MSK/Ortho Flashcards
what is the pathophysiology of carpal tunnel syndrome?
compression of the medial nerve by the carpal tunnel within the wrist
how does carpal tunnel present?
tingling/pain/numbness usually of the hand, and within the median nerve distribution - thumb/1st/middle fingers
can present with pain radiating to the forearm
can have muscle wasting in the thenar eminence + weakness of thumb abduction
what are some causes of carpal tunnel?
usually idiopathic however can be more likely in -
pregnancy
oedema e.g. HF
lunate fracture
RA
what are two signs on examination of carpal tunnel?
Tinels sign - tapping causes parasthesia
Phalens sign - flexion of the wrist recreates the symptomsm
management of carpal tunnel if mild-moderate?
wrist splint - at night
corticosteroid inj
management of carpal tunnel if severe?
surgical decompression
who should be assessed for osteoporosis risk?
women > 65 years
men > 75 years
Those younger with risk factors for poor bone mineral density i.e. px fragility fracture, long term steroid use, history of falls, FH of NOF, hypogonadism, endocrine conditions, RA, low BMI, smoking
ETOH intake
how do you assess risk of oesteoporosis?
use a clinical prediction tool such as FRAX or QFracture
how do you interpret the results of the Qfracture score?
if 10 year fracture risk if > 10% - DEXA should be arranged
how do you interpret the results of the FRAX score?
if risk is orange or red - DEXA to be done
how do you interpret the DEXA scan results?
> -1.0 = normal
-1.0 to -2.5 = osteopaenia
< -2.5 = osteoporosis
first line management of patient with confirmed osteoporosis or high risk of fragility fracture?
oral bisphosphonates - alendronate, risedronate
management of patient who has had a hip fracture and is then recognised as having high risk of fragility fractures?
IV zoledronate - once yearly
What is some general advice to give patients who have osteoporosis or are at risk of developing oesteoporosis?
lifestyle changes: a healthy, balanced diet, moderation of alcohol consumption and avoidance of smoking
a sufficient dietary calcium and vitamin D intake: supplementation should be offered to all women unless the clinician is confident they have adequate calcium intake and are vitamin D replete
encourage a combination of regular weight-bearing and muscle strengthening exercise
how should you manage a patients fragility fracture risk who is postmenopausal (or man > 50) and being treated with glucocorticoids?
if starting > 7.5mg/day prednisolone or equivalent for the next 3 months - start bone protective treatment at the same time , no need to wait for DEXA scan
how to manage the fragility fracture risk of a patient who is A postmenopausal woman, or a man age ≥50 has a symptomatic osteoporotic vertebral fracture?
start oral bisphosphonates straight away
general osteoporosis advice
how long should oral bisphosphonates be commenced for?
Plan to prescribe oral bisphosphonates for at least 5 years, or intravenous bisphosphonates for at least 3 years and then re-assess fracture risk.
how do oral bisphophonates work?
bind to hydroxyapatite in bone, inhibiting osteoclast-mediated bone resorption
what are some side effects of oral bisphosphonates?
gastrointestinal discomfort, oesophagitis, and hypocalcaemia. Atypical femoral fractures and osteonecrosis of the jaw are rare but serious risks.
what is the second line management of osteoporosis?
IV denosumab
how does denosumab work?
human monoclonal antibody that inhibits RANK ligand, which in turn inhibits the maturation of osteoclasts
how is denosumab given?
SC injection ever 6 months
how should you manage patients who have a high risk of fragility fractures when calculated by the FRAX score, but have had a DEXA which is more than -2.5?
T-score is greater than -2.5, modify risk factors where possible, treat any underlying conditions, and repeat the DXA at an interval appropriate for the person based on their risk profile, using clinical judgement (but usually within 2 years).
how should you manage patients who have an intermediate risk of fragility fractures calculated by the FRAX score i.e. their risk is close to the threshold?
if they also have risk factors that may be underestimated by FRAX® , arrange a DXA scan to measure their bone mineral density (BMD) and offer drug treatment if the T-score is -2.5 or lower.
which bisphosphonates are licensed in men?
alendronate (once-daily tablets) and risedronate (once-weekly tablets)
what should you do if a patient does not tolerate oral bisphosphonates due to side effects?
If an oral bisphosphonate is not tolerated or is contraindicated, consider specialist referral. Specialist treatment options include zoledronic acid, strontium ranelate, raloxifene, denosumab, and teriparatide.
what should you prescribe for a patient who has a high fragility risk score, is on oral bisphosphonate and has adequate oral calcium intake?
10 micrograms (400 international units) of vitamin D (without calcium) for people not exposed to much sunlight.
what should you prescribe for a patient who has a high fragility risk score, is on oral bisphosphonate and has inadequate oral calcium intake?
Prescribe 10 micrograms (400 international units) of vitamin D with at least 1000 mg of calcium daily.
Prescribe 20 micrograms (800 international units) of vitamin D with at least 1000 mg of calcium daily for elderly people who are housebound or living in a nursing home.
how should bisphosphonates be taken?
tablet must be swallowed whole w/ plain glass of water of at least 200mls
30 mins before meals
on an empty stomach
remain upright after taking
must not be taken at bedtime or before getting up in the morning
once weekly preparations should be taken on the same day each week
what specific advice should be given to patients who are taking Risedronate regarding how to take them?
should be taken 30 mins before breakfast
if this is not practical -
Between meals — should be taken at least 2 hours before or at least 2 hours after any food, other medicinal product, or drink (other than plain water).
In the evening — should be taken at least 2 hours after any food, other medicinal product, or drink (other than plain water).
what specific advice should be given to patients who are taking alendronic acid?
must be taken at least 30 minutes before the first food, other medicinal product, or drink (other than plain water) of the day.
what should you do after a patient has been on bisphophonates for 3-5 years?
re-asses risk
if risk remains high - continue treatment with alendronic acid for up to 10 years, and risedronate for up to 7 years
if risk is intermediate or unclear - arrange repeat DEXA scan and review depending on T score results
if a patient had an intermediate risk of a fracture, when should they be re-assessed again?
minimum 2 years interval
a patient presents with pain in the wrist. On examination, she is tender over the base of her right thumb, and also over the radial styloid process. ulnar deviation recreates the pain - what is the diagnosis?
De Quervains tenosynovitis
what is De Quervains tenosynovitis?
swelling and inflammation of the tendon sheath covering the extensor pollicis brevis and abductor pollicis longus tendons
what are the symptoms of De Quervains tenosynovitis?
pain on the radial side of the wrist
tenderness over the radial styloid process
abduction of the thumb against resistance is painful
how can you test for De Quervains tenosynovitis?
Finkelstein test - place thumb in closed fist, tilt hand down
what is the management of De Quervains tenosynovitis?
analgesia
steroid injection
immobilisation with a thumb splint (spica) may be effective
surgical treatment is sometimes required
a patient presents with pain at the front of the foot, which is worse on walking, associated with the sensation of having a pebble in the shoe - most likely diagnosis?
mortons neuroma
what is mortons neuroma?
thickening of the tissue that surrounds the digital nerve leading to the toes.
which area is most commonly affected in mortons neuroma?
third inter-metatarsophalangeal space
management of mortons neuroma?
usually footwear modifications + analgesia
if ongoing for > 3 months - referral to ortho for consideration of corticosteroid inj or neurectomy of the involved nerve
45 year old man presents with 2- day history of groin pain, following playing a rugby match. During the match, he felt the sensation of snapping deep in the groin/hip. able to weight bear, however external rotation particularly limited due to pain. what is the diagnosis?
acetabular labral tear
management of an acetabular labral tear?
physio
Nonoperative trial to include NSAIDs, rest and physical therapy.
Arthroscopic labral debridement versus repair for patients with progressive symptoms who failed nonoperative management.
Rest and activity modification to reduce or eliminate movements that cause pain and aggravate the injury.
management of bakers cyst in children?
usually no intervention required - resolve spontaneously
if symptomatic - refer to paediatric orthopaedic surgeon
management of symptomatic bakers cyst in adults?
simple analgeisa
physiotherapy
referral to ortho if particularly large or troublesome
why is ALP raised in rickets?
In rickets, serum alkaline phosphatase is typically elevated, not reduced, as it is produced by osteoblasts in response to vitamin D deficiency and increased parathyroid hormone. The raised alkaline phosphatase reflects increased osteoblastic activity attempting to compensate for defective bone mineralisation.
who is trigger finger more common in - men or women?
women
which fingers are most commonly affected by trigger finger?
thumb
middle
ring finger
what is the management of trigger finger?
steroid inj can be first line
finger splinting
surgery to release the tendon can be considered for patients who have not responded to the steroid injections
how is marfans syndrome inherited?
autosomal dominant
what are the features of marfans syndrome?
tall stature
high arched palate
pectus exacavatum
scoliosis
dilation of aortic sinuses
MR valve prolapse
repeated pneumothorax
blue sclera
why do patients with marfans have reduced life expectancy
due to cardiac complications
what are the cardiac complications of marfans syndrome?
dilation of aortic sinuses which may lead to aortic aneurysms, aortic dissection and aortic regurgitation
what three medications should be avoided when prescribing methotrexate due to interactions?
trimethoprim
co-trimoxazole - both these cause bone marrow aplasia
high dose aspirin
In what 3 conditions are NSAIDs contraindicated?
IHD
renal dysfunction
hiatus hernia
what causes gout? (pathophysiology)
deposition of monosodium urate monohydrate in the synovium
caused by chronic high urate levels
what is the first line management for acute flare of gout?
NSAIDs or colchicine - first line
oral steroids - if colchicine/nsaids contrindicated
what is the second line management of acute flare of gout?
oral steroids - prednisolone 15mg/day
if still does not control flare - can consider steroid injection
what is the criteria for considering urate lowering therapy in gout?
more than 2 attacks in 12 months
gouty tophi on examination
renal disease
uric acid renal stones
if on diuretics/cytotoxics - as prophylaxis as can cause flare of gout
what is the optimum time to start urate lowering therapy in gout?
best delayed until inflammation settled - around 2 weeks post acute flare
what is the first line of urate lowering therapy in gout?
allopurinol - 100mg OD - titrated up every few weeks aiming for uric acid < 360 umol
colchicine cover should be considered when starting allopruinol to ensure no acute flares
what is the second line of urate lowering therapy?
febuxostat - xanthine oxidase inhbitor
what are some further treatments if urate lowering therapy is not tolerated?
refer to rheumatology for consideration of uricase or pegloticase infusions
what are some lifestyle modifications to be made in gout?
reduce ETOH intake
lose weight if obese
avoid high purine foods - liver, kidneys, seafood, oily fish, yeast products
what are some medications that can precipitate gout?
thiazides (furosemide, indapamide) - diuretics
what causes pseudogout? (pathophysiology)
Pseudogout is a form of microcrystal synovitis caused by the deposition of calcium pyrophosphate dihydrate crystals in the synovium
how do you diagnose pseudogout?
suspect in a patient not responding to typical gout treatments
XR - chondrocalcinosis
what is seen on joint aspiration in pseudo gout?
weakly positive birefringent rhomboid shaped crystals
what is the management of pseudo gout?
NSAIDs
or intrarticular / oral steroids
what is the pathophysiology of SLE?
autoimmune condition causing immune complex formation which then deposits in any organ causing wide spread symptoms
what are the typical general symptoms/features of SLE?
fatigue
fever
mouth ulcers
lymphadenopathy
what are the skin symptoms of SLE?
malar butterfly rash
discoid rash - erythematous well demarcated rash in sun exposed areas
photosensitivity
raynauds phenomenon
alopecia
livedo reticularis
what are some MSK symptoms of SLE?
arthalgia
non-erosive arthritis
what are some cardiac features of SLE?
pericarditis - most common
myocarditis
what are some respiratory features of SLE?
pleurisy
fibrosing alveolitis
what are some renal features of SLE?
glomerulonephritis - leading to renal failure in some cases
proteinuria
what are some neuropsychiatric manifestations of SLE?
anxiety/depresion
psychosis
seizures
what antibody blood test is MOST SPECIFIC for SLE?
anti-dsDNA - specific > 99%, but less sensitive 70%
anti-smith - specific > 99% but less sepcific 30%
which antibodies are most SENSITIVE for SLE?
anti-nuclear antibodies - 99% of SLE patients are ANA positive but less specific for SLE - can be raised due to number of different conditions
what is ankylosing spondylitis?
chronic inflammatory disease of the intervetebral joints - SERONEGATIVE (RF not found in blood)
thought to be autoimmune
but no specific autoantibodies have been identified yet
what gene is associated with ankylosing spondylitis?
HLA B27
what are some extra systemic features of ank spond?
anterior uveitis
aortic valve regurg
AV node block
achilles tendonitis
Amyloidosis
apical fibrosis
what are the symptoms of ankylosing spondylitis?
low back pain + stiffness - which is worse in the morning but improves with exercises
may experience pain in the night that improves when getting up
what signs are seen on clinical examination of a patient with ank spond?
reduced lateral flexion
reduced forward flexion
what is the first line investigation for ankylosing spondylitis?
XR of sacroiliac joints - may be normal in early disease, but can show sacroilitis, squaring of the lumbar vertebrae, bamboo spine
what should be done if XRAY is negative for ank spond but the suspicion remains high?
MRI
what is the first line management of ank spond?
NSAIDs + regular exercise + physioptherapy
what exercises can help improve achilles tendonitis?
calf muscle eccentric exercises
what are the symptoms of achilles tendon rupture?
Achilles tendon rupture should be suspected if the person describes the following whilst playing a sport or running; an audible ‘pop’ in the ankle, sudden onset significant pain in the calf or ankle or the inability to walk or continue the sport.
what is the test for achilles tendon rupture?
SIMMONS TRIAD
what is the first line investigation for achilles tendon rupture?
USS
what is the management of achilles tendon rupture?
ortho ref
what is the management of achilles tendonitis?
rest
NSAIDs
eccentric achilles tendonitis exercises
what are the symptoms of spinal stenosis?
Unilateral or bilateral leg pain (with or without back pain), numbness, and weakness which is worse on walking. Resolves when sits down. Pain may be described as ‘aching’, ‘crawling’.
Relieved by sitting down, leaning forwards and crouching down
Clinical examination is often normal
which medication is associated with achilles tendon ruputre?
quinolones - ciprofloxacin
what is cubital tunnel syndrome?
compression of ulnar nerve
what are the symptoms of cubital tunnel syndrome?
tingling and numbness of 4th and 5th fingers
pain often worse when leaning on affected elbow
can develop muscle wasting over time
management of cubital tunnel syndrome
Avoid aggravating activity
Physiotherapy
Steroid injections
Surgery in resistant cases
what test can diagnose tennis elbow?
cozens test
pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
how long does acute pain last in tennis elbow?
6 to 12 weeks, but episodes can last 6 months to 2 years
what is psoriatic arthropathy?
inflammatory arthritis - typically associated with psoriasis (but not always) and is SERONEGATIVE
what are the features of psoriatic arthopathy?
(1) joints - typically DIPJ synovitis, (2) skin - i.e. typical psoriasis, (3) nails - often affecting the same joints that have synovitis, (4) dactylitis - ‘sausage digit’ - DOES NOT HAPPEN IN RA (as described in this question), (5) enthesitis - commonly Achille’s tendon (classically at the insertion in the heel / enthesis, which distinguishes it from ‘runner’s’ Achille’s tendonopathy which is classically the middle third rather than the insertion point), (6) axial disease - as part of the spectrum of spondyloarthropathies.
which joints does RA typically spare?
the DIP joints - as no synovial fluid here
which joints does RA typically affected?
PIP and MCP joints
what is the most common eye associations with RA?
keratoconjunctivitis sicca (most common)
episcleritis
scleritis
corneal ulceration
keratitis
what are some respiratory manifestations of RA?
pulmonary fibrosis
pleural effusion
pulmonary nodules
complications of drug therapy
what are some complications or RA?
eye complications - keratoconjunctivitis sicca
resp - pulmonary fibrosis / effusion / nodules
osteoporosis
increased risk of heart disease
increased risk of infections
depression
what are some XR findings in RA?
loss of joint space
juxta-articular osteoporosis
soft-tissue swelling
periarticular erosions
subluxation
what are the two antibodies usually positive in RA?
RF
anti-ccp - can be positive up to 10 years prior to development of RA
what is first line management of rheumatoid arthritis
DMARD monotherapy (usually methotrexate) + steroid bridging curse
what are the different DMARD options in RA?
methotrexate - most common
sulfasalazine
lefunomide
what bloods should be monitored in methotrexate?
FBC + LFT’s - risk of myelosuppression and liver chirrosis
what is the treatment for RA flares?
course of corticosteroids
what is the indication for TNF inhibitors in RA?
if failed at least 2 DMARD therapies
which nerve is trapped in a patient who has hip pain being referred from the lumbar spine?
femoral spine compression
what is the femoral nerve stretch test and how is it done?
to test if the femoral nerve from the lumbar spine is being compressed
lie the patient prone, extend the hip joint with a straight leg, then bend the knee - this stretches the femoral nerve and will cause pain if trapped
what is trochanteric bursitis?
due to repeated movement of the fibroelastic iliotibial band
pain and tenderness over lateral side of thigh
what are the differentials for hip pain?
OA
inflammatory arthritis - RA etc
referred lumbar spine pain
trochanteric bursitis
meralgia paraesthetica
avascular necrosis
pubic symphysis dysfunction
what is meralgia paraesthetica?
compression of the lateral cutaneous nerve of the thigh - typically presents as burning sensation over the anterolateral aspect of the thigh
can cause altered sensation/burning/numbness
how is meralgia parasthetica managed?
rest
NSAIDs
physio
weight loss
refer for steroid injection if severe
neuropathic medications
surgical treatment if above not helping
what is a red flag feature of OA hip pain to consider alternative diagnoses?
if stiffness > 4 hours - likely inflammatory arthritis cause rather than OA
what are features of L3 root compression?
Sensory loss over anterior thigh
Weak hip flexion, knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
what are features of L4 root compression?
Sensory loss anterior aspect of knee and medial malleolus
Weak knee extension and hip adduction
Reduced knee reflex
Positive femoral stretch test
what are features of L5 nerve root compression?
Sensory loss dorsum of foot
Weakness in foot and big toe dorsiflexion
Reflexes intact
Positive sciatic nerve stretch test
what are features of S1 nerve root compression?
Sensory loss posterolateral aspect of leg and lateral aspect of foot
Weakness in plantar flexion of foot
Reduced ankle reflex
Positive sciatic nerve stretch test
what is the criteria for referral for suspected osteosarcoma in young people/paeds?
if have symptoms - XRAY in 48 hours and if suggestive of osteosarcoma, refer to paeds
which nerve root is responsible for hip flexion?
L3
which nerve root is responsible for sensation in dorsum of foot?
L5
which nerve root is responsible for toe dorsiflexion?
L5
which nerve root is responsible for plantar flexion of foot?
S1
what are the features of prolapsed disc?
pain usually worse in the leg than the back
pain often worse when sitting than standing
what is the management of suspected prolapsed disc?
Rest
analgesia
physio
ref to imsk if no improvement after 4-6 weeks
what ages should be given vit D supps?
6 months to 5 years
and anyone over 65 years in the UK
pregnant
breastfeeding
what is the most common reason for revision of THR?
aseptic loosening of the implant
what is perthes disease?
temporary disruption of the blood supply to the capital femoral epiphysis
leads to necrosis, fragmentation and remodelling of the femoral head over years
who is perthes disease more common in?
male children
aged 4-8 years
symptoms of perthes disease?
gradual onset painless limp
reduced bduction and internal rotation
trendelenburg gait - weakness of hip abductors
what is systemic sclerosis
condition of unknown aetiology characterised by hardened scleotic skin and other connective tissues
what are the symptoms of systemic sclerosis?
CREST syndrome - calcinosis, raynauds phenomenon, oEsophageal dysmotility, scerlodactyly, telangiectasia
which antibodies are positive in systemic sclerosis?
ANA positive in 90%
RF positive in 30%
what is a SE of sulfasalazine?
oligospermia
what is a SE of hydroxychloroquine?
EYEdroxychloroquine - corneal deposits, retinopathy
how long should you wait to conceive after stopping methotrexate?
6 months
what are the adverse effects of methotrexate?
Mucositis
Myelosupression
pneuMoitis
pulmonary fibrosis
liver fibrosis
what blood tests are involved in methotrexate monitoring?
FBC, U+E, LFT - before starting, weekly until therapy stabilised and then monitored every 23 months
what is co-prescribed with methotrexate?
folic acid 5mg - once weekly, taken more than 24 hours after methotrexate dose
what should not be prescribed alongside methotrexate?
co-trimoxazole or trimethoprim - bone marrow aplasia
or high dose aspirin
what are the symptoms of temporal arteritis?
rapid onset of symptoms within 1 month
headache
jaw claudication
sudden loss of vision
tender palpable artery
50% also have features of PMR
what is seen on fundoscopy for temporal arteritis?
swollen and pale disc with blurred margins - due to ischaemia of the optic nerve head
what investigations are usually done for temporal arteritis?
raised ESR > 50
CRP
temporal artery biopsy
management of temporal arteritis?
high dose pred 60mg
urgent opthalmology rv if visual loss
what are the Ottowa rules for suspecting ankle fracture?
Inability to walk four steps immediately after the injury or in the emergency department
Bony tenderness at the medial malleolar zone (tip of medial malleolus to lower 6cm of posterior border of tibia)
Bony tenderness at the lateral malleolar zone (tip of lateral malleolus to lower 6cm of posterior border of fibula).
why does calcium need to be checked after replacing low vit D?
Vit D deficiency can cause a secondary hyperparathyroidism (because a decrease in calcium -from lack of vit D - leads to compensatory increase in PTH). After replacing vit D, need to check calcium levels to make sure there is no tertiary hyperparathyroidism (resulting from prolonged secondary hyperparathyroidism and hyperplasia of parathyroid glands)
what is the best test to screen for hypermobility?
Beighton score
what score on the beighton score indicates possible hypermobility?
5/9 adults
6/9 children
what is the biochemical triad of osteomalacia?
hypocalcaemia
hypophosphataemia
rised ALP
what age should patients be routinely assessed for risk of osteoporosis?
65 years women
75 years men
what is sjogrens syndrome?
autoimmune condition affecting the exocrine glands resulting in dry mucosal surfaces
what are the symptoms of sjogrens syndrome?
dry eyes
dry mouth
vaginal dryness
arthralgia
raynauds
sensory polyneuropathy
parotitis
what antibodies are associated with sjogrens?
anti-ro -> 70% of patients
anti-la -> 30% of patients
RF - 50%
ANA - 70%
what is the management of sjogrens syndrome?
artificial saliva + tears
pilocarpine - to stimulate saliva production
what is a significant complications of sjogrens syndrome?
lymphoid malignancy
what is pagets disease of the bone?
increased and uncontrolled bone turnover - due to unctronlled activity of osteoblasts and increased resorption of osteoclasts
what is the stereotypical presentation of pagets bone disease?
old man with bone pain + isolated raise in ALP
what is typically found on blood tests in pagets bone disease?
ALP raised
Ca + phosphate normal
what one medication is advised by NICE to be used in fibromyalgia?
amitriptyline
which muscle is often implicated in patellofemoral pain syndrome?
vastus medialis
what are the symptoms of deep gluteal syndrome?
Buttock pain;
Aggravation of pain on prolonged sitting;
Tenderness on deep palpation of the buttock; and,
Passive stretching or resisted contraction tests cause pain.
what vaccination should be offered prior to commencing DMARD>
pneumococcal
what are the three signs of rotator cuff injury?
painful arc
drop arm test positive
weakness on external rotation
which nerve is damaged in saturday night palsy?
radial nerve
what are the signs of radial nerve palsy?
loss of sensation over anatomical snuff box
wrist drop
what are some common medications that can cause osteoporosis?
long term antidepressants
antiepileptics
GnRH agonists
PPI
oral glucocorticoids
glitazone medications
what is the recommended daily intake of calcium for an adult?
700-1200mg daily
what is the recommended daily intake of vit D for an adult?
400 IU
what is the DAS28 and what does it take into account?
calculates disease activity in RA
28 joints examined whether swollen or tender, CRP, ESR and patients global assessment of their health
what is the most common type of ankle injury?
lateral ligament strains - 77% of ankle injuries
what is a normal ABPI?
> 0.9
what is the maximum dose of allopurinol in renal disease?
if severe renal disease - max dose of 100mg per day
and should reduce if renal disease severe
most common ligament injury in the knee?
anterior cruciate ligament injury - typically caused by non-contact twisting mechanism
how many degrees of the SLR test would indicate hip pathology
pain at 70 degrees
how many degrees of the SLR would indicate lumbar disc herniation?
30-70 degrees
when should a dexa scan be considered in underweight children and adults?
underweight children - after one year of being underweight or earlier if they have bone pain or recurrent fractures
unweight adults - after 2 years of being underweight or earlier if they have bone pain or recurrent fractures
what are the ottowa knee rules for XRAY of a knee injury?
Age 55 years or older
Isolated tenderness of the patella (no bone tenderness of the knee other than the patella)
Tenderness of the head of the fibula
Inability to flex the knee to 90°
Inability to weight bear both immediately and during the consultation for four steps (inability to transfer weight twice onto each lower limb regardless of limping)
what are some examples of the HLA B27 spondyloarthropathies?
ankylosing spondylitis
psoriatic arthritis
reactive arthritis
which test examines the cruciate ligaments in the knee?
anterior draw test
what is a typical XR finding in rheumatoid arthritis?
periarticular erosions
an allergy to what contradicts prescribing glucosamine?
shellfish
what is severs disease?
calcaenal apophysitis at the point of insertion of the achilles tendon
who is severs disease most common in?
young adults and adolescent athletes
what is osteomalacia?
bone softening due to low vit D
also known as rickets
what are the causes of osteomalacia/
vit D deficiency - lack of vit D in diet, lack of sunlight
CKD
drug induced - anticonvulsants
liver disease - cirrhosis
coeliac disease
inherited
what are the symptoms of osteomalacia?
bone pain
muscle tenderness
fractures
proximal myopathy - which can lead to waddling gait
what are some specific causes of dupytrens contracture?
manual labour
phenytoin treatment
alcoholic liver disease
diabetes mellitus
trauma to the hand
