MSK Flashcards
What are degenerative MSK disorders?
Disorders involving progressive impairment of both the structure and function of part of the body e.g. osteoarthritis
What are inflammatory MSK disorders?
Disorders involving a local response to cellular injury that is marked by redness, heat, pain, swelling and often loss of function e.g. rheumatoid arthritis
What are seronegative/seropositive MSK disorders testing for?
Rheumatoid factor
Name 2 differences between inflammatory and degenerative disorders
Inflammatory pain eases with use, degenerative pain increases with use
Inflammatory is significantly stiff for >60mins in the morning, degenerative is not prolonged <30mins
What are the 4 pillars of inflammation?
Red (rubor), painful (dolor), hot (calor), swollen (tumour)
What are the 2 markers of inflammation?
ESR and CRP
What is osteoarthritis?
A group of diseases characterised by joint degeneration. It is an age-related, dynamic reaction pattern of a joint in response to insult or injury
What are the features of osteoarthritis?
Affects synovial joints
All tissues of the joint are involved
Articular cartilage is the most affected
Describe the pathology of osteoarthritis
Insult to joint tissue initiating a cycle of cellular events, including low-grade chronic inflammation of the synovium, release of metalloproteinases, and degradation of articular cartilage matrix
What are the main pathological features of osteoarthritis?
Loss of cartilage, disordered bone repair
What are the risk factors for osteoarthritis?
Age, female gender, genetic predisposition, obesity, occupation
How does osteoarthritis present?
Joint pain, tenderness, swelling of small joints, stiffness, symptoms typically worsen during the day with activity
How is osteoarthritis diagnosed?
Radiographs show LOSS; Loss of joint space Osteophytes Subarticular sclerosis Subchondral cysts
How is osteoarthritis managed?
Activity and exercise, weight loss
Analgesia, NSAIDs, DMARDs
Joint replacement/ arthroplasty
What is rheumatoid arthritis?
A multisystem autoimmune disease in which the brunt of disease activity falls upon the synovial joints
How does rheumatoid arthritis present?
Symmetrical, swollen, painful, stiff, small joints of hands and feet
Symptoms typically worse in morning
Where are rheumatoid nodules commonly found?
Pressure points e.g. olecranon
How is rheumatoid arthritis diagnosed?
Rheumatoid factor is positive
X-rays show soft tissue swelling, juxta-articular osteopenia and decrease joint space
US and MRI can identify synovitis
How is rheumatoid arthritis managed?
DMARDs
Steroids reduce symptoms and inflammation
Surgery may relieve pain, improve function, prevent deformity
What are the different patterns of fractures?
Transverse, oblique, spiral, butterfly, comminution, segmental, greenstick
How are fractures managed?
Analgesia, reduce, immobilise, rehabilitate
What are the risk factors for fractures?
Osteoporosis, metabolic bone disease e.g. osteomalacia, Paget’s disease, bone infiltrated by malignant tumours
Briefly describe how fractures heal
Haematoma organised and dead bone removed, callus formed, then replaced by trabecular bone, and finally remodelled into lamellar bone
Fracture healing delayed if bone ends are mobile, infected very badly, misaligned or avascular
What is osteoporosis?
A metabolic bone disease characterised by a generalised reduction in bone mass, increased bone fragility, and predisposition to fracture