management of orthopaedics Flashcards
arthritis can be caused by:
general syptmoms/sigs:
can result in -ve effect on:
diagnosis can be — or —–
management is primarily focused on — and —-
-Degenerative, Inflammatory, Crystal deposition
-joint pain, stiffness, reduced ROM and/or loss of function
-mood, sleep and participation in
occupational/recreational/social activities
- clinical ad radiological (+/- biochemical )
- pain management and improving quality of life
risk factors of arthritis:
- preventable:
- non modifiable :
- modifiable:
-Preventable: Anatomical deformity, Joint injury (e.g. intra-articular fracture)
-Non-Modifiable: Age, gender, genetics
-Modifiable: Obesity
non-pharmacological management of arthritis:
1- —- :
- reduce the — of joint
- obesity is associated w increased levels of —- that cause joint damage
2- —– and —— :
- as: — modification which includes Rest/reduction in activity as appropriate ,Exercise plan with progressive loading of volume and intensity
- — modification
- use of — :
Walking stick/frame, graspers, shoe horns
Brace/Splint
Balance benefits of support/rest with risk of increased stiffness
- weight loss
- biomechanics loading
- inflammatory mediators
- physiotherapy n rehabilation
- activity
-biomechaical - aids
pharmacological management of arthritis :
1- oral as:
2- tropical as:
3- intra-articular injection:
1- oral:
Paracetamol (hepatotoxic)
Non-Steroidal Anti-Inflammatory Drugs/NSAIDs (nephrotoxic, GI ulceration)
Opioids (nausea, vomiting, constipation, delirium, dependency)
2- tropical:
NSAID gels e.g. ibuprofen, diclofenac (less systemic effects compared to oral)
3- ira-articualr injection:
Steroid, local anaesthetic or others
additional cause specific consideration:
1- rheumatoid/inflammatory arthrtis:
2- gout:
- which is the reduction of —
- we use +/- pharmacological as:
- usually responds well to —- or —
3- septic arthritis:
- source control:
- we also use:
-Anti-inflammatories/Disease Modifying Anti-Rheumatic Drugs (DMARDs), biologic agents
- uric acid through diet
- allopurinol
-NSAIDS or colchicine
- washouts
- antibiotics
operative management of arthritis includes:
1- arthroplasty aka joint replacement as: hip knee shoulder elbow and ankle
2- fusion :
- less common
- foot ankle and spine
signs of osteoarthritis: LOSS which is:
- loss of —
- —- formation
- ——
- —–
Loss of joint space
Osteophyte formation
Subchondral sclerosis
Subchondral cysts
(check slide 12,13 )
radiological investigation ( x ray , radiograph and plain film ) :
- uses — to produce —- images
- can you – or – views to allow —- interpretation
- good imaging for —-
- minimal details of —
- dense tissues as bones appear —- and less dense as air appear —
- its — line for for investigating for arthritis, fractures or dislocations
- Depending on situation may need further imaging
E.g. CT for assessment of intra-articular fracture pattern
ionising radiation
2D images
2 or more views
imaging bone
soft tissues
white
black
first line
-Ultrasonography (US):
- probe produces — and records as they — back
- good imaging for —-
- requires —
sound waves
echo
soft tissues
skilled operator
CT:
- uses —- and – from many — processed by —- to allow —-
- good for – and takes —
- not best option for —-
- it has — radiation dose than x rays and not as — available
ionising radiation
x ray
many
computers
3D
imagining bone
seconds
larger
readily
imaging musculoskeletal soft tissues
MRI - magnetic resonance imaging:
- uses —- to assess align and alter the spin of nuclei to produce —- images and has various possible sequence
- provides highly detailed imaging of —-
- takes — and needs to remain still and loud , clastrophobic some implants may not be compatible as —– and —-
- may not — available
strong magnetic field
soft tissues
longer
pacemakers and defibrialtor
readily
( check slide 18,19,20 )
tendonopathy/tendonitis:
- usually due to failed — of the tendon
- may occur due to —- or —-
- increased prevalence w —
- Characterised by pain at – of tendon insertion
-Management generally involves :
healing
overuse or inflammation
age
site
combination of rest, analgaesia, splinting, rehabilitation and exercise modification and occassionally surgical intervention
—- is the inflammation around tendinous insertions into bone
- Describe a variety of conditions in and about the elbow as:
1- lateral epicondylitis:
2- medial epicondylitis:
- Occurs in Sportsmen & women due to repetitive use of — muscles
-1-3% from the population
-Only 50% seek medical advice
-50% of the tennis players > – years old
-Both are treated with — , avoid precipitating activity, injection of —
-If conservative fails then consider — tendon from origin at the— epicondyle
- epicondylitis
- classical tennis elbow
- golfers elbow
- forarm
- 30
- rest
-steriod - detaching
- humeral
tennis elbow:
- is due to —- or related – of the —- epicondyle
- P/C: pain over — side of the elbow , Aggravated by movement such as pouring tea, turning a stiff door handle, shaking hands, ect
- sings:
minor trauma
repeated strain
lateral
outer
tender over lat epicondyle, pain on resistance to wrist extension
minor trauma or repeated strain of the medial epicondyle is known as —-
- P/C: pain is in the — side of the elbow
- sings:
golfers elbow
inner
: tender over medial epicondyle, aggravated by passive flexion of the wrist
