Misc Flashcards
6 causes of bone deformity
o Congenital o Rickets/ osteomalacia o Bone dysplasia o Physeal injury o Fracture malunion o Paget’s dx
6 causes of joint deformity
o Skin contracture- burn o Fascial contracture- Dupuytren's o Muscle contracture – Volkmann's o Muscle imbalance o Joint instability o Joint destruction
Hx for knee
any
- locking
- giving way
- pain (one point or whole joint line)
- pain when climbing stairs or standing
- stiffness: morning or constant
- swollen
- noise along joint
- functional: can walk? climb stairs? squat down?
What muscle weakness you expect in sciatic nerve injury?
Difficulty
- ankle flexion/ extension/ inversion/ eversion
- great toe extension
What are the side effects of H&L
with repeated injections
- lowered efficacy
- risk of tendon rupture
- infection
- hypo pigmentation over site of injection
- steroid flare
- fat necrosis
- periarticular osteoporosis
The 3 stages of RA
1: synovitis
2: destructive
3: deformity
X ray features of RA
1: ST swelling and osteoporosis around joints
2: narrowing of joint spaces, small periarticular erosions
3. marked articular destruction, joint deformity and dislocation
NF1
- inheritance
- skeletal abnormalities
AD
bony dysplasia of sphenoid
long bone abnormalities like pseudoarthrosis of tibia
Mgx of gout
non pharm: weight loss, avoid high purine food (red meat, beans)
Pharm:
- xanthine oxidase inhibitor (allopurinol)
- uricosuric agent (probenecid)
acute flare: NSAID, colchicine
Mgx of ganglion
Conservative: - follow up in 1 year - cyst aspiration SX: - excision with partial synovectomy
bankart vs hillsach lesions
both from anterior dislocations of the shoulder
bankart: anteroinferior lesion on gelooid labrum
hillsach: posterolateral lesion of humeral head
Criteria for Ankylosing Spondylitis
Rome criteria
NY critieria
- B/l Sacroilitis >grade1 or unilateral sacroilitis >grade 2 AND any of the following
> LBP inflammatory
> dec lumbar spine movement in sagittal and frontal planes
> dec chest expansion
Grading of ankylosing spondylitis radiologically
1: widening of joint
2: joint erosion
3: sclerosis on both sides
4: ankylosis
Types of seronegative spondyloarthritis
PAIRS - psoriatic arthritis, ankylosing arthritis, IBD, Reiter, Still’s disease
Causes of sacroilitis
PUB CAR
Psoriatic, UC, behcet, crohns, ankylosing spondylitis, Reiter
Symptoms of ankylosing spondylitis
and extraskeletal manifestations
11 As of Anks Spons
- Appearance: question mark posture
- Army boys
- Arthritis: axial - cervical, lumber, SIJ TMJ, costovertebral joints (if peripheral jts,LL>UL)
- Ankylosis severity: posture, occiput wall distance, thoracolumbar ROM, schober test, chest expansion
cx: radiculopathy, spinal stenosis, myelopathy - Atlanto-axial instability
- Achilles tendinitis and other forms of enthesitis (plantar, prebatellar, costochondritis)
- Anterior uveitis
- Aortitis, AR
- AV nodal block, Arrhythmias
- Apical interstitial lung disease
- AA Amyloidosis (abdomen)
- IgA nephropathy
- Anemia
x ray findings of ankylosing spondylitis
SIJ: erosion and fuzziness Vertebrae: - squaring - erosion at vertebrae corners and sclerosis (Romanus lesion) - syndesmophytes - face joint effusion, vertebral fusion - bamboo spine - costovertebral joint involvement - atlantoaxial dislocation - osteoporosis, hyperkyphosis of thoracic spine
Mgx of ankylosing spondylitis
Conservative:
- genetic counselling (AD), fall prevention, lifestyle modification - physiological, exercise, avoid rest
- meds: NSAIDs, sulphasalazine
- RT
- anti TNFalpha (infliximab)
- steroid injections
sx:
- arthroplasty of joints
- spine osteotomy (rare)
Features of psoriatic arthritis
- asymmetrical polyarthritis
- IPJ of fingers and toes > arthritis mutilans
- sacroilitis and spondylitis in 1/4 of patients
- no rheumatoid nodules
- psoriasis of skin and nails (skin folds)
Reiter triad
polyarthritis
conjunctivitis
non specific urethritis (or colitis)
What is still’s disease and its types
Juvenile chronic arthritis - non infective inflammatory joint dz in children <16yo
Types:
- pauciarticular JCA (commonest): medium size joints
- polyarticular seropositive JCA: juvenile RA
- seronegative spondarthritis: juvenile AS
- systemic JCA (classic still): fever, rash, malaise, LN, hepatosplenomeg, joint swelling
Differentials for monoarthritis
GHOST: gout, haemarthrosis, osteoarthritis, septic, trauma
Gouty involvement
MTPJ of big toes (podagra), ankle, finger joints, tendoachilles, olecranon bursae, pinnae of ears, lesser toes
gout x ray features
punched out lesions in para-articular bone ends with overhanging edges
erosion with joint space preservation
may have secondary OA
Mgx of gout
Acute: rest, NSAID, colchicine Chronic: - weight loss, stop alcohol, diuretics - xanthine oxidase inhibitor: allopurinol - uricosuric drug: probenecid
components of calcium pyrophosphate dihydrate deposition
synovial fluid findings
- chondrocalcinosis: calcific material in articular cartilage and menisci
- pseudo gout: crystal induced acute synovitis
- chronic pyrophosphate arthropathy: degenerative joint disease in non weight bearing joints
- affects larger joints
weakly positively birefringent rhomboid shaped crystals in synovial fluid
Causes of secondary osteoporosis
congenital
- osteogenesis imperfecta
- trisomy 18
- ehler danlos syndrome
- inborn errors of metabolism
- neuromuscular diseases and dystrophies
- gonadal dysgenesis
acquired
- endocrine: hypogonad, adrenal cortical (Addison, cortical hyperplasia), pituitary (cushing, acromegaly), hyperthyroidism, hyperPTH
- DM
- Disuse atrophy
- Nutrition deficiency (vit C, protein, calcium, malnutrition)
- Liver dz
- Iatrogenic (steroid, heparin)
What is Paget disease (osteitis deformans)
increased osteoblastic and osteoclastic activity resulting in enlargement and thickening of bone but abnormal and brittle internal architecture
- in pelvis and tibia commonest
s/s of Paget disease
dull pain bone - tibia and femoral bowing - enlarged and flattened skull - kyphosis - otosclerosis (deafness) Neuro: - CN compression - spinal cord/ nerve root compression Steal syndrome: - cerebral impairment, spinal ischemia, high output cardiac failure
what is maffucci syndrome
multiple enchondromas + haemangiomas of skin and viscera
what is osteogenesis imperfecta
heritable CT disorder: abnormal synthesis and structural defects of T1 collagen
bone fragility, osteopenia, recurrent #
ligament laxity
crumbling teeth
x ray: generalised osteopenia # in various stages of healing vertebral compression spinal deformity
