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44 Cards in this Set
- Front
- Back
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Name 5 most common forms of soft tissue Rheumatism
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Bursitis, tendinitis
Adhesive capsulitis Reflex sympathetic dystrophy Dupuytren's contracture Fibromyalgia syndrome |
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Whats the etiology of bursitis and tendinitis?
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Trauma
inflammation: RA, SLE, gout infection: staph and strep |
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Common sites of bursitis and tendinitis?
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subacromial
olecranon illiopsoas trochanteric ischiogluteal prepatellar anserine retrocalcaneal |
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what are the signs and symptoms of bursitis?
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Acute: pain, tenderness (in case of subdeltoid bursitis on lateral side of the upper arm
Chronic: chronic annoying pain |
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Chronic cases of bursitis might cause?
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Adhesive capsulitis
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Whats happening in tennis elbow?
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Lateral epicondylitis
inflammation of the origin of the common extensor tendon pain at the lateral elbow, radiation above and down point tenderness at the lateral epicondyle pain worse by resisted extension of the wrists |
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Whats happening in Olecranon bursitis?
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Caused by trauma, inflammation (RA and gout)
swelling, little spontaneous pain pain on palpation if not infected |
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Sepsis of the olecranon bursa?
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pain and swelling
erythema, heat and tenderness gram stain and culture with aspiration of fluid |
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What is DeQuervain's disease?
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tendinitis of the radial tendons
wrist pain on the radial side tenderness on palpation caused by trauma, direct of repetitive |
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Whats bursitis?
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inflammation of bursa overlaying the bone
pain... usually radiated tenderness caused usually by trauma |
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Why can iliopsoas bursitis be confused by arthritis?
what is the complication of iliopsoas bursitis? |
both cause pain in the groin area
iliopsoas bursitis is inflammation of bursa anterior to the hip joint, behind the iliopsoas muscle a cystic mass may compress the femoral vein and causes venous distention in the knee and the leg pain is worse on extension of hip diagnosis by CT or MRI |
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Whats anserine bursitis?
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inflammation of the sartorius bursa (between common tendon of sartorius, racillis and semitendinosus, medial aspect of the knee)
pain and tenderness on palpation |
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what does erythema, heat and tenderness suggest in prepatellar bursitis?
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prepatellar bursitis is swelling over the patella
heat and erythema suggests infection |
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Whats a must do when there is a chance of infection in bursitis or tendinitis?
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Fluid aspiration and culture
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What is cause of adhesive capsulitis of the shoulder (frozen shoulder)?
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usually shoulder bursitis or tendinitis
trauma immobility coronary artery disease (CAD) |
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Whats the pathology and clinical findings in adhesive capsulitis of the shoulder?
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decreased range of motion
diffuse pain thickening of the joint capsule proliferation of synovial lining membrane and small blood vessels mild chronic inflammation calcification (late stages) |
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How do you differentiate adhesive capsulitis with RA?
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in RA you will see juxtarticular osteopenia and bone erosion on the x-ray
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Reflex sympathetic dystrophy
or Complex regional pain syndrome what is the clinical manifestation |
chronic pain in the extremity
decreased range of motion due to associated adhesive capsulitis initially: swelling, warmth and erythema in extremity later: cold, raynaud's phenomenon, loss of hair, extreme tenderness |
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Whats the histology of Complex regional pain syndrome?
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same as capsulitis.
thickening of the joint capsule proliferation of synovial lining membrane and small blood vessels mild chronic inflammation calcification (late stages) |
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Whats the cause of Complex regional pain syndrome?
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prolonged immobilization due to:
trauma bicipital tendinitis hemiplegia |
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Whats the mechanism of Complex regional pain syndrome?
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increased sympathetic activity resulting form trauma
with internuncial neuronal excitation in the spinal column with activation of adjacent symptomatic effector neurons |
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allodynia?
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stimulus that causes pain
probably touch or pressure characteristic of fibromyalgia |
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What is Duputren's Contracture?
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nodular thickening and shortening of the palmar fascia
unilaterally or bilaterally puckering and dimpling of the skin gradual flexion contracture mostly in 4th and 5th fingers proliferation and then contraction of the myofibroblasts most seen in men! |
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whats the treatment for Duputren's contracture?
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Steroid injection
local injection of collagenase clostridium histolyticum (Xiaflex) limited fasciectomy |
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What percent of population and who get Fibromyalgia?
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3-3.5%
80-90% female peak age 40-60 people with concurrent medical |
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Whats the importance of FMS?
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immense suffering and poor quality of life
high cost to the society much morbidity increased risk of cancer and mortality |
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What is FMS?
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A chronic, widespread musculoskeletal pain syndrome
tender points on palpation at multiple sites |
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Name the most important symptoms of FMS
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Widespread pain
fatigue stiffness cognitive difficulties Tissue swollen feeling dizziness |
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What are some disease associations with FMS?
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Irritable bowel syndrome
headache - tension type migraine headaches chronic fatigue syndrome restless legs syndrome temporomandibular joint |
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What are tender points?
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tenderness on palpation of local tissues such as muscles, ligaments or joint
elicited by applying force (4kg) |
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What are physical findings in FMS?
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tender points
no swelling (feels swollen) no neurological findings signs of accompanying disease (arthritis or neuritis) |
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ACR classification of FMS?
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Widespread aching
>11 tender points among possible 18 sites |
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What is the pathophysiology of FMS?
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disease of the central nervous system with central sensitization
no structural pathology in peripheral tissues peripheral nociception generators (trauma, arthritis) may trigger central sensitization |
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whats the neuroplasticity seen in FMS?
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greater sensitivity to peripheral stimuli, pressure, heat
spread of pain beyond area of stimulus prolonged pain after stimulus |
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What is central sensitization?
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wind up!
Nociceptive output> nociceptive input repetitive nerve discharge --> sensory amplification increased pain transmission and decreased modulation |
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What causes central sensitization?
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Genetic factors
non-restorative sleep physical trauma viral infection inflammation (RA or OA may trigger central sensitization) Psychological distress |
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What is seen in SPECT Scan of brain in FMS?
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decreased blood flow in caudate nuclei and thalami
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What are the psychological factors that affect FMS?
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psychological distress 35%
depression metal stress poor coping catastrophizing |
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What syndromes are in part of central sensitivity syndromes?
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FMS, PTSD, Chronic fatigue syndrome, irritable bowel syndrome, headaches, temporomandibular dysfunction, restless leg syndrome, interstitial cystitis, multiple chemical sensitivity
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How do you manage FMS?
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empathy and education
exercise sleep hygiene behavioral therapy for coping serotonergic and epinephric drugs pregabalin |
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What is pregabalin (Lyrica)?
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binds to the alpha-delta subunit of voltage gated Ca channel
decrease Ca influx to cell reduce the release of substance P and glutamate |
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What is Duloxetine (Cymbalta)?
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selective serotonin and norepinephrine reuptake inhibitor (SNRI)
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What is Milnacipran (Savella)?
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SNRI
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What drugs are used in treatment of FMS?
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serotonergic and epinephric drugs:
amitriptylene, cymbalta, tramadol, milnacipran Pregabalin |
