pulses alternating, PVC
paradoxical breathing
range of motion of joints
deformities?
synovitis?
chronic osteoarthritis?
knee and shoulder joints most important joint exams
fluid in the joint?
anterior posterior draw sign
pitting edema
rheumatoid - inflammatory
ACL(?)
rotator cuff tear
- frozen joint
- inflammation of bursa
- swelling of joint
=> lidocaine / steriod injected
lidocaine for pain(short term mgt), steroid for inflammation(long term mgt)
arthritis - better when moving
osteophytes(?)
--------------------------------------------------------------------------
Premature ventricular contraction (PVC), also known as ventricular premature beat (VPB) or extrasystole, is a form of irregular heartbeat in which the ventricle contracts prematurely. This results in a "skipped beat" followed by a stronger beat. Individuals with the condition may report feeling that his or her heart "stops" after an attack. PVCs are also called heart palpitations (although there are many other forms of arrhythmia). The depolarization begins in the ventricle instead of the usual place, i.e. the sinus node. PVCs can be a useful natural probe, since they induce Heart rate turbulence whose characteristics can be measured, and used to evaluate cardiac function.
Causes
Some possible causes of PVC in adults include the use of cocaine, amphetamines, alcohol, and tobacco. Medicines including digoxin, sympathomimetics, tricyclic antidepressants, and aminophylline have also been known to trigger attacks of PVC.
Heart conditions or a previous history of heart attack, ischemia, myocarditis, dilated or hypertrophic cardiomyopathy, myocardial contusion, atrial fibrillation and mitral valve prolapse may cause PVC. Patients with hypomagnesemia, hypokalemia, and hypercalcemia may also present with PVC.
PVCs in young children are thought to be associated with developmental factors of the autonomic nervous system. In older children, sympathomimetic drugs, such as cold or asthma medication may cause PVCs, along with mild cases of viral myocarditis, and excessive caffeine.
Diagnosis
PVCs are diagnosed by an ECG but some patients will need to wear a Holter monitor to record PVCs that occur outside the doctor's office or hospital. PVCs are often benign but may be a sign of a heart condition. PVCs may be unifocal (coming from the same part of the heart and having the same shape on the ECG) or multifocal (coming from several parts of the heart and having various shapes on the ECG). On the ECG, PVCs are diagnosed by: 1. prematurity 2. wide QRS 3. the presence(usually) of a compensatory pause.
In healthy individuals, PVCs can often be resolved with continuous rehydration and by repleting the balance of magnesium, calcium and potassium within the body.
--------------------------------------------------------------------------
Main Entry: par·a·dox·i·cal
Pronunciation: 
par-
-
däk-si-kl
Variant(s): also par·a·dox·ic /-sik/
Function: adjective
: not being the normal or usual kind paradoxical embolism>
--------------------------------------------------------------------------
Synovitis is the medical term for inflammation of a synovial membrane, which line those joints which possess cavities, namely synovial joints. The condition is usually painful, particularly when the joint is moved. The joint usually swells due to fluid collection.
Synovitis is a risk in several forms of arthritis as well as lupus, gout, and other conditions. Synovitis is one part of distinguishing rheumatoid arthritis from other forms of arthritis, although it can be found mildly in Osteoarthritis. Long term occurrence of synovitis can result in degeneration of the joint.
Symptoms of synovitis can be treated by a doctor with anti-inflammatory drugs including such as NSAIDs. Specific treatment depends on determining the cause of the synovitis.
--------------------------------------------------------------------------
Osteoarthritis (OA, also known as degenerative arthritis or degenerative joint disease, and sometimes referred to as "arthrosis" or "osteoarthrosis" or in more colloquial terms "wear and tear"), is a condition in which low-grade inflammation results in pain in the joints, caused by wearing of the cartilage that covers and acts as a cushion inside joints. As the bone surfaces become less well protected by cartilage, the patient experiences pain upon weight bearing, including walking and standing. Due to decreased movement because of the pain, regional muscles may atrophy, and ligaments may become more lax. OA is the most common form of arthritis. The word is derived from the Greek word "osteo", meaning "of the bone", "arthro", meaning "joint", and "itis", meaning inflammation, although many sufferers have little or no inflammation.
Signs and symptoms
The main symptom is chronic pain, causing loss of mobility and often stiffness. "Pain" is generally described as a sharp ache, or a burning sensation in the associated muscles and tendons. OA can cause a crackling noise (called "crepitus") when the affected joint is moved or touched, and patients may experience muscle spasm and contractions in the tendons. Occasionally, the joints may also be filled with fluid. Humid weather increases the pain in many patients.
OA commonly affects the hand, feet, spine, and the large weight-bearing joints, such as the hips and knees, although in theory, any joint in the body can be affected. As OA progresses, the affected joints appear larger, are stiff and painful, and usually feel worse, the more they are used throughout the day, thus distinguishing it from rheumatoid arthritis.
In smaller joints, such as at the fingers, hard bony enlargements, called Heberden's nodes (on the distal interphalangeal joints) and/or Bouchard's nodes (on the proximal interphalangeal joints), may form, and though they are not necessarily painful, they do limit the movement of the fingers significantly. OA at the toes leads to the formation of bunions, rendering them red or swollen.
Causes of osteoarthritis
Osteoarthritis often affects multiple members of the same family, suggesting that there is hereditary susceptiblity to this condition. A number of studies have shown that there is a greater prevalence of the disease between siblings and especially monozygotic twins, indicating a hereditary basis. Up to 60% of OA cases are thought to result from genetic factors. Researchers are also investigating the possibility of allergies, infections, or fungi as a cause. There is suspectful evidence that allergies, whether fungal, infectious or systemically induced, may be a significant contributing factor to the appearance of osteoarthritis in a synovial sac.
Osteoarthritis may be divided into two types:
[edit] Primary osteoarthritis
This type of OA is caused by aging. As a person ages, the water content of the cartilage decreases, and the protein composition in it degenerates, thus degenerating the cartilage through repetitive use or misuse. Inflammation can also occur, and stimulate new bone outgrowths, called "spurs" (osteophyte), to form around the joints. Sufferers find their every movement so painful and debilitating that it can also affect them emotionally and psychologically.
[edit] Secondary osteoarthritis
This type of OA is caused by other conditions or diseases:
Congenital disorders, such as:
People with abnormally-formed joints (e.g. hip dysplasia) are more vulnerable to OA, as added stress is specifically placed on the joints whenever they move.
Cracking joints—the evidence is weak at best that this has any connection to arthritis [1].
Inflammatory diseases (such as Perthes' disease), and all chronic forms of arthritis (e.g. costochondritis, gout, and rheumatoid arthritis). In gout, uric acid crystals cause the cartilage to degenerate at a faster pace.
hormonal disorders.
Ligamentous deterioration or instability may be a factor.
Obesity. Obesity puts added weight on the joints, especially the knees.
Osteopetrosis (High bone density).
Sports injuries, from exercise, athletic activity, or work. For example, certain sports, such as weightlifting, running, or even football, put undue pressure on the knee joints. Injuries resulting in broken ligaments can lead to instability of the joint and over time wear of the cartilage and eventually osteoarthritis.
Surgery to the joint structures.
--------------------------------------------------------------------------
Main Entry: pitting edema
Function: noun
: edema in which pitting results in a depression in the edematous tissue which disappears only slowly
--------------------------------------------------------------------------
Main Entry: rheu·ma·toid
Pronunciation: -t
id
Function: adjective
: characteristic of or affected with rheumatoid arthritis
--------------------------------------------------------------------------
Rheumatoid arthritis (RA) is traditionally considered a chronic, inflammatory autoimmune disorder that causes the immune system to attack the joints. It is a disabling and painful inflammatory condition, which can lead to substantial loss of mobility due to pain and joint destruction. RA is a systemic disease, often affecting extra-articular tissues throughout the body including the skin, blood vessels, heart, lungs, and muscles.
--------------------------------------------------------------------------
The anterior cruciate ligament (or ACL) is one of the four major ligaments of the knee.
It connects from a posterio-lateral (back & outside) part of the femur to an anterio-medial (front & inside) part of the tibia.
More specifically, it is attached to the depression in front of the intercondyloid eminence of the tibia, being blended with the anterior extremity of the lateral meniscus;
It passes upward, backward, and lateralward, and is fixed into the medial and back part of the lateral condyle of the femur.
--------------------------------------------------------------------------
Bone spurs, also known as osteophytes, are bony projections that form along joints. Bone spurs form due to the body's increase of a damaged (usually due to arthritis) joint's surface area in a futile attempt to improve weight distribution. However, they usually limit joint movement and typically cause pain.
Bone spurs form naturally on the spine as a person ages and are a sign of degeneration in the spine. In this case the spurs are not the source of back pains, but instead a common symptom of the problem.
Spurs can also appear on the feet, either along toes or the heel, and can occur on the hands.
Osteophytes on the fingers or toes are known as Heberden's nodes (if on the DIP joint) or Bouchard's nodes (if on the PIP joints).
