Musculoskeletal Flashcards
What is Osteoarthritis?
Osteoarthritis is a degenerative joint disease that is characterized by the breakdown and loss of cartilage in the joints.
Common condition that typically affects weight-bearing joints such as the knee, hip, and spine.
What is Osteoarthritis characterised by?
- Progressive cartilage loss
- Joint space narrowing
- Development of osteophytes
Can lead to pain, stiffness and limited mobility
H&E of Osteoarthritis
- Gradual onset in middle aged/older people
- Knee, hip, hand or spine involvement
- Pain on use/weight bearing
- Stiffness
- Swelling
- Physical examination may reveal joint tenderness, crepitus, bony enlargements or deformities + reduced joint space
What deformities are seen in Osteoarthritis?
- Heberden’s nodes (DIP)
- Bouchard’s nodes (PIP)
- Squaring at the base of thumb
- Varus/Valgus at knee
Investigations for Osteoarthritis
- X-ray
- Loss of joint space
- Subchondral sclerosis
- Cysts
- Osteophytes
- Bloods and inflammatory markers - normal
- MRI or US may be used to visualise joint structures and can be useful is making early diagnosis
Management of Osteoarthritis
- Self-management
- Education about avoiding activities that exacerbate joint pain, and maintain healthy lifestyle
- Paracetamol and topical NSAIDs (NSAIDs only for hand or knee) - First-line
- Second-line is oral NSAIDs/COX-2 inhibitors, opioids, capsaicin cream or intra-articular corticosteroids
- non-pharmacological treatment options include supports and braces, TENS and shock-absorbing insoles or shoes
- Physiotherapy/hand therapy/podiatry/occupational therapy
- if conservative methods fail then refer for consideration of joint replacement
What are the causes of Osteoarthritis?
- Ageing
- Obesity or being overweight
- History of injury or surgery to a joint
- Joint overuse
- Joints that do not form correctly
- FHx of Osteoarthritis
What is Osteomalacia?
Condition where bones become soft and weak due to a deficiency in vitamin D or calcium
Metabolic Bone disease which results in impaired mineralization of bone matrix
In children this is called rickets
Causes of Osteomalacia
- Vit D deficiency
- malabsorption
- lack of sunlight
- diet
- CKD
- Drug induced e.g. anticonvulsants
- Inherited (hypophosphatemic rickets)
- Liver disease e.g. cirrhosis
- Coeliac disease
H&E for Osteomalacia
- Bone pain
- Muscle Weakness
- Difficulty walking or standing for extended periods of time
- Skeletal deformities
- Fractures (especially NOF)
- Physical examination may reveal tenderness over bones, muscle weakness and a waddling gait (due to proximal myopathy)
Diagnosis of Osteomalacia
- Bloods : low serum Ca2+, low serum PO43-, raised ALP and PTH
- X-ray to looks for bone abnormalities
- Looser’s zones - translucent bands
- Increased radiolucency in bones
- Bowing deformities
- Bone biopsy
Management of Osteomalacia
- Vitamin D supplementation
- Calcium supplementation
- Sun exposure
- Dietary changes
- Avoid factors that may interfere with vitamin D metabolism such as certain medications (e.g. anticonvulsants) or excessive alcohol consumption.
- In severe cases, bisphosphonates or calcitriol may be used to improve bone density and reduce the risk of fractures.
- Physical therapy
- Regular monitoring of bone density and vitamin D levels is important to prevent further bone loss and complications.
H&E of Gout
- Initially involves first MTP joint
- Acute history
- Severe joint pain, tenderness
- Stiffness
- Swelling, often with marked erythema/soft tissue oedema
- Tophi may be visible
- Consumption of meat, seafood, alcohol
Investigation of Gout
Arthrocentesis with synovial fluid analysis
- Negative birefringent crystals
- Needle shaped
Bloods
- High urate (checked two weeks after inflammation settles to avoid false positives)
- High CRP/ESR
XR
- Periarticular erosions (rat bite)
Management of Gout
Treat acute attacks - inhibit inflammatory pathways
- Colchicine 500mcg 2x a day
- NSAIDs - naproxen
- Prednisolone for 7 days (if colchicine not tolerated)
- Steroid injections
Prevent attacks - reduce Uric Acid
- Review Medications
- Dietary advice - reduce purine intake
- Xanthine oxidase inhibitor (allopurinol or febuxostat)
H&E of Pseudogout
- Older people, often female
- Affects knees and wrists
- Acute joint pain
- Stiffness
- Swelling
Investigations for Pseudogout
XR
- Chondrocalcinosis due to calcium pyrophosphate (CPP) crystals depositing in menisci
Arthrocentesis with synovial fluid analysis
- Weakly positive birefringent crystals
- Rhomboid shaped
Management of Pseudogout
Treat acute episodes
- NSAIDs
- Prednisolone
- Colchicine
What is Septic Arthritis?
Joint infection caused by bacteria or other micro-organisms that enter the joint space
Causes pain, swelling and decreased mobility
Can affect any joint but mainly knee, hip or shoulder
MC organism is Staph. aureus
In young adults who are sexually active MC is Neisseria gonorrhoeae
MC spread is hematogenous
H&E of Septic Arthritis
Symptoms often develop rapidly
- Fever and chills
- Joint pain and swelling
- Limited range of motion
- Redness and warmth around the joint
- Possible history of recent infection or injury
- Exam reveals joint tenderness, effusion, decreased ROM + systemic signs
- MC joint is knee
Investigations for Septic Arthritis
Arthrocentesis with synovial joint analysis
- Elevated WBC count
- Positive culture for bacteria
- Decreased glucose levels
Bloods
- Elevated WBC
- Elevated CRP
- Signs of systemic infection
Blood culture
Management of Septic Arthritis
Antibiotics - typically IV for several weeks
- Flucloxacillin or clindamycin if penicillin allergic
- Patients switched to oral after 2 weeks
Aspiration and drainage of affected joint
In severe cases joint replacement may be necessary
Pain management
PT to restore joint function
Close monitoring for adverse affects of Antibiotics and followup to ensure complete resolution of infection
What is Reactive Arthritis?
Inflammatory joint disorder caused by an infection in another part of the body
Commonly affects young adults and is more common in males
Symptoms usually develop 1-4 weeks after the initial infection
May resolve in 6 months but may recur and become chronic is some cases
Common causative agents of Reactive Arthritis
Post-dysenteric:
Shigella flexneri, Salmonella, Yersinia enterocolitica, Camplyobacter
Post-STI:
Chlamydia
