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Ortho Exam > Degenerative Disorders (42) > Flashcards

Degenerative Disorders (42) Flashcards

1
Q

What is Rheumatoid Arthritis and what is it characterized by?

A

Autoimmune systemic inflammatory disease in which the body’s immune system mistakenly attacks the joints
Characterized by exacerbations and remissions

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2
Q

What sex does RA affect more?

A

Women are twice as often affected than men

Native Americans show a 3.5- 5.3% prevalence, suggesting a genetic tie

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3
Q

When does RA usually manifest?

A

20’s to 50’s

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4
Q

Stage 1 RA

A

Synovitis- joint effusions likely
Synovial membrane inflamed and thickened
Soft tissue swelling but no destructive changes
Bones and cartilage gradually eroded

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5
Q

Stage 2 RA

A 
Inflamed tissue hypertrophies
Pannus develops (highly vascular)- cartilage loss  begins with bones becoming more exposed and pitted
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6
Q

Stage 3 RA

A

Pannus erodes articular cartilage- extensive cartilage loss with exposed and pitted bones

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7
Q

Stage 4 RA

A

Inflammatory process subsides

Fibrous or bony ankylosis occurs

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8
Q

Fibrous vs Bony Ankylosis

A

Fibrous- joint invaded by fibrous connective tissue

Bony- bones become fused

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9
Q

What are complications of RA?

A

Joint destruction, flexion contractures, popliteal cysts
Cardiac- pericarditis, atherosclerosis,
Pulmonary- pleurisy, restrictive ventilatory defect
Eyes- Keratoconjunctivitis, sicca (dry eyes)
Glands- Sjogren’s Syndrome- lymphocytic infiltration of lacrimal and salivary glands (reduced tear, saliva and vaginal secretion production)
Death or serious morbidity

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10
Q

Pregnancy and RA?

A

Symptoms improve while pregnant but return about 6 wks after delivery
Breastfeeding may aggravate

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11
Q

What are the different hand deformities that can occur with RA?

A

Zigzag- ulnar deviation
Swan neck deformity- the joint closest to the fingertip (distal interphalangeal joint) is permanently bent down while the nearest joint to the palm (proximal) is bent away from it (DIP flexion with PIP hyperextension)
Boutonniere deformity- the joint nearest to the knuckle is permanently bent toward the palm, while the farthest joint is bent back away (PIP flexion with DIP hyperextension)

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12
Q

Characteristics of RA?

A

Age- 20’s to 50’s
Sex- more females
Course- exacerbations, remissions
Common joints affected- small joints first
Morning Stiffness- 1hr to all day and stiff after rest
Symmetric joint involvement
Effusions are common
Decreased viscosity of synovial fluid with WBC
Thickened synovium
Rheumatic nodules
Advanced disease- global narrowing of joint spaces, erosions, subluxations; OP related to corticoid steroid use

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13
Q

Assessment of RA

A

Early- spindle shaped fingers, mildly achy, transient morning stiffness, stiffness after rest, fatigue, weight loss, lethargy, pain and swelling in hands and feet, loss of ROM
Late- joint deformities, plus all early symptoms
*Intense erythema is UNCOMMON with RA

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14
Q

How is RA diagnosed?

A

Positive rheumatoid factor, antibodies against cirtullinated proteins (anti CCP)
*X-Ray not generally needed

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15
Q

How is RA treated?

A

Drugs
Disease modifying anti rheumatic drugs (DMARDs)
Biologic response modifiers (BRMs)
NSAIDs
Steroids
Nonpharmacological
Therapeutic exercise, heat/cold therapy, splinting, diet, alternative therapies

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16
Q

What is Osteoarthritis and what is it characterized by?

A

Slowly progressive, noninflammatory, degenerative joint disorder of the cartilage in movable joints
Characterized by loss of articular cartilage, thickening of the subchondral bone, bony outgrowth (osteophytes) and mild, chronic nonspecific synovial inflammation

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17
Q

Primary vs Secondary OA?

A

Primary (idiopathic)- no initiating factor, seen in older age group due to degenerative changes in joints
Secondary- from previous damage to cartilage

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18
Q

What is articular cartilage and what is it’s function?

A

Connective tissue covering synovial joint surfaces

Function- low friction with motion, shock absorber, elastic

19
Q

What sex does OA affect more?

A

Women in their 50’s and over are most affected

20
Q

What are complications of OA?

A

Physical limitations, unstable gait, fall risk, chronic pain, decreased joint ROM, loss of independent function, depression/isolation

21
Q

When does OA usually occur?

A

Later in life; 40’s to 60’s

22
Q

What are OA symptoms?

A

Aching joint pain, enlarged joints, swelling from overuse, stiffness that lasts 10-30 min after rising, reduced ROM, Heberden’s (DIP) and Bouchard’s (PIP) nodes

23
Q

Heberden’s vs Bouchard’s nodes?

A

Heberden’s- hard or bony swellings that develop in the DIP (closest to end of fingers and toes)
Bouchard’s- hard, bony outgrowths or cysts on the PIP

24
Q

How is OA diagnosed?

A

X-Ray- best way to diagnose
Asymmetric joint space narrowing, bone spurs (osteophytes), degenerative cysts, sclerosis of subchondral bone
*There are no lab tests specific to OA; ESR may be elevated, but it’s not a reliable marker

25
Q

How is OA treated?

A

Drugs
APAP (acetyl-para-aminophenol)- acetaminophen
NSAIDs
Opioids
Nonpharmacological- PT, cryotherapy, TENS, aerobic exercise (swimming), muscle strengthening
Alternative- glucosamine chondroitin
Surgery- arthroscopy, tibial osteotomy (small varus angulation and stable ligaments), arthroplasty (severe varus/valgus deformity, ineffective pain relief, no cartilage, instability)

26
Q

Varus vs Valgus

A

VaRus- Round; away from midline (knees bowed out)

Valgus- knock-kneed; toward midline (knees bowed in)

27
Q

Antalgic gait pattern?

A

Pain on WB, favors sore limb

28
Q

Ataxic gait pattern?

A

Neurologic; staggering, sway, foot slap

29
Q

Festinating gait pattern?

A

Parkinson’s; rigid, forward lean, shuffle step, delayed start

30
Q

Quadriceps gait pattern?

A

Muscle injury; knee flexion contracture, *hand on thigh

31
Q

Short leg gait pattern?

A

Leg length discrepancy

32
Q

Senile gait pattern?

A

Hesitant short steps, support at start

33
Q

Spastic gait pattern?

A

Jerky, uncoordinated, shirt steps w/dragging or scraping foot; more on toes, knees spread, elbows

34
Q

Steppage gait pattern?

A

Peroneal nerve injury; increased hip knee flexion to clear floor (picking up legs higher when walking)

35
Q

Trendelenburg gait pattern?

A

Myogenic, coxa vara, congenital; foot slaps or drags on ground, drop foot, gluteus medial lurch; hip comes out a little

36
Q

What is a contraindication for a THA?

A

Acute systemic infection, osteomyelitis

37
Q

Which THA approach is more prone to dislocation?

A

Posterolateral approach

38
Q

What are the different types of hip implants and the indications for use?

A

Porus prosthesis- pumice stone like, ingrowth over weeks, WB restriction; used more in younger, active pts
Hybrid- porus surface plus cement; used more in lower demand but still active adults
Cemented- for femoral/acetabular; used if bone quality is poor

39
Q

When is hip resurfacing used? Contraindications? Goals? Complications?

A

Used as a preservation procedure for advanced OA or AVN in a younger pt; used more in males- women have a smaller femoral head, which makes it more complicated
Contraindications- advanced AVN, congenital hip malformation, hx of infection or OP, previous femoral neck fx
Goal- restore fx, increase motion and reduce pain
Complications- femoral neck fx

40
Q

When is a hip hemi done?

A

Femoral neck fx (acetabulum is fine), OA or AVN; used for more sedentary pts, over 70yrs or AMS

41
Q

What/who can a hip arthroscopy be used for?

A

Hip pain in recreational athletes, fem-acetabular impingement; repairs of labral tears, IT band release, frayed articular cartilage, microfracture procedures
* Must be in traction during procedure and use fluoroscopic guidance

42
Q

When is hip girdlestone pseudoarthrosis used?

A

As a last resort to save failed THA or bad infection of THA; there is leg length inequality, interfering with ambulation
Part of the femoral head is removed and the acetabulum is fused to the rest

43
Q

When is a unicondylar knee replacement indicated and why? Contraindications? Advantages?

A

Used for resurfacing of one compartment of the knee when there is degeneration or osteonecrosis of femoral condyle (Ahlbaeck’s Disease) or OA in 1 compartment
Contraindications- over 80kg, demanding sports, hx of torn ACL, patellofemoral degeneration or excessive varus/valgus
Advantages- keeps cruciate ligaments intact, sparing bone, quicker recovery, low blood loss, less hospital time

44
Q

What/who can a proximal tibial valgus osteotomy be used for? Contraindications?

A

To realign distal

Ortho Exam (4 decks)

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