locomotor Flashcards
osteoarthritis:
- pathogenesis?
- variety of minor incidental trauma to synovial joints
- trigger repair processes
- all joint processes take place in repair
- repair often results in structurally different but symptom free joint
- eventually too much repair and damage -> symptoms
osteoarthritis:
- risk factors? 7
- female (3:1)
- over 50
- family history of OA
- obesity
- high or low bone density
- joint injury or occupational/recreational stresses on joints
- joint malalignment (could be dt rare things like marfans)
osteoarthritis:
- symptoms/signs?
- which hand joints affected? (names)
- appearance on plain x-rays? 4 (incl acronym)
pain
- when being used
- worse at end of day
- background rest pain
- crepitus
- limited range of movement
- stiff when start moving (BUT <30mins)
nb often starts unilateral
- DIP (herbeden’s nodes)
- PIP (bouchards nodes)
LOSS L - Loss of joint space O - Osteophytes S - Subarticular sclerosis S - Subchondral cysts
OA is normally a clinical diagnosis (only do x-ray if trying to exclude another cause for pain)
in OA, CRP may be slightly raised
osteoarthritis:
- non-pharm management? 2
- pharm management? 5
- surgery?
- exercise to improve muscle strength
- loose weight (if obese)
- paracetamol
- topical NSAIDs
- topical capsaicin (from chilli)
- oral NSAIDs
- mild opiods
- intra-articular steroid joint injections
- joint replacement
osteoarthritis: differential diagnoses:
- other types of arthritis? 8
- other causes of joint pain? 6
- Rheumatoid Arthritis
- psoriatic arthritis
- ankylosing spondylitis
- gout
- pseudo gout
- reactive arthritis
- arthritis associated w connective tissue disorders (e.g. SLE)
- septic arthritis (esp if one joint)
- fibromyalgia
- fracture of bone adjacent to joint
- major ligament injury
- bursitis
- bone metastases
- primary cancer
gout:
- risk factors? 12
- pathogenesis?
- age
- male
- FH
- purine-rich diet (red meat + sea food)
- alcohol excess
- diuretics
- cytotoxic drugs
- leukaemia
- CVD
- HTN
- CKD
- DM
(nb gout can be first presentation of four above conditions so, if see, look for these too)
uric acid is the end-product of the breakdown of purines (adenine + guanine) if there is excess of this breakdown (purine rich diet) or poor excretion (dt renal failure) -> hyperuricaemia
at areas of relatievyl low temp (ie extremities) the urate crystals precipitate out -> irritation and inflammation of joints
also diuretics can also lead to precipitation of crystals out as get rid of water for it to be dissolved in
gout:
- typical presentation? (incl signs + symptoms)
- most common joint affected?
- non-joint clinical manifestations? 2
5 pillars of inflammation
- redness
- pain
- swelling
- heat
- reduced mobility
often only affects one joint at a time (monoarthropathy)
- tends to be small joints (no larger than elbow normally)
nb can often be triggered by surgery, trauma, starvation, infection or diuretics
> 50% metatarsophalangeal joint of big toe
- urate deposits (tophi) in pinna, tenodns, joints
- urate kidney stones
gout:
- investigations? 2
- non-pharm management? 6
- pharm treatment?
- pharm secondary prevention?
- serum urate (though often low in acute attacks - as uric acid precipitated out)
- polarised light microscopy of synovial fluid shows urate crytals (can also see in xray in later stages)
- loose weight
- avoid prolonged fasts
- avoid alcohol excess
- avoid purine-rich meats
- avoid low dose aspirin (increases serum urate)
- avoid dehydration
- NSAIDs for pain (steroids if kidneys mean NSAIDs are contraindicated)
also ice and rest joint
- allopurinol
gout:
- commonest 3 differntials?
- septic arthritis
- RA
- haemoarthrosis (consider iatrogenic or endogenous haemophilia)
septic arthritis:
- risk factors? 8
- commonest causative organism?
- pre-existing joint disease (especially RA)
- recent joint surgery
- prosthetic joints
- diabetes mellitus
- immunosuppression
- CKD
- IVDU
- age over 80
staph aureus
- often via direct injury to skin or blood borne from another infection/injection site
septic arthritis:
- local signs/symptoms? 5
- joint most commonly affected?
- systemic signs/symptoms? 2
- investigation?
acute
- hot
- painful
- red
- swollen (often joint effusion)
- reduction in movement
- knee (50%)
- fever (+ possibly sepsis etc)
- infection elsewhere
(nb inflammation may be less overt if underlying joint disease or immunodeficient so have a high degree of suspicion)
- joint synovial fluid aspiration for microscopy and culture (USS guidance if needed)
nb xrays may be normal
septic arthritis:
- pharm treatment? 2
- surgery?
- other management?
- differential diagnoses? 4
- Abx (start empirical after joint aspiration then modify with results)
- analgesia
- consider surgical debridement or lasage if large effusion or prosthetic joint
- physio
- splint for 48 hours
- gout (or pseudo-gout)
- RA (or other inflam arthritis)
- fracture of bone adjacent to joint
- bursitis
prolapsed disc:
- risk factors? (incl age affected) 6
- middle aged (35-50)
- men>women
- physically demanding work (heavy listing etc)
- obesity
- smoking (causes faster degeneration of discs)
- FH
prolapsed disc:
- main symptom and what makes better/worse etc?
- associated symptoms? 3
- what to check for?
back pain (normally lumbar so lower back)
- worse with movement, esp hunching forward
- fast onset
leg pain (often worse than the back pain) - searing sharp, electric shooting pain
- numbness/pins + needles in legs
- muscle weakness (incl foot drop)
not all slipped discs cause symptoms, many people will never know they have slipped a disc
CAUDA EQUINA!!
- ask re bladder + bowel control + saddle anaesthesia
prolapsed disc:
- clinical test?
- prognosis?
- when to refer?
- imaging?
- Lower limb neuro/MSK exam
- sphincter tone + saddle anaesthesia (rule out caudal equina)
90% of people get better in 6 weeks
if not beginning to improve after 6 weeks or red flag symptoms
then get MRI
