DIFFERENTIAL DIAGNOSIS the lower limb pain cevy4 cevy4 Differential diagnosis is an ability of ALL physicians lThe specific treatment of the particular disease is the ablity a physician with the particular speciality Výsledek obrázku pro treatment Výsledek obrázku pro diagnosis cevy4 The principle of DD is reverse to learning lLearning – starts with organ systems and gets deeper into different pathologies with deifferent symptoms l lDD – starts at a symptom and tries to find its origin – the diseae Výsledek obrázku pro detective cevy4 The Leading Symptom vs Accompanying symtpoms le.g. lPAIN lVs. lLocal – mobility, neural disorder, skin colour and temperature, gathering lDistant – fever, headache, back pain… cevy4 Exclude life threatening conditions lCritical ischaemia lDeep venous thrombosis lSyndrome of cauda cevy4 ••Achilles tendinitis ••Achilles tendon rupture ••ACL injury (tearing of the anterior cruciate ligament in your knee) ••Ankylosing spondylitis ••Baker's cyst ••Bone cancer ••Broken leg ••Bursitis (joint inflammation) ••Chronic exertional compartment syndrome ••Claudication ••Deep vein thrombosis (DVT) ••Gout (arthritis related to excess uric acid) ••Growing pains ••Growth plate fractures •Hamstring injury ••Herniated disk ••Infection ••Juvenile idiopathic arthritis (formerly known as juvenile rheumatoid arthritis) •Knee bursitis (inflammation of fluid-filled sacs in the knee joint) ••Legg-Calve-Perthes disease ••Meralgia paresthetica ••Muscle cramp ••Muscle strain ••Night leg cramps ••Osgood-Schlatter disease ••Osteoarthritis (disease causing the breakdown of joints) Possible diseases cevy4 •Osteochondritis dissecans ••Osteomyelitis (a bone infection) ••Paget's disease of bone ••Patellar tendinitis ••Patellofemoral pain syndrome ••Peripheral artery disease ••Peripheral neuropathy ••Posterior cruciate ligament injury ••Pseudogout •Psoriatic arthritis ••Reactive arthritis ••Rheumatoid arthritis (inflammatory joint disease) •• •Sacroiliitis ••Sciatica ••Septic arthritis ••Shin splints ••Spinal stenosis ••Sprains ••Stress fractures ••Tendinitis ••Thrombophlebitis (a blood clot that usually occurs in the leg) ••Torn meniscus ••Varicose veins Possible diseases cevy4 The problem arises from CNS to very periphery lBrain lMedulla lSpine lPeripheral nerves lvessels lLocomotory apparatus lTissues cevy4 Origin lLocomotory app. –Trauma, Inflammation, lCNS –Tumours, neuralgias lPeripheral nerves –Redicular et related. syndromes lTissues –Ischaemia, infection, lCardiac –Heart failure woth depressed Card.Output lMetabolic –Acidaemia, Ca, PTH, lVascular –Thrombosis, embolia, stenosis cevy4 Specialist involved lPsychiatrist lNeurologist lRheumatologist lAngiologist lOrthopedist lSurgeon lTraumatologist lPhysiotherapist cevy4 Výsledek obrázku pro pain The leading symptom - pain lSharp and hot - neuropathic lWell localised – somatic nerves affection lBlunt – inflammation, ischaemia lPulsating – innflammation, disecting aneurysm lCramps – hormonal and mineral disorders cevy4 Location lIn relation to visible affection cevy4 Irradiation lWithin neurodermatoma lAlong artery l cevy4 Výsledek obrázku pro duration Duration and time pattern l lAll the time lUpon strain lIn rest only lAfter some period of walking l cevy4 Accompanying symtpoms lSkin discoloration – paleness, lHypaesthesia/anaesthesia/paraesthesia lBack pain – neuropathic lFever lSwelling l cevy4 Examination methods lAnamnesis lPhysical examination lBlood chemistry and count lImaging methods – X-ray, US, CT, MRI, … lEMG Výsledek obrázku pro examination cevy4 Anamnesis lBoth family and personal lThrombosis, embolisation, Atrial fibrilation, Horminal contraception, thrombophilia, Tobacco abuse (passive too)… lDaily routines, occupational anamnesis, trauma l cevy4 Physical examination lColour lTemperature lSwelling lJoint pain, extent of movements, fluctuation, balottement lPulsations lSigns of DVT lNeurologic tests – Lassegue, irritation or depreciation lTreadmill test cevy4 Blood chemistry lDD, LD, myoglobine lCRP, Leu, ASLO, CIK, ANA lUric acid lABR, Ca, Mg. lCalcitonine, Parathormone cevy4 Imaging methods lUS lCTAg lMRI cevy4 Neurologic tests lEMG cevy4 Break or finish J J J