CURS 1 - 2015-16

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1/162

CURSUL NR. 1 - 2

STRATEGII DE DIAGNOSTIC IN

REUMATOLOGIE

MG, ANUL IV, 2015 - 2016

7/25/2019 CURS 1 - 2015-16

2/162

CURSUL 1 si 2

TEMA: STRATEGII DE DIAGNOSTIC INREUMATOLOGIE

CAPITOLUL :1. PRINCIPALELE SINDROAME IN REUMATOLOGIE

2. INVESTIGATIILE BIOLOGICE

3. INVESTIGATIILE IMAGISTICE

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3/162

STRATEGII DE DIAGNOSTIC IN REUMATOLOGIE

CAPITOLUL 1 : Principall !in"r#a$ alr%$al#'ii

SUBCAPITOLE :

1(1( Sin"r#$%l "%rr#! r'i#nal1(2( Sin"r#$%l "%rr#! 'nrali)a&1.3. Durerea vertebrala/sp!ala l"#bara$ %erv%ala

&LON'ALGIA(1.). S!*r"#ul art%ular + ar&r#)a, ar&ri&a in*la$ari

1(5( Sin"r#$%l " "ste"p"r",a1(6( Sin"r#$%l #!#!1(+( Sin"r#$%l $%!c%lar1(( Sin"r#$%l !i!&$ic

7/25/2019 CURS 1 - 2015-16

4/162


CAPITOLUL 2 : In!&i'a&iil .i#l#'ic

SUBCAPITOLE :

2(1( In*la$arii2(2( M%!c%lar2(/( O!li&ic2(( A%an&ic#rpii2(5( An&i'nl " i!c#$pa&i.ili&a&

2(6( Ea$n%l lici"%l%i !in#ial

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5/162


CAPITOLUL 3 :In!&i'a&iil i$a'i!&ic

SUBCAPITOLE :

/(1( Ea$n%l ra"i#l#'ic/(2( Ul&ra!#n#'ra*ia/(/( CT/(( RMN

/(5( O!"n!i$&ria

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6/162

CAITOLUL 1 + r!%paleles!*r"a#e ale reu#at"l"e

SUBCAPITOLE :

1.1. S!*r"#ul *urer"s re"!al1(2( Sin"r#$%l "%rr#! 'nrali)a&1.3. Durerea vertebrala/sp!ala l"#bara$ %erv%ala

&LOM'ALGIA(

1(( Sin"r#$%l ar&ic%lar 3 ar&r#)a, ar&ri&a in*la$ari1(5( Sin"r#$%l $%!c%lar

1(6( Sin"r#$%l !i!&$ic1(+( Sin"r#a$l p"ia&ric

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7/162

1.1. SINDROMUL DUREROS REGIONAL

4 De!te +"%rr car a*c&a)a # !in'%ra ari$%!c%l#!cl&ala ( %$ar, $ana !a% 'n%nci

4 Clas%are#ri'in37 D%rr priar&ic%lara pr"#$inan& la %$ar !i c#&

7 D%rr ar&ic%lara 'n%nci, pici#r 3 MT8, IP

7 D%rr n%r#'na (!cia&ica, !in"r#$%l " canalcarpian

7 D%rr ira"ia&a

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8/162

1.1.1. Durerea perart%ulara

4 De!te +a*c&ara !&r%c&%ril ana$ic i$plica& in$i!caril ar&ic%lar "ar !i&%a& in a*ara cap!%li ar&ic%lar.%r!, &n"#an, li'a$n&,&c

4 M"r"pat"l"e +in*la$a&ia .%r!l#r, a &n"#anl#r !a% ain!r&ii li'a$n&l#r .%r!i& , &n"ini&-&n#!in#i&

4 Et"l"e +7 Tra%$a&i!$l l#cal, incl%!i !%pra!#lici&ara

7 Mani*!&ari l#cal al .#lil#r r%$a&i!$al !i!&$ic!in#ial PR9 a*c&ara rc%rn&a !a% $%l&ipla3 SpA7 8ara # ca%)a i"n&i*ica.ila

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4 Ma!estar %l!%e &s#pt"#e( +

7 Apari&ia:a'raara "%rrii la an%$i& $i!cari

!lc&ii&a&a $i!caril#r "%rr#a!car i$plica !a%c#$pri$a !&r%c&%ril in*la$a&

7 Carac&r%l $canic "!i l)i%nil !%n& " na&%rain*la$ar3 accn&%a& " $i!car, a$li#ra& "rpa%!, r"#ar a.!n&a

7 Apari&ia:a'raara "%rril#r in p#)i&ii car in"%cc#$pr!ia !&r%c&%ril#r in*la$a&("c%.i&%l la&ral p%$ar%l "%rr#! in &n"ini&a r#&aril#r

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10/162


4 Ma!estar %l!%e &se#!e(+

7 Mi!caril ac&i !%n& $ai "%rr#a! "ca& cl pa!i

7 Mi!caril pa!i n% !%n& li$i&a& in l)i%nil ar&ic%lar"%rra ar in&n!i&a& !i$ilara la a$.l &ip%ri "$i!cari

7 M#.ili)ara c% r)i!&n&a in&n!i*ica "%rril

7 Palpara "irc&a a !&r%c&%ril#r in*la$a& !& "%rr#a!a

7 S%n& a.!n& !$nl l#cal " in*la$a&ic% cp&iain*la$a&ii .%r!l#r !%pr*icial

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11/162



1(1(1(1(;%r!i&l1(1(1(2( Tn#!in#i&l

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12/162

1.1.1.1. 'urstele

4 ;%r!a 3 !&r%c&%ra " &ip !ac%lar c c#n&in lici"!inn#ial car pr#&

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13/162

1.1.1.1. 'urstele;%r!i&l !#l"%l%i

Bursita trohanteriana

Bursita iliopsoasului

Bursita ischiatica

(ischiogluteala)

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14/162

1.1.1.1. 'urstele;%r!i&l !#l"%l%i 3 .%r!i&a &r#an&riana

4 'URSATRO0ANTERIANA

7 In&r $arl&r#an&r al*$%r%l%i !i&n"#n%l $%!ci%l%i

*!ir $ar.%r!i&a&r#an&rianapr#*%n"a

7/25/2019 CURS 1 - 2015-16

15/162

1.1.1.1. 'urstele

;%r!i&l !#l"%l%i 3 .%r!i&a &r#an&riana

4 Este %ea #a re%ve!ta %au,a *e *urere as"l*ulu

4 8acri " ri!c 3 !%l *$inin, ar!&a

$"i:inain&a&a

4 Cau,a #a"ra + tulburar ale #ersulu7 a*c&i%ni l#$.#!acra&3 !c#li#)a l#$.ara, ar&r#)a7 in'ali&a&a $$.rl#r7 a*c&ara ar&ic%la&iil#r !acr#iliac7 ar&ri&a 'n%nci%l%i

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16/162

1.1.1.1. 'urstele


4 D%rr !p#n&ana !i lapalpar l#cali)a&a la nil%l&r#an&r%l%i, c% ira"irp *a&a la&rala a c#ap!i

4 D%rra !& accn&%a&a" 3

7 $r!,

7 "c%.i&%l la&ral paca!i par&,

7 $i!cara " r#&a&i&rna !i a."%c&ic#n&ra r)i!&n&i

7/25/2019 CURS 1 - 2015-16

17/162

BURSITA TROHANTERIANA

7/25/2019 CURS 1 - 2015-16

18/162

Mi!cara " r#&a&i &rnaA."%c&i c#n&ra r)i!&n&i

7/25/2019 CURS 1 - 2015-16

19/162

1.1.1.1. 'urstele


4 Dia'n#!&ic 37 Ana$n)a 3 *acri

*a#ri)an&i, l#cali)ara"%rrii, c#n"i&ii "acr.ar !ia$li#rar in*il&ra&il#cala c% ilina

7 Ea$n%l clinic7 Ea#e! ra*"l"% al

ba,!ulu + *e e%lusle,u! "ste" -art%ulare as"%ate

7 RMN 3 "ia'n#!&ic"i*rn&ial

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20/162

1.1.1.1. 'urstele


4 Dia'n#!&ic "i*rn&ial 3

7 8rac&%ra " !&r!!

78rac&%ril #c%l&

7M&a!&a)l

7D%rra ra"ic%lara

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21/162

BURSITA ISCHIOGLUTEALA

Localizare : intre marele fesier si

tuerozitateaisc!iatica

Cauze : ciclismul" se#erea

$relun%ita $esu$rafete tari

7/25/2019 CURS 1 - 2015-16

22/162

BURSITA ISCHIOGLUTEALA

Caractere clinice :

#urerea see&acereaza in $ozitiasezan# si la $resiune$e tuerozitatea

isc!iatica'

$oate ira#ia $e fata$osterioara a coa$sei

7/25/2019 CURS 1 - 2015-16

23/162

BURSELE GE(U(CHIULUI

7/25/2019 CURS 1 - 2015-16

24/162

1.1.1.1. 'urstele;%r!l 'n%nci%l%i3 .%r!i&a p#pli&

In)amatia ursei $o$litee *ursele %astrocnemianuluisi a semimemranosului+ $ro#uce c!istul Ba,er *masaelastica $al$aila in s$atiul $o$liteu+

Orice suferinta a %enunc!iului care #etermina re-arsatsino-ial se $oate com$lica cu a$ritia unui c!ist $o$liteu

#ar

C!isturile foarte mari sunt su%esti-e $entru $rezenta sino-itei

Ru$tura c!istului Ba,er $oate #etermina as$ectul #e.$seu#otromo)eita/ *e#em al %amei" ec!imoza la ni-elulmaleolei me#iale cu a$aritie #u$a un e$iso# #e tumefactie a%enunc!iului

7/25/2019 CURS 1 - 2015-16

25/162

1.1.1.1. 'urstele;%r!l 'n%nci%l%i3 .%r!i&a p#pli&

In)amatia ursei $o$litee *ursele %astrocnemianuluisi a semimemranosului+ $ro#uce c!istul Ba,er *masaelastica $al$aila in s$atiul $o$liteu+

Orice suferinta a %enunc!iului care #etermina re-arsatsino-ial se $oate com$lica cu a$ritia unui c!ist $o$liteu

#ar

C!isturile foarte mari sunt su%esti-e $entru $rezenta sino-itei

Ru$tura c!istului Ba,er $oate #etermina as$ectul #e.$seu#otromo)eita/ *e#em al %amei" ec!imoza la ni-elulmaleolei me#iale cu a$aritie #u$a un e$iso# #e tumefactie a%enunc!iului

7/25/2019 CURS 1 - 2015-16

26/162

1.1.1.1. 'urstele;%r!l 'n%nci%l%i:

ursita $re$atelara su$er0ciala

Cea mai mare ursa a%enunc!iului

Localizare : intre $iele sirotula

1etermina #urere situmefactie su$er0ciala culocalizare $e fata antero2inferioara a rotulei3

A$aritia ei estefa-orizata #e statul

$relun%it si re$etat in%enunc!i *ursitamena4erelor+3

Infectia secun#ara este ocom$licatie frec-enta

In)amatia ei $oate 0secun#ara #e$unerii #e

urati

7/25/2019 CURS 1 - 2015-16

27/162

1.1.1.1. 'ursts;URSELE GENUNC=IULUI 3 ;URSITA

SUPER8ICIALA PREPATELARA

7/25/2019 CURS 1 - 2015-16

28/162

1.1.1.1. 'urstele;%r!i&l %$ar%l%i3.%r!i&a !%.acr#$iala

4 L#cali)ar 37 in&r ac#$i#n%l !cap%li

!i &n"#n%l $%!ci%l%i!%pra!pin#!

4 Si$p$:!$n 37 "%rri la $i!caril

ac&i &! spe%alab*u%ta45ra*e($acr.ar n#c&%rna

4 Ca%) 3

7 &n"ini&a $an!&ir#&aril#r, p#li$ial'iar%$a&ica !&.ila&rala, PR

7/25/2019 CURS 1 - 2015-16

29/162

1.1.1.1. 'urstele;%r!i&l c#&%l%i

4 Ca%)3&ra%$a&i!$,'%&a, PR, in*c&i!c%n"ara l)i%nil#r&'%$n&ar !a%cl%li&i, in*la$a&ia!p&ica "p#)i& "%ra&i

4 Si$p$:!$n 3"%rr, &%$*ac&il#cala

7/25/2019 CURS 1 - 2015-16

30/162

1.1.1.1. 'urstele

4 DIAGNOSTICUL ;URSITELOR 9

7 Ea$n clinic

7 A!pira&ia !i a$n%l lici"%l%i a!pira& 3 cl%lari&a&,$icr#cri!&al, c#lara&ii Gra$, c%l&%ri

7 Ec#'ra*ia

4 TRATAMENTUL ;URSITELOR

7 In*il&ra&ii l#cal c% 'l%c#c#r&ic#i)i !i li"#caina7 A!pira&ia lici"%l%i !i an&i.i#&rapia in ca) "

!%prain*c&i .%r!i&a !p&ica

7 Eci)ia cir%r'icala

7/25/2019 CURS 1 - 2015-16

31/162


1(1(1(1(;%r!i&l

1.1.1.2. Te!"s!"vtele

1 1 1 2 Te!"s!"vtele

7/25/2019 CURS 1 - 2015-16

32/162

1.1.1.2. Te!"s!"vtele,te!*!tele

1e0nitie : in)amatia tecii sino-iala aten#onului sau a ten#onului $ro$iu2zis

Cauze : su$rasolicitare" oli reumatismale #e ti$ in)amator *5R+" %uta sau

fara o cauza a$arenta *i#io$atice+3

sarcina " meno$auza" olile en#ocrine"amiloi#oza" infectiile" me#icamentele*)uoroc!inolone" GC" steroizii anaolizanti+ $ot 0asociate in s$ecial cu tenosino-itele mainilor3

7/25/2019 CURS 1 - 2015-16

33/162

1.1.1.2. Tenosinovitele, tendinitele1.1.1.2.1.Te!*!ta #a!sete r"tat"rl"r

4 Repre,!ta %ea #a re%ve!ta %au,a a *urer*e u#ar !"!-trau#at%a

4 In*la$a&ia !i %)%ra &n"#anl#r&6#p!e#e!t7(prin c#$pr!ia $an!&ir#&aril#r in&r cap%l %$ral !i acr#$i#n in&i$p%l $i!carii 'ln#%$ral7 Cel #a ae%tat este te!*"!ul #us%8ulu

suprasp!"s7 Se as"%a,a re%ve!t %u bursta suba%r"#ala

7 Te!*"!ul b%epsulu p"ate *e ase#e!ea re%ve!tae%tata

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34/162

ANATOMIA UMARULUI

7/25/2019 CURS 1 - 2015-16

35/162

ANATOMIA UMARULUI

7/25/2019 CURS 1 - 2015-16

36/162

1.1.1.2.1. Te!*!ta #a!sete r"tat"rl"r

4 Dia'n#!&ic 37 a$n%l clinic 3

4 ar%ul *urer"s ee%tuat a%tv sau pasv &testNeer( ! p"rtu!ea super"ara &s!*r"#ul *e#p!e#e!t(

4 a."%c&ia ac&ia c% r)i!&n&a &n"ini&a "!%pra!pin#!,

4 r#&a&i &rna ac&ia c% r)i!&n&a &n"ini&ain*ra!pin#! !i r#&%n"%l $ic,

4 r#&a&i in&rna c% r)i!&n&a &n"ini&a "!%.!cap%lar,

7 in!&i'a&i i$a'i!&ica3 ra"i#'ra*ia plana,%l&ra!#n#'ra*ia, RMN

7 &!& " la.#rar3 =L,VS=, PCR, 'lic$ia, 8R, TS=, aci"%ric

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37/162

1.1.1.2.1. Te!*!ta #a!sete r"tat"rl"r

Testele clinice :

(umeroase

E&ecutii #eseori #iferite in functie #e sursa

Sensiilitate crescuta" s$eci0citate re#usa

1e re%ula este necesara o cominatie #e teste

$entru i#enti0carea ti$ului #e leziune

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38/162

Semnul arcului #ureros

4 S$n%l arc%l%i"%rr#! 3 la # $i!cara .ra&%l%i in&r 0-10'ra", "%rra aparin ca"r%l %n'i%l%i "5 'ra" *#r$a& !%. !ip!& plan%l #ri)#n&alal %$ril#r > $i"arc?

T t t i d l d i i t

7/25/2019 CURS 1 - 2015-16

39/162

Testarea pentru sindromul de impingementsubacromial

Semnul Neer*arhiva personal DR. Albina+

7/25/2019 CURS 1 - 2015-16

40/162

Testarea muchiului supraspinos.Em$t6 can test/ *arhiva personal DR. Albina+

7/25/2019 CURS 1 - 2015-16

41/162

Testarea capului lung al bicepsuluibrahialTestul S$ee#*arhiva personal DR.

Albina+

7/25/2019 CURS 1 - 2015-16

42/162

7/25/2019 CURS 1 - 2015-16

43/162

8#cal !%.acr#$ial &n"rn!!

7/25/2019 CURS 1 - 2015-16

44/162

Tn"ini&a $an!&i r#&aril#r

4 Tn"ini&a c#$%na a %$ar%l%i &n"ini&l r#&aril#r%$ar%l%i3 !%pra!pin#!, in*ra!pin#!, !%.!pin#!, $ic%lr#&ar &r.%i "i*rn&ia& " 3

7 Cap!%li&a r&rac&ila 3 r"%cr n"%rr#a!a @ a$i!caril#r ac&i !i pa!i al %$ar%l%i

7 R%p&%ra c#a*i r#&aril#r 3 i$p#!i.ili&a&a " a-!i$n&in .ra&%l ri"ica&

7 Tn"ini&a .icp!%l%i 3 *lia "%rr#a!a a .ra&%l%i

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45/162

Cap!%li&a r&rac&ila

4 R"%cra "ra$a&ica a ra&i" $i!car p%&in !a% "l#c"%rr#a!a !%'ra)a #cap!%li&a r&rac&ila %$ar.l#ca&, %$ar in'&a&

4 E&i#l#'i 3 i"i#pa&ica,!c%n"ara !%*rin&l#r%$ar%l%i ar&ri&a'ln#%$rala, &n"ini&a.icipi&ala, &n"ini&acalci*ica&a "ar !i %n#r .#li

&raar&ic%lar c%$ ar *i&%$#ril p%l$#nar apicalT;C-%l !a% .#lil n"#crin(

7/25/2019 CURS 1 - 2015-16

46/162

1(1(1(2(2(Tn#!in#i&l $ainil#r3Tn#!in#i&a " %rain

7A*c&a)a $%!cii !c%r& &n!#r !i l%n'a."%cr ai p#licl%i(

7D&r$ina "%rr !p#n&ana c% !a% *ara&%$*ac&i "a!%pra !&il#i"i ra"ial(

7D%rra !& accn&%a&a " 34 E&n!ia p#licl%i c% r)i!&n&a

4 A."%c&ia p#licl%i c% r)i!&n&a7P#a& apar !i in !arcina !a%

p#!&par&%$(

7/25/2019 CURS 1 - 2015-16

47/162

7/25/2019 CURS 1 - 2015-16

48/162

Tn#!in#i&a " %rain

Durerea este agravata prin extensia si abductiacu rezistenta (abductia este miscarea policeluiperpendicular pe palma).

Durerea este agravata prin intinderea pasiva atendonului policelui peste stiloida radiala la flexiapolicelui (manevra Finelstein).

!xaminatorul roteste usor in sens ulnar pumnulpacientului in timp ce degetele pacientului suntpeste police

7/25/2019 CURS 1 - 2015-16

49/162

7/25/2019 CURS 1 - 2015-16

50/162

7/25/2019 CURS 1 - 2015-16

51/162


1(1(1( D%rra priar&ic%lara

1(1(1(1(;%r!i&l

1(1(1(2( Tn#!in#i&l1.1.2. Durerea !eur"e!a

1.1.2.1. s!*r"#ul *e %a!al %arpa!

1.1.2.2. *urerea ra*%ulara

1.1.2.3. #erala pareste,%a1(1(/( D%rra ira"ia&a

1(1(( M#n#ar&r#pa&ia

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52/162

1.1.2. Durerea !eur"e!a

4 E&i#l#'i 3 c#$pr!ia !a% iri&a&ia %ni ra"acini nr#a! !a%a %n%i nr pri*ric

4 Cl $ai *rcn& 3 !cia&ica, !i"r#$%l " canal carpian,!in"r#$%l " nr %lnar

4 E( n%r#l#'ic !& nc!ar ROT,&c4 Mani*!&ari clinic &ipic 37 "i!!&)ia ar!%ra, *%rnica&%ra, a$#r&ala, !#c lc&ric

l#cali)a&a in aria !n)i&ia " pr#ic&i a nr%l%i7 "%rra ra"ic%lara !& acr.a&a " $#.ili)ara

!'$n&%l%i !pinal a*c&a& !a% prin $anra Val!ala

%n#ri7 a&r#*ia $%!c%lara !i ip#!&)ia:an!&)ia !%n& !$n

&ar"i in c#$pr!ia ra"ic%lara !a% a nr%l%i pri*ric

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53/162

ANATOMIA PUMNULUI

"!#$"%#$&' !*%#$+' +'

7/25/2019 CURS 1 - 2015-16

54/162

"!#$"%#$&' !*%#$+' +'

!#&'&$ -!D$+

7/25/2019 CURS 1 - 2015-16

55/162

HAND-SYMPTOM DIAGRAM FOR CARPAL

TUNNEL SYNDROME

T!& l Paln

7/25/2019 CURS 1 - 2015-16

56/162

T!&%l Paln

7/25/2019 CURS 1 - 2015-16

57/162

The HoffmanTinel test

7/25/2019 CURS 1 - 2015-16

58/162

CAU9ELE SINDROMULUI DE CANAL CARIAN

4 I"i#pa&ic 7 /B4 8rac&%ra C#ll! !a% al& &ra%$a&i!$ al c#&%l%i 1/( B4 Ar&ri&a r%$ai"a !i al& .#li r%$a&i!$al in*la$arii

6(5 B

4 Mn#pa%)a 6(B4 Dia.& 6(1 B4 Ar&r#)a p%$n%l%i 5(/B4 Sarcina (6B4 Mi"$%l 1( B

4 Al& .#li 3 acr#$'alia, a$il#i"#)a, *i.r#$ial'ia, &%$#ri.ni'n l#cal +(/B4 O.)i&a&a, !%pra!#lici&ari #c%pa&i#nal,pr"i!p#)i&ia

'n&ica, !%l *$inin

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59/162

Dia'n#!&ic%l !in"r#$%l%i " canal carpian

4 Mani*!&ari clinic &ipic

4 T!& lc&r#"ia'n#!&ic in ca) "

!i$p$al#'i a&ipica 37 lc&r#$i#'ra*i

7 !&%"i%l c#n"%crii nr#a!

4 C#$.ina&ia !i$p$al#'ii carac&ri!&ic !ic#n*ir$ara prin &!& lc&r#"ia'n#!&ic a!i'%rac% ac%ra& "ia'n#!&ic%l

E$pl% " "%rr c#$.ina&3 rnia " "i!c c

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!e"te#"$lom#a"$

He"nie de dis%

A%tiva"ea no%i%e&to"ilo" &e"ife"i%i %a'(a %om&onentei no%i%e&tive a d'"e"ii

)om&"esi'nea *i inflama+ia "$d$%inii ne"v'l'i,%a'(a %om&onentei ne'"o&ate a d'"e"ii

E$pl% " "%rr c#$.ina&3 rnia " "i!c cpr#"%c l#$.al'i i ra"ic%l#pa&i l#$.ar

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#+D$&'%/+"$$ '%-B+#!

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#+D$&'%/+"$$ !#$+'!

-a0oritatea radiculopatiilor cervicalesunt secundare modificarilor despondilartroza , altele decat hernia dedisc (Radhakrishnan K et al, 1976)

'eziunile cervicale superioare (1, 2,3) sunt neobisnuite si de regula nudetermina deficit motor

#adacina 4 este cel mai frecventafectata (567)8 5 (97), ; (9

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Testing for lumbar nerve root compromise

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-eralgia parestezica

Durere si disestezie pe

fata anterolaterala a

coapsei prin compresia

nervului femurocutanat

(nerv pur senzitiv) petraseu sau din plexul

lombosacrat, cavitatea

abdominala, pe sub

ligamentul inghinal si ietesutul subcutanat al

coapsei.

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1(1(1(1(;%r!i&l

1(1(1(2( Tn#!in#i&l1(1(2( D%rra n%r#'na

1(1(2(1( Sin"r#$%l " canal carpian

1(1(2(2( D%rra ra"ic%lara

1(1(2(/( Mral'ia par!&)ica

1.1.3. Durerea ra*ata

1(1(( M#n#ar&r#pa&ia

1 1 Sin"r#$%l "%rr#! r'i#nal 3

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1(1((Sin"r#$%l "%rr#! r'i#nal 3"%rra ira"ia&a

4 Apar la "i!&an&a " #ri'ina i ana$icai!cr in&rn, &c

4 M#.ili)ara ar&ic%la&ii n% !& "%rr#a!a

4 Ri&$%l "%rrii n% !& carac&ri!&ic4 Ea$n%l l#cal !& in li$i& n#r$al

4 E$pl 3 %$ar IMA, !%pra!cap%lar )ica.iliara, l#

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-ost common sites and origins of referred pain

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1(1(1(1(;%r!i&l

1(1(1(2( Tn#!in#i&l1(1(2( D%rra n%r#'na

1(1(2(1( Sin"r#$%l " canal carpian

1(1(2(2( D%rra ra"ic%lara

1(1(2(/( Mral'ia par!&)ica

1(1(/( D%rra ira"ia&a

1.1.). M"!"artr"pata

-onoarthropath= :

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-onoarthropath= :

Ar&ri&a 'n%nci%l%i

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Ar&ri&a 'n%nci%l%i

-arginile patelei sunt

estompate si spatiul

suprapatelar disparut

la nivelul genunchiuluistg. ourtes= of Filip

de >e=ser.

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71/162

Joint line palpation

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72/162

+&*!'! &F!#$"!$

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73/162

+&*!'! &F!#$"!$

-%%+#"$&'+#!9. $F!"$$'! : "B, '&!, $F!"$$ B+"!#$!! ?%%%$! +&

%?%%%$! ("+F$'%%),

1. D!/&!#$'! D! -$#%#$"+'! : +"&' -%%%D$ (?&"+)

2. "#+&-+"$-!'!

3. +#"#%*!'!'!

6. B%'$'! #!&-+"$-+'! $F'+-+"%#$$ : +#"#$"!'! #!+"$!+%$+"! & @'+AB14

5. "&-%#$'! /#$-+#! +& !&D+#!

CAITOLUL 1 + r!%palele

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74/162

CAITOLUL 1 + r!%paleles!*r"a#e ale reu#at"l"e

SUBCAPITOLE : 1(1( Sin"r#$%l "%rr#! r'i#nal

1.2. S!*r"#ul *urer"s e!eral,at1(/( D%rra r&.rala:!pinala l#$.ara, cricala1(( Sin"r#$%l ar&ic%lar 3 ar&r#)a, ar&ri&a in*la$ari1(5( Sincr#$%l " #!p#r#)a1(6( Sin"r#$%l #!#!

1(+( Sin"r#$%l $%!c%lar1(( Sin"r#$%l !i!&$ic

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1.2. SINDROMUL DUREROS GENERALIZAT

1urerea afecteaza #iferite $arti ale cor$ului" este #ifuza siim$recis #elimitata" focalizarea $e articulatii estere#usa7asenta

8iromial%ia este cea mai comuna cauza #e #urere

%eneralizata *.#urere $este tot/77toate ma #or77 ce nu ma#oare9/+'

Alte oli reumatismale cu sin#rom #ureros #ifuz : 5R" LES"SA" $olimial%ia reumatica" $olimiozita" oli en#ocrine*!i$otiroi#ism" !i$er$aratiroi#ism+

Asocierea 0romial%iei cu olile reumatismale #e ti$in)amator este frec-enta si re$rezinta o situatie %reu #e#ia%nosticat

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Ce este br"#ala:

4D%rr "i*%)a cr#nica $%!c%l#!cl&alan#nar&ic%lara 3 $%!ci, li'a$n&, &n"#an

4O &%l.%rar a pr#c!l#r " r'lar a"%rrii prin $cani!$l !n!i.ili)ariicn&ral @

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77/162

Ce este br"#ala:

4 E&i#l#'i nprci)a&a !i pa'ni incr&a3

7 re*sp",te e!et%a3 'nl i$plica& in $&a.#li!$%l!r#nini !i ca&c#la$inl#r

7 Alterarea #e%a!s#el"r *e pr"%esare al *urer +s%a*erea praulu pe!tru *urere"r'lari al n%$ar%l%i !i*%nc&ii rcpril#r pn&r% #pi#i)i, cr!&ra nil%l%i!%.!&an&i P, ac&iara c!ia a )#nl#r !n)i&i "in crir

70perrea%tvtate la stress &trau#ats#$ e#"t$ !e%t(

prin an#$alii al a%l%i ip#&ala$#-ip#*i)#-c#r&ic#!%prarnal

7 Dsu!%te a sste#ulu !erv"s aut"!"#

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1.2.1. ;br"#ala

Caracteristici : 1urere a#eseori mi%ratorie

5ot e&ista sim$tome #ominante' $ot 0 %resit #ia%nosticati cu

5R" SA" !ernie #e #isc E&acerata mai #e%raa #u$a efort #ecat in tim$ul efortului

E&$unerea la fri% si stressul sunt factori a%ra-anti

Se asociaza cu alte manifestari : mi%rena"intestinul iritail"o$resiune toracica" #e$resia" insomnia

In-esti%atiile ima%istice si analizele #e laorator sunt inlimite normale

E&ista criterii #e clasi0care *#ia%nostic+" #ar -aloarea loreste limitata mai ales in ceea ce $ri-este numarul $unctelortri%er

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8i.r#$ial'ia 3pi"$i#l#'i

4 Ca $ai *rcn&a ca%)a " !in"r#$ "%rr#! "i*%)la *$il c% ar!& in&r 20-55

4 Rap#r& 8:; 3 6:1

4 Praln&a cr!& c% ar!&a 3 2B la *$il " 20" ani la B la *$il " +0ani

4 A*c&a)a B "in p#p%la&ia 'nrala37 / 7 6 $ili#an " a$ricani a% 8M

4 In 50B "in ca)%ri !i$p$l apar "%pa %nni$n& $arcan&3 &ra%$a *i)ica !a% p!iica

8i.r#$ial'ia3

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8i.r#$ial'ia3$ani*!&ari clinic

3 ;anifestari clinice #e ti$ musculosc!eletal:

1. ureri di!u"e nonarticulare*musculare" osoase+ :

3 cronice si $ersistente #ar -ariaile ca intensitate

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8i.r#$ial'ia3$ani*!&ari clinic

2( Mani*!&ari n#n-$%!c%l#!cl&al 3

1( D%rri a."#$inal " &ip c#l#n iri&a.il2( D%rri racic an&ri#ar/( D%rri plin !i *n#$n %rinar p#laci%ri, $ic&i%ni

i$pri#a!. ;atabltate5( S#$n n#"inir !i a!&ni $a&inala6( C*al

7/25/2019 CURS 1 - 2015-16

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8i.r#$ial'ia 3 "ia'n#!&icCri&rii ACR

4 I!ric " "%rr "i*%)a c% "%ra&a " p!& /l%ni in pa&r% ca"ran al #r'ani!$%l%ic#nc#$i&n& c% "%rr !cl&ala aiala

4 D%rr in 11 "in cl 1 p%nc& "!cri! !pci*icla &n"r p#in&!?

Nota: Tender points portiuni cutanate sensibile lapresiune aplicata local.

8i.r#$ial'ia 3 "ia'n#!&ic

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8i.r#$ial'ia 3 "ia'n#!&ic

Ea$inara ! *ac c% p#licl car aplica # *#r&a

cialn&a cli car al.!& pa&%l %n'ial ':1(c$2

?!!#+'$*!D /+$

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?!!#+'$*!D /+$F$B#%-+'?$+ : tender points

8i. i l i "i &i

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8i.r#$ial'ia 3"ia'n#!&ic

4 Ea$n clinic 37 ip#&n!i%n #r!&a&ica,

7 &aicar"i #r!&a&ica p#!&%rala,

7 an#$alii al &!&l#r n%r#c#'ni&i- !%'ra)a!ri&a&a .#lii(

7 a$n%l clinic al apara&%l%i #!$%!c%lar, !&a&%!-%l

$n&al,a$n%l n%r#l#'ic 3 n#r$al

4 In!&i'a&iil paraclinic .i#l#'ic, i$a'i!&ic,

i$%n#l#'ic 3 n#r$al4 N% i!&a &!& !&an"ar" car !a $a!#ar

!ri&a&a .#lii

1 2 1 ;b l

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1.2.1. ;br"#ala

1IAG(OSTICUL 8IBRO;IALGIEI :

e&amen clinic : criteriile #e clasi0care ale 0romial%iei inclu##urerea %eneralizata $ersistenta #e cel $utin = luni $lus minim $uncte #ureroase *#in ?+

teste iolo%ice : HL"@SH" %licemia" creatininina" e&amenul #e

urina" TG5"TGO"TSH" anti%enul HBs" anti2H@C

TRATA;E(TUL 8IBRO;IALGIEI

tratament farmacolo%ic sim$tomatic *anal%ezice #e ti$$eriferic sau anal%ezice narcotice" anticon-ulsi-ante+ si

neurotro$ *anti#e$resi-e" an&iolitice" miorela&ante+ tratamente to$ice cu AI(S" acu$unctura tratamente alternati-e: !i$notera$ia" ,inetotera$ia

8i.r#$ial'a 3

7/25/2019 CURS 1 - 2015-16

87/162

8i.r#$ial'a 3"ia'n#!&ic%l "i*rn&ial

4 Supras"l%tare #e%a!%a

4 Me*%a#e!te +7 S&a&in !i *i.ra&i

7 An&i$alaric4 E!*"%r!"pat +

7 =ip#&ir#i"i!$7 =iprpara&ir#i"i!$7 Sin"r#$ C%!in'7 Dia.& )aara&

4 '"l !eur"l"%e +7 Sclr#)a $%l&ipla7 Mia!&nia 'rai!

4 Ca!%ere4 Sin"r#$ "%rr#! r'i#nal

4 I!e%t +7 =pa&i&i! C7 =%$an i$$%n#"*i cincH ir%!

=IV7 LH$ "i!a!

4 '"l reu#ats#ale +7 PR7 LES7 Sin"r#$ S

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88/162

8i.r#$ial'ia 3 pr#'n#!&ic

7 N% i!&a l)i%ni "i!&r%c&i $%!c%l#!cl&al7 N% i!&a "*#r$ari, ancil#), an"icap

*%nc&i#nal $#r

4 DAR,

7 D%rra !& cr#nica, pr!i!&n&a, n% ra!p%n"

la an&ial'icl %)%al7 8a&i'a.ili&a&a, "pr!ia, ani&a&a !%n&pr)n&

1 3 DUREREA SPINALA

7/25/2019 CURS 1 - 2015-16

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1.3. DUREREA SPINALA

!ste foarte frecventa in practica medicala

$n marea ma0oritate a cazurilor etiologia ramane

neclarificata chiar dupa invetigatii amanuntite :complexitatea structurilor anatomice implicate(coloana,musculatura, ligamentele, nervii sau tesutulmoale) si slaba corelatie cu metodele imagisticesofisticate

&tilizarea inadecvata a investigatiilor imagistice creeazamai degraba confuzii decat solutii ale problemei

1 3 DUREREA SPINALA

7/25/2019 CURS 1 - 2015-16

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1.3. DUREREA SPINALA

9. 2.9. D!#!+ /$+'+ -!+$+ :C Declansata de miscare, ameliorata de repaus (spondiloartroza este cea mai

frecventa)C cauze : +#"#%*+ !#"!B#+'+ (artroza interapofizara, spondiloza,

discartroza, spondiloza hiperostozanta), contractura musculara dureroasa

9. 2.1. D!#!+ D! "$/ $F'+-+"%# :C Debut 3

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1. 3. 1. Durerea sp!ala %u se#!e *e alar#a

emne de alarma :

C Durere de tip inflamatorC Durere localizataC Durere nocturna

C imptome viscerale sauconstitutionaleC Durere la miscarile in orice

directieC $storic de neoplasnC Factori de risc pentru

osteoporozaC -anifestari neurologice

acroileita

pondilodiscita

-etastaze

Fractura osteoporotica

Durere neurogena

Durere iradiata

'igamentita interspinoasa

. l

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92/162

L#$.al'ia cr#nica

4DE;INITIE$ EIDEMIOLOGIE

7 DURERE LOM'ARA ERSISTENTA 3LUNI

7 A "#%a ca%)a " a"r!a.ili&a& ca&r $"ic la nil

$#n"ial

7 Principala ca%)a " "i)a.ili&a& p &r$n l%n'

7 Ca $ai i$p#r&an&a a*c&i%n pn&r% li.rara "c#nc"ii $"ical la pr!#anl ac&i " ar!&a &anara

7 60B75B praln&a p in&ra'a "%ra&a a i&ii

7 C#!&%ri in"irc& &al in SUA3 J// $iliar" ann%al

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4 ;I9IOATOLOGIE

7 Ac&iara !i !n!i.ili)ara ra"acinil#r nr#a!

prin c#$pr!i !i &rac&i%n7 Sn!i.ili)ara n#cicpril#r "in an%l%! *i.r#!a,

ar&ic%la&ii in&rap#*i)ar, !&r%c&%ril pri#!&al!pinal, li'a$n& "%pa in*la$a&i ac%&a,!&a&%! p#!& &ra%$a&ic,$#"i*icari "'nra&i&c(

('oesser et al, 1

7/25/2019 CURS 1 - 2015-16

94/162

ps!*r"a#e ale reu#at"l"e

SUBCAPITOLE : 1(1( Sin"r#$%l "%rr#! r'i#nal1(2( Sin"r#$%l "%rr#! 'nrali)a&1(/( D%rra r&.rala:!pinala l#$.ara, cricala

1.). S!*r"#ul art%ular + artr",a$ artrta!la#at"re

1(5( Sin"r#$%l " #!p#r#)a1(6( Sin"r#$%l #!#!1(+( Sin"r#$%l $%!c%lar1(( Sin"r#$%l !i!&$ic

1 4 SINDROMUL ARTICULAR

7/25/2019 CURS 1 - 2015-16

95/162

1. 4. SINDROMUL ARTICULAR

Boala articulara 9 *artro$atia oala ce afecteazaarticulatiile+

;anifestarile clinice:Toate miscarile sunt #ureroase

1urerea este localizata

1urerea are intensitate similara $entru miscarileacti-e si $asi-e

5al$area limitelor articulare $ro#uce #urere

5ot 0 $rezente cre$itatii" cal#ura locala"tumefactie

+#"#%*++#"#$"+

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+#"#%*++#"#$"+

+#+"!#$"$$ +#"#%*+ +#"#$"+VARSTA INNAINTATA

REDOARE MATINALA

ACTIVITATE 8IKICA

AMELIORARE PRINREPAUS

MODI8ICARI LOCALE

DA

/0 $in%&

Ac&ii&a&a *i)ica #accn&%a)a, !&$ai$a la !*ar!i&%l )ili

Da

Crpi&a&ii, "%rr lapalpara $ar'inil#rar&ic%lar::#!*i&l#r

:-

/0 $in%&

:-

D%rr n#c&%rna*ara l'a&%ra c%$#.ili)ara

T%$*ir "c#n!i!&n&a la!&ica,"%rr l#cala,r#!a&a '%&a, ar&ri&a!p&ica, ar&ri&ap!#ria)ica

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1.).2. Reu#ats#ele !la#at"r

1urere #e ti$ in)amator tumefactie elastica asociata sau nucu roseata si cal#ura locala

(r3 articulatiilor afectate: mono" oli%o2 *

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1.).2.1. M"!"artrta a%uta s %r"!%a

;onoartrita acuta : %uta" artrita$osttraumatica" se$tica

Artrita se$tica: E-olutie ra$i# #istructi-a" $otential amenintator

#e -iata

1eut ra$i#

Semne $re%nante #e in)amatie : te%umenterosii" etc

Semne sistemice: fera

1 ) 2 1 M"!"artrta a%uta s %r"!%a

7/25/2019 CURS 1 - 2015-16

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&uta ' Cea mai frec-enta cauza #e monoartrita 5rimul e$iso# este localizat in F #in cazuri la I2a

articulatie metatarsofalan%iana *o alta articulatie esteafectata la 0ecare al

7/25/2019 CURS 1 - 2015-16

100/162

1 ) 2 1 M"!"artrta a%uta s %r"!%a

7/25/2019 CURS 1 - 2015-16

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;onoartrita cronica: $oate a-ea o e-olutiein#olora *9+ sa$tamani sau luni

5rinci$alele cauze :

Infectii *tuerculoza+ Artrita in#usa #e cristale

1eutul monoarticular a unei oli%o2"$oliartrite

1ia%nosticul #iferential : Artroza

Hi#artroza recurenta

Tumori

1ia%nosticul etiolo%ic necesita io$sie sino-iala

%steoarthritis: @eberdenGs and BouchardGs nodes

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102/162

#heumatoid arthritis: fusiform sHelling, hand

7/25/2019 CURS 1 - 2015-16

103/162

/soriatic arthritis: hands

7/25/2019 CURS 1 - 2015-16

104/162

/soriatic arthritis: nail changes, rash, and arthritis, hands

7/25/2019 CURS 1 - 2015-16

105/162

/soriatic arthritis: as=mmetric s=no=itis,nees

7/25/2019 CURS 1 - 2015-16

106/162

CAITOLUL 1 + r!%palele

7/25/2019 CURS 1 - 2015-16

107/162

s!*r"a#e ale reu#at"l"e

SUBCAPITOLE :

1(1( Sin"r#$%l "%rr#! r'i#nal1(2( Sin"r#$%l "%rr#! 'nrali)a&

1(/( D%rra r&.rala:!pinala l#$.ara, cricala1(( Sin"r#$%l ar&ic%lar 3 ar&r#)a, ar&ri&a in*la$ari

1.>. S!*r"#ul *e "ste"p"r",a1(6( Sin"r#$%l #!#!1(+( Sin"r#$%l $%!c%lar

1(( Sin"r#$%l !i!&$ic

O!p#r#)a 3 "*ini&i

7/25/2019 CURS 1 - 2015-16

108/162

O!p#r#)a 3 "*ini&i

4 ;#ala !i!&$ica a !cl&%l%i 37carac&ri)a&a prin !ca"ra $a!i

#!#a! !i "&ri#rara $icr#ari&c&%rii

&!%&%l%i #!#!,7 cr!&ra *ra'ili&a&ii #!%l%i

c#$pr#$i&ra r)i!&n&i #!%l%i

7 ri!c cr!c%& " *rac&%ra

1 5 Sin"r#$%l " #!p#r#)a

7/25/2019 CURS 1 - 2015-16

109/162

1(5( Sin"r#$%l " #!p#r#)a

4 Carac&ri)a& prin pr)n&a *acril#r " ri!c 37 P#!&$n#pa%)a7 Mn#pa%)a prc#c7 Mnara &ar)i7 Gr%&a&a c#rp#rala r"%!a7 C#r&ic#&rapia prl%n'i&a

7 S"n&ari!$%l7 I!ric *a$ilial " *rac&%ra #!p#r#&ica

4 O!p#r#)a !c%n"ara 37 =ipr&ir#i"i!$

7 =iprpara&ir#i"i!$7 Alc##li!$7 ;#li pa&ic

O!p#r#)a 3 pi"$i#l#'i

7/25/2019 CURS 1 - 2015-16

110/162

O!p#r#)a 3 pi"$i#l#'i

afectiune cronica cu prevalenta crescuta la varstnici(femei si barbati)8

asociata cu risc crescut de fractura (de 1A2 ori mai marela femei)8

evolutie silentioasa : primul simptom clinic este durereaacuta sau cronica secundara unei fracturi8

identificata prin scaderea B-D sau prezenta unei fracturisecundare unei traume minime

O!p#r#)a 3 "ia'n#!&ic

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111/162

O!p#r#)a 3 "ia'n#!&ic

4 O!p#r#)a 37$a!%rara "n!i&a&ii #!%l%i

7a.!#r.&i#$&ria "%ala c% ra) DA

!& ca $ai %&ili)a&a $"a>!&an"ar"%l " a%r?

7Sc#r%l T -2,5

O!p#r#)a 3 l#cali)ara

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*rac&%ril#r r&.ral

oloana vertebrala

oldul !xtremitatea distala a radiusului

OSTEOPOROKA 38RACTURA VERTE;RALA

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8RACTURA VERTE;RALA

este cea mai frecventa fractura osteoporotica 8

reprezinta un factor de risc pentru orice alta fracturaosteoporotica 8

este un motiv crestere a morbiditatii si a mortalitatii la

populatia varstnica 8

OSTEOPOROKA 38RACTURA VERTE;RALA

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8RACTURA VERTE;RALA

D#ar %na "in pa&r% *rac&%ri r&.ral!& i"n&i*ica&a clinic 3

4 !i$p$al#'i a.!n&a 9

4 &i#l#'ia c#$pla a "%rrii !pinal 9

4 a.!n&a &ra%$a&i!$%l%i

;RACTURA ?ERTE'RALA +MOR'IDITATE

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MOR'IDITATE

)ifo(a

Pie"de"e in inaltime

Ma"i"ea a#domen'l'i

-'"e"e a%'ta si %"oni%a

T'l#'"a"i "es&i"ato"ii sim&tome de "efl'/ si alte

sim&tome 0ast"ointestinale

-e&"esie

)alitate a vietii s%a('ta

TIPURI -E RA)TURA !ERTEBRALA

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TIPURI -E RA)TURA !ERTEBRALA

wedge fracture-fractura n pan fractura biconcava cruch fracture fractura de zdrobire

Modif 'soa"e Modif seve"eModif 'soa"e Modif seve"e

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1

1

1(( Sin"r#$%l #!#!

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1(( Sin"r#$%l #!#!

4 D%rr 37 pr#*%n"a, "i*%)a, c#n&in%a,

7 *ara rla&i c% $i!cara

7 acr.ar n#c&%rna

7 l#cali)ar pr*rn&iala 3 c#l#ana, pli!%l !i!'$n&l pr#i$al al $$.rl#r

4 Ea$n%l l#cal 3 in li$i& n#r$al

1(( Sin"r#$%l #!#!

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1(( Sin"r#$%l #!#!

4 Ca%) 3

7 T%$#ril #!#a! 3 &%$#ril $&a!&a&ic !%n&cl $ai *rcn& n#pla)ii #!#a!, iar #!%l!& a /-a l#cali)ar pn&r% $&a "%pa pla$an!i *ica&

7 ;#lil $&a.#lic #!#a! 3 .#ala Pa'&

7 In*la$a&ia pri#!&%l%i

1(6( Sin"r#$%l $%!c%lar

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1(6( Sin"r#$%l $%!c%lar

4 S carac&ri)a)a prin 37 !la.ici%n $%!c%lara pr#'r!ia 3

7 "%rri $%!c%lar

7 a&r#*i $%!c%lara

7: ar&ral'ii:ar&ri& in a*c&ara $%!c%lara "in .#lil "

c#la'n !clr#)a !i!&$ica, .#ala $i&a " &!%&c#n.#"H incl%!i#n?

1(6( Sin"r#$%l $%!c%lar

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1(6( Sin"r#$%l $%!c%lar

4 Dia'n#!&ic%l "i*rn&ial al p#li$i#)i&i 3

7 Mi#pa&ia "in ip#&ir#i"i, !arc#i"#)a !i#!$alaci

7 D%rra !i r"#ara cn&%ril#r "in p#li$ial'iar%$a&ica, ar&ri&a c% cl%l 'i'an&

7 Mi#pa&ia $"ica$na!a 3 'l%c#c#r&ic#i)i,i"r#icl#r#cin, c#lcicina, cicl#!p#rina,!&a&in !i *i.ra&i

7 Mi#pa&iil n#nin*la$arii 3 .#lil n%r#l#'ic($ia!&nia 'rai!

CAITOLUL 1 + r!%palele * l t l

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s!*r"a#e ale reu#at"l"e

SUBCAPITOLE :

1(1( Sin"r#$%l "%rr#! r'i#nal1(2( Sin"r#$%l "%rr#! 'nrali)a&

1(/( D%rra r&.rala:!pinala l#$.ara, cricala1(( Sin"r#$%l ar&ic%lar 3 ar&r#)a, ar&ri&a in*la$ari1(5( Sin"r#$%l " #!p#r#)a1(6( Sin"r#$%l #!#!1(+( Sin"r#$%l $%!c%lar

1.=. S!*r"#ul sste#%

1. 8. SINDROMUL SISTEMIC1 = 2 M t t t

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1.=.2. Ma!estar %uta!ate

8otosensiilitate

Rash cutanat%L(S

Ras! #iscoi#

Sclero#erma 5ur$ura

Li-e#o reticularis

Ulcere

Alo$ecieTelan%ictazia


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8otosensiilitate

Ras! cutanat

Rash discoid%L(S

Sclero#erma

5ur$ura

Li-e#o reticularis

Ulcere Alo$ecie

Telan%ictazia


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8otosensiilitate

Ras! cutanat

Ras! #iscoi#

Sclero#erma 5ur$ura

Li)edo reticularis%L(S

Ulcere

Alo$ecie

Telan%ictazia


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8otosensiilitate

Ras! cutanat

Ras! #iscoi#

Sclero#erma

5ur$ura

Li-e#o reticularis

Ulcere

Alo$ecie

Telan%ictazia

Sindrom Ra*naud%SS

1.8. SINDROMUL SISTEMI1 = 3 M t

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1.=.3. Ma!estar #u%"ase

C+fte genitale si orale

C ?ura, ochii uscati

C %chii rosii

C Balanita

#eactive arthritis: con0unctivitis

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+n=losing spond=litis: iridoc=clitis Hith

s=nechiae

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s=nechiae

#eactive arhtritis: erosions, tongue

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I(@ESTIGATII UTILIATE I(REU;ATOLOGIE

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REU;ATOLOGIE

In-esti%atii iolo%ice : HL" sin#romul iolo%ic #ein)amatie" sin#romul muscular" #e osteoliza

In-esti%atii imunolo%ice : autoanticor$ii"

com$lementul seric" anti%enele #e!istocom$atiilitate

E&amenul lic!i#ului sino-ial

In-esti%atii ima%istice : ra#iolo%ice"ultrasono%ra0a" scinti%ra0a" CT" R;(" artrosco$ia

In-esti%atii !istolo%ice : io$siile

I(@ESTIGATII BIOLOGICE

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Hemoleuco%rama *HL+ : Anemie

Cronica sim$la *#e ti$ in)amator+ : 5R" SA" LES

Hemolitica autoimuna : LES

8eri$ri-a : r3a la AI(S

Leucocitoza : artrita se$tica" atacul acut #e%uta

Leuco$enie : LES" r3a me#icamentoase" oli

asociate *CH+Tromocitoza : reacti-a la in)amatie sau

anemie feri$ri-a


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Sin#romul iolo%ic #e in)amatie : @SH : creste mai lent si ramane crescut o

$erioa#a mai in#elun%ata Cresteri nonin)amatorii : -arsta" se&" sarcina" olile

%lan#ei tiroi#e" #isli$i#emiile" !i$er%ama%loulinemii 5CR : creste si sca#e ra$i#

@alori usor crescute in stari nonin)amatorii:oezitate" alcool" fumat" 1

@alori f3 crescute in infectii se-ere *JFm%7#lFFm%7l+

8irino%en : #inamica lenta

I(@ESTIGATII I;U(OLOGICE

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Electroforeza Imuno%rama

Com$lementul seric

;oleculele HLA : HLA2B

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8actorul reumatoi# : 5R" alte oli #e cola%en"infectii

5roteinele citrulinate *anti CC5+ : 5R

Anticor$ii antinucleari Anti A1(#c" anti Sm" anti Ro : LES Anti Ro" anti La : sin#rom S4o%ren Anti U2R(5 : sin#rom o-erla$ Anti o2 *antisintetaza+: miozita

Anti Scl KF *anti to$oizomeraza+" anti2centromer :SS

A(CA *ac3 anti cito$lasma neutro0lica+ : -asculite

$!"$?+"$$ $-+?$"$!

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Ra#io%ra0i musculosc!eletale in < inci#ente*antero2$osterior si lateral+ : os" cartila4

Eco%ra0i : structurile $eriarticulare *ten#oane"

li%amente" musc!i+" sino-iala" cartila4ul" osul Scinti%ra0e cu te!netiu: leziune #e os" articulara

Tomo%ra0a com$uterizata : os

R;( : os" sino-iala" structuri $eriarticulare

Osteo#ensitometria : #%3osteo$oroza

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I(@ESTIGATII I;U(OLOGICE

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Com$lementul seric : C=" C

Crescut in in)amatie

Scazut in LES acti- cu afectare renala"afectiuni !e$atice se-ere


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ENA;E(UL LICHI1ULUI SI(O@IAL :

(r3 #e leucocite

#e 5;( Culturi

Cristale #e urat " $irofosfat #e calciu

I(@ESTIGATII HISTOLOGICE

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Sino-iala

5iele

5ulmon

@asele #e san%e

In-esti%atii ima%istice

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Ra#io%ra0i musculosc!eletale in

Documents

CURS 1 - 2015-16