anatomy 136 \200\2239 differential diagnosis of pain 140 frozen 141 \200\2232 instability 1 42 Milwaukee 392 nerve disorders 143 \200\2234 osteoarthritis 142 \200\2233 rheumatoid 143 symmetry of movement 8 shoulder girdle 138, 140 \200\2234 (SACLE) 98, 244 subaxial subluxation 125 subclavius 138 subcutaneous calcaneal bursitis 192 subscapularis 138 subtalar joint injections 114 sulfasalazine 84, 538 \200\2239 supinator 147 suppurative tenosynovitis 459 \200\22360 suprascapular nerve rheumatoid cutaneous vasculitis 98 rheumatoid factor 21, 40 rheumatoid factor (RF) negative polyarticular injections 108 \200\2239 \200\230shrinking lung \200\231 syndrome 55, 61 sickle cell disease 508 \200\2239 sinus ta chycardia 71 sinus tarsi syndrome 191 Sj gren \200\231s syndrome (SS) 254 \200\22362 juvenile idiopathic arthritis 352, 359 rheumatoid factor (RF) positive polyarticular juveni le idiopathic arthritis 352, 360 rheumatoid nodules 56, 98, 199 rheumatology questionnaire tools 4 rhomboid minor/major 138 rhupus 308 rickets 422 \200\2235 right heart catheterization 60, 61 rituximab 84, 568 \200 \22375 rocker bottom foot 494 Rodnan skin score 271 Roos maneuver 161 chest disease 54 eye problems 48, 257 gastrointestinal disease 82 heart disease 66 nervous system 93, 95 pregnancy 367 skin disease 100, 257 skin 16, 20 \200\2231, 85, 98 \200\223103 block 116 injury 144 supraspinatus 138 Sweet \200\231s syndrome 101 Sydenham \200\231s chorea 462 symmetry 8 \200\2239 INDEX 583 thoracic outlet syndrome 161 \200\2232 thoracic spine 119, 122, 128 \200\2239 thromboangiit is obliterans (TAO) 348 \200\2239 thromboembolic disease 57 thumb carpometacarpal joint 152 vasculitis 313 \200\22349 chest disease 54 classi \201 cation 314, 315 clinical features 3 14 \200\22315 cutaneous 100 HIV 470 liver 84 pregnancy 367 \200\2238 primary central nervou s system symptoms emphasis 5 multiple 3 non \200\223musculoskeletal 4 \200\2235 patterns 3, 6 \200\2237 synov ial biopsy 17 synovial chondromatosis 16 synovial \202 uid analysis 42 \200\2233 synovial osteochondromatosis 526 synovial plica syndrome 179 synovitis 14 MTPJ 194 ultrasound 26 vi llonodular 527 injections 111 tibia periostitis 189 stress fracture 188 tibiofemoral joint 174 tibio \201 bular joints 184 Tin nel \200\231s test 12 TNF-receptor-associated periodic syndrome (PCNSV) 336 \200\2237 retinal 49, 52 rheumatoid cutaneous 98 small intestine 83, 88 (TRAPS) 101, 503, 504 ventilation-perfusion (V/Q) scan 36 \200\2237, 60 verbose patients 5 vertebra 118 \200\2231 9 tocilizumab 568 \200\22375 tonometry 51 tophi 16, 384, 385 topical rubs 481 torticollis 126 \200\2237 total lung capacity 58, 59 toxic myopathies 292 \200\2233 toxic oil syndrome 520 \200\2231 Toxoplasma gondii 19 tracheomalacia 55, 62 transbronchial biopsy 60 transcutaneo us electrical nerve stimulation systemic lupus erythematosus (SLE) 240 \200\22352 chest disease 54, 61, 62, 245 drug-related 20, 241, 248 \200\2239 eye problems 48, 49 gastr ointestinal disease 82, 245 heart disease 66, 67, 71, 244, 245, 250, 251 kidney disease 74, 244, 249, 251 nervous system 92, 93, 95, 244 \200\2235, 249 pregnancy 67, 250, 366 \200 \2237 fractures 397, 399 osteomyelitis 454 \200\2235 vertebroplasty 402 villonodular synovitis 527 viral arthritis 468 \200\22371 viral myocardi tis 71 viral myositis 460 visual perimetry 92 vitamin D 398, 422, 423 systemic onset juvenile idiopathic arthritis 352, 362 \200\2233 systemic sclerosis (SSc) 264 \200\22372 (TENS) 481 chest disease 54, 57, 61, 62, 267 eye problems 48 astrointestinal disease 82, 266 \200\2237 heart disease 66, 67, 267 nervous system 93, 95 pregnancy 367 sclerodermal renal crisis 26 7 sine scleroderma 264 skin disease 99 \200\223100, 266 W Wadsworth test 161 walking 166 Weber \200\223Christian disease 514 Wegener \200\231s gran ulomatosis (WG) 324 \200\2235 trapezius 138 TRAPS 101, 503, 504 traumatic bursitis 149 Trendelenberg gait 9 triamcinolone injections 107 triangular \201 brocartilage (TFCC) 152 tricalcium phosphate crystals 392 triceps 146 tendinitis 149 trichinosis 461, 477 trigger \201 nger 112, 159 trochanteric bursitis 112, 168 tryptophan 520 tuberculosis 472 \200\2233 tubulointerstitial nephritis (T IN) 78 \200\2239 tumors eye problems 48 gastrointestinal disease 82 heart disease 66 nervous system 93, 94 pregnanc y 368 treatment 330 \200\2231 T T-spot assay 58 \200\2239 Taenia solium 461 Takayasu arteritis 66, 93, 95, 322 \200\2233, 368 talus, osteochondral lesion 191 tarsal tunnel syndrome 191 Tarui \200\231s disease 522 \200\2233 technetium scan 36 \200\2237 temporal artery biopsy 318 temporomandibular joint (TMJ) arthritis 87 tendinitis whiplash 125 Whipple \200\231s disease 82, 83, 84 WHO pain ladder 481 widespread pain 18 \200\22322 Wilson \200\231s disease 83, 89 WOMAC 4 wrist bone 528 \200\2239 cervical spine 126 osteomalacia induction 425 anatomy 152 \200\2236 fractures 397 ganglion 162 injections 110 \200\22312 main causes of p ain 158 regional musculoskeletal conditions 158 \200\22362 soft tissue lesions 162 Wucherer ia bancrofti 476 U ulcerative colitis 83 ulnar nerve 147, 155 \200\2236 compression 161 ultrasound 16, 26 \200\2238 undifferentiated arthritis 352 undifferentiated (autoimmune) connective bicipital 143, 149 pelvis 171 peroneal 191 rotator cuff 141 triceps 149 tendon tears 26 ten nis elbow, see lateral epicondylitis tenosynovitis X X-linked hypophosphataemia (XLH) 424 xerostomia 85, 87, 257 tissue disease (UAICTD/UCTD) 306, 309 hand and wrist 158 \200\2239 infectious/suppurative 459 \200\22360 ultrasound 26 \200\2237 urogenital reactive arthritis 226 usual interstitial pneumonia (UIP) 56 uveitis 15, 48, 49, 51 TENS 481 teres major/minor 138 tetrahydrocannabinol 481 Thessaly test 180 thiopurine methyl transferase (TPMT) V valvular disease 66, 67, 68, 70, 71 Van Buchem disease 434 vascular malformations 27 genotype 248 This page intentionally left blank Plate 1 The \201 ve functional \200\230joints \200\231 of the shoulder. Involved in arm elevation: depression, giide, rotation and elevation at glenohumeral joint (A); rotation of clavicle with rotational shear at sternoclavicular (B) and acromioclavicular (C) joints, t ranslation of humeral head under coraco-acromial arch (D) and rotation of scapula (E) on th oracic wall. (a) (b) Plate 2 McMurray \200\231s test. Rotation of lower leg while \202 exing at the knee. The test aims to elicit an audible and/or palpable clunk as the damaged meniscus edge obstructs free femoral condylar rotation and \202 exion on the tibial plateau. Plate 3 Anterior draw test. Having \202 exed the patient \200\231s knee and immobilized t he foot, the examiner draws the tibia forward in the plane of upper leg. Excessive anterior translation of the lower leg can denote anterior cruciate de \201 ciency (important to co mpare with opposite leg). Plate 4 Aggressive left achilles \200\231 tendon enthesitis in ankylosing spondylitis (left ). Plate 5 Digital vasospasm in a patient with Raynaud \200\231s Phenomenon (RP). Plate 8 Heliotrope rash in a patient with dermatomyositis. Plate 9 Nailfold capi \202 aroscopy in systemic sclerosis. There is variable size of capil lary loops; the larger ones (patent and dilated).compensating for ischaemia from narrowed o nes. Plate 6 Metacarpophaiangeal joint synovitis in SLE. Plate 7 Gottron \200\231s papules in dermatomyositis. Plate 13 Calcinosis of the skin in systemic sclerosis (note also \201 nger pulp loss). Plate 10 Keratoderma blenorrhagicum in acute reactive arthritis. Macroscopically and histol ogically some investigators maintain the rash is very similar to psoriasis. Plate 14 Vasomotorand skin changes in early chronic regional pain syndrome (R hand). Plate 11 Telangiectasias in systemic sclerosis. (a) (b) Plate 12 (a) Malar rash in SLE (Afro-Caribbean). (b) Malar rash in SLE (Caucasian). Plate 15 Nasal deformity in Wegener \200\231s granulomatosis. Plate 17 Lobe-sparing chondritis of the ear (relapsing polychondritis). Plate 16 Vasculitic skin rash in Wegener \200\231s granulomatosis. Plate 18 Hypermobility of thumb adduction in Marfan Syndrome. Plate 21 Dactylitis of 3rd toe in juvenile spondylarthropathy (ERA). Plate 19 Gout tophus. Plate 22 Ankylosed sacroiliac joint in ankylosing spondylitis. Plate 20 JIA. Left 2nd toe reduced growth due to persistent MTPJ arthritis (note also splay ing between base of 1st and 2nd toes on the left from underlying MTPJ synovitis). Plate 23 Aspiration of \202 uid from the knee (lateral approach). Plate 27 Haematoxylin and eosin stained low power section of synovium encroaching over hyal ine (articular) cartilage in rheumatoid arthritis. The synovium (upper left) contains numer ous lymphocates, macrophages, \201 broblasts and plasma cells. Plate 24 DXA of the lumbar spine. L4 will be omitted from the analysis (Paget \200\231s Dis ease of Bone). Plate 28 Plantar fasciitis in a patient with HLA B27-positive spondylarthropathy. Patchy lu cent-sclerotic appearance at antero- inferior os calcis edge (site of origin of plantar fas cia). Plate 25 Rheumatoid factors (RFs). In conventional assays only IgM anti-fgG RFs are detecte d/measured; however, IgG, IgA and mixed RFs also exist. Plate 26 Metaphysis of femur in child with osteogenesis imperfecta (Type I). Sclerotic band s represent courses of intravenous bisphosphonate. Plate 29 DXA scan. Whole spine lateral images allow an interpretation of vertebral fracture s to be made (vertebral fracture analysis [VFA]). Images are dervied with a fraction of the radiation exposure imparted by conventional spinal X-Ray analysis. Plate 33 CT scan showing scaral unsuf \201 ciency fracture (arrowed). Plate 30 Osteomalacia (Goldner s Trichome). The bone surfaces are covered by large areas of unmineralized osteoid (brown). Plate 31 Osteoporosis in trabecular bone. There is a reduced number of bone trabeculae and trabecular connectivity compared with normal. Plate 32 18FDG Positron Emission Tomography (PET) and CT scan in giant cell arteritis (GCA) . Left: coronal section CT; Middle left: contiguous section 18FDG PET showing abnormal trac er accumulating in descending aorta; Middle right: Contiguous CT and PET sections registere d (superimposed); Right: (PET scan) image shows additional activity in carotid, and subclav ian arteries. Plate 34 Changes in the cerviical spine in ankylosing spondylitis. Single marginal syndesmo phyte in early disease (left, arrowed); more extensive marginal syndesmophytes in advanced disease (right). Plate 36 Class IV lupus nephritis immuno \202 uorescene demonstrating deposition of IgG, I gM, IgA and C3, the so-called "full house" appearance. Plate 35 Class IV lupus nephritis demonstrating segmental necrosis and endocapillary prolif eration.