- chronic multisystem disease of unknown etiology

- inflammatory reaction of synovial lining of multiple joints in a symmetric distribution

- constitutional symptoms including fever, weakness, anorexia, weight loss, and malaise

- pain, tenderness, swelling, & warmth of joints

- joint deformity, stiffness (morning)

Rheumatoid Arthritis

- bony enlargements of the PIP joints are called these

Bouchard's nodes

- bony enlargements of the DIP joints are called

Heberden's nodes

- subcutaneous nodules (necrotic material), macrophages, granulation tissue on extensor surfaces and tissues

- vasculitis of skin, nerve, internal organs

- pulmonary fibrosis or nodules, pleural fibrosis

- splenomegaly, neutropenia and anemia

Extra-articular manifestations of rheumatoid arthritis

- hand joint that is typically spared in rheumatoid arthritis

DIP joints

- hallmark finding of RA

Joint deformity

- the digits deviate in this direction as a result of subluxation of the MCP joints in RA

Ulnar

- this type of finger deformity results from rupture of the flexor tendon of the PIP associated with RA

- hyperextension of PIP joint, flexion of DIP joint

Swan neck deformities

- finger deformities that result from rupture of the extensor tendon of the PIP associated with RA

- flexion of PIP joint, hyperextension of DIP joint

Boutonniere deformities

- failure of movable, synovial lined joints

- most powerful risk factors for are advancing age, trauma and repetitive joint use

- prolonged morning sickness NOT a feature

- no constitutional symptoms or extra-articular manifestations

- limited to no signs of active joint inflammation

- DIP joints primarily affected

- MCP joints are spared

- hip, knee, and spine are particularly common

Osteoarthritis (Degenerative Joint Disease)

- protrusion of the base of the thumb joint produces this deformity associated with OA/DJD

Mushroom deformity

- commonly associated with alcoholic liver disease and smokers

- 7 times more common in males than females

- palmar aponeurosis or palmar fascia should be palpated for this

Nodules

- flexion deformity of the fingers resulting from a nodule

Dupytren's contracture

- diseases that affect the articulation of the hip joint localize their pain in these locations

Groin, Lateral Thigh, Buttocks, Knee

- when gluteus maximus pulls on a tighter than normal iliotibial band causing a rub on the bursa & inflammation

- can also occur following a fall on the hip or after replacement surgery

- pain occurs laterally over the hip just posterior to the bursa and may radiate down the leg mimicking sciatica

- worse when arising, improves with limited walking

Greater trochanteric bursitis

- may cause pain in the lateral hip more typical to posterior hip and buttocks

- "lightning like" or sharp pain

Herniated lumbar disk

- anterior thigh and hip pain may be the result of this

Intra-abdominal processes

- potential side effect of anticoagulant therapy that presents as anterior thigh pain

Retroperitoneal bleeding

- test used to detect hip arthritis

- pt supine, heel of leg placed on medial side of extended opposite knee (flexing hip and knee)

- flexed knee moved laterally to the table (hip flexion, abduction, and external rotation)

Patrick's test

- specific test for identifying arthritis of the hip

- move hip from side to side with the leg fully extended

Log rolling

- pts with hip arthritis walk by shifting their weight over this hip that reduces leverage applied to the joint by the femoral neck

Affected hip

- evaluates weakness of the hip abductors

- with pt standing, ask pt to lift one foot of ground

- note how level the pelvis is

- pts good hip will drop when standing on affected hip

Trendelenburg test

- deformity that results in lateral angulation of the knees (knocked knees)

Valgus deformity

- deformity results in medial angulation of the knee (bow legged)

Varus deformity

- provide medial and lateral stability of the knee

- tested by counter-opposing lateral and medial forces just proximal and distal to the knee joint

Medial and Lateral Collateral Ligaments

- these ligaments prevent dislocation of the tibia on the femur

- anterior and posterior

Cruciate ligaments

- commonly occur with twisting injuries to the knee

- popping sensation is noted w/ severe pain and swelling

- only ligament that is introsynovial, causes bloody knee effusion

- injured pts have their knee give way when trying to change direction

Anterior cruciate tears

- occur following a blow to the anterior aspect of the knee

- femur ruptures this ligament following trauma

- swelling is prominent and occurs immediately

- bleeding does not typically occur

Posterior cruciate tears

- check for stability of the cruciate ligaments

- pt is supine with the knee flexed 90 degrees with foot flat on table

- hands are cupped around the proximal tibia

- pull/push tibia on femur

"drawer" test

- similar to the drawer test

- primary difference is the angle of flexion of the knee (20 degrees)

Lachman test

- medial aspect of the knee is "milked" by stroking the knee laterally and proximally

- used to assess the presence of effusion

Bulge sign

- act as shock absorbers between the femoral and tibial condyles and hold about 50% of the weight bearing load

- medial sustains more injury than the lateral

- aging, osteoarthritis, excessive squating, twisting leg with foot firmly planted

Medial and Lateral Menisci

- following meniscal tear, pain is severe, swelling is present at the joint line and the knee may do this

Lock or buckle

- pain and tenderness is common along the medial and lateral joint lines of the knee in a meniscal tear and this

degenerative joint disease (DJD)

- test for meniscal tear

- internal or external rotation while the knee is flexed and then extended

- popping or clicking will be felt along the joint line

McMurray test

- anterior knee pain during weight bearing w/ knee flexion (stair climbing, standing up) indicates this

- patella is pulled off toward one side of the knee or when the cartilage lining the back side of the patella wears down

- Weight loss and quads strengthening exercises help

Chondromalacia

- most common cause of lateral knee pain in long distance runners and bicyclists

- caused by friction of the on a bursa that overlies the lateral femoral condyle when knee is bent/straightened

- pts complain of tightness and burning pain over lateral knee after activities

Iliotibial band syndrome

- most common cause for knee replacement surgery

- affects the medial side of the knee more commonly than the lateral

Osteoarthritis of the knee

- made up two joints (tibiotalar, talocalcaneal)

- only the tibia bears any weight

Ankle

- located just inferior to the medial (tibial) malleolus

- ligament is so strong that forceful eversion of foot may result in avulsion of the tibia before ligament tears

Deltoid ligament

- supports the lateral aspect of the ankle and is composed of 3 bands (posterior/anterior talofibular, calcaneal fibular)

- sprain is the most common injury of the ankle and results from inversion of foot

Lateral Collateral Ligament

this joint is common location for rheumatoid and gouty arthritis in the ankle

Subtalar joint

- cause pain in the medial tibial area proximal to the ankle joint

- common in runners and produces intermittent or constant pain of dull quality

- pain may diminish during running but when severe limits ability to run

- may lead to stress fracture

Shin splints

- most common joint in the body to be affected by gout

- sudden onset of acute inflammation is characteristic

MTP joint of great toe

- most common deformity of the great toe

- medial displacement of the 1st metatarsal and abduction of the great toe

- bunion results when bursa over deformity becomes inflamed

Hallux valgus