Arthritic conditions Flashcards
1
Q
Define pseudogout?
A
- A metabolic disease resulting from desposition of CALCIUM PYROPHOSPHATE DIHDRATE (CPPD) crystals within the joint space
- Characterised by recurrent monoarticular arthritis
2
Q
What is the epidemiology of pseudogout?
A
- Commonly affects the elderly
- rarely affects the young
3
Q
Name associated conditions?
A
- Haemochromatosis
- Hyperparathyroidism
- SLE
- Gout
- RA
- Wilson’s disease
- Haemophilia
- Long term haemodialysis
- Chondrocalcinosis present in 7%
4
Q
How is it different form gout?
A
- Affects older patient >60 yrs
- Affects more proximal joints
- weakly Positive befringement crystals
5
Q
Describe the symptoms and signs?
A
Symptoms
- Acute onset joint tenderness
- warm , erythermatous joint
- Commonly on knee and wrist joint
Signs
- Erythermatous, monoarticular arthritis
- Joint tenderness to palpation
- May observe superficial mineral deposits under skin at affected joints
6
Q
What is seen on xrays?
A
- Chondrocalcinosis- calcification of fibroartilage structures
- TFCC in wrist
- Mensicus in knee
7
Q
How is pseudogout dx?
A
- Weakly POSTIVE BIFEFRINGENT RHOMBOID shaped crystals
8
Q
What is the tx of acute gout?
A
- Acute
- NSAIDS
- Splints for comfort
- Chronic
- Non operative
- Intra-articular yttrium-90 injection
-
cochicine- 0.6mg PO for recurrent cases
- prophylatic cochicine can help to prevent recurrence
9
Q
Complications of pseudogout?
A
- Can result in permanent damage to joints and renal disease
NB PSEUDO GOUT “P” for
- postive birefringent rhombpid crystals
- calcium Pyrophosphate dihydrate
10
Q
What is the epidemiology of ankle arthritis?
Describe the pathophysiology of ankle arthritis?
A
- Less common than OA of knee/hip
-
Post traumatic arthritis
- Greater than 2/3 ankle arthritis
- Primary OA- Less than 10%
- RA
- Osteonecrosis
- Septic arthritis
- Gout
11
Q
What is the pathoanatomy of ankle arthritis?
A
- Nonanatomic fracture healing alters the joint reaction forces of the ankle and changes the load bearing mechanics of the ankle joint
- Loss of cartilage on the talus and tibial plafound-> joint space naarowing, sunchondral sclerosis and Eburnation
12
Q
Decribe the anatomy of the ankle joint?
A
- Ginglymus joint- HINGE
- Talar dome is biconcave with a central sulcus
- Dorsiflexion 20o
- Plantarflexion 50o
13
Q
What are the signs and symptoms of ankle arthritis?
A
Symptoms
- Pain on weight bearing
- Reduction in motion
Signs
- Joint effusion
- reduced ROM cf contralateral side
- Angular deformity if hx of trauma
14
Q
What investigations are useful?
A
Radiographs
- AP standing, lateral standing, oblique
- Loss of joint space, subchondrial sclerosis, Eburnation, possible angular deformity
15
Q
What is the tx for ankle arthritis?
A
- Nonoperative
- activity modification, bracing to immobilise ankle,NSAIDS
- single rocker can improve things
- Surgery
-
Debridement with anterior tibial/dortsal talectomy
- Mild disease/ pai onpush off
- Distraction arthroplasty
-
Supramalleolar osteotomy
- medial focused ankle pain
-
Arthrodesis
- eldery less active patient
-
Arthroplasty
- Post-traumatic/ inflammatory arthritis/ eldery pt
- Pt selection is key
16
Q
What are the Ci for ankle arthroplasty
A
- Uncorrectable deformity
- Severe osteporosis
- talus ostenecrosis
- Charot joint
- ankle instablity
- obesity
- Young labourer
- Increased reisk of failure and revision
17
Q
What are the outcomes and complcations of ankle arthrodesis?
A
- Outcome- relief in pain and return to ADL
- Complications
- by 10 yrs - 50% subtalar arthritis
-
Non union
- RF= Smoking
- Adjacent joint fusion
- Hx of failed arthrodesis
- Avascular necrosis
18
Q
What are the outomes and complications of ankle arthroplasty?
A
- Recent 5-10 yr fu showed 90% good- excellent results
- Long term studies results still pending
- complications
- syndesmosis nonunion
- Wound infection
- Deep infection
- Osteolysis
19
Q
How wpud you tx metatarsal prominence-> ulcers?
A
20
Q
Double Rocker
A
21
Q
What is the consx tx of toe tip ulceration?
A
Severe angled rocker
22
Q
What consx tx is available for fixed angle dorsiflexion deformities?
A
Negative heel rocker
23
Q
Define midfoot arthritis?
A
Arthritis in
- Naviculocuneiform
- Intercuneiform
- Metatarsal cuneiform
24
Q
What is the aetiology of midfoot arthritis?
A
- Idiopathic- primary osteoarthritis
- Posttraumatic
- Inflammatory
25
What is the pathology of midfoot arthritis?
* Large forces seen by joints that have limited motion
* Soft tissues that support joints abnormally high forces over time
* Results in midfoot collapse
26
What are the symptoms and signs of midfoot arthritis?
Symptoms
* Midfoot pain adn in arch with push off
Signs
* Longitudinal arch collapse- Meary's angle normally =O- but in this negative with collapse
* **Midfoot collapse-** Looks like PTTI
* **Forefoot abduction**
* Hindfoot valgus
* Equinnus contracture of achilles tendon
* Halux valgus
* palpation of arch/midfoot-\> pain
27
What do you see on xrays of midfoot arthritis?
* Lateral- loss of co-linerity between talus and 1st MT= Meary's line
* Apex of deformity is at level of midfoot
* may shows collapse of **LONGITUDINAL ARCH**
* AP
* Arthritic signs in midfoot
* **Abduction of forefoot**
28
What is the ddx of this
* Post tibial tendon insufficiency
* Midfoot arthritis
* Post traumatic LIs- Franc injury
* Lateral ankle instability
29
What is the TX of midfoot arthritis?
* Non operative
* **NSAIDS, Activity modification, orthotic/bracing**
* first line tx
* **steriods injections** under radiographic guidance
* orthotics
* cushioned heel
* longitudinal arch supports
* stiff sole with rocker bottom
* Operative
* **MIDFOOT ARTHRODESIS +/- TAL +/- HINDFOOT REALIGNMENT**
* failure of non op tx
* Outcomes= midfoot joints are non essential joints
* arthrodesis results in close to normal foot function
* Achilles tendon lengthening/ hindfoot relaignment
* may need to be done concomitantly
30
Decribe the technique of midfoot arhrodesis?
* Realignment arthrodesis
* **Fusion of 1st RAY via the TARSO-METATARSAL joint**
* **Fusion of the 2/3rd rays via the NAVICULOCUNEIFORM/INTERCUNEIFROM joint**
* _Don't fuse 4/5 TMT joints_
* lateral ray facilitates foot accomdation during stance
* Interpositional arthroplasties of 4/5 Tarsometatarsal joints
* for select cases
* will maintain length of lateral column
* can assist with gait accomodation
* can use screws. staples and plates for midfoot fusions
31
What is the cause of tibiotalar impingment?
* **Osteophyte** impingment in **anterior tibiotalar joint**
* **Excessive anterolateral soft tissues** or **posterior soft tissue** or osseous abnormalities
32
What is the epidemiology of tibiotalar impingment?
* Common in athletes who play on turf or on grass including
* Rugby
* football
* dancers
33
What is the mechanism of tibiotalar impingment?
* **Repetitive overuse injuries**
* **Trauma**
* **Degenerative sequlae**
34
What are the symptoms and signs of tibiotalar impingment?
* Symptoms
* Pain in anterior ankle
* Signs
* **Pain with forced dorsiflexion**
* **limited dorsiflexion**
* Soft tissue swelling and effusion may be evident
* _subtalar joint is pain free_
35
What imaging is useful in tibiotalar impingment?
* xrays
* Ap, lateral standing and oblique
* spurs seen anterior disatl tibia or dorsal aspect of talus
* CT
* delinates extent of bony osteophytes
* MRI
* Shows spurring and fluid in joint
36
What is the tx of talotibial impingement?
* Non operative
* **Therapy, lifestyle modficiations, NSAIDS**
* first line tx
* Operative
* **Arthroscopic excision**
37
What are the complications of ankle arthroscopy?
* **Superifical peroneal** nerve injury to **anterolateral** portal creation
* **Saphenous vein** injury during **anteromedial** portal creation
* **Dorsal neurovascular bundle** during tibiotalar spur removal
