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Treatments > MSK > Flashcards

MSK Flashcards

1
Q

Treatment of subacromial impingement

A
  • Subacromial steroid injection
  • Physiotherapy
  • Arthroscopic subacromial decompression
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2
Q

Treatment of frozen shoulder

A
  • Early presentation, steroid injection

- Later presentation, surgery

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3
Q

Treatment of dupuytren’s disease

A

-Non-operative
-Operative
Partial fasciectomy
Dermo-fasciectomy
-Percutaneous Needle fasciotomy

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4
Q

Non operative and operative treatment of trigger finger

A
  • Non-operative = splintage or steroid

- Operative = open surgery or percutaneous release

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5
Q

Non-operative and operative treatment of de quervain’s syndrome

A
  • Non-operative = Splints + steroid injection

- Operative = Decompression

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6
Q

Non-operative and operative treatment of ganglion cysts

A 
-Non-operative
Aspiration
Reassure & observe 
"Hit it with a bible"
-Operative 
Excision 
Including "the root"
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7
Q

Treatment of osteomyelitis

A
  • Supportive pain + hydration
  • Rest + splintage
  • Antibiotics
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8
Q

Empirical antibiotics for osteomyelitis

A

Flucloxacillin + Benzylpenicillin

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9
Q

Treatment of Brodie’s abscess

A

Curettage

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10
Q

Treatment of subacute osteomyelitis

A
  • Prolonged course of antibiotic

- Curettage

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11
Q

Treatment of chronic osteomyelitis

A
  • Long-term antibiotics (local or systemic)
  • Eradicate bone infection surgically (multiple operations)
  • Amputation?
  • Massive reconstruction?
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12
Q

What local and systemic antibiotics are used to treat osteomyelitis

A
  • Local = Gentamicin cement/beads or collatamp (fully re-absorbable, gentamicin-impregnated collagen “sponge”
  • Systemic = Oral/IV/home AB
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13
Q

Treatment of acute septic arthritis

A
  • General supportive measures
  • Antibiotics
  • Surgical drainage + lavage (emergency, “never let the sun set on pus”,
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14
Q

2 types of lavage

A
  • Open

- Arthroscopic

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15
Q

2 types of treatment for TB related to orthopaedics

A

-Chemotherapy
-Rest + splintage
Operative drainage rarely necessary

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16
Q

Describe the antibiotic part of ortho TB treatment

A
  • Initially = Rifampicin, Isoniazid, Ethambutol for 8 weeks

- Then = Rifampicin + isoniazid for 6-12 months

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17
Q

4 types of treatment of RA

A
  • Medicines
  • Injections
  • Therapies
  • Surgery
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18
Q

2 DMARDs

A
  • Methotrexate

- Sulfasalazine

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19
Q

Combination treatment of RA

A

Methotrexate + DMARD + biologic

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20
Q

Describe the use of corticosteroid in RA Rx

A
  • Can be prescribed PO, IA, IM, IV
  • Short term benefit vs long term toxicity
  • Rarely appropriate as single drug therapy
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21
Q

Rx for paget’s disease

A

IV bisphosphonate therapy (one off IV zoledronic acid)

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22
Q

3 Bisphosphonates

A

Risedronate
Zoledronate
Pamidronate

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23
Q

Management of OI

A
  • Surgical (treat #s)
  • Medical (prevent #s with bisphosphonates)
  • Social adaptions
  • Genetic (genetic counselling for parents + next generation)
24
Q

Treatment of osteoporosis

A
  • Bisphosphonates (oral) (first line)
  • Parathyroid Hormone Analog (teriparatide)
  • Monoclonal antibody against RANK ligand (Denosumab)
  • HRT
  • Selective oEstrogen Receptor Modulator (SERM)
25
Q

Management of AS

A
  • NSAIDs
  • DMARDs (sulfasalazine)
  • Anti-TNF
  • Treatment of osteoporosis
  • Surgery (joint replacement & spinal surgery)
26
Q

Rx of enteropathic arthritis

A
  • Sulphasalazine
  • Steroids
  • Methotrexate
  • Anti-TNF
  • Bowel resection may alleviate peripheral disease
27
Q

Rx of reactive arthritis

A

Acute

  • NSAID
  • Joint injection (if infection excluded)
  • Antibiotics if chlamydia infection (contacts as well)

Chronic

  • NSAID
  • DMARD (sulphasalazine, methotrexate)
28
Q

Rx of an acute flare up of gout

A
  • NSAIDs
  • Colchicine
  • Steroids (IA/IM/Oral)
29
Q

Rx to lower uric acid

A
  • Xanthine oxidase inhibitor (Allopurinol, Febuxostat)
  • Uricosuric agents (Sulphinpyrazone, Probenecid)
  • Canakinumab (monoclonal antibody targeted at interleukin-1 beta)
30
Q

3 rules of lowering uric acid levels

A
  • Wait until the acute attack has settled before attempting to reduced the urate level
  • Use prophylactic NSAIDs or low dose colchicine/steroids until urate level normal
  • Adjust allopurinol dose according to renal function
31
Q

When to use colchicine over NSAIDs

A
  • Contraindications

- Patient cannot tolerate NSAIDs

32
Q

Management of Pseudogout

A

-NSAIDs
-IA steroids
There are no prophylactic therapies

33
Q

Rx of polymyalgia rheumatica

A
  • Prednisolone (15mg/day initially)
  • 18-24 month course
  • Bone prophylaxis
34
Q

4 types of non-pharmacological Rx for OA

A
  • Thermotherapy
  • Electrotherapy
  • Manual therapy
  • Aids + devices
35
Q

Pharmacological Rx of OA

A
  • Regular analgesia (paracetamol +/- topical NSAIDs/capsaicin)
  • If ineffective give codeine or short term oral NSAIDs (+PPI(omeprazole) )
  • IA steroids with severe symptoms
36
Q

Surgical treatment for OA

A

Joint replacement

37
Q

Management of buckle + greenstick fractures

A
  • Buckle = Cast 3-4 weeks

- Greenstick = Cast 4-6 weeks

38
Q

Rx of undisplaced + hinged tibial spine fracture

A

Long leg cast

39
Q

Rx of hinged + displaced tibial spine fracture

A

ORIF/AxIF

40
Q

Rx of patellar dislocation

A
  • Cast 2 weeks
  • Mobilise
  • VMO exercises
  • Repair medial ligament
  • Medialise tibial tubercle
41
Q

Rx of JIA

A

-Simple analgesics
-IA NSAIDs/steroids
If no response
-Methotrexate
-Anti-TNF (if methotrexate fails)

Physio + Occ therapy

42
Q

Indication for systemic steroids in JIA

A
  • Systemic onset JIA
  • Serious complication with any disease (Pericardial effusion, tamponade, vasculitis)
  • As a bridge between DMARDs
  • Children undergoing surgery
43
Q

Surgical Rx for JIA

A
  • Synovectomy

- Reconstructive/joint replacement

44
Q

Rx for meniscal tears

A
  • Meniscal repair
  • Partial meniscectomy
  • Meniscal transplantation
45
Q

Rx of spasticity in CP

A
  • Baclofen
  • Diazepam
  • Botulinum Toxin
46
Q

Rx of spina bifida

A
  • Surgery to close the opening in the spine + treat hydrocephalus
  • Physiotherapy and occupational therapy
  • Wheelchair, orwalking aids
  • Rx for incontinence
47
Q

Surgical Rx of hallux valgus

A

Only if non-surgical Rx fails
-Release lateral soft tissues
-Osteotomy 1st metatarsal +/- proximal phalanx
Generally good outcome but recurrence inevitable

48
Q

Surgical Rx of lesser toe deformities

A
  • Fusion of IPJ
  • Release of metatarsophalangeal joint
  • Shortening osteotomy of metatarsal
49
Q

Rx of Morton’s neuroma

A
  • Injection for small lesions (?steroids?)

- Surgical excision of lesion + a section of normal nerve

50
Q

Rx of dorsal foot ganglion

A

Non-surgical

  • Aspiration
  • “Bible”

Surgical
-Excision

51
Q

Rx of midfoot arthritis

A

Non-surgical

  • Activity modification/Shoewear/orthotics
  • ?Steroid? injection (X-ray guided)

Surgical
-Fusion

52
Q

Rx of plantar fibromatosis

A

Non-surgical

  • Avoid pressure/Shoewear/orthotics
  • Radiotherapy (high risk of recurrence)

Surgical

  • Excision (high chance of recurrence)
  • Excision + radiotherapy (low recurrence but high risk complications)
53
Q

Non-surgical Rx of Achilles tendinopathy

A
  • Activity modification/shoe with a slight heel
  • Physiotherapy (eccentric stretching)
  • Weight loss
  • Extra-corporeal shockwave treatment
  • Immobilisation (below knee cast)
54
Q

Surgical Rx of Achilles tendinopathy

A
  • Gastrocnemius resection

- Release + debridement of tendon

55
Q

Rx of tibialis posterior tendon dysfunction

A
  • Orthotic (medial arch support)
  • Reconstruction of tendon (tendon transfer)
  • Triple fusion (subtalar, talonavicular and calcaneocuboid)
56
Q

Rx of Perthes disease

A
  • Analgesia
  • Restrict painful activities
  • Splints + physio
  • Consider osteotomy in children >7yrs
57
Q

Rx of developmental dysplasia of the hip

A
  • <3mth simple splint (90% respond)
  • 3-12mth closed reduction + spica cast
  • > 1yr open reduction + capsule reefing
  • > 18mth open reduction + femoral shortening
  • > 6yr + bilateral leave alone
  • > 10yr + unilateral leave alone

Older the child the poorer the results

Treatments (12 decks)

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