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Conditions + definitions > MSK - week 1 > Flashcards

MSK - week 1 Flashcards

1
Q

What are the three joint types?

A

Fibrous
Cartilainous
Synovial

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2
Q

What are the examples of fibrous joints

A

Cranial sutures
Interossous membranes
Peridontal ligaments (teeth)

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3
Q

What are the types of cartiliganous joints?

Give an example of both

A

Primary - only hyaline
– Synchondrosis (growth plates)
Secondary - hyaline and fibrocartilage
–Symphysis - intervertebral discs

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4
Q

What are the common features of a synovial joint?

A

Synovial cavity
Fibrous capsule
Synovial membrane
Articular cartilage

May contain:
Articular discs
Ligaments
Bursea (fluid filled sacs)

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5
Q

What are the types of synovial joints?

A 
Plane
Hinge
Pivot
Condylar
Saddle
Ball and socket
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6
Q

What contributes to joint stability?

A

Shape of articulating surfaces
Capsule + ligaments
Muscles

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7
Q

What is the arrangement of articular cartilage?

A

Made of two levels, superficial and transitional.
Superficial - made up of flattened chondrocytes that produce collagen and glycoproteins
Transitional - round glycoproteins producing protoglycans
Made up of at least 75% water so uncompressible

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8
Q

What are glycoproteins?

A

proteins to which oligosaccharide chains are attached, i.e. more a protein than a carbohydrate!
IE lubricin

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9
Q

What are proteoglycans?

A

proteins that are heavily glycosylated (= a protein core to which one or more GAGs attach), i.e. tend to be more carb than protein!
IE aggrecan

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10
Q

What are Glycosaminoglycans (GAGs)?

A

long unbranched polysaccharides, which are highly polar and thus attract water
IE hyaluronic acid

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11
Q

How does cartilage get its nutrients?

A

Gets it from the synovial fluid (in the synovial membrane)

Not from blood supply as it’s avascular

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12
Q

Describe the synovium.

A

Contains synoviocytes which produce the synovial fluid
Has no epithelial lining and a rich capillary network
This facilitates direct exchange of oxygen + other nutrients

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13
Q

What are the differences between the types of synoviocytes?

A

Type A - look similar to macrophages
Remove debris
Contribute to synovial fluid production

Type B - fibroblast like
Main producer of synovial fluid

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14
Q

What is synovial fluid + functions?

A

A viscous fluid present in small volumes with rapid turnover

Lubricates joints + exchanges nutrients for cartilage

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15
Q

What are bursae?

A

Sacks around joints filled with liquid to reduce friction

Can lead to bursitis if inflammed

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16
Q

How does aging affect joints?

A

Viscosity of the synovial fluid increases
Leads to slower joint movements and reduced lubrication

Water content of cartilage decreases, reducing shock absorption

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17
Q

How does osteoarthritis affect the bones?

A

Narrowing vertebral disks

Bone spurs

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18
Q

What is sarcoma?

A

A malignant tissue from connective tissues
Spreads along fascial planes
Haematogenous spread to lungs

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19
Q

Describe bone tumours

A

Benign tumours common, although malignant is rare

Tend to be more secondary tumours

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20
Q

What are the bone forming tumours? (malignant and benign)

A

Benign - osteoid osteoma
Osteoblastoma

Malignant - osteosarcoma

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21
Q

What are the cartilage forming tumours?

A

Benign - enchondroma
Osteochondroma

Malignant - chondrosarcoma

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22
Q

What are fibrous tissue tumours?

A

Benign - firoma
Malignant - fibrosarcoma
Malignant fibrous histiocytoma (MFH)

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23
Q

What are the vascular tissue tumours?

A

Benign - haemangioma
Aneursmal bone cyst

Malignant - angiosarcoma

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24
Q

Examples of adipose tissue tumours

A

Benign- lipoma

Malignant - liposarcoma

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25
Q

Examples of marrow tissue tumours

A

Malignant
Ewings sarcoma
Lymphoma
Myeloma

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26
Q

What invesitgations are pertinent with suspected bone lesions?

A

Plain X-rays

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27
Q

What are the differences in x-rays for aggressive and non-aggresive bone tumours?

A

Aggressive have less well defined transition zones

Cortical destruction is a sign of malignancy

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28
Q

What are isotop bone scans?

A

Used for staging of skeletal mets
Frequently negative in myeloma

Not great at distinguishing malignant from benign as benign also demonstrate increased uptake

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29
Q

What are the cardinal features of a primary bone tumour?

A

Pain either unexplained, at night or increasing in severity
With a deep seated boring nature
Difficulty weight bearing
Deep swelling

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30
Q

Name 3 examples of primary bone tumours

A

Osteosarcoma
Ewings sarcoma
Chondrosarcoma

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31
Q

What are the clinical features of osteosarcoma?

A

Pain
Loss of function

Swelling
Pathological fracture
Joint effusion
Deformity
Neurovascular effects
Systemic effects of neoplasia
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32
Q

What is the pain like in osteosarcoma?

A

Pain increasing in nature, not related to exercise
Deep boring character worse at night
Analgesics eventually inneffective

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33
Q

What characterises loss of function in osteosarcoma?

A

Limp
Reduced joint movement
Stiff back - especially in a child

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34
Q

What are the clinical features of swelling in osteosarcoma?

A

Generally difuse in malignancy
Near end of long bone
Enlargement can be rapid
Warmth over swelling + venous congestion = active

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35
Q

Why is MRI the investigtion of choice for suspected osteosarcoma?

A 
Very sensitive
Very good for showing:
Intraosseous AND extraosseous (soft tissue) extent of tumour
Can show joint involvement
Skip metastesis
Epiphyseal extension

Good for determining resection margins

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36
Q

Treatment for osteosarcoma?

A

Chemo
Surgery
Radiotherapy

Goal is to make free of disease

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37
Q

What are the suspicous signs of a soft tissue tumour?

A

Deep (deeper than deep fascia)
Subcutaneous tumours greater than 5cm
Rapid growth, hard, craggy or non-tender

If any of these refer to specialist tumour centre

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38
Q

What are the common sites causing bone metastases?

A 
Breast
Melanoma
Lung
Prostate
Kidney
Thyroid
GI tract

Most common site after lung and liver for secondary tumours

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39
Q

What are the common bones to develop a secondary tumour?

A 
Order:
Vertebrae
Proximal femur
Pelvis
Ribs
Sternum
Skull
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40
Q

How can you prevent pathological fractures?

A

Early chemotherpay

Prophylactic internal fixation based on Mirel’s scoring system. 8+ indicates fixation

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41
Q

What is Mirel’s scoring system?

A

Picture needed

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42
Q

What is osteoarthritis?

A 
Most common form of joint problem
Consists of "Tear, flare and repair"
-Trauma and mechanical imbalance
-Causes inflammation and pain
-Repair processes around joint
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43
Q

What are the biomechanical factors of osteoarthritis?

A 
Abnormal anatomy
Intra-articular fracture
Ligament rupture
Meniscal injury
Occupation (farmers/football players
Persistent heavy physical activity
Elite running
Obesity
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44
Q

What events happen due to inflammation in the joints?

A

Synovial hypertophy
Subocondral changes
Joint effusion

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45
Q

What is the pathogensis of primary OA?

A

Wear + tear - joint use over the years causes degeneration in cartilage

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46
Q

What is the pathogensis of secondary OA?

A

Due to increased load that causes joint microtrauma
Increased load can be due to weight gain (obesity) or instability / misalignment of joint
This can arise from either muscle weakness, ligament injury or abnormal anatomy

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47
Q

How do you diagnose OA?

A

A patient who is 45+ with activity related joint pain

With morning joint related stiffness being absent or lasting less than 30 minutes

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48
Q

What are the differentials of OA?

A

Gout
Other inflammatory arthritides
Septic arthritis
Malignancy

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49
Q

What are the non-pharmacological treatments for OA?

A

Thermotheraphy
Electrotherarpy
Aids/devices
Manual therapy

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50
Q

What are the pharmological treatments of OA?

A

Oral analgesia - paracetamol, NSAIDs

Topical - NSAIDs, capsaicin

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51
Q

When do you refer a patient with OA for surgery?

A

Substantial impact on QOL

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52
Q

What are the differentials for a knee injury?

A 
Fracture
Acute/chornic degnerative joint disease
Meniscal injury
Ligament injury
Tendon injury
53
Q

What are the important questions in a knee history?

A

Sport/recreation? Or whilst resting/at work?
Activity at the time - jumping? Sports tackle
Energy at time of impact - how fast/heavy?
Chronology - was it quick or slow onset
For swelling, quick onset means blood
Any previous injuries in same spot?
Pop/crack heard?

54
Q

What are the characteristics of a meniscal injury?

A

Often caused by a twisting movement on a loaded fixed knee
Results in painful squelch
Slow to swell (quicker in young though)
Painful to bear weight
Can result in locked knee - unable for even physician to move

55
Q

What are the characteristics of an ACL tear?

A

Caused by forward momentum against a fixed leg with or without rotation
Loud pop heard at time
Quick to swell
Able to bear weight

56
Q

What are the characteristics of collateral tears?

A

Lateralised pain
Feel of crack with sharp pain
No or minimal effusion
Bruising localised to one side

57
Q

What are the important things to look for in a knee examination?

A

scars, brusing, swelling

Joint line irregularities

58
Q

What are the important things to feel for in a knee examination

A 
Effusion
	Crepitus
	Heat
	Tenderness
	Tissue lumps/defects
59
Q

What are the important movements in a knee examination?

A

Passive/active
Straight leg raise
Range of movement
Ligament + dyanmic testing

60
Q

What are the indications for knee surgery?

A 
Failure of conservative treatment
Demands of work/sport
Problems with daily activities
Prevention of further joint injury
Prevention of falls
61
Q

What are the non-surgical managements for acute knee injuries?

A

Restoration of function
Physio
Analgesia
Swelling reduction

62
Q

What are the surgeries available for a meniscal tear?

A

Meniscal repair
Partial menisectomy
Meniscal transplant

63
Q

What are the zones in a meniscus, what is their significance?

A

Red to white, with red/white inbetween
Indicates the vascularity of the meniscus (more vascular on lateral side)
Indicates how well it will heal
And thus how successful surgery would be

64
Q

Who is eligible for meniscal surgery?

A

Young or sporty
Fresh tears - less than 3 months
Health meniscus with damage in red or red/white zone, NOT in white zone

65
Q

What is the treatment for anterior cruciate ligament issues?

A

Rehab or reconstruction

66
Q

When is reconstruction indicated?

A

Prevention of further injury
Helping to get back to work/sport
To prevent osteoarthritis

67
Q

What is osteomyelitis?

A

Infection in the bone

68
Q

What is septic arthritis?

A

Infection in the joint

69
Q

Who is most likely to get acute osteomyelitis?

A

Children, boys more than girls
Often with history of minor trauma
Associated with diabetes, immunocompromised/steroids, rheumatic arthritis, sickle cell

70
Q

What are the types of osteomyelitis?

A

Acute
Chronic

Can be specific or non-specific causation

71
Q

Who is affected by acute osteomyelitis?

A

Mostly children, favouring boys with history of trauma (minor trauma)

Assocaited with diabetes,
Rheumatic arthritis,
steroid/immune compromised,
sickle cell

72
Q

How is acute osteomyelitis spread?

A

Haematogenous spread in children/elderly
Local spread from contiguous site of infection (open fracture, joint replacement etc)

Secondary to vascular insufficiency

73
Q

What are the sources of infection in acute osteomyeltits?

A

Infants - infected umbilical cord
Children - boils, tonsilitis, skin abraisons
Adults - UTI, arterial line

74
Q

What are the most likely organisms in an infant for acute osteomyelitis?

A

Staph A
Group B streptococci
E coli

75
Q

What are the most likely organisms to cause acute osteomyelitis in older children?

A

Staph A
Strep pyogenes
Haemophilus influenzae

76
Q

What are the most likely organisms to cause acute osteomyelitis in adults?

A

Staph A
Coagulase-negative staphylococci (prostheses)
Propionibacterium (prostheses)
Streptococcus pyogenes (infective arthritis)
Mycobacterium tuberculosis
Pseudomonas aerginosa (especially in penetrating foot injury)

77
Q

What other organisms can sometimes cause acute osteomyeltits?

A 
Brucella in butchers
Mycobacterium marinum in fishermen/filliters
Proteus mirabilis
Candida in immunocompromised
Diabettic foot - mixed anaerobes
Vertebral osteomyelitis - S. Aureus, TB
Sickle cell - salmonella
STD - gonococcus
78
Q

What bones are likely to be affected?

A 
Distal femur
Proximal tibia
Proximal humerus
Hip
Elbow (radial head)
79
Q

What are the clinical features in an infant with acute osteomyeltits?

A 
Minimal signs or may be very ill
Fail to thrive
Possible drowsiness /irritation
Metaphyseal tenderness/swelling
Positional change
Decreased range of movement

Most common around knee

80
Q

What is the pathology of acute osteomyelitis?

A

Trauma causes acute inflammation and vascular stasis
Pus forms and bone reformation occurs
If infection gets into bone whilst reforming granulation tissue walls off diseased bone tissue
Bacterial proliferation resultsin further destruction + potential abscess formation

81
Q

What are the clinical features of acute osteomyeltis in a child?

A 
Severe pain
Reluctant to move (non weight bearing, neighboring joints flexed)
May be tender fever + tachycardia
Malaise
Toxaemia
82
Q

What are the clinical features of osteomyelitis in an adult? (primary)

A 
Backache (most primary OM seen in thoracolumbar spine)
History of UTI/urological procedure
Elderly
Diabetic
Immunocompromised
83
Q

What are the clinical features of osteomyelitis in an adult (secondary)?

A

More common
Often after open fracture
Mixed organisms

84
Q

How do you blood tests are used to diagnose acute osteomeylitis?

A 
History + clinical exam (pulse+temp)
FBC + diffuse WBC
ESR +CRP (inflamm markers)
3 blood cultures
U&Es
85
Q

What are the differentials for acute osteomyelitis?

A 
Acute septic arthritis
Trauma (fracture, dislocation etc)
Acute inflammatory arthritis
Transient synovitis
Soft tissue infection (cellulitis, necrotising fasciitis, gas gangrene, txic shock syndrome)
86
Q

What are the rare differentials for acute osteomyelitis?

A

Sickle cell crisis
Gaunchers disease
Rheumatic fever
Haemophillia

87
Q

What investigations are used to diagnose acute osteomyelitis?

A 
X-Ray
US
Aspiration
Isotope bone scan
Labelled white cell scan
MRI
88
Q

What is shown on an x-ray in acute osteomyelitis?

A

Normal for first 10-14 days
Then shows late metaphysial destruction
Latermedullay changes
Later, osteoneceosis and ner periosteal bone

89
Q

What is the process for microbial identification in acute osteomyleitis?

A

Blood cultures in haemataogenous OM and septic arthritis
Bone biopsy
Tissue/swabs from 5 sites around implant in prosthetic infection

90
Q

How do you treat acute osteomyelitis?

A 
Rest + splintage
Supportive for pain + dehydration
Antibiotics
IV for first week, oral thereafter
4-6wks - treat before results empirically
91
Q

What are the indications for surgery in acute osteomyeltis ?

A

Aspiration of pus
Abscess drainage
Debridement of dead/infected tissue

Infected joint replacements

92
Q

What are the complications of acute osteomyelitis?

A

Sepitcemia
Death

Metastatic infection
Pathological fracture
Septic arthritis
Altered boine growth
Chronic osteomyelitis
93
Q

What is subacute osteomyelitis?

A

osteomyelitis where the host has resistance
Bacteria has lower virulance
Or use of antibiotics
Prolonged by lessened symptoms

94
Q

What are the clinical features of subacute osteomyelitis?

A 
long history (weeks-months)
Variable symptoms
Pain, limp
Local swelling/warmth
Tenderness
95
Q

What are the differentials of subacute osteomyelitis?

A

Ewings sarcoma
Osteoid oseoma
TB

96
Q

What is brodie’s abscess?

A

An abcess that forms in Subacute osteomyelitis
Painful limb with no systemic features
Older children

97
Q

What is seen in X-ray of brodie’s abcess?

A

Luency in long bone metaphysis

98
Q

What are the differntials of brodie’s abscess?

A

Ewings sarcoma

99
Q

What is the treatment of brodie’s abcess?

A

Curettage surgery

100
Q

What are the investigations in subacute osteomyelitis?

A

X-ray
Bone scan
Biopsy

101
Q

How do you treat subacute osteomyelitis?

A

Prolonged course of antibiotics

Surgery - curettage

102
Q

What leads to chornic osteomyelitis

A

May follow acute osteomyelitis
May start de novo
Either after operation or open fracture
Or in immunocomprmised patients - immunosuppressed, diabetics, elderly, drug abusers

Repeated breakdown of healed wounds can contribute

103
Q

What are teh causative organisms of chronic osteomyelitis?

A 
Often mixed
Normally same organism for each flareup
Staph A
E coli
Strep pyogenes
Proteus
104
Q

What is chronic osteomyelitis?

A

Chrnoically discharging sinus attached to underlying bone
Contains dead bone tissue due to infection (sequestrum)
Surrounded by granulation tissue and layer of new bone growth

105
Q

What is the pathology of chronic osteomyelitis?

A

Due to insult cavity occurs which becomes infected
Dead bone leads to abcess + forming of new bone

Picture of chornic inflammation

106
Q

How do you treat chronic osteomyelitis?

A 
Long term antibiotics
Erradicate bone infection (multiple surgeries)
Treat soft tissue problems
Correct deformity if present
Reconstruction?
Amputation?
107
Q

What are the complications of chronic osteomyelitis?

A 
Chronically discharging sinus + flare ups
Ongoing infection
Patolgical fractures
Growth distubrance
Squamous cell carcinoma (0/07%)
108
Q

What is the route of infection in acute septic arthritis?

A

Direct invasion (pentrating wound, intra-articular injury)
Eruption of bone abscess
Haematogenous

109
Q

What are the common caustative agents of acute septic arthritis?

A

Staph A
H. influenzae
Strep pyogenes
Ecoli

110
Q

What is the pathology of acute septic arthritis?

A

Acute synovitis with purulent joint effusion
Articular cartilage attacked by bacterial toxin/cellular enzyme
Complete destruction of articular cartilage

111
Q

What are the possible outcomes (sqeulae) of acute septic arthritis?

A

Complete recover

Partial loss of articular cartilage –> OA

Fibrous or bony ankylosis

112
Q

What is the clinical picture in a neonate with acute septic arthritis?

A

Irritability
Resitant to movement
Ill

113
Q

What is the clinical picture in a child with acute septic arthritis?

A

Acute pain in single large joint
Reluctant to move joint (any movment)
Increased temp + pulse
Increased tenderness

114
Q

What is the clinical picture of an adult with acute septic arthritis?

A

Often superficial joint
Rare in healthy adult
Most common after joint replacement

115
Q

How do you investigate acute septic arthritis?

A

FBC, WBC, ESR, CRP, blood culture
X-ray
US
Aspiration

116
Q

How rare is an infected joint replacement?

A 
1.1-5%
However deadly (staph A)
117
Q

What are the differential diagnoses of acute septic arthritis?

A 
Acute osteomyelitis
Trauma
Irritabile joint
Haemophilia
Rheumatic fever
Gout
Gauchers disease
118
Q

How do you treat acute septic arthritis?

A

General supportive measures
Antibiotics for 3-4 weeks
Surgical drainage in ermgency (ie pus)

119
Q

What are the three types of TB joint infections?

A

Extra-articular (epipihyseal/haemodynamic marrow)
Intra-articular (large joints)
Vertebral body

120
Q

How many patients have multiple TB bone infection lesions?

A

1/3

121
Q

What are the clinical features of TB bone/joint infections?

A 
Insidious onset
History of TB contact
Pain (night!) swelling, weight loss
Joint swelling
Decreased range of movenet
Ankylosis
Deformity
122
Q

What is the pathology of TB bone/joint infections?

A

Primarily in lung
This spreads, sometimes to bones
Forms tuberculos granuloma - early (vascular ) and chronic (avascular)
Chronic develops obliterative endarteritis so difficult to treat with antibiotics

123
Q

How do you diagnose TB joint/bone infection?

A

Long history with single joint involvement
Marked thickening of synovium
Marked muscle wastage
Periarticular osteoporosis

124
Q

How do you investigate TB joint/bone infection?

A 
FBC, ESR
Mantoux test
Sputum/urine culture
Xray
Joint aspiration and biopsy
125
Q

What does the bone x-ray show in joint/bone TB infection?

A

Soft tissue swelling
Periarticular ostepaenia
Articular space narrowing

126
Q

What tests are done on aspirated fluid in a TB joint/bone infection?

A

AAFB (10-20% ID rate)

Culture (50% positive)

127
Q

What are the differentials of TB joint infection?

A

Transient synovitis
Monoarticular RA
Haemorrhagic arthritis
Pyogenic arthritis

128
Q

What is the treatment regime in TB joint/bone infection? (note, differs from usual)

A

8 weeks
Rifampicin
Isoniazid
Ethambutol

Then 6-12 months
Rifampicin
Isoniazid

Rest + splintage

Conditions + definitions (68 decks)

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