sheath surrounding the tendon. Either condition may be the result of trauma, and it is manifested by pain and swelling in the inflamed area.
TREATMENT—Immobilize the area and apply moist heat. Administer analgesics for pain. Anti-inflammatory drugs are indicated. Chronic cases should be referred for more definitive therapy. Arthritis This is an inflammatory process of the joints that can be broken down into the following categories. These specific types are the most commonly encountered.
Rheumatoid—A progressive and debilitating inflammation of one or more joints (usually multiple) that affects women more often than men. The onset may be abrupt or gradual, and although more commonly found in the proximal interphalangeal joints, it may occur in any joint. The primary symptoms are pain and swelling in affected joints with stiffness upon arising from sleep. Afternoon fatigue and thickening of the synovial sheath are common, and there may or may not be some deformity.
Rheumatic—A self-limiting inflammation of the large hinge joints (usually singular) that is most often preceded by a history of streptococcal infection.
Degenerative—Osteoarthritis results from the destruction of the hyaline cartilage. The specific cause is unknown; however, trauma, obesity, and age are predisposing factors. Degenerative arthritis most often occurs at middle age and older and is more common in women than men. The spine and stress joints are most often affected. Muscle spasms, pain, swelling, and deformity are associated symptoms.
TREATMENT—The treatment consists of rest (complete bed rest in severe episodes), proper diet, analgesics, and anti-inflammatory drugs. Aspirin, for those who can tolerate it, is the drug of choice since it possesses both analgesic and anti-inflammatory properties and is relatively safe. Moist heat, reduction of weight (specifically in degenerative arthritis) and corticosteroid injections may be indicated. Evacuate the patient for evaluation.
Gouty Arthritis
This is a form of arthritis primarily affecting the great toe, ankles, and thumbs. It is caused by collections of urate crystals in the tissues and may be chronic.
SYMPTOMS—Deformities, redness, pain, and swelling of tissues around the joints are common. Often this disease resembles cellulitis.
TREATMENT—Indocin® is indicated for acute attacks. Corticosteroids are contraindicated. Recurrent attacks may be prevented by using Zyloprim®. Moist heat and analgesics are indicated for symptomatic treatment.
Gonococcal Arthritis
This acute arthritis results from systemic infection with gonococcus. It usually occurs in the large hinge joints.
SYMPTOMS—Redness, swelling, severe pain, fever, and limitation of movement and markedly increased pain upon movement are common.
TREATMENT—Treatment is aimed at preventing destruction of the affected joints. This destruction occurs in a relatively short period. Penicillin or other antibiotic therapy is definitive. Other treatment is symptomatic.
In all cases of severe or chronic arthritis, refer the patient to a rheumatologist for further evaluation.
DISORDERS OF THE EAR, NOSE, AND THROAT
The following are some of the more common disorders of the ear, nose, and throat that you will encounter when conducting sick call:
Conditions of the Ear
Hearing Loss
Loss of hearing may result from trauma, tumors, infections, impacted cerumen, excessive noise, or as a result of a degenerative nerve process.
SYMPTOMS—Tinnitus, decreased hearing ability, and in some cases, pain are common.
