NR509 Mid-Term Study Guide Revised (New)

Articular structures include joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments and 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.