RHEUMATISME NON ARTICULER (RNA)

FARIDIN HP RHEUMATOLOGIC DIVISION INTERNAL DEPARTEMENT OF HASANUDDIN UNIVERSITY, MAKASSAR

INTRODUCTION

Presenter painfull rheumatic localise Soft tissue out sided of joint (non articular) Terminology its common RNA or rheumatic extra articuler, into view abnormality soft tissue or muscles, ligament, tendon, bursa RNA is not connection sign painfull into joint

Etiology

Causes unknown (predisposing factors) injury, pressure working wisher, postural abnormality, degenerative joint disease 2 causes sided : 1. Mechanic : painfull, acute injury, chronic inflammation Common cases entesopaty, tenosinovitis and bursitis

Joint Ligament Tendon Muscle Bursa

: sinovitis, capsulitis : strain : tendinitis, rupture, entesopathy : rupture, hernia : Bursitis

2. Crystal deposition : Calcium crystal deposition inflamation periarticular Rarely symptom

Diagnostic criteria & treatment

Diagnostic criteria
1. Pain broaden, stiffness 2. Pain with area tender point 3. Sensitive the area painfull 4. Failure sleeping at night

Therapy :
1. Salysilate 2. NSAIDs 3. Physiotherapy 4. Psycotherapy

LOW BACK PAIN

Mostly LBP is triggered by same combination of overuse, muscle strain, and injury to the muscles, ligament and disc that support the spine and vertebra and having working pressure Conservative treatment :
1. Sosft collar, plastic collar 2. tractions, physiotherapy 3. Analgesic 4. Corset support 5. Localized injection corticosteroid

TENDINITIS & TENOSIVITIS

Tendinitis inflammations tendon, local pain insertion tendon Inflammation sheet the tendon tenosinovitis All tendon local area Process degenerative causes rupture tendon Local injection steroid with efective

SHOULDER PAIN

Activity limited humeral joint, pain and stiffness Painfull proximal humerus, around upper arm, scapula Stiffness abduction and elevation sided Fibrosis pericapsule or peri-arthritis of the shoulder joint Degenerative process causes rupture tendon Local injection with steroid Physiotherapy

Shoulder pain

pain (-)

Activity passive with shoulder limitation

pain (+)

Difference muscle/ tendon

Difference capsule/ joint

Activity resisted

Frozen shoulder

Tes Yergasson/ Speed

Tendon muscle Bisipitalis

Resisted external rotation test

Tendo Infraspinatus, teres minor

Resisted internal rotation test

Tendo Subskapularis

Abduction test
Drop arm sign

Tendo Supraspinatus Bursitis Subakromial

Rotator Cuff rupture

TENDINITS DE QUARVAIN

Area part abductor pollicis longus and extensor pollicis brevis Causes frequently activity thumb and wrist Finklestein test positive Female sex > Male Treatment :
Bed rest, immobilization Ice compress and hotnest NSAIDs Local injection steroid If conservative treatment failure Incision tendon

Tendinitis De Quarvain

TENDINITIS ACHILLES

The achilles tendinitis inflammation to tendon rupture, injuries Examination sign swollen achilles tendon, painfull palpation and the crepitus upper calcaneus Treatment
NSAIDs Bed rest, Immobilization Local injection steroid Physiotherapy

TRIGGER FINGER

Inflammation sheet of the tendon flexor digitorium Commonly cause overuse activity of finger Patient straighten hand with support and click sound Treatment
Immobilization NSAIDs Local injection steroid Physiotherapy Surgery

LATERALIS & MEDIALIS EPICONDILITIS

Lateral epicondylitis or tennis elbow is usually precipitated by repetitive contraction of the wrist and characterized by aching pain Worsened with activity tennis atlets Medial epicondylitis golfers elbow Frequently male sex Treatment
Rest arm Ice compress NSAIDs Local injection with steroid Physiotherapy

Lateralis & Medialis Epikondylitis

Epikondilitis lateralis

Epikondilitis medialis

FASCITIS PLANTAR

Commonly object entesopaty, is inflammation fascia plantaris Cause injury, individual human erect position Painfull walking Radiologist examination spur formation Treatment
NSAID Steroid local injection Physiotherapy

Plantar Fasciitis

FIBROMYALGIA

Fibromyalgia syndrome is an illness that causes chronic pain in muscles and ligaments Fibromyalgia in patients who have tender points but who otherwise have severe pain symptoms that are present for at least 3 month Predisposity factor unknown, infection, injury Trias fibromyalgia :
1. Painfull muscle skeleton 2. Stiffness 3. Fatique

Painfull at 18 tender point

1. Occiput bilateral 2. Inferior servical (C5-C7) 3. Trapezium bilateral 4. Supraspinatus bilateral 5. 2nd Costocondral juction bilateral 6. Lateral epicondylus bilateral 7. Gluteal bilateral 8. Major trochanter bilateral 9. bilateral knee

FIBROMYALGIA

Management NSAIDs Anti depressant TENS, massage