Download Other Miscellaneous Joint Diseases

Other Miscellaneous Joint
Diseases
Ankylosing spondylitis
AS
Prevalence 0.1-0.2% M>F
Late teens to age 40
More common in whites than in nonwhites
HLA-B27 positivity
Chronic progressive disease and develop
disability due to spinal inflammation leading
to fusion, often with thoracic kyphosis or
erosive disease
Worse during first 10 years
Begins at sacroiliac joints
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Symptoms
Morning stiffness and fatigue
Fever and weight loss
Radiation of pain into both buttocks
Criteria for diagnosis:
Morning stiffness that lasts more than 30 minutes
Improvement of back pain with exercise but not rest
Nocturnal back pain during second half of the night only
Alternating buttock pain
Achilles tendonitis, Plantar fascitis
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Signs:
Stooped posture and a stiff back
Loss of lumbar lordosis – straight back
Schober test confirms-marking a 10-cm length of the
lumbar spine (with patient in the erect position),
starting at the fifth lumbar spinous process. Instruct
the patient to maximally flex his or her spine.
Remeasure the distance between the marks. Normal
flexion increases the distance by at least 5 cm.
Loss of chest expansion (<3-cm difference between
minimum and maximum chest diameter) late stage of
disease
Eyes can be involved
Aortic valvular leak can happen
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Tests
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Therapy
NSAIDs
TNF alpha
Steroids
Methotrexate
Monitor with ESR, CRP
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Physical therapy
Exercise program and postural training
Spinal extension and deep-breathing
exercises
Maintaining an erect posture during daily
activities
Sleeping on a firm mattress with a thin
pillow also tend to reduce the tendency
toward thoracic kyphosis.
Water therapy and swimming
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Myofascial Pain Syndrome
?Myofascial trigger points
(MTrPs).
200 paired muscles
Any one of these muscles can develop
myofascial trigger points (MTrPs).
MTrPs are hyperirritable tender spots in
palpable tense bands of skeletal muscle that
refer pain and motor dysfunction, often to
another location.
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Major clinical components:
The TrP
The taut band
The local twitch response
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Latent TrPs
Cause motor dysfunction:
Stiffness,
Restricted range of motion without pain
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Active TrPs
Most common:
postural musclesof the neck,
shoulder, and pelvic girdles and
the masticatory muscles
Others: upper trapezius, scalene,
sternocleidomastoid, levator scapulae, and
quadratus lumborum muscles
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Features of myofascial pain:
Results in palpable nodules and the taut
bands associated with TrPs.
TrP triggers:
Acute overload, overwork fatigue, direct
impact trauma, and radiculopathy
Patients with active MTrPs usually complain
of poorly localized, regional, aching pain in
subcutaneous tissues, including muscles and
joints.
They rarely complain of sharp, clearly
localized cutaneous-type pain.
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Disturbances of autonomic functions abnormal sweating, persistent lacrimation,
persistent runny nose, excessive salivation,
and pilomotor activities
Proprioceptive disturbances- imbalance,
dizziness, tinnitus, and distorted perception
of the weight of lifted objects
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Loss of motor functions:
Spasm of other muscles, weakness of the
involved muscle function, loss of
coordination by the involved muscle, and
decreased work tolerance of the involved
muscle.
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Taut band
By gently rubbing across the direction of the
muscle fibers in a superficial muscle, the
examiner can feel a nodule at the MTrP and a
ropelike induration that extends from this
nodule to the attachment of the taut muscle
fibers at each end of the muscle
The taut band can be snapped or rolled
under the finger in accessible muscles. With
effective inactivation of the TrP, this palpable
sign becomes less tense and often (but not
always) disappears, sometimes immediately
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Tender nodule
Palpation along the taut band reveals a
nodule exhibiting a highly localized and
exquisitely tender spot that is characteristic
of a MTrP.
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Local twitch response:
Snapping palpation of the TrP frequently
evokes a transient twitch response of the taut
band fibers. Twitch responses can be elicited
both from active and latent TrPs.
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Diferential Diagnosis
Feature
Myofascial Pain
(TrPs)
Fibromyalgia
Female-to-male
ratio
1:1
4-9:1
Pain
Local or regional
Widespread,
general
Tenderness
Focal
Widespread
Muscle
Feels tense (taut
bands)
Feels soft and
doughy
Motion
Restricted range of
motion
Hypermobility
Examination
Examine for TrPs
Examine for tender
points
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REACTIVE ARHTRITIS
Triad of1. Nongonococcal urethritis,
2. Conjunctivitis, and
3. Arthritis
Preceded by bloody dysentery
Associated with:
Gastrointestinal infectionsShigella
Salmonella and
Campylobacter species and
Genitourinary infections (especially with
Chlamydia trachomatis).
Usually develops 2-6 weeks after infection
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Prognosis:
A self-limited course, with resolution of
symptoms by 3-12 months
Has a high tendency to recur
HLA-B27 positivity
M:F 9:1 Age: 20-40 years
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Symptoms/Signs:
Malaise, fever, prostatitis, epidydimitis
Low-back pain, heel pain
Achilles or plantar fascia inflammation
Small joints of the hands and feet – sausage
shaped digits
Palm and soles skin exfloiation and pustules
Penile foreskin inflammation
Symptomatic treatment
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TM joint disease
TMJ function:
Movements- side to side, up and down, as
well as protrusion and retrusion.
This allows movements needed for
speaking, chewing, and making facial
expressions.
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Causes for TMJ disease:
 Rheumatoid arthritis, osteoarthritis
Other causes- hypermobile TMJs, nocturnal
jaw clenching, nocturnal bruxism, jaw
clenching due to psychosocial stresses, and
local trauma
Trigeminal neuralgia of mandibular
division
Incidence: 10 million people have TMJ
F:M ratio is roughly 4:1
Common in adults aged 20-40 years
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Symptoms
Muscles of mastication: dull ache, unilateral
Pain radiates to the ear and jaw and is
worsened with chewing
When opening the mouth locking of the jaw
Ear clicking or popping
Headache and/or neck ache
A bite that feels uncomfortable
Neck, shoulder, and back pain
Bruxism, teeth clenching
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Signs
Limitation of jaw opening (normal range is at least 40 mm
as measured from lower to upper anterior teeth)
Palpable spasm of facial muscles (masseter and internal
pterygoid muscles)
Unilateral facial swelling
Clicking or popping in the TMJ
Tenderness to palpation of the TMJ via the external
auditory meatus (the tips of the fingers placed behind the
tragi at each external acoustic meatus and pulled forward
while the patient opens the jaw)
Crepitus over joint (in advanced disease)
Lateral deviation of mandible
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Tests
Non specific
Treatment:
Analgesics - Nonsteroidal anti-inflammatory
drugs (NSAIDs)
Muscle relaxants - Benzodiazepines
Moist heat and massage of masticatory
muscles
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