Osteoarthritis Flashcards
What do the nerves of the cauda equina supply?
- Sensation to the perineum, bladder and rectum
- Motor innervation to the lower limbs and the anal and urethral sphincters
- Parasympathetic innervation of the bladder and rectum
7 commonly affected joints in osteoarthritis?
Hips, Knees, Sacro-iliac joints, Distal-interphalangeal joints in the hands (DIPs), Carpometacarpal joint at the base of the thumb (CMC), Wrist, Cervical Spine (cervical spondylosis)
Four key x-ray changes in osteoarthritis
Loss of joint space
Osteophytes
Subarticular sclerosis (increased density of the bone along the joint line)
Subchondral cysts
5 signs of osteoarthritis in the hands
Heberden’s nodes (in DIPJs), Bouchard’s nodes (PIPJs), Squaring at the base of the thumb at the carpometacarpal joint, weak grip, reduced range of motion
Management of osteoarthritis
- Patient education
- Lifestyle changes: weight loss, physiotherapy, occupational therapy, orthotics
- Analgesia: 1. Paracetamol and top NSAIDs 2. po NSAIDs (+PPI) 3. Opiates
- Topical capsaicin
- Intra-articular steroid injections
- joint replacement
At what level does the spinal cord terminate?
L2/3
5 Causes of cauda equina syndrome?
- Herniated disc (most common cause)
- Tumours, particularly metastasis
- Spondylolisthesis (anterior displacement of a vertebra out of line with the one below)
- Abscess (infection)
- Trauma
7 red flags for cauda equina syndrome
Saddle anaesthesia, Loss of sensation in the bladder and rectum, Urinary retention or incontinence, Faecal incontinence, Bilateral sciatica, Bilateral or severe motor weakness in the legs, Reduced anal tone on PR examination
Management of Cauda Equina
MEDICAL EMERGENCY
- Immediate hospital admission
- Emergency MRI scan to confirm or exclude
- Neurosurgical input to consider lumbar decompression surgery
