Musc/Rheum Flashcards
Common extraarticular manifestations of ankylosing spondylitis
Anterior uvietis
Apical fibrosis
Aortic regurg
AVN block
Amyloidosis
Atlantoxial dislocation
Mx of ankylosing spondylitis
Physiotherapy
NSAIDs
Smoking cessation
Intraarticular/intralesional/im steroid for enthesitis/arthritis
Methotrexate for peripheral but not axial disease
Anti-TNF agents for axial disease once failed 2 NSAIDs at max dose for 4 weeks
Mx of ankylosing spondylitis
Physiotherapy
NSAIDs
Smoking cessation
Intraarticular/intralesional/im steroid for enthesitis/arthritis
Methotrexate for peripheral but not axial disease
Anti-TNF agents for axial disease once failed 2 NSAIDs at max dose for 4 weeks
Mx of rheumatoid arthritis?
Methotrexate + short term prednisolone
Measure disease activity DAS-28 score
What joint affected increases suspicion of psoriatic arthritis over rheumatoid arthritis
DIPJ
Mx of psoriatic arthropathy?
NSAIDs
Steroid injections
DMARDs if NSAIDs fail
Anit-TNF afents
Ustekinumab
GCA Mx
EMERGENCY
40mg Prednisolone
IV methylprednisolone 500mg if visual loss
Request temporal artery biopsy
What is Ehlers-Danlos Syndrome
Skin hyperextensibility
Joint hypermobility
Easy bruising, muscle aches, weakness
Causes of erythema nodosum
Sarcoidosis
Inflammatory Bowel Disease (crohns more often than ulcerative colitis)
Behcet’s disease
Hodgkins lymphoma, leukaemia
Pregnancy
Infection: TB, leprosy, Hep B
Causes of bihilar lymphadenopathy
Sarcoidosis
Infection: TB, HIV
Malignancy
Silicosis
Describe the anatomy of the carpal tunnel
Formed by flexor retinaculum and carpal bones
contains median nerve
What is the typical patterns of sensory loss seen in carpal tunnel syndrome?
median nerve supplies thenar eminence and lateral 3.5 fingers
Main cause of carpal tunnel syndrome
Idiopathic
Radial fracture
Inflammation - RA, gout
Soft tissue swelling; lipomas, ganglia, acromegaly, amyloidosis
Surgical Tx of carpal tunnel
Carpal tunnel decompression by division of flexor retinaculum
What are the 4 classic features of RA on X-ray
Loss of joint space
Periarticular Erosions
Soft tissue Swellings
Soft bones i.e. periarticular osteopenia
Causes of positive tredelenberg test
Osteoarthritis
Abductor wasting
Sup. gluteal N. injury: surgery
Structural: DDH
Causes of hip shortening
NOF
Dislocation
Osteomyelitis
Surgery
SUFE, Perthe’s
Scoliosis
Caused of fixed flexion deformity in the hip
Osteoarthritis (most likely)
NOF
Muscle contracture
Features of OA of hip
x5
± Trendelenberg gait or +ve Test
Pain
Stiffness
↓ ROM: esp. internal rotation
Fixed flexion deformity
Osteoarthritis Ix
Exclude Rheumatological Disease
FBC
ESR
RF, ANA
Check Renal Function: U+E
(important before prescribing NSAIDs)
X-ray Changes
X-ray changes in osteoarthritis?
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
Osteoarthritis Mx
MDT
Lifestyle: ↓ wt., ↑ exercise
Physio: muscle strengthening, walking aids
Analgesia
Joint injection: local anaesthetic and steroids
Sx: arthroplasty, realignment
What causes longer early morning stiffness, OA or RA.
Which joints are affected in the hands for OA and RA
RA long early morning stiffness
RA: PIPJs and MCPJs
OA: PIPJs and DIPJs
Commonest complication of total hip replacement
DVT
Mx of intracapsular hip fracture
Undisplaced Fracture:
internal fixation, or hemiarthroplasty if unfit.
Displaced:
Total hip replacement, or hemiarthroplasty if unfit.
Mx of extracapsular hip fracture
stable intertrochanteric fractures: dynamic hip screw
if reverse oblique, transverse or subtrochanteric fractures: intramedullary device
Mx of ACL
Rest and phyio to strengthen quads and hamstrings
Gold-standard is autograft repair surgery
What is Hallux
Stiff big toe (varus or valgus)
Causes of charcot joints
DM
Leprosy
Syringomelia
Peripheral nerve injury
Describe antalgic gait?
Cause?
Decreased stance
Increased swing (classic limp)
Pain
Cause of high stepping gait
Raises one leg like a weirdo
Common peroneal nerve injury
L5 disc
Causes of winged scapular
Seratus Anterior Weakness
Long-thoracic nerve damage: e.g. axillary surgery
Upper brachial plexus injury
Mx of carpal tunnel
Wrist splint
Carpal tunnel decompression by division of the flexor retinaculum
