Orthopaedics unit 1 joint conditions - deck 1

Question 1

What does the word orthopaedics mean ?

Answer 1

‘Straight children’

Question 2

Historically what did orthopaedics mainly deal with ? and what does it deal with now ?

Answer 2

Historically - Musculoskeletal abnormalities occurring at birth or in children as they grow and develop.

Nowadays - encompasses the whole range of diseases affecting the musculoskeletal system.

Question 3

Are birth defects more or less common nowadays - explain your answer

Answer 3

They are less common due to improvements in the nutrition and general health of pregnant women

Question 4

Why are childhood diseases releated to diet such as scurvey and rickets much less common nowadays and what vitamin deficiency is associated with each of these diseases ?

Answer 4

These diseases are less common due to improvements in the nutrition of growing children.

• Scurvey is due to a lack of vit C
• Rickets is due to a lack of vit D

Question 5

Why are other diseases such as Tuberculosis and Polio, which affected the musculoskeletal systems, much more common in children in the past?

Answer 5

Because of improvements in treatment (due to the use of antibiotics) and immunisation programmes.

Question 6

Describe what is meant by an acute disease and what cell type is it characterised by ?

Answer 6

An acute disease is one that strikes the patient suddenly.

It is characterised by a reaction by the body’s immune system whereby the illness is counteracted by the production of a type of body cell found in the blood known as the polymorphonuclear leucocyte or polymorph for short

Question 7

Why is a polymorphonucelar lecuocyte called what it is

Answer 7

It is called a polymorph because its nucleus is in many sections and a leucocyte because it appears white

Question 8

Describe what is meant by the term chronic disease and state what cell type characterises chronic diseases

Answer 8

A chronic disease takes a long time to develop and may last a long time. It can be distinguished from an acute illness because the immune system reacts by producing lymphocytes

Question 9

Where are lymphocytes produced ?

Answer 9

In the bone marrow and the spleen

Question 10

When the term ‘otomy’ is added to the description of an operation what is meant by this ?

Answer 10

It is used to describe the fact the surgeon is oppening something up

For example, opening a joint is an arthrotomy.

Question 11

What term is added to describe that something is being removed during an operation ?

Answer 11

The term ‘ectomy’ is added

For example if we remove a meniscus the procedure is called a meniscectomy.

Question 12

When you develop pain or stiffness affecting a joint what are the typical steps in treatment?

Answer 12

1. Usually the patient will start by taking simple drugs such as aspirin and paracetamol.
2. If this proves ineffective, they consult their GP who can prescribe stronger painkilling drugs and contact the community services to provide help.
3. If these measures prove unsatisfactory, the GP may decide to refer the patient to an orthopaedic specialist. The orthopaedic surgeon would determine whether surgery was necessary and, in conjunction with an anaesthetist, whether the patient was in good enough health for an operation.
4. Junior doctors and nurses make preparations for the operation. The orthopaedic surgeon is assisted during surgery, by anaesthetists, specialist nurses, junior doctors and porters.
5. Physiotherapists, occupational therapists, the GP and the community services (social workers, home helps, meals-on-wheels etc.) will make preparations for convalescence (rehabilitation) and recovery.

Question 13

Describe the overall treatment objectives in the field of orthopaedics.

Answer 13

To provide relief of symptoms e.g. pain & stiffness - as it is rarely possible to return people to normal

Question 14

Describe what we mean when we describe a condition as self-limiting and give an example of a self-limiting condition

Answer 14

Self-limiting - illnesses or “conditions” of the musculoskeletal system that are temporary and will get better

e.g. muscle tears and ligament sprains

Question 15

Give some examples of orthopaedic/MSK conditions which are permanent and have no specific cure

Answer 15

• Arthritis
• Abnormalities of birth (congenital abnormalities)

Question 16

Traditionally, we may define orthopaedic disorders according to the origin of the disease - what are the 5 main categories which classify the origin of disease?

Answer 16

1. Congenital abnormalities
2. Inflammatory abnormalities
3. Metabolic disorders
4. Degenerative disorders
5. Trauma

Question 17

Define the term congenital abnormality and state the main ways in which they can develop

Answer 17

A congenital abnormality is a defect associated with development in the womb i.e. they develop in the womb

They may have a familial/genetic cause or as a result of something happening to the mother or to the child whilst in the womb.

e.g. Measles during pregnancy then the child may have some birth defects or child suffering a lack of oxygen during the process of being born resulting in injury to the brain causing CP/spasticity

Question 18

What are the main causes of inflammatory abnormalities in orthopaedics ?

Answer 18

Bacterial infection causing inflammation of a joint (infective arthritis) or of bone (osteomyelitis).

Often however the cause of inflammation is often not known making this classification (inflammatory abnormalities) particularly unsatisfactory e.g. rheumatoid arthiritis (RA)

Question 19

Define what is meant by the term metabolic disorder

Answer 19

This is a term describing a group of illnesses which usually cause inflammation but the cause can be traced back to some abnormality in body metabolism.

A good example is gout, which is an inflammation of a joint caused by crystals being deposited on the cartilaginous surface of joints. The crystals are uric acid, which is a waste product of cell metabolism. Other examples include abnormalities of vitamin metabolism

Question 20

Define what is meant by the term degenerative disorder

Answer 20

This usually refers to joint conditions where the normal structure of the joint has been disturbed through deterioration and wear e.g. OA usually fits into this category

Note these condition in this category can cause inflammation

Question 21

Define what is meant by the classification ‘trauma’

Answer 21

This is when the musculoskeletal system has suffered damage from an outside physical agent

Question 22

What are the 5 groupings that for this course that disorders of the MSK system will be categorised in ?

Answer 22

1. Arthritis and other joint conditions
2. Back pain
3. Conditions of childhood
4. Common adult disorders
5. Common fractures.

Question 23

What is the most common condition treated by orthopaedic surgeons ?

Answer 23

Arthritis (joint pain)

Question 24

Who is arthritis most common in ?

Answer 24

Elderly people

Question 25

What are all treatment strategies for arthritis based around and why ?

Answer 25

All treatment strategies are based around the relief of the symptoms: pain and stiffness because there is no specific cure

Question 26

Describe what osteoarthiritis (OA) is

Answer 26

It is a condition which causes pain and stiffness (limitation of movement of joints) associated with excessive breakdown of articular cartilage due to a breakdown of the balance between the wear and repair processes in the joint.

Question 27

Do all elderly people develop OA ?

Answer 27

No

Question 28

How is OA classified and what are the two main classifications

Answer 28

• OA is classified based on its cause (aetiology)
• The two main classifications are primary and secondary

Question 29

Define primary OA

Answer 29

This is when there is no identifiable cause for the development of OA within a joint.

Note: In our definition of OA we took it to encompass an inbalance between wear and repair. In the case of secondary OA it is perhaps easy to argue that many cases reflect an increase in wear. So it may be assumed that in primary OA the problem may be dueto a defect in repair

Question 30

Define secondary OA

Answer 30

In this minority group we see obvious causative factors which quite reasonably may be assumed responsible for secondary osteoarthritis.

Question 31

What are the main causes of secondary OA and give an example for each

Answer 31

1. Congenital - congenital dislocation of the hip
2. Childhood - Perthe’s disease, infection
3. Trauma - fracture into a joint
4. Metabolic - gout, crystal arthropathy
5. Infection - TB (tuberculosis).
6. Chronic inflammatory - rheumatoid.

Question 32

What is usually the cause if OA develops in a younger patient ?

Answer 32

In the younger patient there is usually a recognisable predisposing cause as indicated in the causes of secondary OA

Note there is not always a predisposing factor

Question 33

Describe the typical presentation of someone with OA

Answer 33

• The patient complains of pain and associated loss of function of the affected joint and limb - Usually the onset of arthritis is associated with pain during activity.
• Stiffness (limitation of movement) of the joint is also a feature but is nearly always secondary to pain i.e. pain is the primary symptom of OA
• Tirdeness if lower limb affected from effort to move about

Question 34

What are the two main presenting features of OA ?

Answer 34

1. Pain firstly
2. Limitation of movement (stiffness) secondly

Question 35

When does someone with OA (who probably doesn’t know they have OA yet) usually seek help from their GP ?

Answer 35

When simple pain relief (analgesia) no longer adequately controls the pain

Question 36

When do GP’s treating a patient with OA usually seek specialist help from an orthopaedic surgeon or rheumatologist ?

Answer 36

When the patient’s sleep is disturbed

Question 37

Why are successful results of surgery in treating OA related to adequacy of pain relief provided by the surgery rather than improvements in mobility of the joint? (recall stiffness is a prominent feature of OA)

Answer 37

The limitation of movement during a routine examination will be less than any limitation observed during an examination under anaesthetic. i.e. pain is a big factor in limitation of movement