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→Missed Concepts
*'''Lateral''' shoulder pain is the most common symptom in torn rotator cuff.
*'''Lateral''' shoulder pain is the most common symptom in torn rotator cuff.
*Scoliosis that '''causes back pain, is rapidly progressive, or associated with neurological symptoms''' may be pathologic (e.g. spinal tumor). Most cases are idiopathic.
*Scoliosis that '''causes back pain, is rapidly progressive, or associated with neurological symptoms''' may be pathologic (e.g. spinal tumor). Most cases are idiopathic.
*Fracture of Pars interarticularis causes spondylolisthesis
=Systemic Lupus Erythematosus=
=Systemic Lupus Erythematosus=
*H&P: middle aged women, HLA-DR4 serotype; morning stiffness that lasts > 30 min and improves with activity; Swan Neck deformity (PIP extension, DIP flexion), Boutonniere deformity (PIP flexion, DIP extension), ulnar deviation of MCP.
*H&P: middle aged women, HLA-DR4 serotype; morning stiffness that lasts > 30 min and improves with activity; Swan Neck deformity (PIP extension, DIP flexion), Boutonniere deformity (PIP flexion, DIP extension), ulnar deviation of MCP.
*Dx: 4 criteria for 6+ weeks. 3 or more joints (PIP, MCP, wrist, elbow, knee, ankle); symmetrical joint synovial hypertrophy with cartilage loss and osteoporosis on xray; elevated CRP, ESR (sensitive, not specific), rheumatoid factor (75% sensitive), or anti-CCP (most specific); inflammatory synovial fluid on joint aspiration; rheumatoid skin nodules (elbow most common).
*Dx: 4 criteria for 6+ weeks. 3 or more joints (PIP, MCP, wrist, elbow, knee, ankle); symmetrical joint synovial hypertrophy with cartilage loss and osteoporosis on xray; elevated CRP, ESR (sensitive, not specific), rheumatoid factor (75% sensitive), or anti-CCP (most specific); inflammatory synovial fluid on joint aspiration; rheumatoid skin nodules (elbow most common).
*Tx: NSAIDs and PT; DMARDS (Sulfasalazine, Hydroxychloroquine, Azathioprine) ± Glucocorticoids for mild disease; Methotrexate (1st line), anti-TNF biologics (2nd line) ± corticosteroids for moderate-severe disease; anti-TNF biologics AND corticosteroids for severe disease. Avoid methotrexate in patients with HIV, liver disease, ILD, renal disease, pregnancy, or bone marrow suppression; avoid anti-TNF in patients with TB. '''Patients taking methotrexate should also get folate supplementation.'''
*Tx: NSAIDs and PT; DMARDS (Sulfasalazine, Hydroxychloroquine, Azathioprine) ± Glucocorticoids for mild disease; Methotrexate (1st line), anti-TNF biologics (2nd line) ± corticosteroids for moderate-severe disease; anti-TNF biologics AND corticosteroids for severe disease. Avoid methotrexate in patients with HIV, liver disease, ILD, renal disease, pregnancy, or bone marrow suppression; avoid anti-TNF in patients with TB. Patients taking methotrexate should also get '''folate supplementation.'''
=Osteoarthritis=
=Osteoarthritis=