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→Missed Concepts
*Chronic exertional compartment syndrome (worse with exertion) vs. tibial stress fracture (pain with standing) vs. shin splints
*Chronic exertional compartment syndrome (worse with exertion) vs. tibial stress fracture (pain with standing) vs. shin splints
*Septic arthritis of the hip in an infant can lack fever, but presents with pseudo paralysis (due to pain), elevated WBCs, elevated CRP, and effusion. *Legg-Calvé-Perthes disease (idiopathic avascular necrosis of the hip) occurs in children aged 3-8, is insidious in onset, and does not have elevated inflammatory markers.
*Septic arthritis of the hip in an infant can lack fever, but presents with pseudo paralysis (due to pain), elevated WBCs, elevated CRP, and effusion. *Legg-Calvé-Perthes disease (idiopathic avascular necrosis of the hip) occurs in children aged 3-8, is insidious in onset, and does not have elevated inflammatory markers.
*Myotonic dystrophy is autosomal dominant, caused by CTG repeats with genetic anticipation. Classic form presents in adulthood with muscle weakness and myotonia (impaired muscular relaxation). Infantile presentation includes respiratory failure, hypotonia, inverted V upper lip, cataracts, poor feeding, and clubbed foot. Diagnosis is via genetic testing.
*Myotonic dystrophy (most common form of '''adult onset muscular dystrophy''') is autosomal dominant, caused by CTG repeats with genetic anticipation. Classic form presents in adulthood with muscle weakness and myotonia (impaired muscular relaxation). Infantile presentation includes respiratory failure, hypotonia, inverted V upper lip, cataracts, poor feeding, and clubbed foot. Diagnosis is via genetic testing.
*FOOSH with "sail sign" (fat pad visible on xray), should be immobilized in a splint.
*FOOSH with "sail sign" (fat pad visible on xray), should be immobilized in a splint.
*Osteoporosis can lead to vertebral compression fractures after minimal trauma in elderly patients, manage with '''Tylenol/NSAIDs and PT.'''
*Osteoporosis can lead to vertebral compression fractures after minimal trauma in elderly patients, manage with '''Tylenol/NSAIDs and PT.'''
*'''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=
*H&P: Proximal muscle weakness
*H&P: Proximal muscle weakness
*Dx: Elevated CK; Differential includes fibromyalgia and PMR.
*Dx: Elevated CK; Differential includes fibromyalgia and PMR.
*Tx: Can be complicated by ILD.
*Tx: Can be complicated by '''ILD.'''
=Dermatomyositis=
=Dermatomyositis=
*H&P: Symmetric proximal muscle weakness. Gottron papules, heliotrope rash
*H&P: Symmetric proximal muscle weakness. Gottron papules, heliotrope rash