Bone + Joint Disorders Flashcards
Osteoarthritis, Joint Hypermobility Syndrome, Osteomyelitis
Osteoarthritis can be diagnosed clinically if what?
(1) The patient is aged over 45 years
AND
(2) The patient has activity-related joint pain
AND
(3) The patient has no morning stiffness or the morning stiffness lasts less than 30 minutes
Increased bone density beneath the cartilage means what?
It is a characteristic of osteoarthritis, where the degeneration of cartilage leads to increased bone density (subchondral sclerosis) as the bone tries to adapt to the loss of cartilage
Describe the differences between OA and RA
OA
(1) Degenerative, affects large, weight-bearing joints (knees, hips)
(2) Pain worsens with activity, better with rest
(3) Morning stiffness < 30 minutes
(4) Slow progression
(5) No joint disformities
RA
(1) Autoimmune, affects small joints symmetrically (hands, wrists)
(2) Pain, swelling, systemic symptoms (fever, fatigue)
(3) Morning stiffness > 30 minutes
(4) Fast
(5) Joint deformities > swan neck deformity, ulnar deviation etc
What is the first-line treatment for osteoarthritis of the hand or knee?
Paracetamol and topical NSAIDs are first line
Which joints are classically affected in osteoarthritis?
(1) Large weight-bearing joints of the lower limb (hip and knee).
(2) Small joints of the hands, particularly the DIPs (Heberden’s nodes) and PIPs (Bouchard’s nodes
What are the three main aspects of osteoarthritis management?
(1) Conservative (Weight loss, aerobic exercise, and PT / OT input)
(2) Pharmacological (Step up the WHO pain ladder, and steroid injections)
(3) Surgery (joint arthroplasty)
Which signs in the hands are suggestive of osteoarthritis?
Heberden’s and Bouchard’s nodes on the distal and proximal interphalangeal joints respectively
Heberden’s nodes are found in both OA and RA
False.
Only OA
What term describes the flattening or broadening at the base of the thumb often seen in advanced first CMC joint osteoarthritis
Squaring of the thumb
First-line medication for osteoarthritis is what?
Analgesia - paracetamol, topical NSAIDs (avoid opiates) as needed, co-codamol
A 70-year-old man presents to the GP with a 6-month history of pain and stiffness in his left knee. He is a retired gardener and he can cope with his activities of daily living. He is anxious that the pain will worsen to the extent that he will no longer be able to do so. The pain worsens when he kneels and the stiffness lasts less than thirty minutes.
What is the most suitable first-line treatment? - He has osteoarthritis
Topical NSAID
A 76-year-old female sees her GP due to progressively worsening pain in her hands. She is now struggling to do up her buttons when she gets dressed in the morning due to the pain, although she finds that the pain improves after resting for some time. On examination, the GP notes swelling of the distal and proximal interphalangeal joints.
What is the most likely diagnosis?
Osteoarthritis
A 67-year-old woman has struggled with pain and stiffness in her right knee joint for five years and is referred to secondary care for specialist management.
On further questioning, she also reports stiffness, bony swelling and deformity in her fingers bilaterally. She reports that despite perseverance with topical, oral and intra-articular therapy her symptoms have continued to have a significant effect on her quality of life.
A plain radiograph of the knee shows loss of joint space in all three compartments of the joint, with bony spurs seen on the medial side.
What is the single most appropriate next step in this patient’s management?
Joint arthroplasty
A 39-year-old retired footballer presents with knee pain while walking and climbing the stairs. The pain usually worsens with movements and eases with resting. He had suffered from an Anterior Cruciate Ligament (ACL) injury 10 years ago. Otherwise, there is no trauma to his knees of late. Upon physical examination, there is a limited range of motion, minimal effusion and crepitus felt on both knees.
What is the most likely diagnosis?
Osteoarthritis
A 63-year-old female presents to her GP with a 10-week history of progressively worsening pain bilateral knee pain. The knee pain is worse with activities and can be relieved by rest. She has morning stiffness for around 20 minutes each day. The GP thinks that she may have osteoarthritis.
What is required for a diagnosis of osteoarthritis?
No tests are required as it is a clinical diagnosis
What defines joint hypermobility syndrome?
A condition where a hypermobile joint develops chronic pain lasting 3 months or longer
In which demographics is joint hypermobility syndrome more common?
Higher incidence in females, presenting usually in childhood or the 3rd decade
Name two rare genetic syndromes associated with joint hypermobility syndrome
(1) Marfan’s syndrome
(2) Ehlers-Danlos syndrome.
What are the common symptoms of joint hypermobility syndrome?
(1) Joint pain after exercise
(2) Stiffness
(3) Frequent sprains/dislocations
(4) foot/ankle pain
What are some physical features that may present with joint hypermobility syndrome?
Thin, stretchy skin; flat feet; and neck pain
What score is used to assess joint hypermobility?
The Modified Beighton Score
What is the threshold score on the Modified Beighton Scale to indicate hypermobility?
A score of 4 out of 9 or higher
Name tests included in the Modified Beighton Score for hypermobility
- Elbow hyperextension >10°
- Thumb touching the forearm with wrist flexion
- Hyperextension of the knees >10°
What is the main management approach for joint hypermobility syndrome?
Physiotherapy
