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Y4 final checklist_ SURGERY > Ortho conditions > Flashcards

Ortho conditions Flashcards

1
Q

What’s osteomyelitis?

A

Osteomyelitis describes an infection of the bone.

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2
Q

(2) organisms commonly causing osteomyelitis

A
  • Staph. aureus → the most common cause
  • patients with sickle-cell anaemia → Salmonella species
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3
Q

Conditions predisposing to osteomyelitis

A
  • diabetes mellitus
  • sickle cell anaemia
  • intravenous drug user
  • immunosuppression due to either medication or HIV
  • alcohol excess
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4
Q

Ix for osteomyelitis

A

↑ESR/CRP, ↑WCC

  • +ve blood cultures in 60%
  • X-ray
  • MRI is sensitive and specific
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5
Q

Management of osteomyelitis

A
  • flucloxacillin for 6 weeks
  • clindamycin if penicillin-allergic
  • IV Abx: Vanc + cefotaxime until MCS known
  • Drain abscess and remove sequestra
  • Analgesia
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6
Q

Signs and symptoms of osteomyelitis

A
  • Pain, tenderness, erythema, warmth
  • ↓ROM
  • Effusion in neighbouring joints
  • Signs of systemic infection
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7
Q

X-ray changes seen in osteomyelitis

A
  • Changes take 10-14d
  • Haziness + ↓ bone density
  • Sub-periosteal reaction
  • Sequestrum and involucrum
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8
Q

Organisms commonly causing septic arthritis

A
  • Source: local or haematogenous
  • Organisms
  • Staph: 60%
  • Streps
  • Gonococcus
  • Gm-ve bacilli
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9
Q

Risk factors for septic arthritis

A
  • Joint disease (e.g. RA)
  • Immunosuppression (e.g. DM)
  • Prosthetic joints
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10
Q

Symptoms of septic arthritis

A
  • Acutely inflamed tender, swollen joint.
  • ↓ROM
  • Systemically unwell
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11
Q

Ix of septic arthritis

A
  • Joint aspiration for MCS → ↑↑ WCC (e.g. >50,000/mm3) : mostly PMN
  • ↑ESR/CRP, ↑WCC
  • Blood cultures
  • X-ray
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12
Q

Management of septic arthritis

A

Management

  • IV Abx: vanc + cefotaxime
  • Consider joint washout under GA
  • Splint joint
  • Physiotherapy after infection resolved
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13
Q

Complications of septic arthritis

A
  • Osteomyelitis
  • Arthritis
  • Ankylosis: fusion
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14
Q

What’s tennis elbow?

A

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
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15
Q

Features of tennis elbow

A
  • 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
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16
Q

Management of Tennis elbow

A
  • 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
17
Q

What’s Golfer’s elbow?

A

Golfer’s elbow = medial epicondylitis

18
Q

Features of Golfer’s Elbow

A
  • 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

19
Q

Management of Golfer’s elbow

A
  • advice on avoiding muscle overload
  • simple analgesia (NSAIDs)
  • steroid injection
  • physiotherapy
20
Q

What’s olecranon bursitis?

A

Olecranon bursitis (aka student’s elbow, carpet layer’s elbow)

Swelling over the posterior aspect of the elbow

  • usually affects middle-aged men
21
Q

Presentation of olecranon bursitis

A
  • swelling around the elbow
  • if ifected →pain, warmth and erythema.
22
Q

Management of olecranon bursitis

A

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
23
Q

What’s osteoarthritis?

A

Degenerative joint disorder in which there is

progressive loss of hyaline cartilage and new bone

formation at the joint surface and its margin

24
Q

Risk factors for osteoarthritis

A
  • Age (80% > 75yrs)
  • Obesity
  • Joint abnormality
25
Q

Classification of osteoarthritis (2)

A
  • Primary: no underlying cause
  • Secondary: obesity, joint abnormality
26
Q

Symptoms of osteoarthritis

A
  • 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
27
Q

Characteristics of pain in osteoarthritis

A

•Pain: worse with movement, background rest/night pain, worse @ end of day

• Stiffness: especially after rest, lasts ~30min (e.g. AM)

28
Q

Signs of osteoarthritis

A
  • Bouchards and Heberdens nodes
  • Thumb CMC squaring
  • Fixed flexion deformity
29
Q

What to ask about in Hx of osteoarthritis?

A
  • Pain severity, night pain
  • Walking distance
  • Analgesic requirements
  • ADLs and social circumstances
  • Co-morbidities
  • Underlying causes: trauma, infection, congenital
30
Q

Pathophysiology of osteoarthritis

A
  • 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
31
Q

X- ray changes in osteoarthritis

A
  • Loss of joint space
  • Osteophytes
  • Subchondral cysts
  • Subchondral sclerosis
  • Deformity
32
Q

Blood tests in osteoarthritis

A
  • CRP may be mildly elevated
  • Ca, PO4 and ALP all normal
33
Q

Management of osteoarthritis

A

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

Y4 final checklist_ SURGERY (25 decks)

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