Bone and Joint Disorders Flashcards
What might you expect to see when examining a patient for a fracture?
Inability to bear weight Severe pain Swelling and point tenderness Deformity Scrapes and Abrasions Wound Loss of Movement Loss of sensation
What are the three principles of management for fracture management?
- Reduce
- Hold
- Rehabilitate
What does “rehabilitate” involve?
Weight bear, move and physio
What does “hold” involve?
Plaster, fixation / metal
What is the patient likely to have when a snapping sound is heard, and knee swells up immediately?
An anterior cruciate ligament tear
What is the role of the anterior cruciate ligament?
To prevent anterior / posterior knee replacement
What symptoms might patients with an ACL tear complain of?
Instability, redness, pain, swelling, lack of rotation, pop sensation
What are some physical examinations which can be used to determine whether or not an ACL has been torn?
Lachmann’s, Anterior Drawer, Pivot Shift
What are some short term management techniques for bone and joint injuries?
PRICE Protect Rest Ice Compress Elevate
What factors does the management of an ACL Rupture depend on?
Depends on factors to do with the patient like their age, physical activity status, whether they perform movements which requires the ACL
Why does the ACL not heal well?
It has poor vascularisation
What condition is the patient likely to have if they hear a loud snap at the back of their ankle, alongside a very sharp pain?
An injured achilles tendon
What are some examination findings which would be consistent with a ruptured achilles tendon?
Difficulty walking, unable to perform heel raises, thickening, tenderness
What would a patient with a ruptured achilles tendon expect to see when they dangle their feet off the end of the bed?
The foot it held in dorsiflexion
What are the four stages of tendon healing?
Inflammatory, Reparative, remodelling (consolidation and maturation)
What are some operation complications that may arise from a fuptured achilles tendon?
DVT Infection Prolonged immobility Neurovascular injury Tendon rerupture Ankle stiffness Pressure sores from plaster
What arethe differential diagnoses for groin pain?
Hip fracture Lumbar Radiculopathy Arthritis Hernia Infection Hip Labrum tear
What drugs increase the risk of osteoporosis?
Glucocorticoids
Anti-epileptic
Anti-coagulants (Heparin)
What lifestyle factors increase the risk of OP?
Excessive alcohol
Smoking
Physical Activity
Low Body Weight
Which endocrine disorders increase the risk of OP?
Hypogonadism Hyperthyroidism Cushings Disease Growth Hormone deficiency Hyperparathyroidism
Which other disorders increase the risk of OP?
Malnutrition
Anorexia
Chronic inflammatory bowel disease
What is one of the first signs of OP?
Kyphosis - stooped back
What characterises a stooped back?
weakening of bones
At what stage do women have an increased risk of OP?
After menopause as there is a lack of oestrogen
What affect does oestrogen have on bone loss?
It slows it down, and also improves the absorption and retention of calcium
What are some causes of OP?
Long term usage of corticosteroids Certain medications for inflammatory conditions Family History Low BMI Drinking and Smoking
Which scan is used to measure bone density?
DEXA scan
A T score of what indicates Osteopenia?
-1 to -2.5
A T score of what indicates Osteoporosis?
More than -2.5
What is osteopenia?
Pre-osteoporosis
What is the first-line treatment for OP?
Bisphosphonates
Why do bisphosphonates work as an anti-OP drug?
They prevent bone reabsorption by stopping osteoclasts from working
What hormone can patients with OP be given?
Parathyroid hormone as it stops bone thinning
What are SERMs?
Selective Oestrogen Receptor Modulators - have similar effects to oestrogen by helping to maintain bone density
What characterises Osteomalacia?
Inadequate mineralisation of the bone, causing the bone to soften
What causes osteomalacia?
Vitamin D deficiency
What can cause vitamin D levels to be low?
Insufficient dietary intake, faulty vitamin D metabolism, renal tubular acidosis, malnutrition
How can osteomalacia be diagnosed?
Very low vitamin D levels, alongside psuedofractures and protrusion acetabula on radiographic images
How can you treat nutritional osteomalacia?
increased dietary intake
Increase outdoor time
supplementation of vitamin
What are the two inflammatory markers which are commonly tested for?
C Reactive Protein
ESR - Erythrocyte sedimentation Rate
Which bacterial hip infection can be treated with antibiotics before having to be washed out?
Neisseria gonorrhoeae
What is meant by aspiration of a joint?
Using a needle to remove the pus within a joint, in order to remove the infection from it
What is osteomyelitis?
Infection of the bone
what are the three categories of possible causes of a limping child?
Inflammation, infection, trauma
What are the common hip conditions which a 10-16 year old patient might present with?
Slipped femoral epiphysis
Avulsion fractures
Osteomyelitis
What are the common hip conditions which a 4-10 year old patient might present with?
Transient Synovitis
Osteomyelitis / septic arthritis
At what age is transient synovitis common?
up to 10 years of age
What conditions might patients under the age of 4 suffer from?
Juvenile idiopathic arthritis
Non-accidental injury
Transient Synovitis
Osteomyelitis
What is transient synovitis?
an inflammation in the hip joint that causes pain, limp and sometimes refusal to bear weight
What are the Kocher Criteria for Septic Arthritis?
- Must be non-weight bearing
- Fever
- High ESR
- High White Blood Cell Count
Between septic arthritis and transient synovitis, which should be treated with antibiotics and aspiration?
Septic arthritis
What is the treatment for transient synovitis?
Rest and Observation
Keep patient under close observation
Pain killers for pain
What is the treatment for septic arthritis?
Multiples aspirations and irrigations, culture pus sample and the give narrow spectrum antibiotics
What are the cardinal signs of inflammation?
Swelling, redness, heat, painful
How does a bacterial infection change the colour the fluid in a joint?
Colour - more cloudy, darker
How does a bacterial infection change the consistency of the fluid in a joint?
Increase viscosity, large volumes of effusions from swellings
How will changes in the joint fluid following infections be reflected in blood tests
Raised inflammatory markers - White celL count, ESR, CRP
What are the three different routes bacteria can use to spread?
Inoculation, blood, from bone
What is the treatment for an infected joint?
Aspirate Culture Antibiotics If confirmed infection - washout with keyhole arthroscopy Continue antibiotics
