Degenerative arthritis

The patient with peripheral or axial joint osteoarthritis will usually give a history of gradually increasing pain over months or years, with loss of movement of the joint. Early morning stiffness and pain is usually minimal but when present will usually settle with gentle use of the joint over Plantar fasciitis Pustular psoriasis Plantar fasciitis Pustular psoriasis Fig. S.1 Clinical features of reactive arthritis. TABLE B.5 Examples of extra-articular features associated with rheumatic...

No history of trauma

Supra Patellar Swelling

Spontaneous forefoot pain, radiating into the contiguous sides of the third and fourth toes, and typically made worse when the patient wears tight shoes, suggests a plantar Morton's neuroma. Neuromata rarely affect other interdigital clefts. Acute onset of pain and swelling, as in other joints, should prompt consideration of gout, infection and other acute inflammatory arthropathies. A history of insidious onset of pain in the foot, associated with stiffness or Fluid in suprapatellar pouch...

Muscles

Wasting is common in rheumatoid arthritis. It also occurs in lesions of the lower motor neurone. Causes include syringomyelia, poliomyelitis, lesions of the lirst thoracic nerve root, the peripheral neuropathies and motor neurone disease, in which fasciculation is often present. Lesions of the ulnar and median nerves will affect muscle groups, e.g. ill leprosy. In the carpal tunnel syndrome, median nerve compression may result in selective wasting of the thenar muscles. This may occur in...

The locomotor system

The history of rheumatic disorders 260 Pain 260 Stiffness 261 Swelling 261 Weakness 261 Extra-articular or systemic features 261 Guide to the features of pain and stiffness encountered In specific conditions 261 Inflammatory arthritis 261 Degene rative a rthritis 261 Psychogenic symptoms 262 Traumatic lesions 262 General medical background, family and social history 262 Physical examination of locomotor system 262 General inspection 262 Aims of examination 263 Basic techniques 263 Basic...

Sclera

Normal sclera is white, often with small brown spots of pigmentation marking perforating blood vessels in the elderly. The sclera are yellow in jaundice Fig. 2.3B. p. 26 . In osteogenesis imperfecta and severe Iron deficiency anaemia the sclera are thin and appear blue Fig, 2.1 A. p. 25 . Inflammation scleritis causes a dusky red colour, severe eye pain and tenderness. Ii is often a feature of connective tissue disease. The condition scleromalaeia may also be found in rheumatoid arthritis and...

Upper Limb History

Sites Median Nerve Entrapment

The presenting complaints arising from hands and wrists are usually stiffness, pain and loss of function. Pain and stiffness are usually well localised to the affected joints. In early inflammatory arthritis stiffness with reduced function may be the only symptoms, and pain may be minimal or absent. The complaint of local or diffuse swelling is common, but should always be confirmed on examination. The distribution of joint involvement is critical to diagnosis. If hand pain is diffuse or poorly...

Physical Examination Of The Locomotor System

TABLE 8.6 Conditions in which the family history may be diagnostically helpful Diseases linked to the HLA-B27 tissue type - ankylosing spondylitis, iritis, reactive arthritis, weaker association with psoriasis, inflammatory bowel Psoriasis - psoriatic genes may be expressed in either skin, joints or both in any order and at any time Hypermobile joints - Marian's syndrome. Ehlers-Danlos syndrome, benign familial hypermobllity. floopy prolapsing mitral valve

Polyarthritis

The clinical history, a search for extra-articular features and careful identification of the joints involved should narrow the differential diagnosis, which may include seropositive or seronegative rheumatoid arthritis RA , systemic lupus erylhematosus SLE , psoriatic arthritis, reactive arthritis and viral arthritis. Any investigations should be interpreted in the light of the clinical findings none of the available tests is wholly reliable and none can be considered diagnostic. X-rays of the...

Can A Lesion On The Pons Cause Hyperacusis And Opthalmoplegia

Pyramidal Signs

The motor nucleus of VII lies in the lower pons and its fibres initially pass posteriorly and medially to loop around the VI nucleus before turning forwards and emerging from the lateral pontomedullary junction see Fig. 6.19 . Fig. 6.19 Lesions of the pons. Lesions at 1. e.g. haemorrhage cause ipsilateral VI and or VII nerve palsies and contralateral pyramidal signs. Lesions at 2. e.g. basilar thrombosis cause ataxia on the side of the lesion damage to the cerebellar peduncles . There may also...

Examination Of The Upper Limb The hand and wrist

Scleroderma Knuckles

Examination of the hand consists of inspection, palpation and assessment of function. Since a full examination of function is lengthy, it is necessary to tailor the examination to the clinical history and the nature of the problem. For example, in a patient with lacerations of the digits, a thorough assessment of he integrity of the tendons, nerves and circulation is essential. In contrast, in a patient presenting with stiffness, pain and swelling of Ihe hands the examination will he directed...

General Medical Background Family And Social History

The medical background may he important and a careful enquiry into past illnesses and medication often brings to light diagnostic clues, e.g. diuretics may precipitate gout. The family history may also be helpful Table 8.6 . The patient's domestic or working environment may be relevant lo the patient's symptoms. Inability to hold a pen or tools, to knee , stand for long periods or to use ladders may have profound social and economic consequences, particularly for those in manual or unskilled...

Common abnormalities

Trousseau Syndrome

Some people, including those of Mediterranean origin, 'speak' with Iheir hands. For example, the hand pressed flat on the top of the head accompanying a complaint of hcadache suggests a psychogenic symptom 'something weighing on the mind'. Tremors are studied with the hands at rest and then outstretched. Characteristic tremors are described in Table 2.4 p. 28 . Tetany may be recognised by the presence of carpal spasm, where the hand s adopt a characteristic position with flexion of...

Ageing of the skin

Hypodermal Plexus

Ultraviolet radiation is the main factor speeding the ageing process in skin. This may be very obvious when the wrinkled and inelastic exposed skin of an elderly person Protection against Chemicals, particles Ultraviolet radiation Antigens, haptens Langerhans cells, lymphocytes, mononuclear phagocytes, mast cells Horny layer, Langerhans cells, mononuclear phagocytes, mast cells internal environment Prevention of loss of water, electrolytes and macromolecules Shock absorption Strong, yet elastic...