)

Answer 151

Rheumatology.

Answer 152

Male Increasing age High alcohol intake Red meat consumption Fructose consumption

Answer 153

Tophi are uric acid deposits in the soft tissues. Strongly associated with causing destruction and deformity of the joint.

Answer 154

Kidney stones.

Answer 155

Most common sites (in decreasing frequency): first metatarsophalangeal joint (big toe), instep of the foot, ankle, heel, knee, wrist, fingers, elbow

Answer 156

True. Most commonly affected bursae are in elbows, knees, Achilles.

Answer 157

False. Diuretics are a common trigger.

Answer 158

-Meats, especially organ meat. -Seafood, especially shellfish, sardines and anchovies. -ETOH, especially beer..

Answer 159

-Coffee -Vitamin C (500 mg/day) - Low fat dairy (milk, yogurt) -Tart cherries (not in pill form)

Answer 160

Tennis elbow.

Answer 161

Golfer's elbow.

Answer 162

Lateral epicondylitis (tennis elbow): -painful to the outside of the elbow. -pain with both passive and resisted wrist extension with elbow extended -pain increases when lateral area is pressed or when grasping or twisting objects. Medial epicondylitis (golfer's elbow): -pain to the inside of the elbow -pain with both passive and resisted wrist flexion with elbow in full extension -pain occurs on the ulnar side of the forearm, the wrist and occasionally the fingers -stiffness of the elbow, weakness in the hand and the wrist and a numb or tingling feeling in the fingers (mostly ring and little finger)  -local tenderness over medial epicondyle and the conjoined tendon of the flexor group

Answer 163

Patient teaching (early symptoms): -resting the elbow -applying ice or heat several times a day for 1-2 weeks -Stopping or changing activities that irritate tendon (also important for prevention) NSAIDs (topical or oral) for pain control Physio to strengthen and increase flexibility, change of movements Counterforce brace If condition gets worse consider: -Corticosteroid injection -Surgery (not done often)

Answer 164

Same as lateral: Patient teaching (early symptoms): -resting the elbow -applying ice or heat several times a day for 1-2 weeks -Stopping or changing activities that irritate tendon (also important for prevention) NSAIDs (topical or oral) for pain control Physio to strengthen and increase flexibility, change of movements Counterforce brace If condition gets worse consider: -Corticosteroid injection -Surgery (not done often) Mentioned additionally for lateral epicondylitis: -Prolotherapy -Eccentric exercises (no examples given) -Extracorporeal shockwave therapy -Needling -Platelet-rich plasma (PRP) -Autologous tenocyte injections

Answer 165

Pain "facilitators"- act to modulate control over transmission of pain impulses in periphery, spinal cord, and brain

Answer 166

* Glutamate * Substance P * Histamine * Prostaglandin * Bradykinin

Answer 167

Prostaglandin, histamine, bradykinin

Answer 168

Lymphokines

Answer 169

GABA, glycine Norepi and serotonin play a role in pain inhibition of in the medulla, but can excited peripheral nerves

Answer 170

Endogenous opioids (analgesics) are a family of morphine like neuropeptides that prevent the transmission of pain signals in the periphery, spinal cord, and brain.

Answer 171

Bind to opioid receptors (mu, kappa, delta) Hinder ion channels to prevent release of excitatory NTS in the posterior horn of SC In the midbrain, affect descending inhibitory pathways In peripheral inflamed tissue, opioids are made and released from immune cells and active opioid receptors on sensory nerve terminals Opioid receptors are widely distributed throughout the body and are responsible for sensations of well being and modulation of many physiologic processes

Answer 172

Enkephalins

Answer 173

Delta opioid receptors

Answer 174

Endorphins (endogenous morphine)

Answer 175

Dynorphins- play a role in neuropathic pain, mood disorders, and medication addition

Answer 176

Kappa (firmly) to decrease pain signals

Answer 177

Mu receptors- strong pain relief effects

Answer 178

Higher attraction for Mu receptors *endorphins and endomorphins bind to mu receptors

Answer 179

Made from phospholipids, classified as eicosanoids. Activate cannabinoid CB1 (in CNS) and CB2 (immune tissue and spleen) to modulate pain and other function (sleep, memory, appetite, stress, thermoregulation, addiction)

Answer 180

CB2 receptors decrease pain transmission by inhibiting release of excitatory neurotransmitters (in the spinal posterior horn, periaqueductal grey, thalamus, rostral ventromedial medulla, and amygdala)

Answer 181

1) Inflammation/ Hematoma formation (within hours of fracture or surgery; day 1-5) 2) Procallus formation by osteoblasts (within days) 3) Fibrocartilaginous callus formation (day 5-11) 4) Bony callus formation (day 11- 28) 5) bone remodeling (day 18 onwards, lasts months to years)

Answer 182

* Immediately follows fracture * Blood vessels to bone/ periosteum are rupture, causing hematoma around fracture site. * Hematoma clots, forms temporary frame for healing * Injury to bone results in secretion of pro inflammatory cytokines * Osteoclasts and other cells (macrophages, lymphocytes) act together to remove damaged bone and issue and release factors to stimulate healing

Answer 183

* Growth factor leads to angiogenesis, granulation tissue begins to develop * Osteocytes differentiate into fibroblasts, chondroblasts, and osteoblasts * Collagen rich fibrocartilage network develops to span fracture ends; has hyaline cartilage sleeve * Layer of woven bone laid done

Answer 184

* Cartilagenous callus begins to undergo ossification * RANK L is expressed, stimulating further differentiation of chondroblasts, chondroclasts, osteoblasts, and osteoclasts. Cartilage resorbed and beings to calcify * Woven bone layed down * Results in hard, calcified callus of immature bone

Answer 185

* Continued migration of osteoblasts and clasts- repeated remodelling * Resorption by osteoclasts, new bone formation by osteoclasts

Answer 186

osteoBlasts BUILD (bone remodelling)

Answer 187

osteoClasts COLLAPSE (bone resorption)

Answer 188

- produced in response to bone damage; regulates osteoclast formation and activation in bone remodeling

Answer 189

-produced by osteoblasts; binds to RANK L so it cannot act at receptor, which protects bone from excessive resorption

Answer 190

Popliteal fossa; contains popliteal vessels and the tibial and common fibular nerves. It is the transition between the thigh and the leg

Answer 191

Posterior compartment of leg muscles

Answer 192

Anterior compartment of leg muscles

Answer 193

Lateral compartment of the leg

Answer 194

Calcaneal tendon (Achilles tendon) Walking, running

Answer 195

Gastrocnemius muscle to calcaneal tendon

Answer 196

Plantarflexes (toes to the floor) foot at the ankle and flexes leg at the knee joint

Answer 197

Plantarflexes foot at the ankle, steadies' leg over the foot

Answer 198

Weakly assists Gastrocnemius Plantaris tendon connects to the ankle, close to the calcaneal tendon

Answer 199

Weakly flexes leg at knee and unlocks it (rotates femur on the fixed tibia)

Answer 200

Flexor hallucis longus Flexes (curls down) great toes at all joints and plantarflexes foot at the ankle Flexor digitorum longus Flexes lateral four digits and plantarflexes foot at the ankle, supports longitudinal arches of foot

Answer 201

Plantarflexes foot at ankle and inverts foot (tip foot up so the sole of the foot faces the medial aspect of the person) Tibialis posterior tendon connects this muscle to the ankle

Answer 202

Tibialis Anterior Dorsiflexion/inversion of foot Extensor hallucis longus Extends (straighten) great toes and dorsiflexes foot at the ankle Extensor digitorum longus Extension of lateral four digits and dorsiflexes foot Forms 4 tendons superior to the foot and enters the dorsum of the foot along with the tendon associated with the fibularis tertius > splits in to 4, each inserting onto a toe Fibularis tertius (arises from inferior portion EDL – not present in all individuals) Dorsiflexes foot/Extension of great toe

Answer 203

flex ankles and toes

Answer 204

extensors (dorsiflexion) of foot at ankles and toes

Answer 205

Primary function is to evert the foot, and weakly plantarflex foot at ankle Fibularis Longus Everts foot and weakly plantarflexes foot at the ankle Fibularis Brevis Everts foot and weakly plantarflexes foot at the ankle

Answer 206

* Plantarflexor tendons * Dorsiflexor tendons * Fibularis tendons

Answer 207

extensor digitorium and hallucis brevis; extend the toes

Answer 208

four Medial or lateral plantar nerves (comes from the tibial nerve)

Answer 209

Abductor Hallucis Abducts (moves away from midline) and flexes the great toe Flexor Digitorum Brevis Flexes lateral four digits Abductor digiti minimi Abducts and flexes the little toe

Answer 210

Quadratus Plantae (2nd) Assist flexor digitorum longus in flexing lateral four digits Lumbricals (2nd) Flex metatarsophalangeal joints and extend interphalangeal joints of lateral four digits Flexor Hallucis Brevis (3rd) Flexes proximal phalanx of big toe Adductor hallucis (3rd) Adducts (towards midline) big toes, assists in maintaining the transverse arch of the foot Flexor digiti minimi brevis (3rd) Flexes proximal phalanx of little toe, thereby assisting with its flexion.

Answer 211

Planta interossei (three muscles) Adducts digits 3-5, flex metatarsophalangeal joints, extend phalanges Dorsal interossei (four muscles) Abduct digits 2-4, flex metatarsophalangeal joints and extend phalanges

Answer 212

Large hinge Synovial Allows for flexion/ extension of lower limb

Answer 213

femorotibial femoropatellar

Answer 214

Tibiofemoral ligaments Quadricepts

Answer 215

Prevents posterior slipping of femur on tibia; torn in hyperextension, and prevents hyperextension of knee

Answer 216

Prevents anterior slipping of femur on tibia, shorter and stronger than ACL. Prevents posterior translation of tibia, and hyperflexion of knee

Answer 217

Limits extension and abduction of leg, attached to medial meniscus

Answer 218

Limits extension and adduction of leg, overlies popliteus tendon

Answer 219

Made of fibrocartilage, and has thick external margins with unattached edges, that allows for joint congruency, load distribution and joint stability

Answer 220

Sharp turns when knee is twisted, while the foot is firmly on the ground Compressional, rotational, shear stress on meniscus could cause a meniscal tear twisting knee after planting foot is a common mechanism for ACL injuries, which could be complicated by a Segond fracture (avulsion fracture of lateral aspect of tibial plateau) Lateral force applied to the knee with the foot on the ground

Answer 221

Popping noise may be heard Tearing sensation with acute pain may be felt Pain, swelling, clicking/crepitus with walking/knee extension Inability to fully extend/lock knee (more commonly in anterior meniscus tears) Post ACL injuries--- knee may "give out" when walking/standing

Answer 222

Lachman test Patient lays supine, then bends affected knee 20-30 degrees, provider grasps limb over distal femur and proximal tibia, then pull forward and push backward. If there is movement 5mm or more than in normal limb, indicative of ruptured ACL

Answer 223

Used to dx ACL injury Patient is supine on table with hip flexed 45 degrees, knee at 90 degrees, examiner sits on patient's foot to stabilize it, place hands on upper calf and firmly pulls tibia forward. A movement of. 5mm or more is positive Test normal limb first and compare result with normal limb

Answer 224

MCL sprain - usually sports related, from outside blow to knee or rapid change in direction/ speed

Answer 225

Posterior drawer test With the knee flexed to 90 degrees and the foot stabilized (often the examiner sits on the patient's foot), the proximal tibia is grasped firmly with both hands and the tibia is forcibly pushed posteriorly, noting any laxity compared with the other side.

Answer 226

valgus (or abduction) stress test with the knee in both 30 degrees and 0 degrees of flexion looking for joint laxity

Answer 227

Acute (most often from twisting injuries when foot remains planted) and CHRONIC (degenerative tears in older patients that can occur with minimal twisting or stress)

Answer 228

-degree of pain at time of injury = variable à followed by insidious onset of pain and swelling over 24h -pain is exacerbated by twisting/pivoting movements -some patients may describe a “tearing” or “popping” sensation at the time of injury -patients can present weeks after injury and often c/o popping, locking, catching and the knee “giving out” or may just report that the knee is not moving properly -feeling of instability is r/t a meniscal fragment floating between 2 articular surfaces à sensation that the nee is not in the position it should be -locking = inability to fully extend knee d/t interference of torn meniscus -effusions are common (particularly w/ large or complex tears) and can occur intermittently from tears assoc with degen arthritis (Pts with effusion typically complain of stiffness, rather than swelling)

Answer 229

-softening, inflammation, degeneration/ erosion of hyaline cartilage at a joint (affects articular cartilage surfaces of bone)

Answer 230

Destruction/ degeneration of cartilage can occur from: Cytokines/ proteolytic enzymes (i.e., resulting from intra-articular infection) Chondrotoxic substances (i.e., from iatrogenic injections) Microtrauma from repeated activities (due to compressive stress on joint) Aging (decreased number of chondrocytes, therefore decreased proteoglycans, reducing water content of cartilage)

Answer 231

Chondromalacia patella

Answer 232

S&S: Anterior knee pain that worsens with stress on patellofemoral joint (climbing stairs, squatting, running) Dull, aching Usually does not cause swelling Dx History (evaluate risk factors), physical evaluation Clark’s test (evaluates patellofemoral grinding and pain by compressing patella into femoral trochlea, and having pt contract quads to pull patella through groove) XR to rule out ddx MRI can help in diagnosis/ staging

Answer 233

- Affects the abductor pollcis longus (APL) and the extensor pollcis brevis (EPB) tendons. Two of the main tendons to the thumb that assist with bringing the thumb out away from the index finger (APL) and straightening the joints of the thumb (EPB). These two tendons arise from muscles in the forearm and then run together in a sheath that keeps them close to the bone as they cross over from the thumb side of the wrist into the hand. Any swelling of the tendons (De Quervain’s ) and/or thickening of the sheath can result in a situation where the tendons no longer fit well inside the sheath. This results in increased friction and pain with certain thumb and wrist movements. This condition can cause pain and tenderness along the thumb side of the wrist.

Answer 234

-radial side wrist pain -worsened by wrist and thumb movement, radial and ulnar deviation of the wrist -difficulty with tasks like opening jar lid, moving thumb, forming fist, grasping something, turning wrist, lifting child -tenderness over the radial styloid -fusiform (sausage shaped) swelling in this region

Answer 235

test for de quervain tenosynovitis * Thumb flexed and held inside fist * Patient actively deviates the wrist * Causes sharp pain along the radial wrist at first dorsal compartment

Answer 236

-can be self limited and may resolve without intervention -persistent symptoms: splinting, anti-inflammatories, corticosteroid injection -operative management if symptoms fail to improve/ recur after 2 corticosteroid injections (release tendon sheath to make more room for irritated tendons)

Answer 237

-Chronic systemic autoimmune disease that primarily involves the joints. -Prominent immunologic abnormalities include immune complexes produced by synovial lining cells and in inflamed blood vessels. -Released inflammatory mediators and various enzymes contribute to the systemic and joint manifestations of rheumatoid arthritis (RA), including cartilage and bone destruction. -Rheumatoid nodules develop in about 30% of patients with RA. They are granulomas consisting of a central necrotic area surrounded by palisaded histiocytic macrophages, all enveloped by lymphocytes, plasma cells, and fibroblasts

Answer 238

-affects same joints on both sides of body (symmetrical arthritis) -starts at small joints and moves on the larger joints as disease progresses -fingers may be bent (boutonniere or swan neck deformities) -tendons on hand may be prominent (bowstring sign) -stiffness, pain, redness, warmth to touch, swelling -joint stiffness worse in the morning and after being still; persists >1h -can have extra articular sx (vasculitis, effusions, pericarditis, subcut RA nodules...)

Answer 239

*Differentiate Inflammatory from Non-inflammatory Arthritis *Differentiate RA from Other Inflammatory Arthritides *RA is a clinical diagnosis. Referral to a specialist should not be based on the results of lab tests if there are no clinical features suggesting RA. There are no tests that can reliably make the diagnosis of RA. * If there are clinical features then the following lab tests may be useful for monitoring and ruling out other types of arthritis: CRP, ESR, RF, ANA, X-rays, joint aspiration. *CRP is preferred test (covered by MSP).

Answer 240

*Urgent management is important because early recognition and intervention has been shown to improve outcome. *Disease modifying anti-rheumatic drugs (DMARDs), particularly when used early, change the course of the disease and are proven to reduce damage and associated disability. *Aim is to not only treat symptoms, but to also treat the disease progression to prevent permanent joint damage. *Treatment is multi-disciplinary *NSAID and acetaminophen for pain management * severe symp can add prednisone *follow up q 3-6 months

Answer 241

-OA sometimes begins with tissue damage from mechanical injury (eg, torn meniscus), transmission of inflammatory mediators from the synovium into cartilage, or defects in cartilage metabolism. -Obesity triggers some of these defects in cartilage metabolism, leading to cartilage matrix damage and subchondral bone remodeling mediated by adipokines such as leptin and adipsin. The tissue damage stimulates chondrocytes to attempt repair, which increases production of proteoglycans and collagen. However, efforts at repair also stimulate the enzymes that degrade cartilage, as well as inflammatory cytokines, which are normally present in small amounts. -Inflammatory mediators trigger an inflammatory cycle that further stimulates the chondrocytes and synovial lining cells, eventually breaking down the cartilage. Chondrocytes undergo programmed cell death (apoptosis). Once cartilage is destroyed, exposed bone becomes eburnated and sclerotic.

Answer 242

conditions that change microenvironment of cartilage (trauma, metabolic defects, infections, endocrine and neuropathic disorders, RA, etc)

Answer 243

Osteoarthritis

Answer 244

True. May not be symptomatic- only half patients with pathologic changes of OA have symptoms

Answer 245

Pain- deep ache. Usually worse with weight bearing and relieved by rest. Stiffness following awakening/ inactivity, but lasts <30 min and lessens with movt

Answer 246

As OA progresses, joint motion becomes restricted, and tenderness and crepitus or grating sensations develop. Proliferation of cartilage, bone, ligament, tendon, capsules, and synovium, along with varying amounts of joint effusion, ultimately cause the joint enlargement characteristic of OA.

Answer 247

F- usually chronic processes

Answer 248

-xr of symptomatic joints -labs usually normal, but used to rule out other disorders -if causing joint effusions, synovial fluid analysis can help differentiate it from inflammatory arthritises (OA= clear, viscous, WBC < 2000)

Answer 249

Treatment goals are relieving pain, maintaining joint flexibility, and optimizing joint and overall function.

Week 7 MSK and Pain Flashcards

(286 cards)