MSK disorder treatment Flashcards
types of bone cells
osteogenic
osteoblast
osteocyte
osteoclast
structure of compact bone
osteons - central haversian canals
concentric matrix lamellae
canniculi radiate from lacunae to haversian canals to provide passageways
what are lacunae
small spaces containing osteocytes
what are volksmanns canals
transverse perforating canals
structure of long bone
periosteum outer cortex cancellous bone mostly medullary cavity - yellow bone marrow nutrient artery and articular cartilage
what is an epiphysis
end of bone in contact with joint
what is a metaphysis
connects epiphysis (physis in children) to diaphysis
what is a diaphysis
middle section of long bone
mechanisms of fractures
trauma - high/low energy
stress - abnormal stresses on normal bone
pathological - normal stresses on abnormal bone
patholopgical fractures
osteoporosis malignancy vit D insufficiency osteomyelitis osteogenesis imperfecta pagets disease
investigations for fractures
MRI for soft tissue
X-ray for bones - not hairline fractures
bone scans - uncommon
describe a fracture x-ray
location - bone and part of bone pieces pattern - transverse etc displaced or undisplaced translated/angulated XYZ plane
urgent complications of fractures
local visceral injury vascu;ar injury nerve injury compartment syndrome haemarthrosis infection gas gangrene
what is compartment syndrome
blood leaks into soft tissue
pressure builds
cuts off its own arterial blood supply
less urgent fracture complications
fracture blisters plaster sores pressure sores nerve entrapment myositis ossificans ligament injury tedon lesions joint stiffness algodystrophy
late complications of fractures
delayed union malunion/non-union avascular necrosis muscle contracture joint instability osteoarthritis
joint classifications
fibrous
cartilaginous
synovial
types of fibrous joints
sutures
syndesmosis
interosseous membrane
types of cartilaginous joints
synchondroses (spine)
symphyses (pubic)
types of synovial joint
plane hinge condyloid pivot saddle ball and socket
what is synovium
lining of joint cavity containing macrophage like cells (type A synoviocyte)
and fibroblast like cells producing hyaluronic acid (type B synoviocyte)
type I collagen
what is cartilage composed of
chondrocytes
ECM - water, collagen, proteoglycans (aggrecan)
what is aggrecan
proteoglycan possessing chondroitin sulfate and keratin sulfate chains
interacts with hyaluronan to form large proteoglycan
pathophysiology of osteoarthritis
degenerative disease of chondral cartilage, bones end up rubbing together causing stiffness, pain, impaired movement
early - cartilage oedema
late - cartilage damage and loss, osteophytes, subchondral cysts, synovial inflammation
inflammatory mediators in late OA
MMPs
aggrecanases
IL-1b TNF-a
risk factors for OA
age excess weight mechanical constraints FH female - menopause osteonecrosis leg bone malalignment - uneven stress metabolic syndrome injury
presentation of OA
pain on exertion
disability
deformity
PMH of infection or trauma possible
special knee ACL tests
anterior drawer test
lachmanns test
conservative management of OA
analgesics physiotherapy walking aids avoidance of exacerbating activity injections - steroids etc
operative management of OA
replacement
realignment
excise or fuse toes
denervate - wrist
what is osteomyelitis
infection of bone
acute/chronic and primary/secondary
signs of septic arthritis
red painful hot swelling fever immunosuppressed, intravenous drug use
scans for osteomyelitis and septic arthritis
Xrays
MRI scans - CT if not available
bone scans
labelled white cell scans
bloods for osteomyelitis and septic arthritis
CRP
ESR
WCC
TB culture/PCR
management of osteomyelitis
antibiotics IV
surgical drainage
amputation and antibiotic suppression if chronic
management of septic arthritis
surgery - joint lavage and drainage
IV antibiotics
immobilise joint acutely
physiotherapy after
shoulder conditions young people
dislocation
fractures
shoulder conditions middle aged people
impingement dislocation ACJ OA rotator cuff tears fractures
shoulder conditions old people
glenohumeral OA
impingement
cuff tears
fracture
hip conditions young people
developmental dysplasia
leg length discrepancy
impingement
hip conditions middle aged people
OA
avascular necrosis
impingement
hip conditions old people
OA
post-total hip replacement
knee conditions young people
patellofemoral maltracking
ACL/PCL
meniscal tears
fractures
knee condiitons middle aged
OA patellofemoral maltracking ACL/PCL meniscal tears fractures
knee conditions old people
OA
