Joint conditions Flashcards
cells in acute disease
polymorphs (polymorphonuclear leucocyte)
cells in chronic disease
lymphocytes
opening up a joint is called …
arthrotomy
what is most joint replacement surgery aimed at achieving
pain relief
what is gout
inflammation of a joint caused by uric acid crystals being deposited on the cartilaginous surfaces
OA - are most cases primary or secondary
primary
what is OA
condition of pain and limitation of movement of joints assoc with excessive wear of articular cartilage due to breakdown in balance between wear and repair
non surgical arthritis mx
rest and physio
weight loss
use of a stick
eg of an infection that can cause OA
TB
eg of a childhood disease that can cause OA
Perthes
is it common for arthritis to cause stiffness alone?
no this is almost always secondary to pain
when is help from a specialist usually sought out in OA
when sleep is disturbed
in the hip, joint loading can reach up to ? times body weight
5
what is osteotomy
surgical realignment of joint
what is arthrodesis
surgical stiffening in a position of function
long term disadvantage of arthrodesis
puts stress on adjacent joints
what position would the hip usually be fused at in arthrodesis
30 degrees of flexion and some adduction
why is hip fusion more straight forward in males than females
any hip fusion is likely to interfere with female sexual activity
is recovery straight forward following hip fusion?
no, recovery of up to 6 months, often in a plaster splint
name of operation to replace a joint
arthroplasty
what is arthroplasty unlike to alleviate
disability due to stiffness caused directly by disease within the joint
(b/c soft tissue distortion of the capsule and ligaments tends to remain after replacement)
how many degrees of flexion should be maintained in the knee
90 - for going up and down stairs
why is stability in the knee essential
for supporting body weight when standing on one leg
principal indication for operative tx
pain
most successful and common joint replacement
hip
3 requirements of any joint replacement
- capable of pain free, functional range of motion
- able to withstand forces placed upon it without undue wear/becoming loose
- same stability as the natural joint
in which group of people may osteotomy be a good operation
young people who have retained a good range of motion and have a reasonable preservation of articular cartilage
what may the long term plan of action be following arthrodesis to prevent stress on adjacent joints becoming problematic
converting the arthrodesis to arthroplasty in the 5th decade. this is effective in the hip
modern knee replacement consists of two new smooth surfaces but what is another vital part of this operation?
balancing the collateral ligaments
specific early complications of arthroplasty
dislocation
DVT
infection
what organisms commonly cause infection in joint replacement
staph aureus
commensals e.g. staph albus (universally found on skin)
general complications of surgery
UTI, chest infection, pressure sores
specific late complications of arthroplasty
late infection
loosening
wear
most obvious symptoms of rheumatoid arthritis
deformity of joints
severe pain
swelling
RA - principal joints affected?
small joints of hand and feet
is there a pattern in joint involvement in RA?
small joints are affected symmetrically but large joints are not
first noticed sign of RA
stiffness worse in mornings and improving throughout the day
RA - what type of procedure can be done to try to reduce pain and stiffness in early disease. who in particular is it of value in?
synovectomy
particularly of value in the younger patient who retains movement but has pain
What is avascular necrosis
bone tissue death through loss of blood supply
causes of avascular necrosis
trauma
spontaneous
areas at risk of avascular necrosis following trauma
femoral head
proximal part of scaphoid
proximal part of talus
in what situations is avascular necrosis of the femoral head seen
steroid therapy
alcohol abuse
deep sea divers (Caisson’s disease)
presentation of avascular necrosis
acute and often severe joint pain, made worse by movement and relieved to some degree by rest
why is dx for AN difficult
may not initially be seen on X-ray
X-ray signs of AN
bone appears dense (reflecting absence of blood vessels)
can AN be reversed?
if blood supply can be re-established naturally
what is the bone prone to in AN revascularising phase
distortion because it is very soft»_space; secondary arthritic changes
management of avascular necrosis
non specific
rest the affected joint
surgery is of NO value in tx underlying condition
often surgeon is left to salvage the situation with a joint replacement
situations where urate crystals are deposited
diuretic overuse
dehydration
after chemo for cancer
how does septic arthritis present in children
very unpleasant acute illness. high temperature. affectsd joint stiff and tender
how does septic arthritis present in adults
less acute. many px die because of delay in recognition
most likely cause of septic arthritis with little constitutional upset in a young adult?
gonococcus
tx for septic arthritis
surgery and IV abx
first guess abx for septic arthritis in children
anti-staphylococcal
what is the px at risk of following inadequate tx for septic arthritis
septicaemia
degeneration of articular cartilage»_space; fibrous or bony fusion of the joint
which bacterial infection can cause chronic septic arthritis
TB
joint and ? TB are often found together
kidney
clinical presentation of chronic septic arthritis
chronic ill heath
wt loss
considerable muscle wasting around affected joint
radiographs show marked thinning of bone
is surgery necessary for chronic septic arthritis
rarely
meniscal lesions are relatively rare in men/women?
women
meniscal lesions - well or poorly localised?
poorly
which meniscus is more commonly injured?
medial
cleavage lesion of meniscus - common in which age group? what may this cause?
old age
may cause a cyst as the lesion acts like a flap valve that allows build up of synovial fluid
name of a vertical meniscal split anchored at both ends
bucket handle tear
parrot beak tear
split off one end of the lateral meniscus
how are most meniscal lesions repaired nowadays
via arthroscopy
advantage of arthroscopy
quick recovery - days!
what is osteochondritis dissecans
spontaneous osteochondral fragments - occurs rarely, in adolescents
what is a loose body
ostechondral fragment
are cruciate ligaments capable of spontaneous healing?
no, if torn the blood supply is lost
what does loss of a cruciate result in
loss of anteroposterior stability, particularly in flexion
loss of rotary stability when twisting and turning
when may patients experience symptoms of cruciate injury in particular
descending stairs, twisting, turning
management of cruciate tear
leave it alone for a while and rehabilitate knee muscles
surgery if it interferes with daily life or they want to return to sport
why is a replacement cruciate more likely to fail than a natural ligament
it has no sensory receptors to let the brain know if its being over stretched
what is dislocation of the patella usually associated with and what does this cause
malformation of either the patella or the lateral femoral condoyle
this causes mal tracking (patella moving abrasively on the femur) which is painfull because of associated muscle spasm
why would a person with a dislocated patella fall to the ground?
failure of quads to act as an extensor
how are minor degrees of patellar mal tracking dealt with
surgical splitting of the vastus lateralis muscle insertion onto the patella, allowing the patella to fall back into a normal relationship with the femur
how is recurrent and severe patellar mal-tracking dealt with
medial tightening (plication) of the vastus medialis
