Locomotor conditions Flashcards by Ben Edgar

What ratio of men:women does osteoarthritis effect?

3 women:1 man

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How is OA characterised?

By localised loss of cartilage, remodelling of adjacent bone and associated inflammation

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What are the most commonly affected peripheral joints in OA?

Knees
Hips
Small joints of hands

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Constitutionl risk factors for OA?

Age
Female sex
Obesity
High/low bone density

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Local, largely biomechanical risk factors include?

Joint injury
Occupational and recreational stresses on joints
Reduced muscle strength
Joint laxity
Joint malalignment

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Symptoms of OA?

Joint pain exacerbated by exercise and relieved by rest
Joint stiffness in the morning or after rest
Reduced function and participation restriction

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Signs of OA?

Reduced range of joint movement
Pain on movement of the joint
Joint swellings/synovitis
Periarticular tenderness
Crepitus
Absence of systemic features
Osteophytes
Joint instability
Muscle weakness/wasting around the affected joint

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What is the classical presentation of osteophytes in OA?

DIP joint swelling - Heberdens nodes

PIP joint swelling - Bouchards nodes

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Investigations into OA?

Clinical examination
Plain X rays (LOSS)
MRI
Blood tests (should be normal in OA)
Joint aspiration

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What do plain radiographs show i OA?

Loss of joint space
Osteophytes
Subarticular sclerosis
Subchondrial cysts

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What are the core treatments for OA?

Education, advice and info
Exercise
Weight loss
Surgery (joint replacement for severe OA)

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Drug treatments for OA?

Paracetamol/topical NSAIDS
If inneffective use short-term oral NSAIDs or codeine
Topical capsaicin (found in chillies)
Intra-articular steroid injection (for severe symptoms)

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What is the biggest side effect of NSAIDs?

gastrointestinal bleeding

renal impairement

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Patients taking what medication should avoid NSAIDs?

Aspirin

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What are the four types of gout?

Asymptomatic
Hyperuricaemia
Acute gout
Intercritical gout and tophaceous gout

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What is the most common joint for gout to present at?

Metatarsophalangeal joint of the big toe

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What causes gout?

Deposition of monosodium urate crystals precipitated by trauma, surgery, starvation, infection or diuretics

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What are the risk factors for gout?

Male sex
Meat
Seafood
Alcohol
Diuretics
Obesity
Hypertension
Coronary heart disease
Diabetes mellitus
Chronic renal failure
high triglycerides

What diagnosis must be excluded in any acute monoarthropy?

Septic arthritis

How does gout present?

Acute pain in a joint which becomes tender, swollen and erythematous which reaches its crescendo over a 6-12 hour period

How is gout investigated?

Polarized light microscopy of synovial fluid shows negatively bi-refringent urate crystals
Serum urate is usually raised but may be normal

What is the pharmaceutical treatment of gout?

Use high-dose NSAID or coxib

If NSAIDS are contraindicated what drug should be used?

Colchicine

How quickly should gout symptoms subside with suitable treatment?

3-5 days

What medication can be used for gout prophylaxis?

If >1 attack in 12 months start allopurinol

When should allopurinol be started?

Never during an acute attack. Wait for 1-2 weeks after the attack resolves

How quickly can septic arthritis destroy a joint?

>24 hours

Risk factors for septic arthritis?

``` Increasing age Diabetes mellitus RA Joint surgery Hip or knee prosthesis Skin infection in combination with joint prosthesis Infection with HIV ```

In what joint is septic arthritis most common?

The knee (>50%)

How does septic arthritis classically present?

Single swollen joint with pain on active or passive movement | Fevers and rigors (may be absent)

Conditions associated with immunosuppressive disease?

``` Pre-existing joint disease Immunosuppressive disease Recent steroid injection STDs Intravenous drug use ```

What are the red flags for septic arthritis in children?

Fever Refusal to use a joint ESR and CRP elevated

Investigations for joint aspiration?

Urgent joint aspiration for synovial fluid microscopy and culture is the key investigation. CRP and radiographs may be normal

Treatment for septic arthritis?

Empirical IV antibiotics (after aspiration) until sensitivities are known Adequate analgesia Consider physiotherapy

What red flag symptoms suggest cauda equina syndrome?

Saddle anaesthesia or paraesthesia Recent onset of bladder dysfunction Recent onset of faecal incontinence Severe or progressive neurological deficit in the lower extremities

What red flag symptoms suggest a high risk of permanent damage to the compressed nerve?

Significant muscle weakness or wasting Loss of tendon reflexes Positive babinski reflex

What age group are most at risk of a prolapsed invertebral disc?

under 40 years | degeneration of discs tends to present in those aged over 40 years

What is meant by the term sciatica?

Pain, tingling and numbness that arise due to nerve root entrapment in the lumbrosacral spine

How does a lumrosacral disc herniation present?

Unilateral leg pain (radiating to below the knee) The leg pain being more sever than the back pain Numbness, paraesthesia, weakness and/or loss of tendon reflexes Positive straight leg test Pain relieved by lying down and exacerbated by long walks

How does thoracic disc herniation present?

Shooting pain down legs | Pain, paraesthesia or dysaesthesia in a dermatomal distribution

Investigations for prolapsed disc?

No investigations needed if symptoms settle within six weeks MRI is very sensitive Plain x rays are sometimes useful

What is the management for prolapsed disc?

Analgesia Encouragement to keep active Avoidance of activities that may aggravate pain Physiotherapy Surgery (if symptoms do not settle within 6 weeks)

What analgesia is used for prolapsed disc?

paracetemol/NSAIDS (first line) codeine/tramadol Consider benzodiazepine if there is muscle spasm Consider tricyclic antidepressant/ gabapentin if persistent sciatica