Psoriatic Arthritis: Pathogenesis and Clinical findings
In tendons and connective tissues:
• Enthesitis - Pain/tenderness over ligament insertion into bone
• Dactylitis - Inflammation of entire digit- soft tissue and joints are inflamed
In skin:
• Psoriatic plaques on skin, pitting, ridging, oil spots, onycholysis, discoloration and hyperkeratosis
In Joints:
1. Asymmetric oligoarthritis
2. Arthritis of DIP joints
3. Symmetric polyarthritis (like RA)
4. Axial involvement (unknown reason, probably due to "biomechanical", "innervation" & "vascularity")
5. Arthritis mutilans (aggressive & destructive)
• X-ray: Periostitis; syndesmophytes, erosions, pencil in cup deformities due to osteolysis (IP joints), ankylosois of IP joints
#PsoriaticArthritis #pathophysiology #diagnosis #signs #symptoms
Scoliosis: Pathogenesis and clinical findings (Cobb Angle > 10 Degrees)
• Incr Axial rotation of thoracic vertebrae is transferred through the costovertebral joints to the ribs -> The rib cage is rotated and displaced in the transverse plane -> Rib Hump (unilateral prominence of the rib cage)
• Incr lateral curvature of the spine is transferred through the sacroiliac joints to the pelvis -> The pelvis is tilted and displaced in the transverse plane -> Asymmetrical Iliac Crests, Shoulders. Scapula and/or Breasts, Apparent Leg and/or Arm Length Discrepancy
• Incr Lateral curvature of the spine narrows the intervertebral canal -> Spinal nerve impingement -> Neuropathy, pack pain
• Incr lateral curvature and/or axial rotation of the thoracic vertebra (Cobb Angle > 40 degrees) -> Thoracic cage deformity in the coronal and/or transverse plane -> Decr thoracic volume -> Decr lung expansion -> Decr lung compliance -> Shortness of Breath On Exertion, Restrictive Pulmonary Disease, Right Sided Heart Failure
#Scoliosis #pathophysiology #msk #diagnosis #signs #symptoms
Charcot Joint - Neuropathic Arthropathy: Pathogenesis and Clinical findings
• Impaired joint protection -> abnormal joint movements -> Incr ROM, joint instability, ligamentous laxity over time
• Joint mounts an inflammatory response -> Local swelling, warmth, & erythema, joint effusion, pain (variable dependent on degree of denervation)
• Inflammatory cytokines act on osteoclasts to promote periarticular bone resorption -> On X-ray: osteopenia
• Joint progresses from minor deformity -> major deformity -> Visibly abnormal joint: joint subluxation
• Destruction of articular cartilage -> On X-ray: joint space narrowing
• Inability to move joint, Interference with movement of limb -> Inability to ambulate: unsteady, antalgic gait
#CharcotJoint #Neuropathic #Arthropathy #pathophysiology #diagnosis #signs #symptoms
Cauda Equina Syndrome
Causes:
• Large lumbar degenerative disc herniation (central)
• Severe lumbar spondylosis
• Neoplasm in lumbar spine
• Trauma or epidural hematoma
• Infection (abscess, etc) in lumbar spine
Signs / Symptoms / Complications:
• Weakness (flaccid paralysis) in both legs
• Areflexia (loss of normal leg reflexes)
• Urinary and fecal retention -> Overflow Incontinence
• Saddle Anesthesia
• Sensory disturbance in both legs (numbness, tingling, loss of temperature sensation, etc)
• Neuropathic pain (shooting, stabbing, lancinating, burning pain radiating down both legs)
Note: Surgical Emergency!
• Goal is to prevent permanent damage to sacral nerves which can happen quickly (within hours) if not treated!
• Pain/sensory disturbance in legs does not have to be bilateral.
• As soon as bladder/bowel dysfunction is suspected, immediate MRI and surgery!
#CaudaEquina #Syndrome #MSK #pathophysiology #diagnosis #symptoms #signs
Radiculopathy: Signs and Symptoms
• Back/Neck Pain
• Decr Range of motion
• Abnormal posturing
• Fasciculations (uncommon, but can happen)
• Muscle atrophy (over time)
• Weakness (flaccid paralysis)
• Decr tendon reflexes (at those muscles supplied by the nerve root)
• Neuropathic Pain: -> Shooting, stabbing, lancinating, burning (often intense, 10/10)
• Sensory disturbance in nerve root's dermatome: -> Pinprick+Temp. lost first, proprioception and vibration later
• Spurling's sign: Tilting head back + laterally further impinges on cervical nerve root, worsens pain Lasegue's sign:
• Straight leg raise + foot dorsiflexion further pulls on lumbar nerve root, worsens pain
#Radiculopathy #MSK #diagnosis #signs #symptoms #pathophysiology
Takayasu’s Arteritis: Pathogenesis and clinical findings
- Fatigue, weight loss, low grade fever, arthralgias
- Incr ESR, CRP, WBC
- Aortic aneurysm (with potential for aortic regurgitation), other arterial aneurysms
- Visual Dysfunction
- Orthostasis, Syncope, Headache, Convulsions, TIA/Stroke
- Angina, Incr risk of Acute Coronary Syndrome
- >10mmHg systolic pressure difference between arms
- Abdominal Pain
- Arm/Leg Claudication (pain with use)
- Decr palpable pulses in limbs, Often asymmetrical (common)
- Ischemic Skin Ulcers
- Bruit (may be heard anywhere. most commonly carotid)
- Systemic Hypertension
#Takayasus #Arteritis #Vasculitis #Diagnosis #Signs #Symptoms
Meralgia paresthetica: Pathogenesis and Clinical Findings
Compression/injury of Lateral Femoral Cutaneous Nerve (LFCN) -> Meralgia paresthetica
• Symptoms are typically unilateral and rarely follow dermatomal distributions
• In most patients recovery is spontaneous within 3-6 months of symptom onset
• LFCN is a purely sensory nerve, thus symptoms are purely sensory
• Before diagnosis can be made, rule out: focal mass compression, spinal stenosis, lumbar arthropathies, intervertebral disc disease
• Following must be absent: lower back pain, constitutional or radicular symptoms, motor abnormalities (gait, strength, reflexes), palpable mass
Sensory Symptoms Only:
- Decreased sensation
- Dysesthesias (Tingling, Burning, Stinging, Stabbing)
- Negative Straight Leg Raise Test
- Pain on palpation of lateral inguinal ligament (near anterior superior iliac spine)
#LFCN #MeralgiaParesthetica #MSK #pathophysiology #differential #diagnosis #signs #symptoms
Pseudogout: pathogenesis and clinical findings
- Idiopathic (vast majority of cases) -> Mechanism unknown
- Familial chondrocalcinosis -> Overactivity of the NTPPPH enzyme and mutations in the ANKH gene, Incr pyrophosphate production
- Hyperparathyroidism -> Incr levels of parathyroid hormone produced, incr gut Ca2+ absorption
- Hemochromatosis -> Clearance of calcium pyrophosphate dihydrate (CPPD) crystals from joints is inhibited by iron
- Hypomagnesia -> The relative absence of magnesium impairs pyrophosphatase activity, reduces pyrophosphate breakdown
- Hypophosphatasia -> Defective mineralization of calcium and phosphorous in bones
- Chondrocalcinosis, seen on high-resolution ultrasound and/or x-ray
- CPPD Crystals - Positively birefringent (crystals appear blue parallel to axis of polarizer)
- PAINFUL, warm, swollen joint (sudden onset)
- Incr C-reactive protein (CRP); erythrocyte sedimentation rate (ESR)
- Subchondral sclerosis & cysts, joint space narrowing, and osteophytes seen on x-ray
#Chondrocalcinosis #Pseudogout #CPPD #Disease #Signs #Symptoms #Pathophysiology #Diagnosis