locomotoro Flashcards by Libby s

what is the most common locomotor condition?

osteoarthritis

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how does it differ from RA?

OA is a degenerative condition from wear and tear over the years whereas RA is AI

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who does it affect

F:m 3:1 
Over 50s
those who have had previous injury
wear and tear-overuse from job
obesity

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define osteoarthritis

degenerative condition where cartiladge becomes damaged and worn
there is the formation of osteophytes
often inflamed and tender on palpation

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signs and symptoms

pain on movement
background rest pain
worse at night
inactivity of 30 mins can cause joints to jel
crepitus on movement
hebeden and bouchards node 
reduced range of movement

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commonly affected sites

cervical and lumbar spine
knee 
foot MTP
hand- DIP PIP
hip
often asymmetrical

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investigations

XRAY-LOS loss of JOINT SPACE , osteophytes, subarticular scleross
Elevated CRP

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Management

exercises and physiotherapy
pain relief-nsaids, coedeine
weight loss
intraarticular steroid injections 
heat packs, walking aids 
TENS
surgery-joint replacement

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bursitis
gout
psueogout

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who does RA affect?

2:1 F:m
5-6th decade
more common in smokers
genetic tendency -HLA-DR4/1

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what is it?

autoimmune progressive disorder of the joints-often presents symmetrically - autoantibodies against the synovial joints
the synovial membrane becomes inflammated and infilterated with lymphocytes - forming a plaque on te cartiladge known as PANNUS

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presents

inflammation and pain in small joints
symmetrical distribution
pain worse in morning and stiffeness worse at rest
signs- boutinneres , swan neck deformities
ulnar deviation/subuxaltion of joints

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boutinneres and swan neck deformities -difference between them

boutinneres- fixed flexion of PIP

swan neck deformities- fixed hyperextension of PIP

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diagnostic criteria

4 of the 7 of the following 
- rheumatoid nodule
-rheumatoid factor +
- 3 or more joints involved 
- hand joint involvement
radiograph changes 
-symmetrical
 -morning stiffness for 6  or more weeks over an hour

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areas affected

wrist, below, knee, shoulder, ankle

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3 key descriptives

swollen, stiffiness and warm

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investigations

clinical examination
rheumatoid factor present In 70%
anti-CRP antibody
Xray shows- swelling, osteopenia, redcued joint space, subulaxtion

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management

1st line- DMARDS - Ciclopsorin methotrexate
biologics -▪abatacept
▪rituximab
▪tocilizumab.

surgery
Sulfasazmine
•leflunomide

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what is gout?

gout is a monoarthropathy caused by a build up in sodium urate crystals
seen with severe inflammation

where do most occur

60% ATJ of big toe

risk factors and causes

increased dietary purines
alcohol
diuretics 
leukemia 
renal impairment 
infection
trauma
surgery

associations

indicator of disease:
hypertension
IHD
Diabetes

investigations

polarised light microscopy
Xray -radiographs
bloods- ESR , urate
synovial fluid - urate crystals

treatment

nsaids
steroids
clochines 
allopurinol
ice pack
rest and elevate

septic arthritis

inflammation of joint caused by infection

presentation

single swllen joint with pain on active/passive movement chest wall pain if joints such as sternoclavicular affect fever rigors

signs

bacteriaema may present as hypotension and vomiting abscess at joint site

causes

s.aureus | streptococci

investigations

joint aspiration | cultures

``` Pre-existing joint disease immonosupression diabetes joint surgery chronic renal ailure over 80 yars of age IV drug use prosthetic joints ```

differentials

OA, RA

investigations

joint aspiration | blood cultures

treatment

cause dependent fluxoacillin vancomycin nsaids, ice pack, rest refer if prosthetic joint affected

what is slipped prolapsed disc?

when the NUCLEUS PULPOSUS buldges through a weakness in fibrous outer ring of disc and may put pressure on nearby structures or become inflamed.

symptoms

``` back pain - severe, sudden onset eased by lying flat, worse on movement and cough or sneezing pins and needles numbness or weakess in buttons leg food or neck pain bladder and bowel malfunction sadle anaethestia ```

test

raise leg of pt | patiet between 3o and 70 degrees

who

M> F | 30-50 year olds

risk factors s

weight lifting strenuous job involing lots of lifting smoking obesity age sitting a lot

treatment

exercise pain relief surgery-disecktomy diazepam

investigations

xray | MRI

Define osteoporsis

It is the weakening of bone can lead to loss of bone | Defined as decreased bone mass + deranged bone micro architecture = failure of structural integrity

Common site of fractures

Spine Neck of femur Wrist

Causes and risk factors

``` Women esp post menopause Increasing age Hyperthyroidism Cushing syndrome Malabsorption condition such as ibd coeliac Myeloma Ckd Diabetes Medications such as corticosteroids , heparin, Hysterectomy ```

Investigations

``` Dexa scan Calcium and bone profile Vitamin d Frax score T scores less than -2.5 ```

TreAtment

Bisphosphates such as alendronic acid and zolendronic acid ``` Non bisphosphates- denosumab terparatide Testosterone in men HRT calcium and vitamin d supplements Strontium ranelate ```

What is teriparatide

Parathyroid hormone