Aquifer Case 11: Osteoarthritis Flashcards
what do you do during pre-op prep?
RISK STRATIFICATION
1. CBC to check Hb and CMP electrolytes
- cardiac risk factors like MI, what’s their EF, do EKG
- pulmonary conditions like COPD, smokers (quit 8 weeks before), sleep apnea, GERD,
- limit bleeding risks like aspirin use or liver disease
what is the differential for knee pain?
- patellofemoral pain syndrome
- iliotibial band tendonitis
- ACL train
- MCL sprain
- LCL sprain
- meniscal tear
- septic arthritis
- osteoarthritis
- gout/pseudogout
- popiteal (Baker) cyst
1
which NSAID is the best for osteoarthritis pain?
diclofenac
followed by naproxen
what does an abnormal varus stress test tell you?
rupture of the lateral collateral ligament
valgus stress test assesses the medial collateral ligament
what does the McMurray test assess?
the medial and lateral menisci
The clinician holds the patient’s heel with one hand and grasps the knee over the medial and lateral joint lines with the other hand. The patient’s knee is flexed as much as possible. The tibia is rotated either internally (tests lateral meniscus) or externally (tests medial meniscus) as the knee is extended to about 90 degrees. A varus stress (lateral meniscus) or valgus stress (medial meniscus) is applied across the knee joint while the knee is being extended. The test is positive if a clunk or click is felt, or if testing causes reproducible knee pain.
what does the Lachman test assess?
stability of the ACL
test is performed with the patient lying supine with the injured knee raised and slightly flexed to 30 degrees
distal femur is stabilized by the clinician with one hand, while the proximal tibia is held by the other hand then force is applied to move the tibia anteriorly
the test is considered positive if there is excessive motion of the tibia.
what is the Thessaly test?
assess medial and lateral menisci
the patient stands flat-footed on the affected leg, with the knee at 20 degrees flexion, while holding the clinician’s hands for stability. The other knee should be flexed to avoid contact with the floor. The patient internally and externally rotates the knee three times. Pain at the medial or lateral joint line is considered a positive test.
what are some options to treat osteoarthritis?
- exercise (land or water based)
- acetaminophen (DOC over NSAIDs)
- NSAIDs
- intra-articular corticosteroid injections
- acupuncture
- glucosamine and chondroitin
- tramadol
if pain becomes uncontrollable refer to orthopedic surgeon for knee replacement
how useful are tines and Phalens for carpal tunnel?
somewhat useful with lower sensitivities and higher specificities
what is a side effect of tramadol?
lowers the seizure threshold in patients with epilepsy
serotonin syndrome
respiratory depression
angioedema
bronchospasm
dependency
which drug interaction is contraindicated while on NSAIDs?
warfarin
