Clinical High-Yield · 8 min read · June 19, 2026
Most common joint disease. Degenerative, not inflammatory. Affects weight-bearing joints (knees, hips) and DIP/PIP joints. Morning stiffness <30 minutes. Bony enlargements: Heberden's nodes (DIP), Bouchard's nodes (PIP).
X-ray: Joint space narrowing, osteophytes, subchondral sclerosis.
Treatment: Weight loss, exercise, acetaminophen first-line, NSAIDs, intra-articular corticosteroids, joint replacement for severe disease.
Autoimmune, inflammatory. Symmetric small joint involvement (MCP, PIP — spares DIP). Morning stiffness >1 hour. Systemic symptoms: fatigue, fever, weight loss.
Labs: RF positive (70–80%), anti-CCP (more specific), elevated ESR/CRP.
X-ray: Periarticular osteopenia, joint space narrowing, erosions (late).
Treatment: MTX first-line DMARD. Biologics (TNF inhibitors) for inadequate MTX response. NSAIDs/steroids for symptom control.
Monosodium urate crystal deposition. Acute attacks: severe, sudden-onset monoarthritis, most commonly first MTP joint (podagra). Tophi in chronic gout.
Diagnosis: Joint aspiration — negatively birefringent needle-shaped crystals.
Acute treatment: NSAIDs, colchicine, or corticosteroids.
Prophylaxis: Allopurinol or febuxostat (urate-lowering therapy). Start after acute attack resolves. Target uric acid <6 mg/dL.
Red flags requiring immediate workup: Fever (infection/malignancy), unexplained weight loss (malignancy), bowel/bladder dysfunction (cauda equina — emergency), saddle anesthesia, age >50 with new pain, history of cancer, IV drug use, immunosuppression, trauma.
Cauda equina syndrome: Urinary retention or incontinence, saddle anesthesia, bilateral leg weakness. Surgical emergency. MRI immediately.
Lumbar radiculopathy: Dermatomal pain, paresthesias, weakness. L4: medial leg, ankle dorsiflexion. L5: lateral leg/dorsal foot, great toe extension. S1: posterior leg/lateral foot, plantar flexion, absent Achilles reflex.
Nonspecific low back pain: Most common. Conservative treatment: NSAIDs, acetaminophen, muscle relaxants, heat, activity as tolerated. Imaging not indicated in first 4–6 weeks without red flags.
Rotator cuff tear: Weakness with abduction and external rotation. Positive drop arm test. MRI for diagnosis. Conservative vs. surgical repair.
Subacromial impingement: Pain with overhead activities, positive Neer and Hawkins signs. Treatment: Physical therapy, NSAIDs, corticosteroid injection.
Adhesive capsulitis (frozen shoulder): Progressive loss of active and passive ROM in all directions. Often follows period of immobilization. Treatment: Physical therapy, corticosteroid injection, manipulation under anesthesia.
AC joint separation: Fall on outstretched hand or direct blow. Step deformity. Treatment: Sling for mild cases, surgical repair for severe.
Colles fracture: Distal radius fracture with dorsal displacement. ...