Osteoarthritis

Question 1

What are red flag conditions?

Answer 1

Infection
Fracture
Malignancy

Question 2

Which movements are first affected with osteoarthritis in the hip?

Answer 2

Rotational movements

Question 3

What is the Tendelenberg test?

Answer 3

Get patient to stand on good leg and bend knee slightly
If abductors of affected knee normal > contract > hip lifts up on unsupported side
If abductors affected > hip drops

Question 4

What is Schober’s test?

Answer 4

Assessment to determine if inflammation in spine
Measure 10 cm up from posterior superior iliac crests
Get patient to bend over > if space doesn’t increase by 5 cm, then rigidity = inflammation in spine

Question 5

What are possible causes of low back pain?

Answer 5

Facet joint osteoarthritis
Disc degeneration
Disc herniation
- Central > canal stenosis
- Posterolateral > radicular impingement
Inflammatory
Fractures
Malignancy
Infection
Intra-abdominal pathology

Question 6

What are some causes of inflammatory back pain?

Answer 6

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis/Reiter’s syndrome

Question 7

What cancers are likely to metastasise to bone?

Answer 7

Breast
Lung
Prostate
Kidney
Thyroid

Question 8

What are some intra-abdominal pathologies that cause low back pain?

Answer 8

AAA
Renal
Pelvic

Question 9

Is an x-ray necessary to do in osteoarthritis?

Answer 9

If someone has classical signs, no need - you will find osteoarthritic changes

Question 10

What is the clincal syndrome of lumbar claudication?

Answer 10

Lumbar/buttock/thigh pain
Usually unilateral
Not present at rest
Comes on with exercise

Question 11

What features or risk factors suggest the cause of acute low back pain is infection?

Answer 11

Symptoms and signs of infection; eg: fever
Risk factors for infection; eg:
- Underlying disease process
- Immunosuppression
- Penetrating wound

Question 12

What features or risk factors suggest the cause of acute low back pain is fracture?

Answer 12

History of trauma
Minor trauma
If >50 years old, history of osteoporosis and corticosteroid use

Question 13

What features or risk factors suggest the cause of acute low back pain is malignancy?

Answer 13

Past history of malignancy
Age >50 years
Failure to improve with treatment
Unexplained weight loss
Pain at multiple sites
Pain at rest

Question 14

What features or risk factors suggest the cause of acute low back pain is an aortic aneurysm?

Answer 14

Absence of aggravating features

Question 15

What is the first line treatment for simple back pain and osteoarthritis in the hip and knee?

Answer 15

Paracetamol

Question 16

What is the role of NSAID use in the treatment of acute back pain and osteoarthritis?

Answer 16

Short-term use in acute back pain may be useful

Early in natural history, osteoarthritis often inflammatory - late osteoarthritis usually isn’t

Question 17

What are the key points in a back pain history?

Answer 17

Site
- Localised
- Diffuse
Radiation - consider
Referred pain
- Musculoskeletal
- Visceral
Radicular pain
- Nerve root irritation
Timing
- Onset
- Progression
- Exacerbators
- Relievers
Red flag conditions

Question 18

What is the aetiology of osteoarthritis?

Answer 18

Peripheral joint osteoarthritis determined by
- Genetic determinants
- Environmental factors
- Trauma
- Obesity
Degenerative back conditions usually start with traumatic disc pathology > vertebral changes

Question 19

What are the commonest joints affected in osteoarthritis?

Answer 19

Carpo-metacarpal joints
1st metacarpo-phalangeal joint
1st metatarso-phalangeal joint
Acromioclavicular joint
Hips
Knees