Term
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Definition
| Diagnosis given to people w/chronic widespread musculoskeletal pain for which no alternative cause can be identified |
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Term
| Fibromyalgia is a diagnosis of exculsion, what must the provider exclude? |
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Definition
| Tissue inflammation or damage |
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Term
| Consider a diagnosis of fibromyalgia when a patient complains of what 5 thing? |
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Definition
1)Widespread pain for >3 months
2)Fatigue associated w/ usual daily activities
3)Sleep disturbances
4)Changes in personality or mood
5)Multiple symptoms that cannot be easily explained
*sign & symptoms must not have alternative explanations |
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Term
| How do you characterize fibromyalgia? |
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Definition
| Chronic widespread musculoskeletal pain and tenderness |
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Term
| List 4 neuropsychological symptoms that are commonly associated w/ fibromyalgia? |
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Definition
1)Fatigue
2)Disturbing sleep
3)Cognitive dysfunction anxiety
4)Depression |
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Term
Fibromyalgia reflects deficiencies in which 2 pathways of transmission in the CNS?
Which is not affected? |
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Definition
1)Serotonergic
2)Noradrenergic
1)Opioidergic |
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Term
| List 5 common disorders associated w/ fibromyalgia? |
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Definition
1)Chronic fatigue syndrome
2)Irritable bowel syndrome (IBS)
3)Irritable bladder syndrome
4)Interstitial cystitis
5)Temporomandibular disorder (TMD) |
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Term
| T/F Patients w/ fibromyalgia experience only 1 pain syndrome over their lifetime, but are more likely to be affected by several related conditions. |
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Definition
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Term
| According to current evidence, what is directly involved w/ maintaining the pain & core symptoms of fibromyalgia? |
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Definition
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Term
| Fibromyalgia is associated w/ substantial negative consequences for physical and social functioning, such as . . . |
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Definition
| Changes to patients activities of daily living (hard for pts to function at a job or usual tasks) |
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Term
Epidemiology of fibromyalgia:
1)Prevalence
2)Gender
3)Age
4)Onset |
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Definition
1)2% of adult general population
2)Male to Female: 1:9
3)Increases w/ age. High in middle age (50-59 yrs). Lower at 80+ yrs
4)Average age of onset: 30-50 yrs |
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Term
| Describe the pathophysiology/change of function causing of fibromyalia? |
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Definition
-Largely unknown
-Likely genetic defect associated w/ pathways controlling pain sensitivity & stress response
-Believed to be part of cental pain processing that produces heightened responses to painful & nonpainful stimuli |
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Term
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Definition
| Heightened response to painful stimuli |
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Term
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Definition
| Painful responses to nonpainful stimuli |
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Term
| What is an explaination for hyperalgesia and allodynia in fibromyalgia patients? |
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Definition
| Altered sensory afferent pain processing and impaired descending noxious inhibitory control |
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Term
| What is the most common presenting complaint in pts w/ fibromyalgia? |
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Definition
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Term
| Where is pain typically located in fibromyalgia patient? |
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Definition
Poorly localized, but is often:
-Bilateral
-Above and below the waist
-Involves axial skeleton (neck, back, chest) |
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Term
| Describe fibromyalgia pain in general terms? |
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Definition
-Poorly localized
-Difficult to ignore
-Severe in intensity
-Associated w/ reduced functional capacity |
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Term
| How often do patients with fibromyalgia experience the pain? |
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Definition
| Present most of the day on most days for at least 3 months |
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Term
| List neuropsychological symptoms of fibromyalgia? |
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Definition
-Pain, stiffness, and fatigue (worse w/ exercise or unaccustomed activity)
-Cognitive dysfunction (slow processing, difficulties w/ attention or concentration, problems w/ word retrieval, short-term memory loss)
-Anxiety and depression (80%)
-Sleep disturbances (pts awake feeling unrefreshed) |
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Term
| Anxiety and depression are commonly associated w/ fibromyalgia affecting __%. Thus, screening for major depressive disorders is important. |
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Definition
| prevalence of mood disorders is ~80% |
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Term
ACR Diagnostic Criteria:
Diagnosis criteria for fibromyalgia includes what 3 conditions? |
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Definition
1)Widespread pain index (WPI): 7 and symptom severity (SS) scale score: 5 Or WPI 3-6 and SS 9
*Based on 19 anatomical locations
2)Symptoms present at similar level for at least 3 months
3)Patient does not have a disorder that would otherwise explain the pain |
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Term
| List 19 anatomical locations for pain & symptoms scoring for fibromyalgia? |
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Definition
| Shoulder, Hip, Jaw, Lower back, Upper arm, Lower arm, Upper leg, Lower leg, Chest, Neck, Abdomen |
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Term
| How do you assess pain in fibromyalia patient using the widespread pain index (WPI)? |
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Definition
| Note the number of areas, of the 19, in which the patient has had pain over the last week |
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Term
| The symptom severity (SS) scoring for fibromyalgia diagnosis includes what 3 criteria? |
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Definition
1)Fatigue
2)Waking unrefreshed
3)Cognitive symptoms |
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Term
| Explain how fibromyalgia Symptom Severity (SS) scoring works? |
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Definition
1)Indicate the level of severity over the past week (no problem:0-3:severe)for 3 criteria (fatigue, waking unrefreshed, cognitive symptoms)
2)Sum severity of 3 symptoms
3)Add extent of severity of somatic symptoms in general
4)Determine final score between 0-12 |
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Term
Describe meaning of each symptom severity score:
0-
1-
2-
3- |
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Definition
0- no problem
1- slight or mild problems, generally mild or intermittent
2- moderate, considerable problems, often present and/or at moderate level
3-severe, pervasive, continuous, life-disturbing problems |
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Term
| Why are lab and radiographic test normally performed on patients with fibromyalgia? |
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Definition
| They focus on differential diagnosis & are used to evaluate for pain generators and comorbid conditions |
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Term
| What is the treatment for fibromyalgia? |
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Definition
-No effective pharmacological classes for treatment
-Identify all associated conditions that serve as triggers
-Drugs used to treat triggering comorbid conditions
-Individualized due to clinical presentation |
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Term
| What are the 4 most effective pharmacologic classes for fibromyalgia? |
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Definition
-TCAs
-SSRIs/SNRIs
-Heterocyclic antidepressants
-Anticonvulsants |
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Term
| What is carpal tunnel syndrome (CTS)? |
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Definition
| A compressive neuropathy of the median nerve as it passes under the transverse carpal ligament at the wrist. |
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Term
| Describe carpal tunnel borders |
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Definition
-Scaphoid bone radially
-Lunate and capitate bones dorsally
-Hook of hamate bone ulnarly
-Transverse carpal ligament is superficial |
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Term
| What signs and symptoms are associated with carpal tunnel syndrome? |
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Definition
-Numbness & paresthesias variably in thumb, index, middle, and half of ring finger
-Paresthesias can include entire hand and extend into forearm or upper arm or can isolate 1 or 2 fingers
-Pain located in hand and forearm and, at times, in proximal arm |
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Term
| Carpal tunnel syndrome is often misdiagnosed as what? |
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Definition
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Term
| What is the etiology/cause of carpal tunnel syndrome? |
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Definition
-Idiopathic (mostly)
-Space occupying lesion
-Repetitive strain or job related motions
-Crystal induced arthropathies |
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Term
| Carpal tunnel syndrome can be associated with what 4 conditions? |
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Definition
1)Diabetes
2)Hypothyroidism
3)Pregnancy
4)Acromegaly |
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Term
| What is the epidemiology & demographics for CTS? |
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Definition
Onset:30 to 60 yrs
Gender: Females affected 2 to 5 times as often as males. |
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Term
| What symptoms should you be concerned about when doing a history on a potential CTS patient? |
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Definition
1)Location and character of symptoms
2)Sleep disturbances due to symptoms
3)Hx of dropping objects or picking things up
4)Difficulty manipulating small objects (buttons, coins) |
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Term
| During physical exam, what tests should be done to determine CTS? (4) |
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Definition
1)Look for evidence of wasting or thenar muscles
2)Test tinel sign over median nerve from volar wrist flexion crease to proximal palm
3)Perform Phalen and reverse Phalen test (hands in prayer)
4)Test stregth of thumb in opposition |
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Term
| What are the treatment options for carpal tunnel syndrome? |
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Definition
-Early tx: conservative management using splint to keep wrist at 20 degree extension worn overnight
-Corticosteroid injection of carpal tunnel
-Surgery: open carpal tunnel release |
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Term
| How affective is the use of conservative management using a splint (1), corticoid injection (2), surgery (3) to treat CTS? |
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Definition
1)Years of symptom relief for many
2)Strong correlation to relief of symptoms & good response to carpal tunnel release
3)Long-term relief of symptoms |
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Term
| What is open carpal tunnel release surgery? |
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Definition
| A direct incision made over the carpal tunnel, typically in line with where ring finger pad touches proximal palm in flexion |
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Term
| What is complex regional pain syndrome (CRPS)? |
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Definition
| Excruciating burning pain and functional impairment of an extremity distal to and following trauma or surgery (idiopathic sometimes). |
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Term
| When in history was CRPS first described? |
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Definition
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Term
| What signs and symptoms are involved with complex regional pain syndrome (CRPS)? (4) |
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Definition
1)Sensory function
2)Autonomic function (vascular, swelling)
3)Motor function (weakness or reduced range of motion
4)Occasionally occurs spontaneously |
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Term
| What are the 2 types of CRPS? |
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Definition
1)Type I (no nerve lesion)
2)Type II (peripheral nerve lesion) |
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Term
| Complex regional pain syndrome (CRPS) was previously known as. . . |
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Definition
| Reflex sympathetic dystrophy (RSD) |
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Term
| What is the pathophysiology of CRPS? |
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Definition
-Not well understood
-Starts w/ precipitating event such as trauma or surgery (ex: bone fracture & carpal tunnel surgery)
-Develops distal to precipitating event |
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Term
| What are the 4 main diagnosis criteria for CRPS? |
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Definition
1)Sensory abnormalities: spont. pain; mechanical, thermal, or deep somatic hyperalgesia
2)Vascular Abnormalities: Vaso- dialation or constriction; skin temp asymmetries; skin color changes
3)Motor & Trophic changes: weakness; tremors; dystonia; coodination deficits; nail & hair changes; skin atrophy; joint stiffness
4)Sweating/Edema: swelling; hyper- or hypohidrosis |
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Term
How do you diagnose CRPS?
Sensivity __%
Specificity __% |
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Definition
-At least 1 symptom from 3 or more categories
AND
-At least 1 sign from 2 or more categories
85% sens.
60% selec. |
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Term
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Definition
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Term
| List some clinical presentations of complex regional pain syndrome? |
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Definition
-Cold feeling, warm feeling, or both in affected area
-Edema
-Increased nail & hair growth
-Hyperhidrosis
-Abnormal skin color
-Hyper or Hypoesthesia
-Hyperalgesia
-Mechanical or thermal allodynia, or both
-Movement disorder (tremor, spasms, weakness, dystonia
-Patchy demineralization of bone (Sudek atrophy) |
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Term
| Describe how temp changes occur due to autonomic dysfunction? |
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Definition
-Evident early as hyperemia of limb with rapid capillary refill time
-Later, limb becomes cool, cyanotic, and mottled w/ diminished blood flow and prolonged capillary refill time |
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Term
| True/False Complex regional pain syndrome commonly results from a stroke or MI |
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Definition
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Term
| What treatments are prescribed for CRPS patients? |
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Definition
-NSAIDs
-Gabapentin
-TCAs
-Opioid analgesics
-Physical therapy (keeps joints mobile)
*Difficult to treat and typically only partially effective at relieving signs and symptoms
-Sympatheic block or IV lidocaine followed by oral mexiletine (refractory pts)
-Spinal cord stimulation (decrease pain and improve quality of life)
-Bisphosphonates or calcitonin for bone atrophy |
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Term
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Definition
-Closed bursal fluid sacs that are lined by a synovial membrane and serve as a cushion.
-Located between tendon & bone, tendon & tendon, or bone & skin
-Allow smooth gliding motion |
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Term
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Definition
| -Inflammation of bursa, swelling, pain associated due to activity |
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Term
| What is the pathophysiology of bursitis? |
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Definition
| -Bursa becomes inflamed from trauma or overuse, or becomes infected |
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Term
| List some common sites for bursitis? |
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Definition
-Subacromial (shoulder)
-Olecranon (elbow)
-Trochanteric (hip)
-Ischial
-Iliospoas
-Pes Anserine (lower leg)
-Prepatellar (knee)
-Retrocalcaneal |
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Term
| What is the epidemiology for bursitis? |
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Definition
-Incidence of bursitis and tendinitis is high
-More common than rheumatoid arthritis and systemic lupus erythematosus
-Commonly associated w/ injury (young) or overuse (elderly) |
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Term
| When diagnosing bursitis, a complete neuromusculoskeletal exam should be done, this includes what? (5) |
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Definition
1)Palpation
2)Passive range of motion
3)Active ROM alone & w/ resistance
4)R/o a septic joint
5)Diagnostic ultrasonography & MRI (sometimes) |
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Term
| What are some treatment options for bursitis (and tendinitis)? (8) |
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Definition
1)Nonsteroidal anti-inflam drugs (NSAIDs)
2)Relative rest of injured site
3)Stretching and strengthening exercises
4)Friction massage
5)Use of heat, ice, and ultrasound
6)Splinting
7)Corticosteroid joint injections
8)Surgery |
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