Msk Treatments Flashcards
Pagets disease
1st: analgesia
2nd: bisphosphonates
non pharmacological management of OA (when to use)
non pharmacological 1st line: physio, weight loss, activity modification-
pharmacological management of OA (when to use)
1st line: paracetomol + topical NSAId (if knee/ hand)
2nd: oral nsaid + ppi
intra-articular steroid injections (up to 3 per year)- if other management is unsuitable
surgical management of OA (whent to use)
joint replacement- if other methods not working/greatly impacting life,
arthroscopic surgery to remove loose bodies
septic arthritis
Tx for >5 yrs old
1) flucoxacillin IV
clindamycin if penicillin allergic
2) after blood results- IV antibiotic specific for culture for 1-2 weeks- gd response then give PO antibiotics for 6 weeks
possible wash out of joint
acute gout management (not including prophylaxis)
when is management stopped
(3 diff lines of management)
NSAIDs- prescribe til 1-2 days after attack:
1)naproxen (do not give nsaid to ckd patient)
2) (po) colchicine is alternative (for ppl w/ HF, CKD-except for ESRD, gastric ulcers)
3) steroids (oral/injection)- use if on dialysis/ have End Stage Renal Disease (ESRD)
acute gout prophylaxis management and who gets it?
management: 1st line and 2ns line
when is prophylaxis started?
Every1 after 1st attack
management:
2 weeks after acute attack start Urate Lowering Drugs (ULD)
-xanthine oxidase inhibitors: 1st- allopurinol, 2nd-febuxostat
have to prescribe colchicine/NSAID w/ allopurinol for first 6 months
intra-capsular fracture low functionn management
hemi arthroplasty
intra-capsular fracture management for high functioning patient
Displaced fracture:
Total hip replacement
undisplaced:
dynamic hip screw/internal fixation
extra-capsular fracture: intertrochanteric
Dynamic hip screw
extracapsular fracture- subtrochanteric
Inter Medullary Nail
Rhuematoid arthritis management]
give exact das threshold
and what do you prescribe … with
within 3 months of onset
1st) DMARDs (methotrexate 1st) - prescribe with folate (to reduce bone marrow supression)
2nd) add another DMARD
3rd) despite 2 DMARDs if Das28 is >3.2 then biologic is added (anti-tnf etc)
steroids, analgesiacs etc used for symptomatic relief
ankylosing spondylitis management
1st line NSAIDs (have to try 2 b4 going onto anti-tnf + physio
DMARDs only if there is peripheral joint involvement
3) anti-tnf: for highly persistent disease, if all else fails
polymyalgia rheumatica management
prednisolone eg. 15mg
(patients typically respond dramatically to steroids, failure to do so should prompt consideration of an alternative diagnosis)
Giant cell arteritis management
include if there is vision loss
and any other necessary actions
-urgent high dose glucocorticoids- b4 temporal artery biopsy
-if there is is vision loss then IV methylprednisolone
there should be a dramatic response, if not another diagnosis should be considered
-urgent opthatmology review
Acute flare of rheumatoid arthritis treatment
IM or PO methylprednisolone
Plantar fasciitis treatment
(4 points)
Rest, achilles and plantar fascia stretching excersises and a gel filled heel pad may help.
Corticosteroid injections may alleviate symptoms.
(Surgical release of PF is not beneficial)
Management if quadricep tendon rupture
Almost always surgically managed
(as quadricep tendon is vital for leg extension therefore ambulation/knee function)
What tendons tears absolutely require surgical management
Quadricep tendon and patellar tendon
When is arthodesis used
End stage ankle arthritis
Wrist arthritis
First MTP joint of foot (hallux rigidus)
Myositis ossificans Tx
include prophylactic treatment
Once settled, abnormal bone is excised.
High strength NSAIDs (indomethacin)
Or
Radiotherapy used as prophylaxis
CRPS (chronic regional pain syndrome) management
reuires urgent referral to a specialist (to improve prognosis).
tx: analgesiacs, anticonvulsabts, steroids, TENs machines, physio, lidocaine patches & sympathetic nerve blocking injections may help.
tricky to manage
1st line carpal tunnel syndrome treatment
wrist splints +/- steroid injections
achillies tendonitis management
rest, NSAIDs,
if symptoms persist beyond 7 days then physio too
treatment of an ankle fracture which has disrupted the tibio fibular syndemosis (widening of ankle mortise) (weber c classification)
requires ORIF- open reduction internal fixation
(although if elderly then avoid surgery- usually)
treatment for Weber B fracture
what does this fracture describe
(4)
fibular fracture at the level of syndemosis ankle
operate depending on instability of fracture and age.
if old then dont operate, instead:
application of below the knee plaster cast to include midfoot.
(boot goes om after cast)
treatment weber type A fracture
and also decribe what this type of fracture is
(conservative management)
below the knee cast 6 weeks
fibular fracture distal to syndemosis (tibiofibular)
initial management of open fracture
What should be avoided?
IV antibiotics, photography and application of saline soaked gauze w impermeable dressing
THEN
wound debridement and external fixation
ORIF should be avoided
most appropriate initial management for a suspected scaphoid fracture
Futuro splint or standard below-elbow backslab before specialist review
definitive treatment for non displaced scaphoid fracture
(distal vs proximal)
cast for 6 weeks if distal, if proximal then surgery
osteoporosis treatment
(3 points)
vit D and Ca++ (unless they defo have enough already)
bisphosphonates: 1st line: alendronate, 2nd: ritedonate
APP syndrome management
primary thrombprophylaxis:
low dose aspirin
secondary thromboprophylaxis (so after venous thromboembolic events): lifelong warfarin w/ target INR of 2-3
SLE treatment of choice
(2 lines)
hydroxychloroquine
prednisolone/biologics indicated in sever disease
sciatica treatment
(1st and 2nd line)
1st: analgesia and physio
2nd: refer to neurosurgery if symptoms havent improved after 4-6 weeks of analgesia/physio
acute gout management for someone with heart failure
colchicine
( the alternative to naproxen)
acute gout management for someone with chronic kidney disease
colchicine
( the alternative to naproxen)
displaced scaphoid fracture treatment
usually surgical fixation
rib fracture treatment
conservative
if morphine/analgesia is not managing pain then give a nerve blocker
when to consider surgival fixation:
if symptoms have not been controlled after 12 weeks
management for dermosytosis/polymyositosis
(4 points)
1st line: high dose corticosteroids, reduce over time to eventually stop
if not responsive:
2nd- immunosupression eg aza
(other biologucs etc can be used in severe cases)
treatment for kawasaki disease
High dose aspirin
IV immunoglobulin
SUFE management
internal fixation
(typically with a single cannulated screw)
stage … CKD and someone with an eGFR of …. or less requires what alternative to bisphosphonates?
IV , 35mL/minute/1.73m2
denosumab (human monocolonal antibody): given as a subcutaneous injection every 6 months
(denosumab is 2nd line to alendronic acid for those who cannot tolerate it )
septic arthritis tx for <5 yrs
flucoxacillin IV and ceftriioxine IV (Ceft. covers h.influ)
give clindamycin instead of flucox if allergic
2) after blood results- IV antibiotic specific for culture for 1-2 weeks-
gd response then give PO antibiotics for 6 weeks
scleroderma renal crisis treatment
1st line: ace inhibitor ie. ramipril
trigger finger management
1st: steroid injection, finger splint
2nd line: surgery
psoriatic arthritis tx
mild peripheral: NSAID
more severe: DMARD
3rd: 2 DMARDS
reactive arthritis treatment
symptomatic: NSAIDS, intra-articular steroids
persistent disease: sulfasalzine/methotrexat
osteoporotic crush fracture treatment
Conservative or balloon vertebroplasty
if allergic to co-trimaxazole what anti rheumitic drug should you not take
sulfasalazine (as co trimaoxazole is a sufa drug)
when should steroids be co-prescribed with bisphosphonates
if someone will be taking steroids for 3 months or more then bisphosphonates should be prescribed immedietley to reduced the risk of osteoporosis
treatment for prolapsed disc
nsaids +/- ppi
if it perists for 4-6 weeks then referral for consideration of MRI is appropriate
high velocity radial shaft fracture tx in a young healthy patient
surgical fixation
mechanical back pain tx
NSAIDS and KEEp MOVING
acute disc tear tx
analgesia and physio
cauda equina tx
surgery
(cauda equina - urinary incontenence, poo yourself, cant feel legs etc)
duputryens contracture management
1st: reassure, self limiting
2nd: (if not flattening)then refer to specialist for surgical intervention/ inject enzyme therapy
potts disease tx
anitbiotics, rifampicin, isonazid & spinal mobilisiation!
necrotising fasciitis tx
urgent surgical debridement and Abx IV to culture
bunion tx
conservativ: wider/deeper shoes
2nd: surgical: osteotomies
Mortons nueroma tx
1st line: conservative- pad/insole. steroids/LA injections
talipes equinovarus (club foot) tx
1st: manipulation + progressive casting soon after birth
takes 6-10 wks to correct
85% then require achilles tetonotomy
achilles tendon rupture tx
medical: series of casts with foot plantarflexed
surgical: tendon repair
ACL tear mx
(3)
(1) ask patient to return in 6-7 days to re-examine
(1) NSAIDS + RICE
rest
Ice
Compression
Elevation
(1) many will require arthroscopic surgery for tendon graft surgery
patella fracture mx
strengthen quadriceps
avascular necrosis tx
drill holes into affected head
if evidence of bone collapse then total hip replacement
trochanteric bursitis tx
analgesia + NSAIDs
steroid injetions
femoral shaft fracture inital and definitive
inital: femoral nerve block and thomas splint
definitive: intermedullary nail
acetabulum fracture management
undisplaced: conservative
displaced: young- reduction + fixation
old- Total hip replacement
boxers fracture tx
strap to neighboring finger (occurs on 5th metacarpal)
wash fight bite out in theatre
lateral epidondyitis tx vs medial epidoncylitis tx
lat: rest + NSAIDs + steroid injections
medial: the same but no steroid injections
olecranon fracture tx
ORIF
If avulsion= tension band wiring
mx for acromioclavicular joint injury
grade I/II= sling
grade IV-VI = surgery
shoulder dislocation management
closed reduction under sedation/ anaethetic
sling
spinal stenosis management
laminectomy
frozen shoulder tx
1st line: avoid activities tht exacerbate condtion, NSAIDs then physio
2nd: corticosteroid injections
