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Musculoskeletal System > Monoarticular pain > Flashcards

Monoarticular pain Flashcards

1
Q

Why do we replace joints?

A

Because of pain, stiffness or correction of deformity

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2
Q

What 2 most common types of joint replacement?

A
  1. Hip

2. Knee

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3
Q

What are the 4 options of joint arthroplasty?

A
  1. Fixation
  2. Bearing surface
  3. Bone preserving/sacrificing
  4. Hemiarthroplasty/total arthroplasty
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4
Q

What are the major complications of joint replacement?

A
  • Dislocations
  • Infections
  • Thromboembolic disease
  • Leg length discrepancy
  • Nerve palsy
  • Fracture
  • On going pain
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5
Q

How long do most replacements last for?

A

10 - 15 years

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6
Q

Joint arthroplasty is a minor surgery. TRUE or FALSE

A

FALSE - it is a MAJOR surgery

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7
Q

What properties should the material of the joint replacement have?

A
  • Strength
  • Elastic modulus
  • Biocompatible
  • Bearing surface
  • Attachment to bone
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8
Q

What measures can be taken to prevent post-operative infections of the joint replacement?

A
  • clean, filtered air

- prophylactic antibiotics

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9
Q

What are some metal on metal complications that can occur with JA?

A
  • wear debris (cobalt and chrome ions can form)
  • debris can cause response in local tissues
  • ions are usually filtered by kidneys
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10
Q

What is osteoarthritis?

A

A disease of the entire joint that breaks down the tissues and causes pain and stiffness
- also known as wear and tear disease

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11
Q

What places are usually affected in osteoarthritis?

A
  • Knees, Hips, Hands (first metacarpal joint)
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12
Q

What is primary osteoarthritis caused by?

A

EXACT CAUSE IS UNKNOWN

  • Biological factors (genetics)
  • Mechanical factors (excessive use of the joint)
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13
Q

What is the onset of osteoarthritis?

A

> 40 years old

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14
Q

Name 4 treatments for OA?

A
  1. Patient education
  2. Exercise
  3. Weight loss
  4. Use of analgesia
  5. Surgery
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15
Q

In OA the articular cartilage around the joint is damaged. TRUE or FALSE

A

TRUE

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16
Q

Name some secondary causes of OA

A
  • Trauma
  • Infection
  • Inflammatory diseases
  • Perthes disease
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17
Q

Which types of surgery are carried out for OA?

A
  • Arthrodesis (fusion)
  • Excision arthroplasty (removal of joint)
  • Hemi arthroplasty
  • Total joint arthroplasty
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18
Q

What is a trapezectomy?

A

Removal of the small bone called trapezium

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19
Q

What are the risks and benefits of a trapezectomy?

A 
Benefits: 
- non - weight bearing bone
- preserves range of movement 
Risks: 
- It can cause instability
- long rehabilitation time
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20
Q

Name 3 risk factors of osteoarthritis?

A
  1. Obesity
  2. Age
  3. Females
  4. Muscle weakness
  5. Occupation
  6. Calcium crystal deposition
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21
Q

Osteophytes can be formed due to osteoarthritis. TRUE OR FALSE

A

TRUE

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22
Q

What is the rotator cuff arthritis?

A

Type of shoulder arthritis that can develop after a massive and prolonged rotator cuff tear

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23
Q

What is the function of the rotator cuff?

A

stabilize the glenohumeral joint by compressing the humeral head against the glenoid.

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24
Q

What are the radiographical features of osteoarthritis?

A
  • Loss of joint space
  • Cyst forming on bone
  • Sclerosis
  • Formation of osteophytes

LOSS

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25
Q

What are the clinical features of osteoarthritis

A
  • Asymmetrical joint pain
  • Pain worse after exercise but gets better with rest
  • Night pain occasionally
  • usually systemically well
  • Morning stiffness for < 30mins
  • older than 45 yrs
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26
Q

Name 3 reasons why we need bones?

A
  • Production of blood cells
  • Protection of vital organs
  • Transmission of forces generated by muscle
  • Mechanical support
  • Mineral homeostasis
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27
Q

What is the diaphysis (shaft)

A
  • the middle part of the bone
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28
Q

Where does the metaphysis extend from?

A

Extends from the growth plate to the point where the bone becomes narrow.

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29
Q

Where is the metaphysis in immature or growing bone?

A

It is separated from the epiphysis by a growth plate or physis

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30
Q

What kind of forces are long bones exposed to?

A

Twisting forces

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31
Q

What is the difference between woven bone and lamellar bone

A
  • Lamellar bone can withstand stress equally well in all directions and is more stable than woven bone.
32
Q

When is bone made rapidly and what type of bone is produced

A
  • unborn child
  • when bone is produced rapidly
  • woven bone is produced
33
Q

How is woven bone formed

A

Type 1 collagen fibres are laid down in a criss cross pattern

34
Q

Does woven bone or lamellar bone take longer to form

A

Lamellar bone

35
Q

How long intramembranous ossification last for?

A

From in vitro to adolescent

36
Q

What kind of bones undergo intramembranous ossification?

A

Flat bones e.g

  • skull
  • clavicle
37
Q

Name 3 types of fractures

A
  • Simple
  • Compound
  • Comminuted
  • Displaced (if ends of bones are not aligned properly)
  • Stress (repeated physical stress e.g load on bone)
  • Greenstick fracture (only happens in children - only part of bone is broken)
  • Pathological (bone is weakened by a disease)
38
Q

What is a displaced fracture

A

when the ends of the bones are not aligned properly

39
Q

What is a stress fracture

A

-physical stress causes by repeated load on bone

40
Q

What is a greenstick fracture

A
  • occurs in infants and children where the bone is soft

- fracture does not extent through the bone

41
Q

In a clinical settings how do most fractures occur?

A
  • in the elderly who have loss of bone density (osteoporosis)
42
Q

Name some impaired healing of fractures

A
  • Open fractures could cause secondary infection
  • Non- union could cause (pseudo-arthrosis)
  • Displaced- comminuted fractures could cause deformity
43
Q

What is osteonecrosis?

A

Ischaemic necrosis of bone and bone marrow

-

44
Q

How does osteonecrosis usually occur?

A
  • Fractures and trauma
  • Sickle cell anemia (abnormal shape of rbc)
  • Corticosteroid therapy
45
Q

What is osteomyelitis?

A

Inflammation of the bone and bone marrow usually due to infection with bacteria
- usually hematogenous bacteria spread

46
Q

What kind of bacteria is usually involved in osteomyelitis?

A
  • Stapyhloccucus aureus
47
Q

What are some features of osteomyelitis?

A
  • bone pain

- signs of infection e.g fever

48
Q

How is osteomyelitis is diagnosed?

A

By blood culture

49
Q

Septic arthritis is common. TRUE OR FALSE

A

FALSE - it is not common

50
Q

What is the most common area for septic arthritis?

A
  • hip and knee but can be present in any synovial joint
51
Q

What are some risk factors of septic arthritis?

A
  • Skin infection
  • Prosthetic joint
  • Immune suppression
  • IV drug use
  • Liver cirrhosis
  • Comorbid conditions e.g diabetes
  • Children and Elderly >80 yrs
52
Q

How does septic arthritis clinically present?

A
  • Fever
  • Joint pain - any movement causes intense pain
  • Loss of weight bearing in that joint
  • Limited movement
  • Swelling
  • Joint effusion
53
Q

What is septic arthritis?

A

Infection within a synovial joint caused by a microorganism

54
Q

What bacteria most commonly causes septic arthritis?

A
  • Staphylococcus aureus
  • Streptococci A or B
  • Haemophilus influenza
  • Gonorrhoea bacteria
55
Q

How does septic arthritis occur?

A
  • Haematogenous pathway
  • Dissemination from osteomyelitis
  • Penetrating trauma
  • Puncture or injections
56
Q

Describe the pathophysiology of septic arthritis

A

Bacterium settles in synovium and proliferates > causes inflammation and leucocytes migrate into joint
- variety of enzymes breakdown products damage articular surface

57
Q

What are the two main types of crystal arthritis?

A
  1. Gout

2. Calcium pyrophosphate dihydrate (CPPD)

58
Q

What drugs cause hyperuricemia?

A
  • Cyclosporine
  • Alcohol
  • Thiazide
  • Aspirin
  • Lasix
  • Nicotinic acid
59
Q

Name 3 risk factors of gout

A
  • High purine diet and protein diet
  • Obesity
  • Males
  • Cancer
  • Psoriasis
  • Hypertension and renal disease
  • Diuretic use
60
Q

What are the clinical presentations of gout?

A
  1. Severe pain
  2. Rapid onset (patients often wake up with pain)
  3. Extreme tenderness
  4. Marked swelling with overlying red , shiny skin
61
Q

How many people does gout affect in the UK?

A

2.5%

62
Q

Gout affects males more than woman. TRUE OR FALSE

A

TRUE

63
Q

What causes gout?

A

Gout is caused by hyperuricemia where the uric acid levels in the blood is soo high that it gets deposited in joints and tissues and forms crystal

64
Q

What kind of crystals are formed in gout?

A

Monosodium urate monohydrate

65
Q

What kind of crystals are formed in pseudogout?

A

Calcium pyrophosphate dihydrate crystals

66
Q

Why does uric acid build up?

A

Builds up when the kidneys cannot filter them enough uric acid out.

67
Q

What can be used to treat gout?

A
  • NSAIDs e.g colchicine
  • Urate lowering therapy e.g allopurinol
  • Advice on healthy life style
  • Analgesia
68
Q

How is gout diagnosed?

A
  • joint aspiration (urate crystals might be present)
  • blood tests (serum uric acid levels)
  • X-rays and ultrasound to detect inflammation and tophus
69
Q

Describe the urate crystals in gout

A

Yellow and needle shaped

- negatively birefringent

70
Q

Describe the urate crystals in pseudogout

A

crystals appear rhomboid shaped and blue

- weakly positively birefringent

71
Q

What is the most common site for gout

A

Big toe

72
Q

What is the most common site for pseudogout

A

Knees

73
Q

Pseudogout is rare for people under the age of 55. TRUE OR FALSE

A

TRUE

74
Q

What are some risk factors for pseudogout

A
  • Age
  • Osteoarthritis
  • Hyperparathyroidism
  • Hypophosphatasia
  • Hemochromatosis (build up of iron)
75
Q

What is the clinical presentation of pseudogout?

A

Similar to gout - can be differentiated by joint aspiration

76
Q

What does allopurinol do?

A

It inhibits the enzyme xanthine oxidase (converts xanthine into uric acid)

Musculoskeletal System (14 decks)

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