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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
What is the treatment for acute osteomyelitis?
Supportive - pain and dehydration Rest and splintage Antibiotics
26
How long would someone be on antibiotics for acute osteomyelitis?
4-6wks (depends on response)
27
What anitbiotics usually used for acute osteomyelitis?
Fluclox + BenzylPen
28
Why might antibiotics not work in acute osteomyelitis?
``` Drug resistance Bacterial persistence (dormant) Poor host defences Poor drug absorption Drug inactivation by host flora Poor tissue penetration ```
29
When would surgery be indicated for acute osteomyelitis?
``` Aspiration of pus Abscess drainage Debridement Refractory to non-operative Rx Infected joint replacement ```
30
What are the complications of acute osteomyelitis?
``` Septicemia Death Metastatic infection Pathological fracture Septic arthritis Altered bone growth Chronic osteomyelitis ```
31
How might someone get chronic osteomyelitis?
Follow acute osteomyelitis De novo - after op, following open fracture, immunosuppressed, diabetics, elderly, IVDU Repeated breakdown 'healed' wounds
32
What organisms are involved in chronic osteomyelitis?
``` Mixed Staph aureus E.coli Strep. pyogenes Proteus ```
33
What is the pathology of chronic osteomyelitis?
Chronic inflammation: cavities, dead bone (sequestra), involucrum
34
What are the complications of chronic osteomyelitis?
``` Chronically discharging sinus+flare ups Ongoing (metastatic) infection Abscesses Pathological fracture Growth disturbance+deformities Squamous cell carcinoma ```
35
What is the treatment for chronic osteomyelitis?
``` Long term antibiotics (local - gentamicin cement/beads, collatemp or systemic) Eradicate bone infection - surgery Treat soft tissue problems Deformity correction Massive reconstruction? Amputation? ```
36
What are the possible routes of infection for acute septic arthritis?
Haematogenous Eruption of bone abscess Direct invasion
37
What organisms might be involved in acute septic arthritis?
Staph aureus Haemophilus influenzae Strep pyogenes E.coli
38
What is the pathology of acute septic arthritis?
Destruction of articular cartilage
39
What are the usual outcomes of acute septic arthritis?
Complete recovery Partial loss of articular cartilage+OA Fibrous or bony ankylosis
40
How does acute septic arthritis present in a neonate?
Like septicaemia: - Irritable - Resistant to movement - Ill
41
How does acute septic arthritis present in a child/adult?
Acute pain in single large joint - Reluctant to move joint - Increase temp and pulse - Increase tenderness
42
What is the most common cause of septic arthritis in adults?
Infected joint replacement
43
What is the most common organism in an infected joint replacement?
Staph
44
What are the investigations for acute septic arthritis?
FBC, WBC, ESR, CRP, blood cultures XR US Aspiration
45
What are the differential diagnoses for acute septic arthritis?
``` Acute osteomyelitis Trauma Irritable joint Haemophilia Rheumatic fever Gout Gaucher's disease ```
46
What is the treatment for acute septic arthritis?
Antibiotics (3-4wks) Surgical drainage + lavage Joint revisions
47
What are the classifications of TB in bones and joints?
Extra-articular Intra-articular Vertebral body
48
Where does extra-articular TB happen in bones?
Epiphyseal
49
Where does intra-articular TB usually occur?
Large joints
50
What are the clinical features of TB in bones and joints?
``` Insidious onset + general ill health Contact with TB Pain (at night) Swelling Weight loss Low grade pyrexia Joint swelling Decrease ROM Ankylosis Deformity ```
51
What is ankylosis?
Abnormal stiffening and immobility of a joint due to fusion of the bones
52
What is the pathology of TB in bones and joints?
Primary complex (lung/gut) Secondary spread Tuberculous granuloma
53
How does TB of the spine usually present?
Little pain | Present with abscess or kyphosis
54
What are the investigations for TB in bones and joints?
``` FBC, ESR Mantoux test Sputum/urine cultures XR Joint aspiration+biopsy ```
55
What are the signs on imaging of TB in a joint?
Single joint Marked thickening of synovial Marked muscle wasting Periarticular osteoporosis
56
What are the differential diagnoses for TB in a joint?
``` Transient synovitis Monoarticular RA Haemorrhagic arthritis Pyogenic arthritis Tumour ```
57
What is the treatment for TB?
``` Rifampicin Isoniazid Ethambutol Pyrazinamide - 8wks Rifampicin Isoniazid - 6-12mo ``` Rest and splintage
58
What are the most likely shoulder injuries in teens/20s?
Fractures | Instability
59
What are the most likely shoulder injuries in 30/40s?
Rotator cuff | Capsulitis
60
What are the most likely shoulder injuries in 50/60s?
Impingement | AC joint
61
What are the most likely shoulder injuries in 70s+?
Degenerative rotator cuff and joint
62
What is the most mobile joint in body?
Shoulder joint
63
What is sacrificed in shoulder joint for mobility?
Stability
64
What are the most common types of shoulder dislocation?
Anterior
65
What are the treatment options for shoulder dislocation?
Manipulation Immobilisation Physiotherapy Surgery
66
What is subacromial impingement?
SuPain and dysfunction resulting from any pathology which decreases volume of subacromial space or increases size of contents
67
What are the treatment options for subacromial impingement?
Subacromial steroid injection Physiotherapy Arthroscopic subacromial decompression
68
What is the other name for frozen shoulder?
Adhesive capsulitis
69
What is frozen shoulder?
Shoulder joint loses range of motion and becomes painful
70
How is frozen shoulder diagnosed?
Clinically
71
What is the treatment for frozen shoulder?
Physiotherapy Analgesia Steroid injections
72
What are the three phases of frozen shoulder?
Freezing/painful stage Frozen/stiff stage Thawing stage
73
What are the two mains causes of rotator cuff tear?
Traumatic | Degenerative
74
What is the main muscle normally affected in rotator cuff tears?
Supraspinatus
75
What is the treatment for acute rotator cuff tears?
Early surgery
76
What is the treatment for chronic degenerative tears?
Surgery IF symptomatic
77
What is the surgery that is an option for massive, irreparable rotator cuff tears?
Superior capsular reconstruction
78
What happens in a superior capsular reconstruction?
Cadaveric skin graft to reconstruct capsule, not tendon, of rotator cuff tear
79
What are the types of arthritis that cause shoulder arthritis?
OA Inflammatory arthritis Post-traumatic arthritis
80
What are the options for reconstruction of an arthritis shoulder?
Custom made implants
81
What is the likely cause of elbow pain in young people?
Fractures | Dislocations
82
What is the likely cause of elbow pain in middle age people?
Tendinopathies
83
What is the likely cause of elbow pain in older people?
Degenerative disease
84
What could be a cause of elbow pain at any age?
Cubital tunnel syndrome
85
What is Golfer's elbow?
Pain on the inside of the elbow at the medial epicondyle
86
What is Tennis elbow?
Pain on the outside of the elbow at the lateral epicondyle
87
What are the questions in an MSK GALS screening?
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
What is GALS screening?
Gait Arms Legs Spine Rapid screen for MSK and neurological deficits and functional ability
89
What are cardinal presenting complaints of orthopaedics?
``` Pain Stiffness Swelling Deformity Discolouration ```
90
What are red flags from history suggesting serious pathology?
``` 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
What is REMS?
Regional examination of the musculoskeletal system
92
What else would you say at the end of an MSK examination?
1) Assess joint above and below 2) Neuro exam of whole limb 3) Other relevant systematic exams

MSK (17 decks)

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