Thread by @joannamarco

T-5 days until rheum boards! 🙃 Today, let’s review MSK manifestations of endocrine disease. We’ve got it all: diabetes, hypothyroid, hyperthyroid, parathyroid...ready?
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Let’s start with diabetes. People with diabetes tend to produce more “advanced glycation end products,” which are metabolic byproducts that get deposited into tissues and make tissues thicker, stiffer, and weaker.

The worse the glycemic control, the more AGEs get deposited, and the worse the stiffness gets. This phenom is at the root of a LOT of diabetes MSK issues.

How does diabetes affect the hands?
1⃣Diabetic cheiroarthropathy: finger contractures+stiffening resulting in inability to press hands together. Classic “prayer sign.”
2⃣Carpal tunnel syndrome: happens in 20% of diabetic patients!

3⃣Flexor tenosynovitis: aching in the palms, +/- trigger nodules.
4⃣DeQuervain’s: also about 20% of diabetic patients
5⃣Dupuytren’s contractures

How does diabetes affect the feet? You guys already know about ulcers and neuropathy.
Charcot foot is a rare complication of DM that causes swelling and progressive, destructive deformity of the feet. XR look awful but pain is disproportionately low (possibly bc of neuropathy).

How does diabetes affect the joints?
1⃣Frozen shoulder/adhesive capsulitis
2⃣BCP periarthritis (commonly of shoulder as well)
3⃣General stiffness and decreased ROM

How does diabetes affect the muscles?
1⃣Diabetic amyotrophy: Gradual pain & weakness of thighs and hips (sometimes shoulders). CK normal, muscle biopsy w/atrophy only.
2⃣Diabetic muscle infarction: acute muscle pain & swelling. CK high. Ddx infection, malignancy, myositis.

On to the thyroid! What do we see in hypothyroid?
1⃣Fibromyalgia
2⃣CTS
3⃣Raynaud’s
4⃣Myositis mimic!🚨Prox muscle weakness and elevated CK. Muscle biopsy normal.
5⃣Myxedematous arthropathy: Swelling and stiffness, often of hands. Noninflammatory but super viscous synovial fluid.

How about hyperthryroid?
1⃣Osteoporosis
2⃣Painless proximal muscle weakness (not generally a myositis mimic since CK normal)
3⃣Thyroid acropachy: Hand swelling, clubbing, and periostitis on XR. Often woody, nodular skin changes as well. Case report w/pics:
ncbi.nlm.nih.gov/pmc/articles/P…

How about hyperPTH?
1⃣Chondrocalcinosis and pseudogout attacks
2⃣Proximal muscle weakness (normal CK, painless)
3⃣Osteoporosis

There's some unique XR findings in hyperPTH.
Osteitis fibrosa cystica is seen in late-stage hyperPTH. It’s a syndrome of excessive bone resorption and manifests as:
💠Blurry cortical borders
💠Finger tuft resorption
💠“Brown tumors” (cyst-like deossified areas, not actual tumors)

XR buzzwords for hyperPTH:
✨Salt and pepper skull✨
✨Rugger-jersey spine✨It’s from a pattern of bone resorption➡️reactive osteoid deposition that makes the spine look stripey.

Let’s check understanding with some MCQs! Which condition can cause muscle pain and weakness with an elevated CK?

Which condition can cause Raynaud’s?

Which condition causes a variety of hand stiffness/contracture syndromes?

Which condition causes multiple radiographic findings consistent with excessive bone resorption?

Hope you learned something! I’m having a blast making these tweetorials, so thanks everyone for the likes, comments, nice messages, and ideas for upcoming threads!