Treatments > MSK > Flashcards

MSK Flashcards

(57 cards)

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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

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

Treatment of osteoporosis

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A
  • Bisphosphonates (oral) (first line)
  • Parathyroid Hormone Analog (teriparatide)
  • Monoclonal antibody against RANK ligand (Denosumab)
  • HRT
  • Selective oEstrogen Receptor Modulator (SERM)
25
Management of AS
- NSAIDs - DMARDs (sulfasalazine) - Anti-TNF - Treatment of osteoporosis - Surgery (joint replacement & spinal surgery)
26
Rx of enteropathic arthritis
- Sulphasalazine - Steroids - Methotrexate - Anti-TNF - Bowel resection may alleviate peripheral disease
27
Rx of reactive arthritis
Acute - NSAID - Joint injection (if infection excluded) - Antibiotics if chlamydia infection (contacts as well) Chronic - NSAID - DMARD (sulphasalazine, methotrexate)
28
Rx of an acute flare up of gout
- NSAIDs - Colchicine - Steroids (IA/IM/Oral)
29
Rx to lower uric acid
- Xanthine oxidase inhibitor (Allopurinol, Febuxostat) - Uricosuric agents (Sulphinpyrazone, Probenecid) - Canakinumab (monoclonal antibody targeted at interleukin-1 beta)
30
3 rules of lowering uric acid levels
- 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
When to use colchicine over NSAIDs
- Contraindications | - Patient cannot tolerate NSAIDs
32
Management of Pseudogout
-NSAIDs -IA steroids There are no prophylactic therapies
33
Rx of polymyalgia rheumatica
- Prednisolone (15mg/day initially) - 18-24 month course - Bone prophylaxis
34
4 types of non-pharmacological Rx for OA
- Thermotherapy - Electrotherapy - Manual therapy - Aids + devices
35
Pharmacological Rx of OA
- Regular analgesia (paracetamol +/- topical NSAIDs/capsaicin) - If ineffective give codeine or short term oral NSAIDs (+PPI(omeprazole) ) - IA steroids with severe symptoms
36
Surgical treatment for OA
Joint replacement
37
Management of buckle + greenstick fractures
- Buckle = Cast 3-4 weeks | - Greenstick = Cast 4-6 weeks
38
Rx of undisplaced + hinged tibial spine fracture
Long leg cast
39
Rx of hinged + displaced tibial spine fracture
ORIF/AxIF
40
Rx of patellar dislocation
- Cast 2 weeks - Mobilise - VMO exercises - Repair medial ligament - Medialise tibial tubercle
41
Rx of JIA
-Simple analgesics -IA NSAIDs/steroids If no response -Methotrexate -Anti-TNF (if methotrexate fails) Physio + Occ therapy
42
Indication for systemic steroids in JIA
- Systemic onset JIA - Serious complication with any disease (Pericardial effusion, tamponade, vasculitis) - As a bridge between DMARDs - Children undergoing surgery
43
Surgical Rx for JIA
- Synovectomy | - Reconstructive/joint replacement
44
Rx for meniscal tears
- Meniscal repair - Partial meniscectomy - Meniscal transplantation
45
Rx of spasticity in CP
- Baclofen - Diazepam - Botulinum Toxin
46
Rx of spina bifida
- Surgery to close the opening in the spine + treat hydrocephalus - Physiotherapy and occupational therapy - Wheelchair, or walking aids - Rx for incontinence
47
Surgical Rx of hallux valgus
Only if non-surgical Rx fails -Release lateral soft tissues -Osteotomy 1st metatarsal +/- proximal phalanx Generally good outcome but recurrence inevitable
48
Surgical Rx of lesser toe deformities
- Fusion of IPJ - Release of metatarsophalangeal joint - Shortening osteotomy of metatarsal
49
Rx of Morton's neuroma
- Injection for small lesions (?steroids?) | - Surgical excision of lesion + a section of normal nerve
50
Rx of dorsal foot ganglion
Non-surgical - Aspiration - "Bible" Surgical -Excision
51
Rx of midfoot arthritis
Non-surgical - Activity modification/Shoewear/orthotics - ?Steroid? injection (X-ray guided) Surgical -Fusion
52
Rx of plantar fibromatosis
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
Non-surgical Rx of Achilles tendinopathy
- Activity modification/shoe with a slight heel - Physiotherapy (eccentric stretching) - Weight loss - Extra-corporeal shockwave treatment - Immobilisation (below knee cast)
54
Surgical Rx of Achilles tendinopathy
- Gastrocnemius resection | - Release + debridement of tendon
55
Rx of tibialis posterior tendon dysfunction
- Orthotic (medial arch support) - Reconstruction of tendon (tendon transfer) - Triple fusion (subtalar, talonavicular and calcaneocuboid)
56
Rx of Perthes disease
- Analgesia - Restrict painful activities - Splints + physio - Consider osteotomy in children >7yrs
57
Rx of developmental dysplasia of the hip
- <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
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