MSK Flashcards
What are the five types of connective tissue?
Bones, cartilage, ligaments, tendons, and fascia
What two structures absorb energy from impact?
Bones and cartilage
What are the three bone cells and their functions?
- Osteoblasts - bone forming cells
- Osteocytes - mature bone cells
- Osteoclasts - bone remodelling
What does rheumatoid factor, creatine kinase, and ESR blood studies indicate?
- Rheumatoid factor - Measures presence of autoantibody in serum
- CK - Measures serum levels of an enzyme found in skeletal muscle, heart muscle, and brain (Not a specific test that indicates area that has been effected, it is a general test)
- ESR - Measures non-specific index of inflammation
What does CRP, uric acid, calcium, and phosphorus blood studies indicate?
- CRP - Used to diagnosis inflammatory disease (Not a specific marker, just indicates inflammation is present)
- Uric acid - End product of purine metabolism
- Calcium - Mineral needed to build and maintain strong bones
- Phosphorus - Mineral needed to build and maintain strong bones
Does arthritis affect men or women more?
Women
Define osteoarthritis
Slow, progressive, unilaterl, non-inflammatory disorder that affects diarthrodial joints (synovial)
What types of joints does osteoarthritis and rheumatoid arthritis affect?
Diarthrodial joints
What is osteoarthritis the gradual loss of?
Cartilage in the joints
What age can osteoarthritis begin and the average age?
May begin between 20-30, but average is 40
Does osteoarthritis have a known cause?
May have a cause of a known event/condition or no known cause
What six factors increase the risk of osteoarthritis?
- Decreased estrogen may play a part
- obesity
- regular moderate exercise
- sports with quick stops and pivots
- occupations with kneeling and stooping
- genetic and metabolic factors
How does the cartilage change in osteoarthritis?
Becomes yellow, dull, granular, softer, less elastic, and less able to take impact/move
Cartilage cannot repair fast enough
Cartilage is cracked and worn
How do the joint edges become with osteoarthritis?
Central cartilage is thinner, joint edges become thicker; making the joints uneven
Is osteoarthritis an inflammatory or non-inflammatory condition?
Non-inflammatory
What are the 6 clinical manifestations of osteoarthritis?
- Crepitation
- Pain that increases with joint use
- Pain relieved with rest (early stages)
- Sleep disrupted by pain (late stages)
- Pain leads to disability and loss of function
- Referred pain
Would someone with osteoarthritis spend more time standing or sitting as a result of pain?
Spend more time standing due to joint stiffness after rest/static positions
Would someone with osteoarthritis feel joint stiffness relief in the morning?
Yes, usually within 30 minutes
Is osteoarthritis unilateral or bilateral?
Unilateral
What joints does osteoarthritis commonly effect?
Fingers, thumb, weight bearing joints (hips or knees), foot, cervical, and lower lumbar spine
Heberden’s and Bouchard’s nodes are related to what disease?
Osteoarthritis
What is the difference between Heberden’s and Bouchard’s nodes?
Heberden’s - exist on the first joint (distal)
Bouchard’s - exist on the second joint
How do Heberden’s and Bouchard’s nodes present?
Red, swollen, and tender
Do Heberden’s and Bouchard’s nodes cause dysfunction?
No, not usually
What joint will often cause deformities in osteoarthritis?
The knee joint - unilateral with changes to ROM on the effected leg
Can/does osteoarthritis become systemic?
Fatigue, fever and organ involvement is NOT present
What three diagnostics would be used for osteoarthritis diagnosis?
Bone scan, CT, MRI
What three primary things does interprofessional care focus on for osteoarthritis?
- Managing pain and inflammation at the joint
- Preventing disability
- Maintaining and improving joint function
Would heat or cold be used more often for osteoarthritis?
Heat
When would complementary/alternative therapy be used for osteoarthritis?
Usually used when conventional therapy does not work
Define rheumatoid arthritis
Chronic, systemic, autoimmune disease, inflammation of connective tissue in diarthrodial (synovial) joints, bilateral
What is the most common type of arthritis?
Rheumatoid arthritis
What is the most disabling type of arthritis?
Rheumatoid arthritis
What is the peak age range for rheumatoid arthritis?
Peaks age 30-50 years
Is there a known cause for rheumatoid arthritis?
No exact cause known
Describe the 5 clinical manifestations of rheumatoid arthritis
- Non-specific fatigue, anorexia, weight loss, generalized stiffness
- Bilateral effect
- Joint stiffness after periods of inactivity
- Joints tender to touch, painful, warm
- Deformity, disability, muscle atrophy, and tendon destruction
Will individuals have stiffness relieved or worsened in the morning?
60 mins or more of morning stiffness typically occurs
What disease is Sjoren and Felty’s syndrome associated with?
Rheumatoid arthritis
Describe Sjorgen syndrome
Inflammation damages tear producing glands, eyes will feel gritty and dry, photosensitivity
How is Sjorgen syndrome managed?
Eye drops & sunglasses
Define Felty’s syndrome
Enlarged spleen and low WBCs
What are flexion contractures and what disease are they associated with?
Fingers become permanently flexed and hand deforms; rheumatoid arthritis
Is depression associated with rheumatoid arthritis?
Yes
What three diagnostic studies/assessments will be used to diagnose rheumatoid arthritis?
o History and physical findings
o Positive rheumatoid factor
o Synovial fluid
How do disease modifying anti rheumatic drugs (DMARDs) effect rheumatoid arthritis?
Slow disease progression and decrease risk of joint erosion/deformity
What are biological response modifiers (BRMs) and what do they treat?
Slow disease progression of rheumatoid arthritis
Why would corticosteroids used for in rheumatoid arthritis?
Symptom control
What is dexamethasone? Contraindications? Side effects? Cautions?
Adrenocortical agent (glucocorticoid) that prevents release of substances that cause inflammation - SHORT TERM solution for exacerbation
Contraindications: allergy, fungal infection
Cautions: can weaken the immune system, dosage may need to be adjusted with unusual stress (serious illness, fever/infection)
Side effects: adrenal suppression, HYPOkalemia, hypertension, pancreatitis, depression, suicidal thoughts
What drug will cause patients to have boosted energy that does not stop at night (reducing sleep)?
Dexamethasone
What drug suppresses the adrenal gland?
Dexamethasone
Is dexamethasone long or short acting?
Long acting
What medication would be used as a short-term solution for rheumatoid arthritis exacerbation?
Dexamethasone
What is methotrexate? Side effects? Contraindications? Caution?
Antimetabolites - releases a molecule that blocks inflammation
Side effects - GI (nausea, vomiting, ulcers), mouth sores, monitor LFTs
Contraindications - allergy
Caution - not with breast feeding/pregnancy (teratogenic), individuals will become immunocompromised and may not be able to receive immunizations
What drug is high alert and requires appropriate PPE due to its teratogenic effects?
Methotrexate
What is capsaicin? Contraindications? Side effects?
Topical non-opioid analgesic - active ingredient in chili peppers that makes them spicy; heat will activate certain nerve cells that decrease the pain message
Contraindications - allergy
Side effects - severe pain/skin redness, loss of feeling at application site
ONLY BECOMES EFFECTIVE ATER 1-2 WEEKS
How long does capsaicin take for it to become effective?
Only effective after 1-2 weeks
Define osteoporosis and what does it lead to
Chronic, progressive, structural deterioration of porous bone tissue that leads to increased bone fragility (fractures)
Is osteoporosis higher among men or women? Why (5)?
Women
- Low calcium intake
- Less bone mass
- Bone resorption begins earlier, accelerated at menopause
- Pregnancy and breast feeding
- Longevity – women live longer, so risk increases over time
What age is peak bone mass?
20
What type of exercise is best for osteoporosis?
Weight bearing
Briefly define how bone remodelling works
bone deposits by osteoblasts (bone deposits – calcium) and resorbed by osteoclasts (resorb the calcium into the blood), normally this process is equal
What condition/woman phase is bone remodelling unequal?
Unequal in menopause
Is bone resorption greater/equal/less than deposits in osteoporosis?
Resorption is greater than deposits
Calcium is being put into the blood
What causes a Dowager’s hump? What condition is it associated to?
Hump on the back that occurs due to spaces between the intervertebral discs shrinking from osteoporosis
What are the very first signs of osteoporosis? What usually happens for this condition to become confirmed?
back pain/spontaneous fractures
Osteoporosis may not be confirmed until a spontaneous fracture occurs (i.e., someone picks up their laundry and feels a bone in their spine crack)
What are the clinical manifestations of osteoporosis?
Often considered a silent disease, as there aren’t really symptoms until a fracture occurs
Until bones become so weak that a sudden strain, bump, or fall causes a fracture (hip, wrist, or vertebra) – known as fragility fractures
What % of calcium in the bone must be lost for radiology to detect osteoporosis?
25-40%
How much calcium intake in the diet should women and men take to manage osteoporosis? Age specific
1000 mg/day in women 19-50 and men 19-70
1200mg in women greater than 50 and men greater than 70
How much vitamin D should individuals supplement for osteoporosis? Age-specific
supplement ages 19-50 with 400-1000 IU, over 50 800-2000 IU
Why should someone supplement vitamin D for osteoporosis?
Vitamin D improves the absorption of calcium
What is the best weight bearing exercise for osteoporosis?
Walking
Who would hormone therapy be prescribed for in osteoporosis treatment? What bone cell activity does it reduce? What are the primary side effect/concern of the medication?
First line of treatment for symptomatic menopause
Inhibits osteoclasts activity
Increases the risk of MI/stroke, estrogen based meds will increase risk of cancer, and progesterone/estrogen meds will decrease risk of uterine cancer
How does estrogen based medications affect cancer? Progesterone/estrogen based?
estrogen based meds will increase risk of cancer, and progesterone/estrogen meds will decrease risk of uterine cancer
What is calcium carbonate med? Contraindications? Side effects? Cautions?
Calcium supplement, prevents os treats calcium deficiency
Contraindications - allergy
Side effects - little/no urinating, swelling, rapid weight gain, signs of HYPERcalcemia, may make the individual hypertonic
Should be taken with food and cannot be crushed
Can vitamin D supplementation lead to hypercalcemia?
Yes, if eating high calcium or calcium supplementation
What is the largest concern with alendronate and how do we manage it?
It can cause esophageal erosion
Must be taken first thing in the morning, sitting upright, with a glass of water - patient must sit upright for thirty minutes after taking
What is the difference between an open (compound) and closed (simple) fracture?
Open - skin is broken, exposing bone and causing soft tissue injury
Closed (simple) – skin is not ruptured, remains intact
What is the difference between a complete and incomplete fracture?
Complete – break completely through the bone
Incomplete – occurs across the bone shaft, but bone is still in one piece
What is the difference between a displaced and non-displaced fracture?
Displaced – two ends of broken bone are separated from one another and out of normal position
Non-displaced – periosteum (lining on the outside of the bone) intact and bone in alignment
What are hip fractures often resultant of?
Older age, women over 75, long hospital stays, and serious injuries
What are the four clinical manifestations of hip fractures?
external rotation, muscle spasm, shortening of the affected extremity, and severe pain/tenderness in region of the fracture site
What are the three surgical options for hip fractures?
Repair with internal fixation device (example screw)
Replace part of femur with a prosthesis (partial hip replacement)
Total hip replacement (involves both femur and acetabulum)
What is something we want to continually assess for in someone with a hip fracture?
VTE (venous thrombotic embolism)
What types of ROM can individuals with hip fractures NOT do?
Patient cannot adduct hip/vastus lateralis, cannot sit in a 90-degree angle for the first six weeks
Define intervertebral degenerative disc disease
Structural, progressive degeneration of the intervetberal discs of the spine
Is intervertebral degenerative disc disease normal or abnormal with aging?
This process is normal with aging
Is an acute herniated intervertebral disc injury natural with aging?
Yes, it is usually due to repeated stress or trauma
Define herniation
Compression tension that leads to pain and the herniation can press against nerves causing radiculopathy
Define radiculopathy
radiating pain, numbness, tingling, diminished strength/ROM
What are the 4 clinical manifestations of intervertebral degeneration?
- Lower back pain that leads to radiating down the butt to below the knee (sciatic nerve involvement)
- If pain occurs with a straight leg raise, there may be degeneration occurring
- Decreased/absent reflexes
- Parasthesia, muscle weakness in legs, feet or toes
What condition is a straight leg raise a useful diagnostic tool for?
Degenerative disc disease
Define cauda equina and what condition it is associated with
Sudden bowel/bladder incontinence, erectile dysfunction
A medical emergency during disc herniation
What are the symptoms of cervical disc disease?
pain, radiating into arms, hands, decreased/absent reflexes, weaker hand strength
What is a myelogram and what will it be used to diagnose?
X-ray with contrast to diagnose intervertebral degenerative disc disease
What is traction therapy and what is it used to treat?
Weight/lever to relieve tension/pressure for disc herniation
List six conservative therapies for disc herniation
Physiotherapy, local heat/ice, ultrasound shockwave therapy, traction, TENS, medications (i.e., NSAIDs, opioids, muscle relaxants, gabapentin, antidepressants)
Define intradiscal electrothermoplasty (IDET) and Radiofrequency discal nucleoplasty
heat is used to denervate and change structure; alters ability of the nerve to transmit pain signals
radiofrequency is used to break up the damaged disc and changes the way our brain perceives messages of paresthesia and pain
Define interspinous process decompression system (X Stop) and laminectomy
Titanium device to lift the vertebrae up and release compression
excision of part of the posterior arch of vertebra
Define discectomy, spinal fusion and percutaneous discectomy
removal of damaged portion
fusing damaged areas, which alters spinal mobility and ROM
outpatient basis, laparoscopy that removes damaged tissue
What is Baclofen? Contraindications? Side effects?
Skeletal muscle relaxant that acts within the CNS to relieve pain with muscle spasms; sedative effects
Contraindications: allergy
Side effects: euphoria, light headedness, drowsy, dizzy, fatigue, confusion, muscle weakness
What medication should be taking with milk to allow for slower digestion?
Baclofen should be taken with milk to allow for slower digestion and protection of the stomach
Define gout
Type of arthritis, hyperuricemia (high levels of uric acid), deposit of crystals in one/more joints
Painful flare ups that last days to weeks followed by periods without issue
Are men or women effected by gout?
Men
What are the four causative factors for gout?
- Obesity
- Hypertension
- Diuretic use
- Excessive alcohol
What diet is related to increased exacerbations of gout? How does fasting affect gout?
Diet high in purine foods - vegetables (lentils, asparagus, spinach), meats (beef, chicken, pork)
Prolonged fasting may increase exacerbations
What happens with the kidneys that causes gout?
Occurs when kidneys can’t excrete enough uric acid or there is too much being made for kidneys to handle
What is the difference between primary and secondary hyperuricemia?
Primary - genetic
Secondary - conditions that increase uric acid production or decrease uric acid excretion (kidney function issues)
What two factors must be present for someone to be diagnosed with gout?
In order for it to be diagnosed as gout, crystallization and inflammation MUST be present
What is Podagra?
Inflammation of the great toe due to gout
What are the 4 primary symptoms of acute gout?
- One or more joints (usually less than 4)
- joints dusky/cyanotic, very tender (not receiving appropriate blood flow)
- usually triggered by trauma, surgery, alcohol, systemic infection
- Symptoms begin at night, sudden swelling, excruciating pain, peaks in hours, low grade fever (37.5 – 37.8)
What joints are typically affected by acute gout?
Podagra, mid tarsal foot, ankle, knee, wrist
What are the six clinical manifestations of chronic gout?
- multiple joint involvement
- visible deposits of sodium urate crystals (can feel/palpate crystals)
- severity varies (infrequent to multiple)
- chronic inflammation - joint deformity, cartilage destruction
- large urate crystals may perforate skin - may lead to abscess if it becomes infected
- may lead to kidney/urinary tract stones
What are tophi?
Visible deposits of sodium urate crystals due to chronic gout
What will synovial fluid look like in gout patients?
Often cloudy and thick in gout patients when it should be clear and runny
What is Colchicine? Contraindications? Adverse effects/cautions?
Antigout that reduces inflammation response to deposits of urate crystals in joint tissue
Contraindications: allergy
Adverse effects: GI/GU bleeding, fetal risk
