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NR509 • Articular structures include joint capsule and articular cartilage, the synovium and synovial fluid, intra-articular ligaments and juxta-articular bone o Articular disease involves: ▪ Swelling ▪ Tenderness of the joint ▪ Crepitus ▪ Instability “locking” ▪ Deformity ▪ Limits active and passive range of motion due to stiffness or pain • Extra-articular structures include periarticular ligaments, tendons, bursae, muscle, fascia, bone, nerve and overlying skin o Extra-articular disease involves: ▪ “point of focal tenderness in regions adjacent to articular structures ▪ Limits active range of motion ▪ RARELY causes swelling, instability, joint deformity Know the sources of joint pain (pg. 627 algorithm) • Nonarticular conditions: trauma/fracture, fibromyalgia, polymyalgia rheumatica, bursitis, tendinitis • Intra-articular (acute, < 6 weeks): acute arthritis o infectious arthritis o gout o pseudogout o Reiter syndrome • Intra-articular (chronic, > 6 weeks): chronic inflammatory arthritis vs chronic noninflammatory arthritis o Chronic inflammatory arthritis with 1-3 joints involved: ▪ Indolent infection ▪ Psoriatic arthritis ▪ Reiter syndrome ▪ Periarticular JA o Chronic inflammatory arthritis with >3 joints involved: ▪ Psoriatic arthritis or Reiter syndrome (no symmetry) ▪ rheumatoid arthritis if not RA then  systemic lupus, scleroderma, polymyositis *Know what causes saddle numbness and urinary retention (pg. 678?) • CES (cauda equina syndrome) most commonly results from a massive herniated disc in the lumbar region. • A single excessive strain or injury may cause a herniated disc. • However, disc material degenerates naturally as a person ages, and the ligaments that hold it in place begin to weaken. As this degeneration progresses, a relatively minor strain or twisting movement can cause a disc to rupture. ..........................................continued.......................................