NR509
• Articular structures include joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments and
... [Show More] juxta-articular bone
o Articular disease involves:
▪ Swelling
▪ Tenderness of the joint
▪ Crepitus
▪ Instability “locking”
▪ Deformity
▪ Limits active and passive range of motion due to stiffness or pain
• Extra-articular structures include periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve and overlying skin
o Extra-articular disease involves:
▪ “point of focal tenderness in regions adjacent to articular structures
▪ Limits active range of motion
▪ RARELY causes swelling, instability, joint deformity
Know the sources of joint pain (pg. 627 algorithm)
• Nonarticular conditions: trauma/fracture, fibromyalgia, polymyalgia rheumatica, bursitis, tendinitis
• Intra-articular (acute, < 6 weeks): acute arthritis
o infectious arthritis
o gout
o pseudogout
o Reiter syndrome
• Intra-articular (chronic, > 6 weeks): chronic inflammatory arthritis vs chronic noninflammatory arthritis
o Chronic inflammatory arthritis with 1-3 joints involved:
▪ Indolent infection
▪ Psoriatic arthritis
▪ Reiter syndrome
▪ Periarticular JA
o Chronic inflammatory arthritis with >3 joints involved:
▪ Psoriatic arthritis or Reiter syndrome (no symmetry)
▪ rheumatoid arthritis if not RA then systemic lupus, scleroderma, polymyositis
*Know what causes saddle numbness and urinary retention (pg. 678?)
• CES (cauda equina syndrome) most commonly results from a massive herniated disc in the lumbar region.
• A single excessive strain or injury may cause a herniated disc.
• However, disc material degenerates naturally as a person ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or
twisting movement can cause a disc to rupture.
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