module 7 rheumatology patho

Sprain

tear/injury to ligament

Strain

tear/injury to tendon and/or muscle

Avulsion

separation of tendon/ligament from its bony attachment

What is tendonitis?

tendon injury with inflammation and damage

What is Epicondylitis?

tendonitis at the epicondyle attachment site

What is Tennis elbow?

Lateral epicondylitis

What is Golfer’s Elbow?

medial epicondylitis

Signs and Symptoms of Epicondylitis?

ache that progresses to pain with repeated use; tenderness on palpation

Treatment of epicondylitis?

acute onset- treat with NSAIDS for 4-6 weeks

What is osgood-schlatter disease?

tendonitis of the anterior patellar tendon

Risk factors for Osgood-Schlatter Disease?

age: pre-adolescents and adolescents who play sports

S/S of Osgood-Schlatter Disease?

pain and swelling around tibia tuberosity

Diagnosis and treatment of Osgood-Schlatter Disease?

x-ray and rest for 4-8 weeks

What is Bursitis?

inflammation of Bursa (synovial fluid filled sacs allowing smooth motion)

Causes of Bursitis?

trauma → repetitive stress injury

RA, infection, DM, HIV, Gout

Tests for Bursitis?

some cases of bursitis are visible and palpable, confirm with U/S

if not palpable, confirm with MRI

treatment for Bursitis?

rest, ice, NSAIDS, Corticosteriods

Causes of Carpel Tunnel Syndrome?

pressure on the median nerve in wrist

overworked, repetitive work - thickening of the tendons (students wrists)

S/S of Carpel Tunnel Syndrome?

Tingling, numbness and pain in wrist and hand

“pins and needles” feeling on palm side

Symptoms usually occur at night

Loss in grip strength

Testing for carpel tunnel syndrome?

Tinel’s test - tapping on wrist; if pain radiates up- positive test

Phalen’s test - putting back of hands together at a flat angle; if pain radiates up- positive test

nerve conduction test

Treatment for carpel tunnel syndrome?

BEST-cut ligament!!

physiotherapy - wrist splinting

What is Sciatica?

nerve pain with radiation along one leg

Causes of Sciatica?

nerve compression → muscular, disk, piriformis syndrome, tumors

S/S of Sciatica?

radiation of pain from lower back to buttock to lower leg

neuropathies

paresthesias

loss of bladder and bowel control

Testing for Sciatica?

X-ray, CT, MRI

What is osteopenia?

stage before osteoporosis; reduction in bone mass

What is Osteoporosis?

decrease in bone density AND bone reabsorption > bone formation

porous bone / poorly mineralized bone

Causes/ Risk Factors of Osteoporosis?

decreased activity / sedentary lifestyle

decreased vitamin D and decreased calcium

decreased estrogen / androgens

corticosteriod use → increased RANKL and decreased OPG

Diagnosis of Osteoporosis?

DXA - Dual x-ray absorptiometry. Looking for T-SCORE (compares BMD to young adults)

S/S of Osteoporosis?

fragility fractures, diminished height, bone deformity, pain

What is Rickets?

Vitamin D deficiency in children

What is Osteomalacia?

Vitamin D deficiency in adults

Cause of Rickets?

MCC: X-linked Hypophosphatemia

Causes of Osteomalacia?

malabsorption, decreased vit D intake, decreased sun exposure

Pathophysiology of Osteomalacia/Rickets?

Bone formation progresses to osteoid formation, but calcification does not occur → SOFT BONES (decent density but SOFT AND BENDY BONES)

S/S of Osteomalacia?

PAIN!!! (Bendy bones = pain) bone fractures, vertebral collapse, bone malformation

S/S of Rickets?

early fractures, slow healing fractures, bowing of the legs, RACHITIC ROSARY (BUZZWORD)

What is Osteoarthritis?

narrowing of joint space due to loss of articular cartilage or sclerosis of underlying bone

Risk Factors of Osteoarthritis?

incidence increases with age; symptoms appear @ 50-60 y/o

S/S of Osteoarthritis?

pain and stiffness of joints in hips, hands, knees, spine

Osteoarthritis Joint Stiffness?

decrease initiation of movement with limited range of motions

WORSE BEFORE JOINT MOVEMENT BEGINS (worse in morning) but goes away after 30 minutes of use

Osteoarthritis Joint Pain?

swelling and tenderness with enlargement of joint

PAIN WORSE WITH MOVEMENT; GOES AWAY AT REST

Osteoartiritis Joint Effusion?

Heberden nodes (DIP)

Bouchard Nodes (PIP)

What is Rheumatoid Arthritis?

chronic, systemic, inflammatory autoimmune disease with joint swelling and tenderness, DESTRUCTION OF SYNOVIAL MEMBRANE

Causes of Rheumatoid Arthritis?

Multifactorial but more common in F>M

S/S of Rheumatoid Arthritis?

inflammatory symptoms (fever, fatigue, weakness)

joint pain: stiffness worse for 1st hour after waking up

Joint Deformities: ulnar drift, boutonniere deformity, swan neck deformity

DX criteria for Rheumatoid Arthritis?

more joints affected, more likely RA.

Antibodies- RF (rheumatoid factor), ACPA (anti-citrullinated protein Ab)

Inflammatory factors - increased CRP or ESR

What is Osteomyelitis?

infection of the bone

Risk Factors of Osteomyelitis?

increased risk in **diabetes,** alcoholics, immunocompromised

What is Gout?

uric acid crystal deposition in synovial fluid triggers an inflammatory response

Hyperuricemia → inflammation

Causes of Gout?

increased uric acid levels

inherited abnormality of metabolizing uric acid

obesity, excessive alcoholism, medication

S/S of Gout?

painful joint inflammation → MC in BIG TOE

Tophi - small white nodules

uric acid kidney stones → renal failure

Treatment of Gout?

DIET CHANGES (decrease foods high in purines)

NSAIDS, Colchicine, allopurinol, hydrocortisone