Unit 1: Joint Conditions Flashcards
What causes cruciate ligament lesions?
The cruciate ligament is commonly injured by either hyperextension or a twist, often in association with the foot being anchored in a studded boot or a ski
Describe the management of meniscal lesions
Peripheral tears can be reattached with sutures. Tears within the substance of the meniscus have no apparent capacity to repair and so the torn peripheral part should be removed. Once clinical suspicion is raised, patients should be examined by arthroscopy. Most meniscal lesions can be removed via the arthroscope (arthroscopic meniscetomy)
Describe the management of cruciate ligament lesions
In general, the ligament should be left untreated for a while and the knee muscles rehabilitated. Treatment should only be offered if symptoms interfere with daily life or if the patient wishes to return to sport. Treatment consists of replacing the torn ligament with a synthetic one
Why do cruciate ligaments not heal spontaneously?
When a cruciate ligament is torn it loses its blood supply and therefore cannot heal spontaneously
Which organism may cause septic arthritis a young adult, often with little constitutional upset?
Gonococcus
Discuss the aetiology of gout
Gout is caused by urate crystal deposition. The most common cause in the West is overuse of diuretics
Discuss the aetiology of inflammatory abnormalities seen in orthopaedics
Inflammatory abnormalities may be associated with bacterial infection causing inflammation of a joint or bone. Sometimes the cause of the inflammation is not known, e.g. rheumatoid arthritis
Discuss the aetiology of congenital abnormalities seen in orthopaedics
Congenital abnormalities are defects associated with development in the womb. They may have a familial or genetic cause or they may be the result of something happening to the mother or to the child whilst in the womb
Name two types of avascular necrosis
Two types of avascular necrosis are post-traumatic and Caisson’s disease
Describe arthrodesis
Arthrodesis, or the surgical stiffening of a joint in a position of function, is an appropriate operation in a young person with a painful and limited range of movement
What is a meniscectomy?
The surgical removal of a meniscus
List the professionals involved in treating orthopaedic conditions
The orthopaedic surgeon is dependent on theatre nurses and porters, orthopaedic nurses, other doctors e.g. GPs, anaesthetists, and paramedical specialists e.g. physiotherapists
What is a synovectomy?
A synovectomy is a surgical procedure used in the management of rheumatoid arthritis. It involves the removal of the diseased synovial tissue (synovium). It is a good operation for clearing up damage around extensor tendons, reducing pain and stiffness
Name the important types of movement of the hip
Flexion, extension and abduction
Describe the overall treatment objectives in the field of orthopaedics
The ideal outcome would be to return people to normal. However, in most orthopaedic cases we cannot achieve a cure but we may try to relieve the patient of their principle complaints - pain and stiffness
What is the important difference between treating tuberculosis and acute septic arthritis?
The important difference between treating TB and acute septic arthritis is that surgery is rarely necessary in the treatment of TB
Why are prosthetic knee ligaments liable to fail?
Prosthetic knee ligaments are liable to fail as they have no sensory receptors and so may be overstretched without the brain ‘knowing’. The brain is therefore unable to initiate protective muscle action
Describe an osteotomy
Osteotomy consists of the surgical realignment of a joint, with the aim being to redirect forces across a joint so that they are more evenly distributed
Name one principle difference between the requirements for an upper limb and lower limb joint replacement
An upper limb joint replacement must be capable of a larger range of movement than a lower limb joint replacement, but it does not require to withstand such large forces
List and classify the causes of osteoarthritis
The classification starts by grouping patients into those whose arthritis has a known cause (secondary osteoarthritis) and those where the cause remains unknown (primary arthritis)
Name the early problems which may occur after a joint replacement
Dislocation is a risk as in the immediate post-operative period the prosthesis will not be fully supported by the surrounding tissues. Deep vein thrombosis and infection are also risks
Name the late problems which may occur after a joint replacement
Infection and loosening and wear
Name the important types of movement of the knee
Flexion and extension
What is the principal indication for operative treatment of arthritis?
Pain is the principle indication for operative treatment
Which late complication of arthroplasty is possibly almost inevitable?
Loosening and wear
What causes meniscal lesions?
The principal cause of meniscal lesions is twisting injury, often associated with skiing, or games where studs are worn on shoes or boots
Discuss the reasons why goals for lower limb joint replacement differ from goals for upper limb joint replacement
The relationship between pain relief and function is quite different from that observed in the lower limb. In the upper limb, the loads involved are quite low but a large range of motion is required. Intrinsic stiffness can still be a problem after arthroplasty as soft tissue distortion of the capsule and ligaments remains after replacing the articular surfaces
Define an effusion
An effusion is excess fluid in the joint
Define the term ‘acute’
An acute disease is one that strikes the patient suddenly. It is characterised by the production of polymorphonuclear leucocyte (polymorph for short)