Osteoarthritis Flashcards
What are red flag conditions?
Infection
Fracture
Malignancy
Which movements are first affected with osteoarthritis in the hip?
Rotational movements
What is the Tendelenberg test?
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
What is Schober’s test?
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
What are possible causes of low back pain?
Facet joint osteoarthritis Disc degeneration Disc herniation - Central > canal stenosis - Posterolateral > radicular impingement Inflammatory Fractures Malignancy Infection Intra-abdominal pathology
What are some causes of inflammatory back pain?
Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis/Reiter’s syndrome
What cancers are likely to metastasise to bone?
Breast Lung Prostate Kidney Thyroid
What are some intra-abdominal pathologies that cause low back pain?
AAA
Renal
Pelvic
Is an x-ray necessary to do in osteoarthritis?
If someone has classical signs, no need - you will find osteoarthritic changes
What is the clincal syndrome of lumbar claudication?
Lumbar/buttock/thigh pain
Usually unilateral
Not present at rest
Comes on with exercise
What features or risk factors suggest the cause of acute low back pain is infection?
Symptoms and signs of infection; eg: fever Risk factors for infection; eg: - Underlying disease process - Immunosuppression - Penetrating wound
What features or risk factors suggest the cause of acute low back pain is fracture?
History of trauma
Minor trauma
If >50 years old, history of osteoporosis and corticosteroid use
What features or risk factors suggest the cause of acute low back pain is malignancy?
Past history of malignancy Age >50 years Failure to improve with treatment Unexplained weight loss Pain at multiple sites Pain at rest
What features or risk factors suggest the cause of acute low back pain is an aortic aneurysm?
Absence of aggravating features
What is the first line treatment for simple back pain and osteoarthritis in the hip and knee?
Paracetamol
What is the role of NSAID use in the treatment of acute back pain and osteoarthritis?
Short-term use in acute back pain may be useful
Early in natural history, osteoarthritis often inflammatory - late osteoarthritis usually isn’t
What are the key points in a back pain history?
Site - Localised - Diffuse Radiation - consider Referred pain - Musculoskeletal - Visceral Radicular pain - Nerve root irritation Timing - Onset - Progression - Exacerbators - Relievers Red flag conditions
What is the aetiology of osteoarthritis?
Peripheral joint osteoarthritis determined by
- Genetic determinants
- Environmental factors
- Trauma
- Obesity
Degenerative back conditions usually start with traumatic disc pathology > vertebral changes
What are the commonest joints affected in osteoarthritis?
Carpo-metacarpal joints 1st metacarpo-phalangeal joint 1st metatarso-phalangeal joint Acromioclavicular joint Hips Knees
