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Systemic Diseases and Musculoskeletal System

Systemic Diseases and Musculoskeletal System. Johan van Rensburg. Systemic Diseases and Musculoskeletal System. Endokrine associated. When to suspect occult endocrinopathy?. Entrapment Neuropathy (Carpal tunnel Syndrome). Calcium Pyrophosphate Dihydrate (CPPD) arthropathy.

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Systemic Diseases and Musculoskeletal System

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  1. Systemic Diseases and Musculoskeletal System Johan van Rensburg

  2. Systemic Diseases and Musculoskeletal System

  3. Endokrine associated

  4. When to suspect occult endocrinopathy?

  5. Entrapment Neuropathy (Carpal tunnel Syndrome)

  6. Calcium Pyrophosphate Dihydrate (CPPD) arthropathy

  7. Diffuse myalgia (with or without muscle weakness)

  8. Raynaud's phenomenon

  9. Diabetes Mellitus • Intrinsic complications • Conditions with increased incidence

  10. Intrinsic complications Neuro-vascular prominent

  11. Diabetic cheiroathropathy (diabetic hand syndrome of limited joint mobility)

  12. Diabetic arthropathy: neuropathic joint disease, feet (clinical and radiograph)

  13. Diabetic osteolysis

  14. Diabetic amyotrophy Diabetic neuropathy characterized by painful muscle wasting and weakness. It affects the lower limbs and is typically asymmetric.

  15. Conditions with increased incidence • Increased deposition of abnormal protein • Increase in growth factors • Decreased immunity

  16. Frozen shoulder (periarthritis of the shoulder)

  17. Reflex sympathetic dystrophy (shoulder hand syndrome)

  18. Flexor tenosynovitis of the hand

  19. Dupuytren's contracture

  20. Carpal tunnel syndrome

  21. Diffuse idiopathic skeletal hyperostosis (DISH)

  22. Septic joint/osteomielitis

  23. Thyroid • Hypothyroidism • Hyperthyroidism

  24. Hypothyroidism • Tunnel (carpal) syndrome • Raynaud's phenomenon • Aching muscle with findings indistinguishable of fibromyalgia • Proximal muscle weakness and stiffness with elevated CK • Myxedematous arthropathy in severe hypothyroidism • Auto-immune thyroiditis and other auto-immune diseases

  25. Hyperthyroidism • Thyroid acropachy (1%) • Painless proximal muscle weakness • Osteoporosis • Adhesive capsulitis of the shoulder

  26. Hyperthyroidism: acropachy, hand (clinical and radiograph)

  27. Hyperparathyroidism • Painless proximal muscle weakness • (Normal CK BUT Myopathic or neuropathic EMG) • Chondrocalcinosis with pseudogout attacks (usually due to CPPD) • Osteogenic synovitis due to subchondral bony collapse from thinning of bone (leading to secondary OA) • Osteoporosis • Ectopic soft-tissue calcification

  28. Hypoparathyroidism • Hypocalcaemia

  29. Acromegaly • Raynaud's Phenomenon Secondary OA Proximal muscle weakness with normal CK Carpal tunnel syndrome

  30. Acromegaly Chondrocalcinosis

  31. Acromegaly: hand (radiograph)

  32. Cushing's Syndrome Osteoporosis Steroid withdrawal syndrome Osteonecrosis Proximal muscle weakness

  33. Hematological disorders

  34. Bone pain (worse at night) • Hypercoagulabilty • Antiphosfolipid syndrome • Sickle cell disease • Leukemia • Mieloma

  35. Sickle-cell disease: bone infarcts, upper tibiae (radiograph)

  36. Hemophilia: knees (radiograph)

  37. Other Malignancies

  38. Metastatic adernocarcinoma: hand (radiograph)

  39. Osteosarcoma: femur (radiograph)

  40. Other

  41. Infections • TB • Osteomielitis • Spinal involvement • Brucella • Sero-negative arthritis • Involvement of the spine • Virus • Myopathy

  42. Syphilitic neuropathic joint disease: knees

  43. Hemochromatosis: hands (radiograph)

  44. Electrolyte disorders • Myopathies • Low Potassium • Low magnesium • Low/high calcium

  45. Amyloidosis • Associated with • Chronic dialysis • Mieloproliferative diseases • Chronic inflammation

  46. Amyloidosis: shoulder (clinical and photomicrographs)

  47. Amyloidosis: tongue

  48. Granulomas, abnormal protein and chronic inflammation

  49. Erythema nodosum: legs

  50. Sarcoid arthritis: hands

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