MSK Flashcards
What things can precipitate osteonecrosis?
1) Trauma
2) Haemolytic disease
3) Steroids
4) Alcohol
What are the complications of GCA?
Vision loss, vascular stenosis and aneurysms and CVA- occlusion of internal carotid artery or vertebral arteries.
How do you diagnose GCA?
Clinical presentation- typical headache, appropriate age, clinical examination findings- temporal artery asymmetry, thickening, loss of pulsatilla, acute phase response- raised ESR/CRP.
What is vasculitis?
Inflammation of blood vessels. Large vessel, medium vessel, small vessel.
Name 2 types of large vessel vasculitis?
Takaysu arteritis
Giant cell arteritis
Name 2 types of medium cell vasculitis?
Polyarteritis Nodosa
Kawasaki disease
Granulomatosis with polyangiitis (GPA)
Also known as Wegener’s granulomatosis. Characterised by granulomatous necrotising inflammatory lesions of the upper and lower respiratory tract and often a pauci-immune glomerulonephritis. Classic triad of: upper airway/ENT, lower respiratory and renal disease.
Types of ANCA associated small cell vasculitis
- Microscopic polyanglitis
- Granulomatosis with polyangitis
- Eosinophilic granulomatosis with polyangitis
Granulomatosis with polyangiitis (GPA)
Also known as Wegener’s granulomatosis. Characterised by granulomatous necrotising inflammatory lesions of the upper and lower respiratory tract and often a pauci-immune glomerulonephritis.
What is cyclosporin?
Small molecule inhibitor of calcineurin. Leads to profound inhibition of T-cell activation.
What does anti-TNF therapy increase your risk of?
Tuberculosis, particularly disseminated. Anyone prescribed anti-TNF is screened for latent TB. Also increased risk of salmonella and listeria.
What does taking Abatacept (Anti-CD86) increase your risk of?
Increased risk of pneumonia and respiratory tract infection. Increased risk of TB but less than TNF blockade.
What does taking Rituximab (Anti-CD20) increase your risk of?
Generalised increased risk of serious infection. High risk of Hepatitis B reactivation- need to screen and prophylax if necessary.
What is indirect fracture healing?
Secondary healing. Formation of bone via a process of differential tissue formation until skeletal continuity is restored.
What is direct fracture healing?
Primary healing. A unique ‘artificial’ surgical situation. Direct formation of bone, without the process of callus formation, to restore skeletal continuity. Relies upon compression of bone ends.
What fractures can lead to potential problems with blood supply?
- Proximal pole of scaphoid fractures.
- Talar neck fractures
- Intracapsular hip fractures
- Surgical neck of humerus fractures
What patient factors can inhibit fracture healing?
Increasing age, diabetes, anaemia, malnutrition, peripheral vascular disease, hypothyroidism, smoking, alcohol.
What medicines can inhibit fracture healing?
NSAIDs, steroids and bisphosphonates.
What are the causes of ‘non-specific lower back pain’?
- Lumbar strain/sprain
- Degenerative discs/facet joints
- Disc prolapse, spinal stenosis
- Compression fractures
What are the symptoms of cauda equina syndrome?
Bilateral sciatica, saddle anaesthesia. Bladder or bowel dysfunction- reduced anal tone.
What conditions can cause referred pain in the back?
Aortic aneurysm, acute pancreatitis, peptic ulcer disease, acute pyelonephritis/renal colic, endometriosis/gynae.
What pathogen most commonly causes infective discitis?
Staph. aureus
Ankylosing Spondylitis
A chronic progressive inflammatory arthritis of sacroiliac joints and spine.
What does a tendon do?
Transmits force from muscle to achieve movement. Parallel collagen fibrils with tenocytes. Surrounded by paratenon/sheath (depending on where they are in the body). Largely avascular.
What is a tendinopathy?
Chronic tendon injury of over use-repetitive loading. Degeneration, disorganisation of collagen fibres, increased cellularity, little inflammation. Loss of balance between micro damage from overuse and reparative mechanisms.
Risk factors for tendinopathy
Age, chronic disease, diabetes, RA, adverse biomechanics. Repetitive exercise, recent increase in activity, quinolone antibiotics.
Common tendinopathies
Achilles tendinopathy, rotator cuff, tennis elbow (lateral epicondylitis), golfers elbow (medial epicondylitis), patella tendinopathy, hamstring tendonitis, adductor tendonitis, plantar fascitis.
What type of physiotherapy is good for tendinopathy?
Eccentric loading.. Contraction of the musculotendinous unit whilst it elongates. Beneficial in approximately 80%.
Definition of compartment syndrome
Elevated interstitial pressure within a closed fascial compartment resulting in microvascular compromise. Common sites- leg, forearm, thigh. Orthopaedic emergency- loss of function, limb or life.
What are the causes of compartment syndrome?
Increased internal pressure: bleeding, swelling, iatrogenic infiltration.
Increased external pressure: casts/bandages, full thickness burns. Or a combination.
Pathophysiology of compartment syndrome?
Pressure within the compartment exceeds pressure within the capillaries- muscles become ischamic and develop oedem through icnreased endothelial permeability- necrosis begins in the iscahemic muscles after 4 hours- ischaemic nerves become neuropraxic.
What is normal compartment pressure?
0-4mmHg, 10mmHg with exercise. CP>30mmHg.
Surgical release of compartment syndrome
Full length decompression of all compartments. Excise any dead muscle, leave wounds open. Repeat debridement until pressure down and all dead muscle excised. Wound closure/ skin grafting.
What is a Boutonniere deformity?
A deformed position of the fingers or toes, in which the joint nearest the knuckle (the proximal interphalangeal joint, or PIP) is permanently bent toward the palm while the farthest joint (the distal interphalangeal joint, or DIP) is bent back away.
Name the 3 common DMARDs
1) Methotrexate
2) Sulphasalazine
3) Hydroxychloroquine
What are the 4 features of osteoarthritis seen on x-ray?
1) Narrowing or loss of joint space
2) Osteophyte formation
3) Subchondral sclerosis
4) Cyst formation
What is an antalgic gait?
A gait that develops as a way to avoid pain while walking. It can be a good indication of pain with weight-bearing.
What is Felty’s syndrome?
RA and splenomegaly and neutropenia. Leads to recurrent infections.
What is a ‘grass blade sign’ on x-ray?
A wedge-shaped area of translucent bone on x-ray, typical of the lytic phase of Paget’s Disease of Bone
Treatments for tendinopathy
NSAIDs, corticosteroid injections, GTN patches, extracorporeal shock wave therapy (ESWT). Eccentric strengthening programmes (physical therapy).
Name 3 benign primary bone tumours
Osteoid osteoma
Chondroma
Giant cell tumour
Name 3 malignant primary bone tumours
Osteosarcoma
Chondrosarcoma
Ewing’s tumour
