Syphilis

Syphilis
by: Erik Austin, D.O., M.P.H.

Syphilis
* AKA lues
* Contagious, sexually transmitted disease caused by the
* Spirochete: Treponema pallidum
* Enters through skin or mucous membrane where primary manifestations are seen

Treponema pallidum
* Spiral spirochete that is mobile
* # of spirals varies from 4 to 14
* Length is 5 to 20 microns
* Can be seen on fresh primary or secondary lesions by darkfield microscopy or fluorescent antibody techniques

Syphilis epidemiology
* Major health problem throughout world
* 2.6 cases per 100,000 in 1999 in the US
* Lowest level ever recorded
* Concentrated in 28 counties in the SE U.S.
* Mainly gay men and crack cocaine users
* Enhances risk of transmission of HIV
* HIV testing recommended in all patients with syphilis
* Reportable disease

Serologic Tests
* Testing reveals patients immune status not whether they are currently infected
* Non-treponemal antigen test uses lipoidal antigens rather than T. pallidum or components of it
* RPR = rapid plasma reagin
* VDRL = Venereal Disease Research Laboratory
* Positive within 5 to 6 weeks after infection
* Strongly positive in secondary phase
* Strength of reaction is stated in dilutions
* May become negative with treatment or over decades
* MHA-TP: microhemagglutination assay for T. pallidum
* FTA-ABS: fluorescent treponemal antibody absorption test
* All positive nontreponemal test results should be confirmed with a specific treponemal test
* Treponemal tests become positive early, useful in confirming primary syphilis
* Remain positive for life, useful in diagnosing late disease
* Treatment results in loss of positivity in 13-24% of patients

Biologic False-Positive Test Results
* Positive test with no history or clinical evidence of syphilis
* Acute BFP: those that revert to negative in less than 6 months
* Chronic BFP: those that persist > 6 months

BFP Test Results in Syphilis
* Acute BFP
* Vaccinations
* Infections
* pregnancy
* Chronic BFP
* Connective tissue disease (SLE)
* Liver disease
* Blood transfusions
* IVDA

Cutaneous Syphilis
* Chancre is usually the first cutaneous lesion
* 18 to 21 days after infection
* Round indurated papule with an eroded surface that exudes a serous fluid
* Usually painless and heals without scarring

Chancre
* Inguinal adenopathy 1-2 weeks after chancre
* Generally occur singly, but may be multiple
* Diameter mm to cm

Chancres
* In women, the genital chancre is less often observed due to location within the vagina and cervix
* Edema of labia may occur
* Untreated, the chancre heals spontaneously in 1 to 4 months
* Constitutional symptoms begin just as chancres disappear
* Extragenital chancre: may be larger, frequently on lips, rarely tongue, tonsil, breast, finger, anus.

Chancre Histology
* Ulcer covered by neutrophils and fibrin
* Dense infiltrate of lymphocytes and and plasma cells
* Spirochetes seen with with silver stains; Warthin-Starry
* Direct fluorescent antibody tissue test (DFAT-TP) = serous exudate collected on a slide sent for exam

Serology
* Nontreponemal tests positive 50%
* Treponemal tests positive 90%
* Positivity depends upon duration of infection, if chancre has been present for several weeks, test is usually positive

Chancre vs. Chancroid
* Incubation 3 weeks
* Painless
* Hard
* Lymphadenopathy may be bilateral, nontender, nonsuppurative
* Incubation 4-7 days
* Painful
* Soft
* Lymphadenopathy unilateral, tender, suppurative

DDx in Syphilis
* Chancroid - multiple lesions, may coexist with chancre, must r/o syphilis
* Granuloma Inguinale - indurated nodule that erodes, soft red granulation tissue, Donovan bodies in macrophages with Wright or Giemsa stain
* Lymphogranuloma Venereum - small, painless, superficial non indurated ulcer, primary lesions followed in 7 to 30 days by adenopathy
* HSV - grouped vesicles, burning pain

Secondary Syphilis
* Skin manifestations in 80% called syphilids
* Symmetric, generalized, superficial, macular - later papular, pustular
* May affect face, shoulders, flanks, palms and soles, anal or genital areas

Secondary Syphilis Macular Eruptions
* Exanthematic erythema 6-8 weeks after chancre - may last hours to months
* Round, slightly scaly ham-colored macules
* Pain and pruritus may be present
* Generalized adenopathy

Secondary Syphilis Papular Eruptions
* Occurs on face and flexures of arms, legs, and trunk
* Yellowish-red spots may appear on palmar and plantar surfaces
* Ollendorf’s sign = tender papule
* May produce a psoriasiform eruption
* May appear as minute scale-capped papules
* Tend to be disseminated, but may be localized, asymmetrical, configurate, hypertrophic or confluent.
* Annular syphilid - mimics sarcoidosis and is more common in blacks
* Pustular syphilid – rare - face, trunk, extremities red small crust-covered ulceration
* Rupial syphilid - superficial ulceration is covered with a pile of terraced crusts resembling an oyster shell.
* Lues Maligna - rare, severe ulcerations, pustules, or rupioid lesions, accompanied by severe constitutional symptoms.
* Condylomata lata - papular mass, weeping, gray 1-3cm, groin, anus (not vegetative like condylomata acuminata)
* Syphilitic alopecia - irregular, scalp has a moth-eaten appearance 5% of pts

Secondary Syphilis Mucous Membrane
* Present in 1/3 of secondary syphilis
* Most common is “syphilitic sore throat”
* Diffuse pharyngitis, hoarseness
* Tongue may show patches of desquamation of papillae
* Ulcerations of tongue and lips in late stages
* Mucous patches are the most characteristic mucous membrane lesions; macerated, flat. Grayish, rounded erosions covered by a delicate, soggy membrane.

Secondary Syphilis Systemic Involvement
* Lymphadenopathy common.
* Acute glomerulonephritis, gastritis, proctitis, hepatitis, meningitis, iritis, uveitis, optic neuritis, Bell’s palsy, pulmonary nodular infiltrates, osteomyelitis, polyarthritis.

Secondary Syphilis Diagnosis
* Nontreponemal serologic tests for syphilis are strongly reactive (seronegativity rarely in AIDS)
* Spirochetes on darkfield exam

Secondary Syphilis DDx “Great Imitator”
* Pityriasis rosea
* Drug eruptions (pruritic)
* Lichen planus; Wickham’s striae, Koebner’s, pruritic
* Psoriasis; no adenopathy
* Sarcoidosis; need serology and silver staining of biopsy
* Infectious mononucleosis, false pos RPR
* Geographic tongue
* Aphthous stomatitis

Latent Syphilis
* After the lesions of secondary syphilis have involuted, a latent period occurs where the patient has no clinical signs, but positive serological tests
* May last a few months or a lifetime
* 60-70% of pts that are untreated remain asymptomatic for life
* Women may infect unborn child for 2 years
Late Syphilis
* Defined by CDC as infection of greater than 1 years duration
* Tertiary Cutaneous Syphilis
* Late Osseous Syphilis
* Neurosyphilis
* Late Cardiovascular Syphilis

Tertiary Cutaneous Syphilis
* Tertiary syphilids usually occur 3-5 years after infection
* 16% of untreated pts will develop lesions of skin, mucous membrane, bone or joints
* Skin lesions are localized, destructive, heal with scarring

Tertiary Syphilids
* Two main types; Nodular syphilid and the Gumma
* Nodular - reddish brown firm papules or nodules 2mm or larger, scales.
* Gumma - larger

Nodular Tertiary Syphilid
* Lesions tend to form rings and undergo involution as new lesions develop
* Characteristic circular or serpiginous pattern
* “kidney-shaped” lesion occurs on the extensor surfaces of the arms and on back
* Patches have scars and fresh ulcerated lesions
* Process may last for years, slowly marching across large areas of skin

Gumma
* May occur as unilateral, isolated, single or disseminated lesions, or serpiginous
* May be restricted to the skin, or originate in deeper tissues, and break down the skin
* Lesions begin as small nodules, enlarge to several centimeters
* Central necrosis, deep ulcer with a gummy base, most frequent site is lower legs

Diagnosis of Tertiary Syphilis
* Histopathology - tuberculoid granules with multinucleated giant cells
* Nontreponemal tests (VDRL, RPR) positive in 75%
* Treponemal tests (FTA-ABS, MHA-TP, TPI) positive in nearly 100%
* Darkfield negative, PCR may be positive

DDx Tertiary Syphilis
* R/O tumors; SCCA tongue, leukemic infiltrates, sarcoidosis
* Ulcerated syphilids resemble scrofula, atypical mycobacterium, sporotrichosis, blastomycosis
* Mycosis fungoides (CTCL) has eczema and pruritus
* Perforation of hard palate and septum

Late Osseous Syphilis
* Gummatous lesions can involve the periosteum and bone
* Head, face, tibia
* Periostitis, osteomyelitis, osteitis, gummatous osteoarthritis
* “Osteocope” - bone pain often at night
* Charcot joint - loss of contours of joint, hypermobility, painless
* Associated with tabes dorsalis

Neurosyphilis
* CNS involvement with syphilis can occur at any stage
* Most are asymptomatic; CSF shows pleocytosis
* 4-10% of untreated pts will develop neurosyphilis

Early Neurosyphilis
* First year of infection - meningeal
* Headache, stiff neck, cranial nerve disorders, seizures, delirium, increased ICP

Meningovascular Neurosyphilis
* 4-7 years after infection
* Thrombosis of vessels in the CNS
* Hemiplegia, aphasia, hemianopsia, transverse myelitis, progressive muscular atrophy
* CN palsies; CN IIX, III, IV, VI
* “Argyll Robertson Pupil” accommodates, but doesn’t react

Late Neurosyphilis
* Parenchymatous neurosyphilis occurs more than 10 years after infection
* Two classical patterns; Tabes Dorsalis, and General Paresis

Tabes Dorsalis
* Degeneration of the dorsal roots of the spinal nerves and posterior columns of the the spinal cord
* Gastric crisis with severe pain and vomiting is most common
* Pain, urination problems, paresthesias, ataxia, diplopia, vertigo, deafness
* Signs: Argyll Robertson pupil, reduced lower cord reflexes, Romberg sign, sensory loss, atonic bladder, Charcot’s joints, optic atrophy
* Personality changes, memory loss, apathy, megalomania, delusions, dementia

Late Cardiovascular Syphilis
* Occurs in 10% of untreated pts
* Aortitis, aortic insufficiency, coronary disease, aortic aneurysm

Congenital Syphilis
* Prenatal syphilis acquired in utero
* Infection through the placenta usually does not occur before the fourth month, so treatment of the mother before this time will almost always prevent infection in the fetus.
* If infection occurs after the fourth month 40% risk of fetal death

* 40% of pregnancies in women with untreated early syphilis will result in a syphilitic infant.
* Most neonates with congenital syphilis are normal at birth.
* Early congenital syphilis - lesions occurring within first two years of life
* Late congenital syphilis - lesion occur after two years

Early Congenital Syphilis
* Cutaneous manifestations appear most commonly during 3rd week
* Snuffles (a form of Rhinitis) is most frequent, bloody drainage, ulcers may develop, later septal perfs
* 30-60% of infants develop cutaneous lesions similar to secondary syphilis
* Red to copper maculopapular, become large, scaling, pustules, crusting
* Face, arms, buttocks, legs, palms and soles

Early Congenital Syphilis
* Face, perineum, and intertriginous areas, usually fissured lesions resembling mucous patches. Radial scarring results leading to Rhagades
* Bone lesions occur in 70-80% , epiphysitis is common and causes pain on motion, leading to infant refusing to move; Parrot’s pseudoparalysis.
* Radiologic features of the bone lesions in congenital syphilis during the first 6 months are characteristic.
* Bone lesions occur at the epiphyseal ends of long bones.
* Lymphadenopathy, hepatomegaly, nephrotic syndrome, meningitis, nerve palsies may all occur

Late Congenital Syphilis
* Lesions are two types - malformations of tissue affected at critical growth periods (Stigmata) and persistent inflammatory foci
* Inflammatory - lesions of the cornea, bones, and central nervous system, i.e., interstitial keratitis in 20-50%, perisynovitis of knees (Clutton’s joints), tabes dorsalis, seizures, and paresis

Late Congenital Syphilis
* Malformations (Stigmata) - destructive effects leave scars or developmental defects
* Hutchinson’s Triad - Changes in incisors, corneal scars, and eighth nerve deafness
* Also, saber shins, rhagades of the lips, saddle nose, mulberry molars

Hutchinson’s Teeth
* Malformation of the central upper incisors that appears in the second or permanent teeth. Teeth are cylindrical rather than flattened, cutting edge narrower than base, notch may develop
* Mulberry molar - first molar hyperplastic, flat occlusal surface covered with knobs representing abortive cusps

Treatment of Syphilis
* PCN is drug of choice for treatment of all stages of syphilis.
* HIV testing is recommended in all patients
* If less than one year; 2.4M U of Benzathine PCN G
* PCN-allergic; Tetracycline 500mg QID for 14 days

Jarisch- Herxheimer Reaction
* Febrile reaction occurs after the initial dose of antisyphilitic tx, 60-90% of pts
* 6-8 hours after dose - chills, fever, myalgia, increase in inflammation (neurosyphilis)

Treatment of Sex Partners
* Persons exposed to a patient with early syphilis within the previous 3 months should be treated, even if seronegative
* Single dose azithromycin effective in treating incubating syphilis

Serologic Testing after Tx
* VDRL or RPR repeated every 3 months in first year, every 6 months in second year, than annually
* A fourfold decrease in titer should be seen at 6 months, if not then 3 weekly PCN IM injections
* Response for latent syphilis is slower, 12-24 months
* If not responding; HIV and CSF testing repeated
* Pts with late syphilis may be “serofast”, and titers may not improve
* Neurosyphilis pts should have CSF every 6 months

Syphilis and HIV
* Most HIV pts exhibit the classic clinical manifestations and course, and respond similarly to tx
* More likely to present with secondary syphilis and have a persistent chancre

Yaws
* Treponema pallidum subsp. Pertenue
* Endemic in some tropical, rural regions
* Overcrowding, poor hygiene, transmitted by contact with infected lesions
* Children, disabling course, affects skin, bones, and joints

Early Yaws
* Primary papule or group of papules appear at site of inoculation after 3 week incubation period, initial lesion becomes larger and crusted (Mother Yaw, maman pian )
* Feet, legs, buttocks, face, not genitals
* Mother yaw disappears after a few months
* Secondary Yaws – appears weeks or months after mother yaw appears. May be smaller and appear around primary lesion; may be annular (ringworm yaws)
* Condylomata may develop around body orifices and creases
* Palms and soles may form hyperkeratotic plaques leading to a painful crab-like gait (crab yaws)

Late Yaws
* 10% progress to late stage where gummas occur
* Ulcer with clean edges that tend to fuse to form con figurate and serpiginous patterns similar to tertiary syphilis
* Bone, joint, saddle nose, saber shin, Gangosa (destruction of palate and nose)
* Diagnosis = Darkfield, VDRL or RPR

Endemic Syphilis (Bejel)
* Bejel is a Bedouin term for nonvenereal treponematosis, nomadic tribes of North Africa, Southwest Asia, Eastern Mediterranean
* T. pallidum subsp. Endemicum
* Usually occurs in childhood through skin contact
* May affect the skin, oral mucosa, and skeletal system

Bejel
* Primary lesions rare, probably go undetected in the oral mucosa
* Secondary oral lesions - shallow, painless ulcers, laryngitis
* Condyloma of axillae and groin, lymphadenopathy, osteoperiostitis causes night leg pain
* Untreated secondary bejel heals in 6-9 months
* Tertiary stage - gummatous ulcerations of the skin, nasopharynx, and bone.
* Neuro - uveitis, choritis, optic atrophy

Pinta
* T. carateum; nonvenereal, endemic
* Only skin lesions occur
* All ages, Brazilian rain forest
* Primary Stage - 7 to 60 days after inoculation. Lesion begins as a tiny red papules and become an elevated erythematous infiltrated plaque 10cm in diameter over 2-3 months. Legs -satellite lesions, no erosion or ulceration as in chancres.
* Secondary Stage - 5 months to 1 year
* Small, scaling papules that enlarge and coalesce – affects extremities and face
* Red to blue, black with postinflammatory hyperpigmentation
* Nontreponemal tests reactive in 60%
* Late Dyschromic Stage - young adults – may appear as hyperpigmented and depigmented macules resembling vitiligo
* Face, waist, wrist, trochanteric areas
* Histo - acanthosis, lichenoid, spirochetes in epidermis

Treatment of Yaws, Bejel, and Pinta
* Benzathine PCN G 1.2 to 2.4 M units IM
* Tetracycline 500mg QID for adults
* EES 10mg/kg children QID for 14 days
Nonvenereal Treponematoses
* Yaws
* Endemic Syphilis
* Pinta

Treatment
* Syphilis >1year; 2.4M PCN G weekly for 3 weeks Pcn-allergic; Tetra 500mg QID for 30 days
* Neurosyphilis; IV
* Infant 100,000 to 150,000 units/kg/day Procaine PCN BID for first seven days of life

Syphilis.ppt

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Common Foot & Ankle Problems

Common Foot & Ankle Problems

Hallux Valgus / Bunion Deformity
* A structural (bony) deformity where the metatarsal bones spread apart causing a prominent bone to protrude on the inside of the foot.
* A progressive deformity.
* May be treated conservatively, but usually requires surgical correction if pain persists.

Bunion prior to correction
Bunion after correction
Severe Hallux Valgus / Bunion Deformity
Cut in bone and fixation with screws

Tailor’s Bunion / Bunionette
* Bony deformity which is located on the outside part of the foot.
* The bump, bunionette or Tailor’s Bunion, can become very painful due to shoe irritation.
* Tailor’s bunions may be treated conservatively. Surgical correction may be necessary.

Note prominent 5th metatarsal head with swelling
Note Bowing of the Metatarsal
Note Straight Metatarsal
After Correction
Prior to Correction
Tailor’s Bunion / Bunionette
Hammertoe Deformity
* Contracted or abnormal position of the toes, which may be flexible or rigid in nature.
* Usually caused by weakened muscles of the foot.
* May cause pain due to irritation from other toes. The pain may be exasperated by tight fitting shoes.
* Hammertoes are often accompanied by a corn or callous.
Toe prior to surgery
Toe after surgery
Hammertoe Deformity
Hallux Rigidus
* Osteoarthritis of the big toe joint usually associated with pain and restricted motion.
* May be caused by injury or repetitive joint damage due to a biomechanical / structural problem of the foot.
* Chronic wear and tear causes a wearing out of the cartilage at the joint and bone spurs to form.
Hallux Rigidus of the Big Toe Joint
Note bone spur formation

Hallux Rigidus of the Big Toe Joint
Note joint space narrowing and bone spur formation at the joint margins
Rheumatoid Arthritis
* An inherited arthritis which affects joints in the feet and hands.
* The joint destruction and deformities are progressive in nature.
* May predispose patients to bunion and hammertoe formation.
Bunion Deformity
Hammertoe Deformities
Rheumatoid Arthritis
Rheumatoid nodule
Plantar Wart
* Human papaloma virus infection in the feet.
* Warts are obtained by barefoot exposure to the virus.
* Warts are often spread in showers, gyms, or other areas where barefoot walking is common.
* May be treated with any number of methods but recurrence ranges between 18-22%.
Plantar Wart
Callous / Corn
* Thickened area of skin caused by chronic rubbing or irritation of a bony prominence by the ground or shoe gear.
* Very high areas of pressure within a callous can develop a painful central core.
* Lesions reoccur because the cause of the lesion is often from bone.
Callous / Corn
Athletes Foot
* A fungal infection typically caused by fungus found in soil (Dermatophyte).
* Picked up by contact with the fungus usually walking barefoot (Gym, hotel, pool, etc.).
* May occur anywhere on the foot and may burn and/or itch.
* The affected areas of skin will often peel or may have small blisters.
Ingrown Nails
* Toenail which grows into the skin. Most often caused by a wide toenail and an external pressure.
* The nail may cause pain or infection due the pressure of the nail border.
* May be treated with removal and/or antibiotics. May be permanently corrected with retaining a normal nail appearance.
Fungal Toenail
* A thickened nail caused by a fungus.
* Initially caused by an injury to the nail which allows the organism to enter the nail.
* Progressive in nature and slow growing.
* May spread to other nails or other people in close contact. Organism may also spread from nail to the skin (athletes foot).
* May be treated if pain or concerns arise.
Fungal Toenail
Fungal Infection which caused ingrown nail
Thickened curled nails caused by fungus
Nail Injury
* Chronic injury (i.e. athletic activities) causes injury to the nail root and results in nail horizontal layers.
* Isolated injury may also cause bleeding under the nail, leaving a dark spot which persists until the nail grows out.
Lines of injury
Dried blood under the nail plate from injury.
Eczema
Gout
Redness and swelling of the big toe joint
High Arched Feet / Pes Cavus
Pes Cavus / High Arch Feet
Flat Feet
Note low medial arch height
Pes Planus / Flat Feet
Note collapse of entire foot inward
Note low medial arch height
Plantar Fascitis / Heel Spur Syndrome
* Inflammation and partial tearing of a ligament band which attaches from the heel to the ball of the foot.
* Usually a result of poor arch support and overuse.
* May be accompanied by a calcified spur on the heel.
* Usually resolves with conservative treatments.
Ankle Sprain
* Tear or stretching of the ligaments of the ankle. Usually the ligaments on the outside of the ankle are involved.
* Caused by and twisting injury of the foot / ankle .
* Instability of the ankle can develop due to the ligament injury.
* Most often treated conservatively. Surgical repair can be performed to treat chronic ankle sprains.
Bruising after ankle sprain
Morton’s Neuroma
* Injured or compressed nerve most often between the 3rd and 4th toes.
* Burning / pain on the ball of the foot or toes.
* Patients may feel fullness or a mass in the area when they walk.
* Treatments may be conservative or surgical.
Haglund’s Deformity / Retrocalcaneal Exostosis
* Prominent bone on the back of the heel.
* Back of the heel is irritated by shoes and activity, which places pressure on the area.
* Can also be aggravated by a tight Achilles tendon over prominent heel bone.
* Treatments may be conservative or surgical.
Ulcerations
* Erosions of the skin caused by loss of sensation or poor circulation.
* Skin break down occurs which, places patients at risk for local or systemic infection.
Ischemic Ulceration(Ulcer due to poor circulation)
Diabetic Ulceration
Ganglion Cyst
* Benign soft tissue mass which arises from a weak area in a tendon lining or joint.
* Cyst is often filled with a gelatinous fluid.
* Cyst may change size depending on irritation.
Subungual Exostosis
* Bone and cartilage growth under the great toe nail.
* Pain may arise if pressure is placed over the area.
* May be treated with shoe style changes, nail removal or surgical removal.
Venous Stasis
* Discoloration of skin due to longstanding swelling of legs.
* Persistent swelling can lead to skin breakdown.
* Compression and elevation of the legs are essential to the prevention of complications.
Heel Fissuring / Cracking
Heel Fissuring with Hyperkeratosis
Fractured Proximal Phalanx (Toe)
Fractures
Hyperhydrosis
Achilles Tendonitis
Inflammation of tendon

Common Foot & Ankle Problems.ppt

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Work Related Musculoskeletal Disorders

Work Related Musculoskeletal Disorders

Upper Extremity Disorders
* Carpel tunnel syndrome
* Cubital tunnel syndrome
* Thoracic outlet syndrome
* Raynaud’s syndrome (white finger)
* Rotator cuff syndrome
* DeQuervain’s disease
* Tendinitis
* Tenosynovitis
* Trigger finger
* Ganglion cyst

Neurovascular Disorders
* Carpal Tunnel Syndrome
o Impingement of the median nerve caused by irritation and swelling of the tendons in the carpal tunnel
* Cubital Tunnel Syndrome
o Pressure on the ulnar nerve when the elbows are exposed to hard surfaces

Neurovascular Disorders
* Thoracic Outlet Syndrome
o Compression of the blood vessels between the neck and shoulder caused by reaching above shoulder level or carrying heavy objects

* Raynaud’s Syndrome
o Also known as Vibration White Finger ; Blood vessels of the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time

Tendon Disorders
* Rotator Cuff Syndrome
* DeQuervain’s Disease
o Combination of tendinitis and tenosynovitis
* Tendinitis
o Irritation of the tendon
* Tenosynovitis
o Irritation of the synovial sheath
* Ganglion Cyst
o Accumulation of fluid within the tendon sheaths

Tendinitis
Hand and Wrist
Common Occupational CTDs of the Upper Extremities

Carpal Tunnel Syndrome occurs from chronic swelling of the flexor tendons in the wrist.

The median nerve, which feeds the first three fingers and the thumb, can become impaired from pressure in the carpal tunnel in the wrist.

Symptoms include:

# pain in the first three fingers and the thumb
# numbness in these areas
# tingling in these areas

Carpal Tunnel Syndrome
Common Occupational CTDs of the Upper Extremities

Raynaud’s Syndrome is when blood vessels of the hand are damaged (narrowed) from repeated exposure to vibration for long periods of time

This is connected with use of vibrating tools, such as hair clippers and jack hammers.

Raynaud’s Syndrome
Symptoms

o Numbness and tingling in the fingers during vibration exposure; may continue after exposure has been discontinued
o Blanching (whitening) of one fingertip because of a temporary constriction of blood flow
o Other fingers also blanch
o Intensity of pain & frequency of attacks increase in time

Common Occupational CTDs of the Upper Extremities

Cubital Tunnel Syndrome is caused by resting the elbows on hard surfaces such as unpadded tables or armrests.

The ulnar nerve, which feeds the ring and little fingers, can become impaired from pressure near the elbows.

Symptoms include:
+ pain in the ring and little fingers
+ tingling in these areas
+ numbness in these areas


Cubital Tunnel Syndrome
Common Occupational CTDs of the Upper Extremities
Thoracic Outlet Syndrome is caused by frequent reaching above shoulder level, by carrying heavy objects, or poor posture involving a forward head tilt.

A Neurovascular bundle called the brachial plexus, which passes between the collar bone and the top rib, can become impaired from pressure associated with movements that causes these two bones to be positioned close together.

Symptoms include:
+ the arms “falling asleep”
+ weakened pulse
+ numbness in the fingers

Thoracic Outlet Syndrome
Common Occupational CTDs of the Upper Extremities
Rotator cuff syndrome is a disorder involving swelling and pain of tendons comprising the rotator cuff muscle group:

subscapularis, supraspinatus, infraspinatus, & teres minor

Symptoms include:

o Pain when you bend the arm and rotate it outwards against resistance
o Pain on the outside of the shoulder possibly radiating down into the arm
o Pain in the shoulder, which is worse at night
o Stiffness in the shoulder joint.

Rotator Cuff Syndrome Anterior View Posterior View
Common Occupational CTDs of the Upper Extremities

Tendinitis is a common CTD for the wrist, elbow, and shoulder. It occurs when we continually stress the tendon cables, causing them to become irritable and sore.

Lateral Epicondylitis - “Tennis elbow”

Medial Epicondylitis - “Golfer’s elbow”

Symptoms include:

# point tenderness
# swelling
# tennis elbow, pain radiates down to back of hand
# golfer’s elbow, pain radiates down to back of hand

Tendinitis

Tenosynovitis is swelling of the sheath that covers the tendon from constant rubbing against the tendon.

Symptoms include:
swelling
pain
loss of motion
loss of strength
Tenosynovitis
Trigger Finger is a tendon disorder that occurs when there is a groove in the flexing tendon of the finger

If the tendon becomes locked in the sheath, attempts to move the finger cause snapping or jerking movements

Usually associated with using tools that have handles with hard or sharp edges.

Trigger Finger
Ganglion Cyst is a bump under the skin caused by an accumulation of fluid within the tendon sheath. It is commonly found at the hand and wrist.

Ganglion Cyst

De Quervain’s Disease is an inflammation of the tendon sheath of the thumb attributed to excessive friction between two thumb tendons and their common sheath.

It’s a combination of Tendonitis and Tenosynovitis.

May be caused by twisting and forceful gripping

Symptoms include:

* swelling
* pain at the base of the thumb.

De Quervain’s Disease
Prospective Study of Computer Users
Fredric Gerr, et. al., 2002, “A Prospective Study of Computer Users: 1. Study Design and Incidence of Musculoskeletal Symptoms and Disorders”.

o 632 individuals
o Newly hired into jobs requiring  15 hr/week of computer use
o Were followed for up to 3 years

Primary Results
* Hand/Arm (H/A) & Neck/Shoulder (N/S) MSS and MSD were common among computer users
* More than 50% of users reported MSS during the 1st year after starting a new job
* Most common H/A disorder was DeQuervain’s tendonitis
* Most common N/S disorder was somatic pain syndrome

Common Occupational Injuries of the Back

Strains and sprains are damage to the tendons and ligaments caused by one time exertions such as lifting or carrying heavy objects.

These can lead to very noticeable back pain, but the pain usually begins to subside within a few days

Facet joint pain results from irritation of the area where the ribs meet the spinal column.

Typically, there is muscle swelling in the affected area and it can become very painful to sit or stand up straight. In some cases it may also be difficult to breath deeply.

Disk erosion occurs from prolonged pressure on the spinal disks, which causes them to become permanently compressed.

The space between the vertebrae becomes smaller, which can lead to impingement of the nerve roots leading out from the spine.

Sitting puts more pressure on the spinal disks than standing, and sitting with the back unsupported can lead to high levels of disk pressure.

Disc Erosion

Sciatic nerve impingement, also called sciatica, is common for people who sit for prolonged periods of time.

The sciatic nerve runs from your lower back down the back of your leg and into to your feet.
Swelling in certain muscles in the buttocks can put pressure on the sciatic nerve, causing pain down the leg.

Herniated discs occur when the inner portion of the disc protrudes, putting pressure on the nerve roots leading from the spine.

Pain or numbness in the legs is a common symptom of herniated discs in the lower back.

Herniated/Bulging Disc
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