Lesson 1, Topic 1
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non-arthritic joint Diseases and Disorders

April 11, 2024

Nonarthritic Joint Diseases and Disorders

Learning Objective: Examine nonarthritic joint diseases and disorders, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Besides arthritis, other conditions impact the joint and a person’s ability to move. The following sections describe nonarthritic joint diseases and disorders.

Bursitis

Learning Objective: Discuss bursitis, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Bursitis is the inflammation of the bursa. It usually affects the hip, buttock, knee, calf, and shoulder.
Bursitis is common after age 40. It occurs with the overuse or repetitive use of a joint. Injuries can also cause bursitis. Stress and inflammation from other conditions, such as gout and thyroid disorders, can increase the risk for bursitis. Pain is the most common symptom. Joint stiffness, swelling, and redness can also occur.
After an examination, the provider may order an x-ray, MRI, and ultrasound to rule out other conditions. Treatment consists of rest, splinting, heat and cold therapy, medications (NSAIDs, analgesics, and corticosteroid injection), and physical therapy.

20.9

Critical Thinking Application

Suzanne has been a runner for years, but recently she was diagnosed with bursitis in her knees. Explain how Suzanne’s running may have contributed to this condition.

Carpal Tunnel Syndrome

Learning Objective: Discuss carpal tunnel syndrome, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Carpal tunnel syndrome results when the median nerve becomes compressed at the wrist. The carpal tunnel is a narrow passageway located on the palm side of the wrist that is surrounded by bones and ligaments. This tunnel protects the median nerve to the hand and the nine tendons that bend the fingers.
The etiology includes repetitive motions, trauma, injury to the wrist, and conditions such as thyroid disease and rheumatoid arthritis. Females are more likely to have carpal tunnel syndrome than males. Signs and symptoms start gradually, with tingling, burning, or numbness of the thumb and fingers, except for the little finger. Symptoms can come and go initially but can worsen and become more persistent with time. Without treatment, a person can lose grip strength and feeling in the fingertips.
The provider will examine the arm and wrist. X-rays and an electromyogram may be done. Treatments include limiting repetitive tasks, cold therapy, a wrist splint, NSAIDs, and corticosteroid injections. Surgery may be performed to relieve pressure on the median nerve. With treatment, the prognosis is good.

Dislocation and Subluxation

Learning Objective: Describe dislocations and subluxations, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

A dislocation (or luxation) occurs when a bone has been completely displaced from the joint (FIGURE 20.17). A subluxation is a partial or incomplete dislocation of the joint. The most common site of joint dislocation in children is the elbow, whereas, in an adult, it is the shoulder. Other joints that can be dislocated include the ankle, knee, hip, jaw, toe, or finger.
The etiology of dislocations is related to sports and trauma (e.g., a blow or fall), which forces the joint out of position. The larger the joint, the greater the force needed for dislocation. Some people have a hereditary risk because their ligaments are looser, making them more prone to injury. Signs and symptoms include pain and swelling in the joint area and the inability to move the extremity. Many times, a visual distortion in the joint area is seen.
A dislocated joint is an emergency and requires immobilization and application of a cold pack as first aid. Once the provider examines the joint, an x-ray may be ordered. Treatment depends on the severity of the injury and the joint involved. The joint needs to be manipulated back into position. Additional complications may require surgical intervention. Once the joint is back into its normal position, the area may be immobilized in a splint or sling to heal. NSAIDs to reduce inflammation and pain may be ordered. Once a joint has been dislocated, there is a greater risk of dislocating it in the future.

FIGURE 20.17  Dislocation (luxation) of the shoulder. From Frazier MS, Drzymkowski JW: Essentials of human diseases and conditions, ed 3, Philadelphia, 2004, Saunders.

20.10

Critical Thinking Application

A patient comes into the office from her weekly softball game. After sliding into home plate, she was immediately unable to move her right arm, and she says she has a lot of pain in her right shoulder. What steps should Suzanne take to help this patient?

Hallux Valgus

Learning Objective: Describe hallux valgus, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Hallux valgus, also called a bunion, is a progressive condition. A bunion is an abnormal enlargement of the first metatarsophalangeal (MTP) joint of the great toe, caused by inflammation of the synovial bursa. Extra bone and a fluid-filled sac at the base of the big toe cause a bump to appear. Over time, the enlargement can cause lateral displacement of the toe.
Bunions can be genetic. Some people have abnormalities with their feet bones that increase the likelihood of bunions. Wearing narrow-toed, high-heeled shoes can lead to bunion development. Females are more likely to have bunions than males. A person can experience a hard bump and pain in the large toe joint. The large toe may bend toward and cross over the second toe.
After the exam, the provider will usually order a foot x-ray. Many times, the x-ray shows an abnormal angle of the big toe. As the bunion starts to develop, patients are encouraged to wear wide-toed shoes. Soft pads and toe spacers can be used to protect the bunion and separate the toes. The provider may recommend a bunionectomy to realign the toe and remove the medial eminence (protrusion) of the metatarsal bone. It is important to keep a bunion from worsening. Surgery may help in some cases.The etiology of dislocations is related to sports and trauma (e.g., a blow or fall), which forces the joint out of position. The larger the joint, the greater the force needed for dislocation. Some people have a hereditary risk because their ligaments are looser, making them more prone to injury. Signs and symptoms include pain and swelling in the joint area and the inability to move the extremity. Many times, a visual distortion in the joint area is seen.
A dislocated joint is an emergency and requires immobilization and application of a cold pack as first aid. Once the provider examines the joint, an x-ray may be ordered. Treatment depends on the severity of the injury and the joint involved. The joint needs to be manipulated back into position. Additional complications may require surgical intervention. Once the joint is back into its normal position, the area may be immobilized in a splint or sling to heal. NSAIDs to reduce inflammation and pain may be ordered. Once a joint has been dislocated, there is a greater risk of dislocating it in the future.

Hip Dysplasia

Learning Objective: Describe hip dysplasia, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Hip dysplasia is an abnormality of the hip joint in which the femoral head does not fit in the acetabulum as it should. When people are born with this condition, it is called developmental dysplasia of the hip or congenital hip dislocation.
About 1 in every 1000 infants is born with hip dysplasia. First-born children and females are more at risk for hip dysplasia. Hip dysplasia can be caused by genetics. It can also result if the baby’s position in the womb puts pressure on the hip. Signs and symptoms can include hip pain, a loose or unstable hip joint, limping, and unequal leg lengths. People with mild hip dysplasia may not have symptoms until their teen to young adult years.
Providers screen for hip dysplasia in infants by checking for it shortly after birth and during well-child exams. X-rays, ultrasound, and CT scans may also be used to confirm the diagnosis. The goal of treatment is to manage the pain and protect the hip joint. A brace may be used for an infant younger than age 6 months. Physical therapy can help strengthen the joint and increase flexibility. In most cases, the provider will perform surgery to repair or replace the hip socket. Surgery usually corrects the dysplasia.

Patellofemoral Syndrome

Learning Objective: Describe patellofemoral syndrome, including the signs, symptoms, etiology, diagnostic procedures, and treatments.

Patellofemoral syndrome is also called chondromalacia patella and “runner’s knee.” It causes pain at the front of the knee around the patella. It is more common in adolescents, young adults, and women.
Patellofemoral pain syndrome can be caused by overuse of the knee joint, muscle weakness, and trauma to the patella. Dull, achy knee pain at the front of the knee is the primary symptom. The pain increases when running, kneeling, squatting, or doing stairs.
After an examination, the provider might order an x-ray, CT, and MRI of the knee. Arthroscopy may also be done. Treatment consists of rest, avoiding climbing stairs and kneeling, and over the counter (OTC) analgesics. Additional treatments may include physical therapy, supportive braces, and cold therapy. For severe cases, surgical realignment procedures may be done. With treatment, the prognosis is good.

Sprain

A sprain is a stretched or torn ligament. A sprain can be graded to indicate the severity:

• Grade I for a stretched ligament
• Grade II for a partial tear
• Grade III for a complete tear of the ligament

Sprains of the ankle and wrist are the most common. A sprain is different from a strain, which is a stretched or torn tendon or muscle.
Sprains occur when a person overextends or tears a ligament when stressing a joint. Sprains can occur with sports injuries, falls, and walking on uneven surfaces. Signs and symptoms of sprains include pain, swelling, and difficulty moving the affected muscle. With sprains, a popping sound may be heard at the time of the injury, and bruising may occur later.
During the examination, the provider will check the affected area and the range of motion. X-rays and an MRI may be ordered to rule out other injuries. Treatment includes rest, ice (cold applications), compression (elastic wraps), and elevation (RICE) to help minimize the swelling. NSAIDs and analgesics may be taken. With severe sprains, a brace or splint may be used to immobilize the area. Surgery may be done to repair a torn ligament. With treatment, the prognosis is good. Stretching, warming up, and cooling down exercises are important to prevent sprains.

Additional Joint Disorders

There are many joint disorders. The following are some examples:

• Adhesive capsulitis: Also known as a frozen shoulder; the movement in the shoulder is limited due to inflammation of the shoulder joint capsule.
• Collateral ligament injury: The medial collateral ligament (MCL) runs along the inside of the knee, and the lateral collateral ligament (LCL) runs along the outside of the knee. When one or both ligaments are stretched or torn, the knee becomes unstable.
• Contracture: Occurs when the normal tissue is replaced with a nonstretchy, fiber-like tissue. This can affect the skin, muscles, ligaments, and tendons. The affected joint can have a limited range of motion. Contracture can be related to disorders (e.g., cerebral palsy, stroke), nerve damage, scarring, or reduced use of the joint.
• Cruciate ligament injury: The anterior cruciate ligament (ACL) is in the middle of the knee and works with the posterior cruciate ligament (PCL). When one or both ligaments are stretched or torn, the knee becomes unstable.
• Cubital tunnel syndrome: Pressure or stretching of the ulnar nerve causes numbness and tingling of the ring and small fingers, forearm pain, and hand weakness.
• Dupuytren contracture: A thickening and shortening of the palmar fascia in the hand results in the contracture of one or more fingers.
• Hammertoe: An abnormal bend in the middle joint of the second, third, or fourth toe.
• Temporomandibular joint disorder (TMD): Causes difficulty chewing and pain and tenderness in the jaw.
• Torn meniscus: The meniscus in the knee joint tears, causing pain, swelling, and locking of the knee.