Orthopaedics Part 1 Flashcards
Which condition is associated with Lost of Joint spcae ?
Osteoarthritis
What is the acronym for osteoarthritis in the xray ?
L oss of joint space
O steophytes
S ubchondral cysts
S ubchondral sclerosis
What is the first line management for osteoarthritis ?
Weight Loss (Check BMI)
Analgesia( Paracetamol, Topical NSAIDs)
Physio refferal
What is the secondline management for osteoarthritis ?
Steroid Injection
(Intricately Knee injection)
What is the third line injection?
Surgery
What kind of surgeries do you do for osteoarthritis ?
Partial Knee replacement
osteoarthritis of the hip ?
Degenerative joint disease characterised by loss of articular cartilage
What are the RF of Hip osteoarthritis ?
Age
Obesity
Female
Vitamin D Deficiency
Post Traumatic pain to the hip
Anatomic Abnormalities
What happens after a facture of a bone ? Will bone ever be the same ?
NO !
When you break a bone Post traumatic arthritis is very common after fracture, therefore the bone will heal by time but it won’t be the same.
What are the Clinical Features of hip osteoarthritis ?
- Groin pain aggravated by weight bearing & improves with rest
- Stiffness with crepitus
What are you looking for in hx of pts with Hip osteoarthritis ?
- Back Pain
- difficulty in crossing one leg over the other
- difficulty in bending down to cut the toe nails
- Antalgic Gait
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What do you look in the examination of someone with hip osteoarthritis ?
- Pain & Stiffness while doing internal & external rotation
- loss in range of movement
- Antalgic Gait (abnormal walking)
- Passive movement is painful (carried by another person)
- Ask the pt to stand on one leg because they’re putting more weight through that leg & if it hurts that’s also an indication of probloem with the hip
What happens to the people in later stage with hip osteoarthritis ?
Fixed Flextion deformity & Trendelenberg’s gait
Pt 1
70,M, Fall, Interpret the X-ray?
- Osteoarthritis - most common form, classified into primary and secondary which present with loss of function & joint pain.
- O/E - joint pain, stiffness, locomotor restriction ( restriction in the movement of the limbs)
- Pain relates to activity & improved by rest
What is Primary Osteoarthiritis?
Primary occurs on its own with no known cause
What is Secondary Osteoarthritis ?
Secondary occurs due to another underlying cause including injury, abnormality ( infectious arthritis
Pt 2
60yr M, attends primary care complaining of right knee pain & swelling following gardening over the weekend.
On O/E, can actively perform knee flextion & extension but **limited with knee flextion due to swelling. **
Red Flag ?
Diagnosis ?
Key to differentiate in this situation ?
- Pyrexic
- Pain on active & passive would be concerning
Diagnosis is Bursitis
What is Non-septic arthritis and Septic arthritis ?
What is Septic arthritis ?
- an infection of a joint
- Symtpoms include pain, tendorness over a joint, pain on moving a joint, feeling unwell
- Urgent treatment required
- Local cellulitis
Management of septic arthritis ?
Antibiotics
Physiotherapy once the infection is healed
When would you arrange urgent admission ?
When the pt is systemically unwell, pyrexia of 38 degree, hypotensive, tachycardic, evidence of severe infection, immunocomprimised or has developed an abscess
When they have high temp and septic, bp drops and heart rate increases so it compensate
When would you refer to Orthopaedics urgently ?
If septic arthritis which has not responded to abx
What is Knee Bursitis ?
Inflammation within bursa,
What is Bursa ?
A small sac of fluid within a thin lining found around joints and where ligaments & tendons pass over the bones
What is the function of bursa?
To reduce friction and allow maximum ROM around joints
What is housemaids knee ?
Prepatellar bursa is commonly affected in knee bursitis
What are the causes of knee Bursitis ?
- Fall/direct blow,
- recurrent minor injury
- infection
- RA got increased risk and Gout
What are the symtoms of knee bursitis ?
- Swelling and Pain
- erythema
- reduced range of motion (ROM)
What is the management of knee bursitis ?
Rest
ice packs
NSAIDS
IV abx only if the pts are systemically unwell
What is Greator Tronchantric Bursitis ?
- common and painful condition which affects the outer side of the hip and thigh
- also called as Lateral hip pain due to inflammation of bursa
Where is the pain felt for the Greater Tronchantric Bursitis ?
can irritate the illotibial band and the pain extends down lateral aspect of the thigh
What are the risk factors of Greater Tronchantric Bursitis ?
Females
age 40-60
overweight/obese
How do you clinically differentiate someone with back pain but also lateral hip pain & what would they mention in history?
- The pain radiates but does not typically extend below the knee
- When you examine the pts around the hip joint they’ll jump cuz of the pain
- They mention tendor on palpation of the Greator tronchantor
They irritate the IT band that’s the reason for the reffered pain
What is the symptom of Greater Tronchantric Bursitis ?
- Worse laying down in the affected side
- Walking up the stairs
- standing from sitting
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What is the treatment for Greator Trochantric Bursitis ?
If felt tendor on palpation - Ultrasound
If evidence of bursitis - Injection
