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MSK > MSK: infection bones/joints, shoulder/elbow, clinical assessment > Flashcards

MSK: infection bones/joints, shoulder/elbow, clinical assessment Flashcards

1
Q

What is the more common type of osteomyelitis?

A

Non-specific

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2
Q

Who does acute osteomyelitis usually affect?

A

Children

Boys

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3
Q

What predisposes someone to acute osteomyelitis?

A 
History of trauma
Other disease (diabetes, rheum arthritis, immune)
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4
Q

How can acute osteomyelitis spread?

A

Haematogenous spread
Local spread from site of infection
Secondary to vascular insufficiency

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5
Q

What might be the source of acute osteomyelitis in an infant?

A

Infected umbilical cord

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6
Q

What might be the source of acute osteomyelitis in children?

A

Boils, tonsillitis, skin abrasions

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7
Q

What might be the source of acute osteomyelitis in adults?

A

UTI

Arterial line

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8
Q

What might be the organism involved in acute osteomyelitis in children?

A

Staph aureus
Strep pyogenes
Haemophilus influenza

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9
Q

What might be the organism involved in acute osteomyelitis in infants?

A

Staph aureus
Group B strep
E coli

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10
Q

What might be the organism involved in acute osteomyelitis in adults?

A

Staph aureus
Coagulase neg staph
Mycobacterium tb
Pseudomonas aeroginosa

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11
Q

What might be the organism involved in acute osteomyelitis in those with diabetic foot/pressure sores?

A

Mixed infection including anaerobes

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12
Q

Which part of the bone does acute osteomyelitis usually affect first?

A

Metaphysis

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13
Q

What is the pathology of acute osteomyelitis?

A

Acute inflammation and necrosis of bone, new bone formation

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14
Q

What are the clinical signs of osteomyelitis in an infant?

A 
Failure to thrive
Drowsy/irritable
Metaphyseal tenderness + swelling
Decrease ROM
Positional chance
Around knee
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15
Q

What are the clinical signs of osteomyelitis in a child?

A 
Severe pain
Reluctant to move, non weight-bearing
Tender fever (swinging pyrexia)
Tachycardia
Malaise
Toxaemia
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16
Q

What are the clinical signs of osteomyelitis in an adult?

A

Seen in thoracolumbar spine
Backache
History: UTI/urological procedure/open fracture/surgery
Elderly, diabetic, immunocompromised

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17
Q

How is acute osteomyelitis diagnosed?

A 
History and clinical exam
FBC + diff WBC
ESR, CRP
Blood cultures
U&Es
X-ray
US
Aspiration
Isotope bone scan
Labelled white cell scan
MRI
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18
Q

What are the differential diagnoses of acute osteomyelitis?

A

Acute septic arthritis
Acute inflammatory arthritis
Trauma
Transient synovitis
Haemophilia/rheumatic fever/sickle cell crisis
Soft tissue infection: cellulitis, necrotising fasciitis, TSS

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19
Q

How many days until periosteal changes seen on XR?

A

10-20 days

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20
Q

What is sequestrum?

A

Piece of dead bone become separated during process of necrosis from normal bone

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21
Q

When is it called when late osteonecrosis happens in acute osteomyelitis?

A

Sequestrum

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22
Q

When is it called when late periosteal new bone happens in acute osteomyelitis?

A

Involucrum

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23
Q

What are some labels used in scans for acute osteomyelitis?

A

Technetium-99m labelled diphosphonate
Gallium 67 citrate delayed imaging
Indium-111 labelled WBC scan

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24
Q

What is the microbiological diagnosis of acute osteomyelitis?

A

Blood cultures
Bone biopsy
Tissue or swabs at 5 sites (prosthetic infections)

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25
Q

What is the treatment for acute osteomyelitis?

A

Supportive - pain and dehydration
Rest and splintage
Antibiotics

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26
Q

How long would someone be on antibiotics for acute osteomyelitis?

A

4-6wks (depends on response)

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27
Q

What anitbiotics usually used for acute osteomyelitis?

A

Fluclox + BenzylPen

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28
Q

Why might antibiotics not work in acute osteomyelitis?

A 
Drug resistance
Bacterial persistence (dormant)
Poor host defences
Poor drug absorption
Drug inactivation by host flora
Poor tissue penetration
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29
Q

When would surgery be indicated for acute osteomyelitis?

A 
Aspiration of pus
Abscess drainage
Debridement
Refractory to non-operative Rx
Infected joint replacement
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30
Q

What are the complications of acute osteomyelitis?

A 
Septicemia
Death
Metastatic infection
Pathological fracture
Septic arthritis
Altered bone growth
Chronic osteomyelitis
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31
Q

How might someone get chronic osteomyelitis?

A

Follow acute osteomyelitis
De novo - after op, following open fracture, immunosuppressed, diabetics, elderly, IVDU
Repeated breakdown ‘healed’ wounds

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32
Q

What organisms are involved in chronic osteomyelitis?

A 
Mixed
Staph aureus
E.coli
Strep. pyogenes
Proteus
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33
Q

What is the pathology of chronic osteomyelitis?

A

Chronic inflammation: cavities, dead bone (sequestra), involucrum

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34
Q

What are the complications of chronic osteomyelitis?

A 
Chronically discharging sinus+flare ups
Ongoing (metastatic) infection
Abscesses
Pathological fracture
Growth disturbance+deformities
Squamous cell carcinoma
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35
Q

What is the treatment for chronic osteomyelitis?

A 
Long term antibiotics (local - gentamicin cement/beads, collatemp or systemic)
Eradicate bone infection - surgery
Treat soft tissue problems
Deformity correction
Massive reconstruction?
Amputation?
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36
Q

What are the possible routes of infection for acute septic arthritis?

A

Haematogenous
Eruption of bone abscess
Direct invasion

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37
Q

What organisms might be involved in acute septic arthritis?

A

Staph aureus
Haemophilus influenzae
Strep pyogenes
E.coli

38
Q

What is the pathology of acute septic arthritis?

A

Destruction of articular cartilage

39
Q

What are the usual outcomes of acute septic arthritis?

A

Complete recovery
Partial loss of articular cartilage+OA
Fibrous or bony ankylosis

40
Q

How does acute septic arthritis present in a neonate?

A

Like septicaemia:

  • Irritable
  • Resistant to movement
  • Ill
41
Q

How does acute septic arthritis present in a child/adult?

A

Acute pain in single large joint

  • Reluctant to move joint
  • Increase temp and pulse
  • Increase tenderness
42
Q

What is the most common cause of septic arthritis in adults?

A

Infected joint replacement

43
Q

What is the most common organism in an infected joint replacement?

A

Staph

44
Q

What are the investigations for acute septic arthritis?

A

FBC, WBC, ESR, CRP, blood cultures
XR
US
Aspiration

45
Q

What are the differential diagnoses for acute septic arthritis?

A 
Acute osteomyelitis
Trauma
Irritable joint
Haemophilia
Rheumatic fever
Gout
Gaucher's disease
46
Q

What is the treatment for acute septic arthritis?

A

Antibiotics (3-4wks)
Surgical drainage + lavage
Joint revisions

47
Q

What are the classifications of TB in bones and joints?

A

Extra-articular
Intra-articular
Vertebral body

48
Q

Where does extra-articular TB happen in bones?

A

Epiphyseal

49
Q

Where does intra-articular TB usually occur?

A

Large joints

50
Q

What are the clinical features of TB in bones and joints?

A 
Insidious onset + general ill health
Contact with TB
Pain (at night)
Swelling
Weight loss
Low grade pyrexia
Joint swelling
Decrease ROM
Ankylosis
Deformity
51
Q

What is ankylosis?

A

Abnormal stiffening and immobility of a joint due to fusion of the bones

52
Q

What is the pathology of TB in bones and joints?

A

Primary complex (lung/gut)
Secondary spread
Tuberculous granuloma

53
Q

How does TB of the spine usually present?

A

Little pain

Present with abscess or kyphosis

54
Q

What are the investigations for TB in bones and joints?

A 
FBC, ESR
Mantoux test
Sputum/urine cultures
XR
Joint aspiration+biopsy
55
Q

What are the signs on imaging of TB in a joint?

A

Single joint
Marked thickening of synovial
Marked muscle wasting
Periarticular osteoporosis

56
Q

What are the differential diagnoses for TB in a joint?

A 
Transient synovitis
Monoarticular RA
Haemorrhagic arthritis
Pyogenic arthritis
Tumour
57
Q

What is the treatment for TB?

A 
Rifampicin
Isoniazid
Ethambutol
Pyrazinamide
- 8wks
Rifampicin
Isoniazid
- 6-12mo

Rest and splintage

58
Q

What are the most likely shoulder injuries in teens/20s?

A

Fractures

Instability

59
Q

What are the most likely shoulder injuries in 30/40s?

A

Rotator cuff

Capsulitis

60
Q

What are the most likely shoulder injuries in 50/60s?

A

Impingement

AC joint

61
Q

What are the most likely shoulder injuries in 70s+?

A

Degenerative rotator cuff and joint

62
Q

What is the most mobile joint in body?

A

Shoulder joint

63
Q

What is sacrificed in shoulder joint for mobility?

A

Stability

64
Q

What are the most common types of shoulder dislocation?

A

Anterior

65
Q

What are the treatment options for shoulder dislocation?

A

Manipulation
Immobilisation
Physiotherapy
Surgery

66
Q

What is subacromial impingement?

A

SuPain and dysfunction resulting from any pathology which decreases volume of subacromial space or increases size of contents

67
Q

What are the treatment options for subacromial impingement?

A

Subacromial steroid injection
Physiotherapy
Arthroscopic subacromial decompression

68
Q

What is the other name for frozen shoulder?

A

Adhesive capsulitis

69
Q

What is frozen shoulder?

A

Shoulder joint loses range of motion and becomes painful

70
Q

How is frozen shoulder diagnosed?

A

Clinically

71
Q

What is the treatment for frozen shoulder?

A

Physiotherapy
Analgesia
Steroid injections

72
Q

What are the three phases of frozen shoulder?

A

Freezing/painful stage
Frozen/stiff stage
Thawing stage

73
Q

What are the two mains causes of rotator cuff tear?

A

Traumatic

Degenerative

74
Q

What is the main muscle normally affected in rotator cuff tears?

A

Supraspinatus

75
Q

What is the treatment for acute rotator cuff tears?

A

Early surgery

76
Q

What is the treatment for chronic degenerative tears?

A

Surgery IF symptomatic

77
Q

What is the surgery that is an option for massive, irreparable rotator cuff tears?

A

Superior capsular reconstruction

78
Q

What happens in a superior capsular reconstruction?

A

Cadaveric skin graft to reconstruct capsule, not tendon, of rotator cuff tear

79
Q

What are the types of arthritis that cause shoulder arthritis?

A

OA
Inflammatory arthritis
Post-traumatic arthritis

80
Q

What are the options for reconstruction of an arthritis shoulder?

A

Custom made implants

81
Q

What is the likely cause of elbow pain in young people?

A

Fractures

Dislocations

82
Q

What is the likely cause of elbow pain in middle age people?

A

Tendinopathies

83
Q

What is the likely cause of elbow pain in older people?

A

Degenerative disease

84
Q

What could be a cause of elbow pain at any age?

A

Cubital tunnel syndrome

85
Q

What is Golfer’s elbow?

A

Pain on the inside of the elbow at the medial epicondyle

86
Q

What is Tennis elbow?

A

Pain on the outside of the elbow at the lateral epicondyle

87
Q

What are the questions in an MSK GALS screening?

A

Do you have any pain or stiffens in your muscles, joints or back?
Can you dress yourself completely without any difficulty?
Can you walk up and down stairs without any difficulty?

88
Q

What is GALS screening?

A

Gait
Arms
Legs
Spine

Rapid screen for MSK and neurological deficits and functional ability

89
Q

What are cardinal presenting complaints of orthopaedics?

A 
Pain
Stiffness
Swelling
Deformity
Discolouration
90
Q

What are red flags from history suggesting serious pathology?

A 
Severe and worsening pain
Night pain disturbing sleep
Non-mechanical pain
General malaise, febrile, rigours
Unexplained weight loss, anorexia, night sweats
Past history malignant disease
91
Q

What is REMS?

A

Regional examination of the musculoskeletal system

92
Q

What else would you say at the end of an MSK examination?

A

1) Assess joint above and below
2) Neuro exam of whole limb
3) Other relevant systematic exams

MSK (17 decks)

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