Ortho conditions Flashcards
What’s osteomyelitis?
Osteomyelitis describes an infection of the bone.
(2) organisms commonly causing osteomyelitis
- Staph. aureus → the most common cause
- patients with sickle-cell anaemia → Salmonella species
Conditions predisposing to osteomyelitis
- diabetes mellitus
- sickle cell anaemia
- intravenous drug user
- immunosuppression due to either medication or HIV
- alcohol excess
Ix for osteomyelitis
↑ESR/CRP, ↑WCC
- +ve blood cultures in 60%
- X-ray
- MRI is sensitive and specific
Management of osteomyelitis
- flucloxacillin for 6 weeks
- clindamycin if penicillin-allergic
- IV Abx: Vanc + cefotaxime until MCS known
- Drain abscess and remove sequestra
- Analgesia
Signs and symptoms of osteomyelitis
- Pain, tenderness, erythema, warmth
- ↓ROM
- Effusion in neighbouring joints
- Signs of systemic infection
X-ray changes seen in osteomyelitis
- Changes take 10-14d
- Haziness + ↓ bone density
- Sub-periosteal reaction
- Sequestrum and involucrum
Organisms commonly causing septic arthritis
- Source: local or haematogenous
- Organisms
- Staph: 60%
- Streps
- Gonococcus
- Gm-ve bacilli
Risk factors for septic arthritis
- Joint disease (e.g. RA)
- Immunosuppression (e.g. DM)
- Prosthetic joints
Symptoms of septic arthritis
- Acutely inflamed tender, swollen joint.
- ↓ROM
- Systemically unwell
Ix of septic arthritis
- Joint aspiration for MCS → ↑↑ WCC (e.g. >50,000/mm3) : mostly PMN
- ↑ESR/CRP, ↑WCC
- Blood cultures
- X-ray
Management of septic arthritis
Management
- IV Abx: vanc + cefotaxime
- Consider joint washout under GA
- Splint joint
- Physiotherapy after infection resolved
Complications of septic arthritis
- Osteomyelitis
- Arthritis
- Ankylosis: fusion
What’s tennis elbow?
Tennis elbow = Lateral epicondylitis
- typically follows unaccustomed activity such as house painting or playing tennis (‘tennis elbow’)
- most common in people aged 45-55 years
- typically affects the dominant arm
Features of tennis elbow
- pain and tenderness localised to the lateral epicondyle
- pain worse on wrist extension against resistance with the elbow extended or supination of the forearm with the elbow extended
Management of Tennis elbow
- Episodes typically last between 6 months and 2 years. Patients tend to have acute pain for 6-12 weeks
- advice on avoiding muscle overload
- simple analgesia
- steroid injection
- physiotherapy
What’s Golfer’s elbow?
Golfer’s elbow = medial epicondylitis
Features of Golfer’s Elbow
- pain and tenderness localised to the medial epicondyle
- pain is aggravated by wrist flexion and pronation
- symptoms may be accompanied by numbness / tingling in the 4th and 5th finger due to ulnar nerve involvement
Pain elicited by resisted wrist flexion
Management of Golfer’s elbow
- advice on avoiding muscle overload
- simple analgesia (NSAIDs)
- steroid injection
- physiotherapy
What’s olecranon bursitis?
Olecranon bursitis (aka student’s elbow, carpet layer’s elbow)
Swelling over the posterior aspect of the elbow
- usually affects middle-aged men
Presentation of olecranon bursitis
- swelling around the elbow
- if ifected →pain, warmth and erythema.
Management of olecranon bursitis
A. Non-surgical:
- icing, compression bandage, and avoidance of the aggravating activity
- oral or topical NSAIDs
- Elbow padding can also be used for symptomatic relief
Surgical: (for more severe)
- aspirating the excess bursa fluid with a syringe (draining of the bursa)
- injecting into the bursa a hydrocortisone type medication which is aimed at relieving the inflammation and preventing further accumulation of fluid
- in case of infection, the bursitis should be treated with an antibiotic
What’s osteoarthritis?
Degenerative joint disorder in which there is
progressive loss of hyaline cartilage and new bone
formation at the joint surface and its margin
Risk factors for osteoarthritis
- Age (80% > 75yrs)
- Obesity
- Joint abnormality
Classification of osteoarthritis (2)
- Primary: no underlying cause
- Secondary: obesity, joint abnormality
Symptoms of osteoarthritis
- Affects: knees, hips, DIPs, PIPs, thumb CMC
- Pain: worse with movement, background rest/night pain, worse @ end of day.
- Stiffness: especially after rest, lasts ~30min (e.g. AM)
- Deformity
- ↓ ROM
Characteristics of pain in osteoarthritis
•Pain: worse with movement, background rest/night pain, worse @ end of day
• Stiffness: especially after rest, lasts ~30min (e.g. AM)
Signs of osteoarthritis
- Bouchards and Heberdens nodes
- Thumb CMC squaring
- Fixed flexion deformity
What to ask about in Hx of osteoarthritis?
- Pain severity, night pain
- Walking distance
- Analgesic requirements
- ADLs and social circumstances
- Co-morbidities
- Underlying causes: trauma, infection, congenital
Pathophysiology of osteoarthritis
- Softening of articular cartilage → fraying and fissuring of smooth surface → underlying bone exposure
- Subchondral bone becomes sclerotic with cysts
- Proliferation and ossification of cartilage in unstressed areas → osteophytes
- Capsular fibrosis → stiff joints
X- ray changes in osteoarthritis
- Loss of joint space
- Osteophytes
- Subchondral cysts
- Subchondral sclerosis
- Deformity
Blood tests in osteoarthritis
- CRP may be mildly elevated
- Ca, PO4 and ALP all normal
Management of osteoarthritis
MDT: GP, physio, OT, dietician, orthopod
Conservative
- Lifestyle: ↓ wt., ↑ exercise
- Physio: muscle strengthening
- OT: walking aids, supportive footwear, home
Medical
• Analgesia
-Paracetamol
§-NSAIDs: e.g. arthrotec (diclofenac +misoprostol)
- Tramadol
• Joint injection: local anaesthetic and steroids
Surgical
- excision
- arthrodesis (surgical immobilisation of joint by fusion of bones) - last resort for pain Mx
- nowel techniques: steam cells, autologous chondrocyte implantation
- joint replacement
