bone and cartilage disorders: oa, Paget's, AVN, Flashcards
a. Osteoarthritis - primary and secondary osteoarthritis, chondromalacia patellae b. Metabolic bone disease: osteoporosis, osteomalacia, bone disease related to renal disease c. Paget’s disease of bone d. Avascular necrosis of bone: idiopathic, secondary causes, osteochondritis dissecans e. Others: transient osteoporosis, hypertrophic osteoarthropathy, diffuse idiopathic skeletal hyperostosis, insufficiency fractures
What diseases cause arthritis?
Likely causes include: rheumatoid arthritiis, gout, Crohn’s disease, ulcerative colitis, Lyme disease, psoriatic arthritis, Reiters syndrome, ankylosis spondylitis, Systemic lupus erythematosus, reactive arthritis, acute serum sickness. Less common causes include sarcoidosis, spondyloarthritis, gonococcal arthritis, viral arthritis-parvovirus b19, post traumatic arthritis, Intraarticular hemorrhage, loose body, torn meniscus, post traumatic arthritis, and osteochondritis. Degenerative joint disease, and degenerative disc disease are more likely to cause pain and noninflammatory swelling.
What are the red flags indicating the need for further evaluation in cases of backache of recent onset?
Red flags indicating possible definite cause for backache include: trauma, unexplained weight loss, age over 50 especially if osteoporotic, unexplained fever, history of urinary tract or other infections, immunosuppression, diabetes mellitus, history of cancer, intravenous drug abuse, long use of corticosteroids, age greater than 70, focal neurologic deficit, progressive or disabling symptoms, associated bowel or bladder dysfunction, duration longer than six weeks, and prior spinal surgery.
What commonly causes bilateral knee pain in an adolescent with normal x-rays?
Billateral anterior knee pain is a descriptive diagnosis for a condition formally called chondromalacia patella. The descriptive term is more honest as chondromalacia is difficult to demonstrate as a specific cause of knee pain and is often asymptomatic. Bilateral anterior knee pain seems to occur in late adolescence during vigorous physical activity and then subsides over years. It is not a precursor to osteoarthritis or rheumatoid arthritis. Mechanical irritation in the soft tissues guiding the quadriceps/patellar tendon from overuse and/or poor biomechanical stress tolerance is the probable cause.
What is the relationship between spinal pain and degenerative disc disease
Spinal pain and degenerative this disease are both very common but not tightly connected given that radiographic disk changes persist and gradually worsen whereas most spinal pain is intermittent. Nevertheless, disc disease probably makes the spine more susceptible to minor trauma/stress which generally is the proximal cause of spinal pain. Radicular pain suggests nerve pressure however discogenic pain can also radiate.
What is the natural course of enthesitis?
Enthesitis refers to the condition where in the site of muscle/tendon and bone attachment becomes painful related to repetitive excessive tension. The term implies inflammation however pathologically there is minimal change so that the precise pain generator is undefined. Probably prostaglandins, cytokines, from either the periosteum or muscle participate in the process. Most instances probably spontaneously resolve however a vicious cycle of damage followed by insufficient healing can lead to persistent pain lasting maybe priorhs, or years in duration. Enthesitis associated with spondyloarthropathy may require anti-TNF agents to stop the progression.
What is the average degree of osteoarthritis by age and severity expected during the examination of healthy adults?
60% of the population has radiographic evidence of osteoarthritis by age 65 of which 60% are symptomatic. The joints most commonly affected by osteoarthritis include the cervical and lumbar spine, first carpel metacarpal joint, proximal interphalangeal joint, distal interphalangeal joint, hip, knee, subtalar joint, first metacarpophalangeal joint. Severity is judged on the degree of joint space narrowing, subchondral sclerosis, marginal osteophytosis, and subchondral cysts.
What are the symptoms of fluoroquinolone induced musculoskeletal toxicity?
Side effects include cardiac arrhythmias, aggravation of muscle weakness, tendon rupture, and myositis. Symptoms of tendinopathy can appear from 2 hours to 6 months after fluoroquinolone ingestion. Achilles tendinitis is the most common form, but common extensor origin the lateral elbow, subscapularis, biceps brachii, brachioradialis, adductor longus, quadriceps, and patellar tendons are at risk.
What are the usual causes of avascular necrosis?
the usual causes of aseptc necrosis, osteonecrosis, avascular necrosis include posttraumatic, steroid induced, caisson disease, systemic lupus erythematosus, antiphospholipid syndrome, sickle cell anemia, alcoholism, chronic renal failure, pancreatitis, hyperlipidemia, radiation, intravascular coagulation.
Apoptosis and ischemic necrosis account for the death of osteocytes.
What physical signs indicate severe shoulder osteoarthritis?
Severely restricted motion is indicated by:
The Apley scratch test compares the ability to reach backwards along the spine as high as possible. Right and left sides are compared.
Shoulder crepitation is best felt while lifting the arm against resistance or while the arm is lowered.
decreased elevation during performance of the touchdown sign.
What is the initial treatment of shoulder osteoarthritis?
Shoulder osteoarthritis initially is treated with NSAIDs and rest-avoiding pushing pulling, heavy work, and overhead reaching. The anterior shoulder should be heated for 10 to 15 minutes then weighted (5-10 pounds) pendulum exercises performed for five minutes.
This program should help within three weeks, At which point NSAID can be switch to acetaminophen.
What is the management following steroid injection for shoulder osteoarthritis?
Intra-articular steroids are indicated should pain persist and followed by restricted motion for one month, pendulum stretch exercises after four days, then passive stretching-abduction, elevation up a wall, and towel behind the back-20 repetitions each position daily. After some improvement, rotator cuff toning exercises should be done to restore muscle strength.
What is the indication for intra-articular steroid shoulder injection?
Intra-articular steroids are indicated should pain persist and followed by restricted motion for one month, pendulum stretch exercises after four days, then passive stretching-abduction, elevation up a wall, and towel behind the back-20 repetitions each position daily. After some improvement, rotator cuff toning exercises should be done to restore muscle strength.
What is the conservative treatment for acute flare of shoulder osteoarthritis?
Shoulder osteoarthritis initially is treated with NSAIDs and rest-avoiding pushing pulling, heavy work, and overhead reaching. The anterior shoulder should be heated for 10 to 15 minutes then weighted (5-10 pounds) pendulum exercises performed for five minutes.
How might cyanotic heart disease and pulmonary AV shunts cause hypertrophic pulmonary osteoarthropathy?
Hypertrophic pulmonary osteoarthropathy occurs in about 30% of patients with cyanotic congenital heart disease and may present in middle age.
Both platelet derived growth factor and vascular endothelial growth factor are destroyed in the lungs that are capable of affecting bone formation.
What are the radiological features of diffuse idiopathic skeletal hyperostosis?
Diffuse idiopathic skeletal hyperostosis is characterized by exuberant osteophyte formation with flowing ossification that span at least four continuous vertebral bodies. Disc spaces are preserved as are sacroiliac and apophyseal joints. There may also be extra spinal involvement with hyperostosis about the olecranon, patella, calcaneus, shoulder, and acetabulum.
