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CC4 - Regional Pain
Regional pain relevant to rheum and ortho.
59
Medical
Undergraduate 1
05/14/2015

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Cards

Term
Give 13 differential diagnosis for back, leg and hip pain.
Definition
• Simple low back pain
• Osteoarthritis
• Prolapsed intervertebral disc
• Degenerative disc disease
• Inflammatory spondyloarthropathy
• Vertebral crush fracture
• Spinal stenosis
• Spondylolisthesis
• Malignancy
• Discitis
• Avascular necrosis of the hip
• Trochanteric Bursitis
• Paget's Disease
Term
What does acute low back pain without radiation suggest?
Definition
Mechanical low back pain.
Term
How is mechanical low back pain often described?
Definition
As a band across the back.
Term
Give 7 red flag signs of sinister back pain.
Definition
○ Age of onset <20 or >55
○ History of malignancy
○ Persistent, non-mechanical pain
○ Night pain
○ Fever/Unexplained weight loss
○ Bladder/Bowel dysfunction
○ Progressive neurology, abnormal gait, saddle anaesthesia
Term
Back pain combined with weight loss and night sweats may indicate 2 things, what are they?
Definition
Malignancy or tuberculosis.
Term
What is back and leg pain suggestive of?
Definition
Nerve root entrapment.
Term
Describe how true sciatica radiates.
Definition
From the lower back, down the back of the leg and into the foot.
Term
What is the pain from sciatica like?
Definition
An electric shock
Term
Does sciatica normally settle over time?
Definition
Yes
Term
Give three things that may aggrevate sciatica
Definition
Standing straight, sneezing, coughing.
Term
Back pain with leg pain that comes on after walking suggests what?
Definition
Spinal Stenosis
Term
Back or leg pain that is relieved on leaning forward is suggestive of what?
Definition
Spinal stenosis.
Term
Aching back pain that radiates into the leg but not below the knee is indicative of what?
Definition
Facet Joint Osteoarthritis
Term
Where is true hip pain felt?
Definition
The groin
Term
Can a prolapsed intervertebral disk present with just leg pain?
Definition
Yes
Term
Gradual onset leg pain or weakness, felt with a constant aches suggests what?
Definition
Muscular dystrophy or myositis
Term
Crampy leg pain on walking that is relieved by rest suggests what?
Definition
Peripheral vascular disease
Term
Can OA of the hip produce leg pain distally?
Definition
Yes
Term
What disturbances is it essential to ask about in any patient with back pain?
Definition
Urinary or bowel disturbance
Term
What does incontinence with back pain suggest?
Definition
Cauda equina syndrome.
Term
What does back pain combined with numbness, pins and needles and weakness of the foot suggest?
Definition
True sciatica
Term
What investigation should not be done for mechanical lower back pain?
Definition
Plain x-ray
Term
What investigation is the investigation of choice in a young patient with suspected back or sacroiliac pathology.
Definition
MRI
Term
What does winking owl sign indicate
Definition
Destruction of the pedicle, indicating malignancy.
Term
What are 9 differential diagnosis for knee pain?
Definition
• Meniscal injuries
• Ligament injuries
• Osteochondritis
• Bursitis
• OA
• Septic Arthritis
• RA or other inflammatory arthritis
• Anterior knee pain/patellofemoral disorders
• Referred from hip or spine.
Term
What does sudden onset of knee pain suggest?
Definition
Injury
Term
Spontaneous knee pain over a few days suggests what?
Definition
Septic or crystal arthritis, or possibly an inflammatory flare-up.
Term
What kind of pain do meniscal injuries often produce?
Definition
Sharp, stabbing pain
Term
What kind of pain is arthritic pain, normally?
Definition
A deep, gnawing pain.
Term
CLassically, what makes OA worse?
Definition
exercise
Term
Classically, when is patellofemoral pain worse?
Definition
When walking up or down stairs.
Term
Knee pain that is worse on full flexion or twisting hints at?
Definition
Meniscal tears.
Term
Extremely intense pain exacerbated by movement suggests what?
Definition
Acute crystal or septic arthritis.
Term
What action makes prepatellar bursitis pain worse?
Definition
Kneeling.
Term
What does pain affecting the joint in general suggest?
Definition
An arthritic process.
Term
What does anterior knee pain suggest?
Definition
Patellogemoral pain, prepatellar bursitis or infrapatellar bursitis.
Term
What does posterior knee pain suggest?
Definition
A Bakers cyst or bursitis.
Term
What does medial or lateral knee pain suggest?
Definition
Meniscal tears or colateral ligament sprain.
Term
What does localised pain to the medial knee joint line, combined with varus knees indicate?
Definition
OA of the knee.
Term
What does pain down the front of the thigh and into the knee suggest?
Definition
Hip pathology.
Term
Where could pain down the back of the knee be referred from?
Definition
The hip.
Term
What does a history of locking of the knee suggest?
Definition
Meniscal injury or loose body.
Term
In a painful knee, what is an MRI useful for?
Definition
Confirming ligamentous or meniscal pathology.
Term
What kind of imaging is useful for confirming ligamentous or meniscal pathology?
Definition
MRI
Term
In a painful knee, what is a CT useful for?
Definition
Giving detailed information on bony structures and visualising patellar tracking.
Term
What kind of imaging is good at giving detailed information on bony structures and visualising patellar tracking.
Definition
CT
Term
When might you use an isotope bone scan for a painful knee?
Definition
If you were unsure as to the diagnosis.
Term
if a knee is swollen and the synovial fluid is straw/yellow in colour, what is it likely to be?
Definition
A simple effusion, or possibly crystal arthropathy.
Term
if a knee is swollen and the synovial fluid is green or dirty in colour, what is it likely to be?
Definition
Pus and hence septic arthritis
Term
if a knee is swollen and the synovial fluid is bloody in colour, what is it likely to be?
Definition
A haemarthrosis following injury or as a result of a bleeding disorder/being on warfarin
Term
What is arthroscopy?
Definition
Using keyhole surgery to look into the joint to see if there is any pathology.
Term
What does recurrent self limiting foot or ankle pain suggest?
Definition
Crystal arthropathy
Term
Chronic pain in the foot with soft tissue swelling indicates what?
Definition
Inflammation or infection.
Term
What might coldness or pallor in the foot be due to?
Definition
Peripheral vascular disease.
Term
Give three conditions associated with paraesthesia or burning pain in the foot.
Definition
Morton neuroma
Painful diabetic neuropathy
tarsal tunnel syndrome
Term
What does discomfort on the sole of the foot suggest?
Definition
Plantar fasciitis
Term
What is plantar fasciitis associated with?
What should you ask about as a result?
Definition
spondyloarthropathies
Psoriasis and IBS
Term
What might a recent illness or initiation of diuretic therapy trigger?
Definition
An acute attack of gout.
Term
In foot pain, what are nerve conduction studies useful for?
Definition
Confirming the diagnosis of tarsal tunnel syndrome or peripheral neuropathy.
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