Bone and Joint Disorders Flashcards
What are the possible causes of groin pain
Groin strain Lumbar radiculopathy Early arthritis Kidney stone Hip arthritis Inguinal hernia- can you see a lump Hip labrum tear Hip fracture - is there a deformity of the lower limb making it short and externally rotates Osteoarthritis Nerve impingement - any change in sensation
What factors increases risk of osteoporosis
Age Female Previous low energy fracture Smoking Diet Excessive alcohol use Emotional stress Medications Genetics Environmental toxins Inflammation oxidation
Life style factors affecting risk of OP
Excess alcohol
Smoking
Physical inactivity
Low body weight
Drugs increasing risk of OP
Glucocorticoids
Antiepileptic
Anticoagulant ( heparin)
Endocrine diseases
Hypogonadism Hyperthyroidism Cushings disease Growth hormone deficiency Hyperparathyroidism
Medical disorders ;
Malnutrition of malabsorption Anorexia nervosa Inflammatory intestinal disease Intestinal resection Chronic inflammatory disease ( RA) Transplant patients ( solid organs and bone marrow) Systemic mastocytosis
Osteoporosis cause
Weakening of bones which means that it is more likely to fracture and break
Why do women have an increased risk of osteoporosis
Particularly after menopause as oestrogen slows bone loss and improves bodies absorption and retention of calcium
Main way of diagnosing osteoporosis
DEXA Scan - score of > -1 = normal
Score of -1 to -2.5 = osteopenia
Score of
Treat,ent of osteoporosis
Biphosphates - increase production of bones and act as anti bone resorption agents
Calcium and vitamin D supplements
PTH - re
Oestrogen receptor modulators - similar effects to oestrogen
HRT - replaces loss of oestrogen after menopause and helps to managing bone density
Osteomalacia
Inadequate mineralisation of the bone - more like cheesy bone
Phosphate deficiency caused by increased renal losses
Causes of osteomalacia
Insufficient dietary intake
Faulty vitamin D metabolism coeliac disease
Malnutrition during pregnancy
Diagnosis of osteomalacia
Very low vitamin D come
Treatment of vitamin D
Increase in dietary intake
Increase in outdoor time
Supplementation of vitamin D
Measure 24-hydroxy vitamin D
Possible causes of leg pain
Inflammation due to common colds/ bacterial infection
Infection - osteomyelitis / chicken pox
Others like tumours
Trauma
Abuse ?
Growing pains ? Unlikely as usually symmetrical
Tests
FBC
Esr
CRP
Renal function
Autoantibodies? - autoimmunity
? MRI - suspecting bone infection but to do an 3/4 yo you need general anaesthetic so this decision is not taken likely
What does pus indicate
Usually indicative of bacterial infection
Transient synovitis - usually due to infection or inflammation in joint
Treatment ; rest and NSAIDs- anti inflammatory drugs Follow fever cure Close observation for ; - persistent/ worsening limping - fever - signs of systemic illness
Septic arthritis treatment
Drainage in all cases - drain plus joint and the pus is usually indicative of bacterial infection
Multiple aspirations and irrigation - unstable patient , maybe gonococcal infection
Arthroscopic drainage
Open surgical drainage
IV antibiotics
Multi focal endocarditis
Infection causing problems in other parts of the body
How will bacteria change the joint fluid and blood
The clear straw coloured joint lubricating fluid would have changed its colour and consistency. In the presence of infection, it would look turbid or cloudy and maybe darker, presence of pus, increased viscosity and large volume of effusions from swellings
How will bacterial infection be reflected in blood tests and joint fluid examination
Inflammatory markers within the blood tests include white cell count, ESR and CRP. Joint fluid should he aspirated and sent fro MC&S , gram staining and to rule out crystal arthropathy like gout/pseudo gout
What increases the risk of gout in middle aged men
Increasesd red meat intake and drinking
