orthopaedics Flashcards
Causes of lumbar back pain? mechanical/inflammatory/serious
MECH - disc prolapse, arthritis, fractures, spinal stenosis
INFLAMMATORY - ankylosing spondylitis, infection
SERIOUS - cancer, myeloma, TB
features of mechanical back pain?
sudden onset, worse in the afternoon, no morning stiffness, exercise aggravates
features of inflammatory back pain?
gradual onset, pain worse in the morning + morning stiffness
features of serious back pain causes?
> 50, constant pain (even in the night), systemically unwell, localised bone tenderness, bilateral leg signs, bladder/bowel dysfunction
Ix into back pain?
detailed Hx - pain + neurological history ESR/CRP/Ca/Ph/PSA Spine X ray bone scan MRI
Features of acute disc prolapse?
acute severe back pain following a strenuous activity
aggravated by movement
pain can radiate to the areas supplied by the nerve
pain related to position
Mx for acute disc prolapse?
bed rest, pain relief, epidural corticosteroid
surgery
What causes chronic disc disease? Features
degenerative changes in L spine and facet joints, causes mechanical pain
Pain can radiate to the sciatic region
Mx for chronic disease?
decompress the nerve roots
What is spondylolisthesis?
slipping forward of one vertebra on another (commonly at L4/5)
what is spinal stenosis?
narrowing of the lower spinal canal compressing the cauda equina
features of spinal stenosis?
back and buttock pain at the end of the day
Mx of spinal stenosis?
surgical decompression
RF for osteoarthritis?
obesity, fractures, joint dysplasia, occupation, age, remale
What is the process that leads to osteoarthritis?
inflammatory and reparative process. There is progressive destruction and loss of articular cartilage. Exposed bone becomes sclerotic - increased vascularity with cyst formation and osteophyte formation
features of osteoarthritis?
joint pain which worsens with movement, relieved by rest
affects weight bearing joints and DIPJ
hand signs for OA?
heberden nodes (swelling at DIPJ) bouchard nodes (swelling at PIPJ)
findings OE of OA?
deformities, bone enlargements, crepitus, joint effusion
Ix for OA?
FBC, ESR, RF
Xray
MRI
what are the X ray findings for OA?
loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts
How do you manage OA?
PHYSICAL - physio, exercises, lose weight, local heat and ice packs, joint supports, shoe insoles
MEDS - paracetamol, NSAIDS
SURGERY - THR/TKR
What is the common cause of septic arthritis?
staph aureus
risk factors for septic arthritis?
prosthetic joint, pre-existing joint disease, recent IA steroids, DM
features of septic arthritis?
hot painful swollen joint, develops acutely, fever, joint discharge, effusion, reduced function of joint
Ix for septic arthritis
Joint aspiration - gram stain, recent IA steroids
FBC/ESR/CRP/culture
XRay joint
swab urethra - gonorrhea?
Mx for septic arthritis
IV flucloxacillin, drain the joint, immobilise the joint, NSAIDS for pain
what is osteoporosis?
reduced bone mass and microarchitectural deterioration of bone = bone fragility and increased risk of fracture
name some BMD dependant RF for osteoporosis?
female, caucasian, immobilisation, CKD, GI disease, reduced Ca intake, Vit D deficiency, steroids, DM, myeloma
name some BMD independant RF for osteoporosis?
increased age, previous fragility fracture, family history of hip fracture, low BMI, smoking, alcohol, RA
Features of osteoporosis
fractures!
- T and L spine - kyphosis (widows stoop)
- proximal femur
- distal radius
Ix into osteoporosis?
DXA - frax score
XRay - identify fractures
Bloods - Ca, Ph, ALP (normal)
secondary causes screen - myeloma, coeliac, thyrotoxicosis
Mx of osteoporosis?
Fractures: pain relief, bed rest, stop smoking, reduce alcohol, increase calcium intake, weight bearing exercise
Bisphosphonates - alendronate (inhibit osteoclasts)
strontium ranelate
Raloxifene (SERM)
HRT if post menopausal
what is Paget’s disease?
focal disorder of bone remodelling - increased osteoclastic bone resorption and formation of weaker bone
where are paget disease lesions commonly found? features of these lesions
pelvis, L spine, femur, T spine, skull, tibia
Pain + deformities (e.g bowed tibia)
Ix for pagets disease?
raised ALP
increased urinary hydroxyprotine excretion
XRay of the affected bone
Mx for pagets disease?
bisphosphonates
RF for Vitamin D deficiency
pigmented skin, suncream, concealing clothing, elderly, institutionalised, malabsorption (small bowel issues), liver disease
Features of vitamin D deficiency?
proximal muscle weakness
low bone density
Ix for vitamin D deficiency?
low serum Vit D, serum biochemistry (raised ALP, Ph, Ca) X ray
Mx for vitamin D deficiency
Calciferol
