Locomotor Core Conditions Flashcards
What is the most common form of arthritis?
Osteoarthritis
Who gets OA?
Women >55
Younger people who suffered injuries
Causes of OA?
Wear and Tear
Active/inflammatory processes in response to injury
Ligament/tendon problems
Bone/cartilage damage
What is the difference between primary and secondary OA?
Primary - no known cause
Secondary - known cause (joint damage, systemic disease)
Risk factors for OA?
Increasing age Female FHx Previous joint injury/infection Intra-articular # or ligament tear Joint malalignment Slipped upper femoral epiphysis Congenital dislocation of the hip Obesity Occupational stress Ethnic origin
Symptoms of OA?
Seen in synovial joints Cartilage loss and periarticular bone response Stiffness in the morning Pain Loss of ROM Grating/crepitus Joint effusion NO systemic illness Bony swelling and deformity Heberden's and Bouchard's
Differentials for OA?
Bursitis Referred pain from hip/spine Psoriatic/Rh/infective arthritis Pseudogout Connective tissue disease Seronegative arthritis Sarcoidosis/endocarditis which can present with arthropathy
Investigations for OA?
Examination of joint Plain XR (osteophytes, narrow joint space, subarticular sclerosis, bone cysts ) BMI/weight MRI FBC, CRP, creatinine, LFTs Joint aspiration of synovial fluid
Treatment for OA?
Education Weight loss Exercise NSAIDs (oral/gel) COX-2 inhibitors (w/PPI) IA corticosteroid injections Arthroscopic lavage (for joint locking) Joint arthroplasty (if pain, stiffness,
How many adults int he UK are affected by gout?
1 in 70
Who gets gout?
M>F
Post menopausal women
People of Asian/Pacific island populations have more severe disease
Causes of gout?
Hyperuricaemia
Kidneys usually excrete uric acid but an excess ends up in blood and can deposit crystals in cool temperature joints (distal)
Risk factors for gout?
Diet rich in red meat Diuretics Niacin Male Alcohol use FHx Obesity HTN Hyperlipidaemia Chronic renal failure DM CHD
Symptoms of acute sodium urate gout?
Sudden, agonising onset Swelling and redness of 1st MTP Precipitating factor (food, alcohol, dehydration, diuretic) W/o treatment will last 7 days Overlying cellulitis Mainly affects the great toe
Symptoms of chronic polyarticular gout?
Unusual
Long standing diuretics w/renal failure
Men
Allopurinal started too soon after an acute attack
Symptoms of chronic tophaceous gout?
Sodium urate forms tophi in skin at joints 9usually ear, finger, achilles tendon) Chronic pain Restricted movement Crepitus Deformity Renal impairment/diuretics Punched out bone cysts on XR Urate renal stones formed
General symptoms of gout?
Acute pain Swollen joints Tender Erythematous Peaks in 25 hours Fever malaise Untreated should resolve in 5-15 days Itching and desquamation of overlying skin
Differentials for acute gout?
Pseudo gout
Septic arthritis
Haemoarthrosis
Palindromic RhA
Differentials for chronic gout?
RhA
Generalised nodal OA
Xanthomatosis w/arthropathy
Multicentric reticulohistiocytosis
Investigations for gout?
Joint fluid microscopy
Serum uric acid (>600micromol/L - check again several weeks later as levels fall quickly after attack)
U+E
Renal function
Treatment for gout?
Ice, elevate
Weight loss, exercise, diet (inc reducing alcohol)
Increase fluid intake
NSAIDs (+PPI)
Colchicine (for pts with HF and anticoag)
Corticosteroids
Allopurinol
Who gets pseudogout?
> 50
M>F
Those with metabolic/familia causes
What causes pseudogout?
Calcium pyrophosphate deposition in synovial fluid of joints
Runs in families
Risk factors for pseudogout?
Male Increased age FHx Hypothyroidism Hyperparathyroidism Hypercalcaemia Mg def Haemophilia Ochronisis Amyloidosis Haemochromatosis
Symptoms of pseudogout?
Bouts of joint pain
Swelling of affected joint with fluid build up
Chronic arthritis
Commonly affects knees (but also ankles, elbows, wrists)
Investigations for pseudogout?
Joint fluid aspiration and analysis
XR - calcification of cartilage and joint cavities
Differentials for pseudo gout?
RhA
Gout
OA
Treatment for pseudo gout?
Synovial fluid drain NSAIDs Colchicine Hydroxychloroquine Methotrexate Interleukin-1-B-antagonists
What % of prosthetic joints get infected?
2-10%
Who gets septic arthritis?
Any age
Elderly with multiple morbidities
Immunosuppressed
Causes of SA?
Staph aureus (and other staph) Strep Neisseria gonorrhoea H. flu in children Other gram -ve in the elderly
Risk factors for SA?
Artificial joint Bacterial infection elsewhere Chronic illness IVDU Immunosuppression Recently injured/surgery Overlying infection of skin/soft tissues
Symptoms of SA?
Single, red hot, swollen, painful, immobile joint
Medical emergency
Fever, rigors, systemic illness
Vomiting, hypotension
Effusion
May be an abscess or loosening of prosthetic joint
Differentials for SA?
Gout/pseudogout Vasculitis Drug/reactive/viral arthritis Post infection diarrhoeal syndrome Post meningococcal/gonococcal arthritis Arthritis of intrinsic bowel disease Lyme disease Infective endocarditis
Investigations for SA?
FBC, inflammatory markers
Aspirate and exam synovial fluid
Culture bloods and synovial
Swabs of anus, cervix, urethral, pharynx if gonorrhoea suspected
Lyme disease test
Immunology serology for RhA and vasculitis
US
CT/MRI for osteomyelitis/periarticular abscesses
Treatment for SA?
Abx - Pencillin + gentamicin, or cephalosporins
IV Abx for 2-3 weeks
Then oral for 2-4 weeks
Joint drainage if not responding
Splint in position of function
Once infection is controlled immediately mobilise to prevent contractures
How many cases of subacute backpain are prolapsed discs?
<1 in 20
Who gets slipped discs?
30-50
M>F
Causes of slipped disc?
Annulus fibrosus braks and the nucleus pulposus protrudes
Old age decreases water content of discs
Sneezing
Awkward bending
Heavy lifting
Risk factors for slipped disc?
Lots of sitting Smoking Overweight Weight bearing sports Traumatic injury to back Lots of lifting
Symptoms of slipped disc?
Pain in lower back Severe, acute Better when lying flat Worsened by movement/coughing/sneezing Can be asymptomatic if no cord compression Sciatica (lasting, aching pain in leg) Muscle pain/spasm from affected nerve supply Urinary incontinence
Symptoms of cauda equina and nerve roots involved?
Loss of function of L2-S5 Lower back pain Saddle anaesthesia Paralysis of one or both legs Rectal pain Bowel disturbances Urinary incontinence Inner thigh pain
Investigations for slipped disc?
Physical exam (peripheral nerves) Straight leg raise (no more than 2/3rds before tingling, pain, numbness) XR MRI for surgery Discography (contrast and XR)
Treatment for slipped disc?
Exercise and maintain AODL Paracetamol/NSAIDs Codeine Diazepam for muscle spasms Physio Osteopath Surgical removal of prolapse
