Osteoarthritis Flashcards

1
Q

What are red flag conditions?

A

Infection
Fracture
Malignancy

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2
Q

Which movements are first affected with osteoarthritis in the hip?

A

Rotational movements

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3
Q

What is the Tendelenberg test?

A

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

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4
Q

What is Schober’s test?

A

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

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5
Q

What are possible causes of low back pain?

A
Facet joint osteoarthritis
Disc degeneration
Disc herniation
- Central > canal stenosis
- Posterolateral > radicular impingement
Inflammatory
Fractures
Malignancy
Infection
Intra-abdominal pathology
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6
Q

What are some causes of inflammatory back pain?

A

Ankylosing spondylitis
Psoriatic arthritis
Reactive arthritis/Reiter’s syndrome

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7
Q

What cancers are likely to metastasise to bone?

A
Breast
Lung
Prostate
Kidney
Thyroid
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8
Q

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

A

AAA
Renal
Pelvic

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9
Q

Is an x-ray necessary to do in osteoarthritis?

A

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

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10
Q

What is the clincal syndrome of lumbar claudication?

A

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

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11
Q

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

A
Symptoms and signs of infection; eg: fever
Risk factors for infection; eg:
- Underlying disease process
- Immunosuppression
- Penetrating wound
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12
Q

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

A

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

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13
Q

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

A
Past history of malignancy
Age >50 years
Failure to improve with treatment
Unexplained weight loss
Pain at multiple sites
Pain at rest
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14
Q

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

A

Absence of aggravating features

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15
Q

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

A

Paracetamol

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16
Q

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

A

Short-term use in acute back pain may be useful

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

17
Q

What are the key points in a back pain history?

A
Site
- Localised
- Diffuse
Radiation - consider
Referred pain
- Musculoskeletal
- Visceral
Radicular pain
- Nerve root irritation
Timing
- Onset
- Progression
- Exacerbators
- Relievers
Red flag conditions
18
Q

What is the aetiology of osteoarthritis?

A

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

19
Q

What are the commonest joints affected in osteoarthritis?

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