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BRS YR2 > How to Treat Musculoskeletal Conditions > Flashcards

How to Treat Musculoskeletal Conditions Flashcards

1
Q

What is an osteocyte?

A
  • mature bone cell
  • formed when an osteoblast becomes imbedded in its secretions
  • sense mechanical strain to direct osteoclast and osteoblast activity
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2
Q

What is an osteoblast?

A
  • bone forming
  • secretes osteoid
  • catalyses the mineralisation of osteoid
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3
Q

What is an osteoclast?

A
  • bone breaking
  • dissolve and resorb bone by phagocytosis
  • derived from bone marrow
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4
Q

What is an osteon?

A
  • repeated structural units

- concentric lamellae around a central haversian canal

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5
Q

What is a haversian canal?

A

contains blood vessels, nerves and lymphatics

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6
Q

What are lacunae?

A
  • small spaces containing the osteocytes

- tiny canaliculi radiate out, filled with extracellular fluid

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7
Q

What is Volkmans canal?

A

transverse perforating canals

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8
Q

What is the structure of long bones?

A
  • periosteum
  • outer cortex
  • cencellous bone
  • medullary cavity
  • nutrient artery
  • articular cartilage
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9
Q

What is the periosteum?

A

connective tissue covering

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10
Q

What is the outer cortex comprised of?

A

compact bone

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11
Q

What is in the medullary cavity?

A

yellow bone marrow

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12
Q

Where is articular cartilage found?

A

on the surface of a bone at a joint

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13
Q

What are the different mechanisms of bone fracture?

A
  • trauma
  • stress
  • pathological
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14
Q

What are the different trauma mechanisms of fracture?

A
  • low energy

- high energy

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15
Q

What is the stress mechanism of bone structure?

A

abnormal stresses on normal bone

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16
Q

What is the pathological mechanism of bone fracture?

A

normal stresses on abnormal bone

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17
Q

What are the possible causes of pathological bone fracture?

A
  • osteoporosis
  • malignancy
  • vitamin D deficiency (osteomalacia, rickets)
  • osteomyelitis
  • osteogenesis imperfecta
  • Paget’s
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18
Q

What is the first step of fracture healing?

A

Inflammation

  • hematoma
  • release of cytokines/prostaglandins
  • granulation tissue and blood vessel formation
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19
Q

What is the second step of fracture healing?

A

Repair

  • soft callus formation (type 2 collagen - cartilage)
  • converted to hard callus (type 1 collagen - bone)
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20
Q

What is the third step of fracture healing?

A

Remodelling

  • callus responds to activity: external forces, functtional demands and growth
  • excess bone is removed
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21
Q

What is Wolff’s law?

A

bone grows and remodels in response to the forces that are placed on it

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22
Q

What are the clinical signs of a fracture?

A
  • pain
  • swelling
  • crepitus
  • deformity
  • adjacent structural injury (nerves/vessels/ligament/tendons)
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23
Q

What investigations can be done in a fracture?

A
  • radiograph
  • bone scan
  • CT scan
  • MRI scan
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24
Q

What are the steps to describe a fracture radiograph?

A
  • location?
  • pieces?
  • pattern?
  • displaced/undisplaced?
  • translated/angulated?
  • X/Y/Z plane?
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25
Q

What is considered an urgent complication of fractures?

A
  • local visceral injury
  • vascular injury
  • nerve injury
  • compartment syndrome
  • haemarthrosis
  • infection
  • gangrene
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26
Q

What is considered a less urgent complication of fractures?

A
  • fracture blisters
  • plaster sores
  • pressure sores
  • nerve entrapment
  • myositis ossificans
  • ligament injury
  • tendon lesions
  • joint stiffness
  • algodystrophy
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27
Q

What is considered a late complication of fractures?

A
  • delayed union
  • malunion
  • non-union
  • avascular necrosis
  • muscle contracture
  • joint instability
  • osteoarthritis
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28
Q

What treatment is given to an extracapsular neck of femur fracture?

A

fix with plate and screws (dynamic hip screw)

29
Q

What treatment is given to an intracapsular, undisplaced neck of femur fracture?

A

fix with screws

30
Q

What treatment is given to an intracapsular, displaced neck of femur fracture?

A
  • replace in older patients

- fix in younger patients

31
Q

What are the 3 different classifications of joints?

A
  • fibrous
  • cartilaginous
  • synovial
32
Q

What are the different types of fibrous joints?

A
  • sutures
  • syndesmosis
  • interosseous membrane
33
Q

What are the different types of cartilaginous joints?

A
  • synchondroses (spine)

- symphyses (pubic)

34
Q

What are the different types of synovial joints?

A
  • plane
  • hinge
    condyloid
  • pivot
  • saddle
  • ball and socket
35
Q

How are synovial joints stabilized?

A
  • muscles and tendons
  • ligaments
  • bone surface congruity
36
Q

What are the components of synovial joints?

A
  • synovium
  • synovial fluid
  • articular cartilage
37
Q

What is synovium?

A

1-3 cell deep lining containing:

  • macrophage like phagocytic cells (type A synoviocyte)
  • fibroblast-like cells that produce hylauronic acid (type B synoviocyte)
  • Type 1 collagen
38
Q

What is synovial fluid?

A

hylauronic acid-rich viscous fluid

39
Q

What is articular cartilage comprised of?

A
  • Type 2 collagen

- Proteoglycan (aggrecan)

40
Q

What is cartilage comprised of?

A
  • specialised cells (chondrocytes)

- extracellular matrix (water, collagen and proteoglycans (aggrecan)

41
Q

What is aggrecan?

A
  • a proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains
  • characterized by its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates
42
Q

What are common knee conditions for 15-45 years old?

A
  • Patellofemoral maltracking
  • ACL/PCL
  • Meniscal tears
  • fractures
43
Q

What are common knee conditions for 45-60 years old?

A
  • OA
  • Patellofemoral maltracking
  • ACL/PCL
  • Meniscal tears
  • Fractures
44
Q

What are common knee conditions for people above 60 years old?

A

OA

45
Q

What are common hip conditions for 15-45 years old people?

A
  • developmental dysplasia
  • leg length discrepancy
  • impingement
46
Q

What are common hip conditions for 45-60 years old people?

A
  • OA
  • Avascular necrosis
  • impingement
47
Q

What are common hip conditions for people above 60 years old people?

A
  • OA

- post total hip replacement

48
Q

What are common shoulder conditions for 15-45 years old people?

A
  • dislocation

- fractures

49
Q

What are common shoulder conditions for 45-60 years old people?

A
  • impingement
  • dislocation
  • ACJ OA
  • rotator cuff tears
  • fractures
50
Q

What are common shoulder conditions for above 60 years old people?

A
  • glenohumeral OA
  • impingement
  • cuff tears
  • fracture
51
Q

What are the risk factors of septic arthritis?

A
  • immunosuppressed
  • pre-existing joint damage
  • intravenous drug use
52
Q

How is septic arthritis diagnosed?

A

joint aspiration (gram stain and culture)

53
Q

What common organisms are responsible for septic arthritis?

A
  • Staphylococcus aureus
  • Streptococci
  • Gonococcus (affects multiple joints)
54
Q

What is the treatment of septic arthritis?

A
  • surgical wash-out
  • IV ABx
  • immobilise in acute phase
55
Q

What is osteoarthritis?

A

Degenerative disease of chondral cartilage

56
Q

What happens in the processes of developing osteoarthritis?

A
  • Inflammation occurs late in disease cf. rheumatoid
  • Inflammatory mediators include proteinases, e.g., matrix metalloproteinases (MMPs) and aggrecanases, and inflammatory cytokines, including interleukin (IL)-1β and tumor necrosis factor α (TNFα), which enhance the synthesis of proteinases and other catabolic factors to degrade the articular cartilage membrane
57
Q

What are the risk factors of developing osteoarthritis?

A
  • age
  • obesity
  • mechanical constraints
  • hereditary
  • female, menopause
  • osteonecrosis
  • leg bone malalignment
  • estrogen deficiency
  • metabolic syndrome
  • advanced hip OA (spondylarthritis and RA)
58
Q

What conservative management is available for OA?

A
  • analgesics
  • physiotherapy
  • walking aids
  • avoidance of exacerbating activity
  • injections (steroid/viscosupplementation)
59
Q

What operative management is available for OA?

A
  • replace (knee/hip)
  • realign (knee/big toe)
  • excise (big toe)
  • fuse (big toe)
  • synovectomy (R)
  • denervate (wrist)
60
Q

What radiographic changes can be seen with OA?

A
  • subchondral cysts
  • loss of joint space
  • sclerosis
  • osteophyte
61
Q

How does OA present?

A
  • pain (exertional/rest/night)
  • disability (waliing/stairs)
  • deformity
    Hx
  • trauma/infection
62
Q

What is a bone infection?

A

osteomyelitis

63
Q

How does osteomyelitis present?

A
  • acute or chronic
  • pain
  • swelling
  • discharge
  • fevers
  • sweats
  • weight loss
64
Q

What is septic arthritis?

A

infection of the joint

65
Q

How does septic arthritis present?

A
  • pain
  • swelling
  • stiffness
  • fevers
  • sweats
  • weight loss
66
Q

How is osteomyelitis treated?

A
  • IV ABx
  • surgical drainage
  • chronic: ABx suppression
  • ?amputation
67
Q

What radiological investigations can be done for bone/joint infections?

A
  • Plain films
  • MRI scans: bony architecture/collections
  • CT if MRI not available
  • Bone scans: multifocal disease
  • Labelled White cell scans
68
Q

What blood investigations can be done for bone/joint infections?

A
  • CRP (acute marker)
  • ESR (slower response)
  • WCC
  • TB culture/PCR

BRS YR2 (70 decks)

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