Week 5 - B - Elective Surgery (2) - soft tissue and osteomyelitis Flashcards
Which drug should not be given in tendonitis?
Ciprofloxacin - fluoroquniolones
What do the vast majority of soft tissue inflammatory problems settle with?
The vast majority of soft tissue inflammatory problems settle with RICE:
* rest, ice, compression and elevation
Also can alleviate with analgesia and antiinflammatory medications if appropriate.
Some tendons and entheses are amenable to injection of steroid around the tendon (eg rotator cuff, tennis albow) whilst in others there is substantial risk of tendon rupture
What are exmaples that are at high risk of tendon rupture if a steroid injection was given?
Extensor tendonitis (extensor mechanism of the knee) and Achilles tendonitis
What is used in the knee examination to test the extensor mechanism function is intact?
Carry out a straight leg raise - lock knee and raise leg
What is tennis and golfers elbow?
Tennis elbow - lateral epidcondylitis - where the extensor mechanism of the arm insert
Golfer’s elbow - medial epicondylitis where the flexor muscles of the arm insert
What can be performed for the extensor tendons of the wrist in rheumatoid arthritis or for inflammation of the tibialis posterior tendon to prevent rupture?
Synovectomy
Synovectomy is a procedure where the synovial tissue surrounding a joint is removed.
This procedure is typically recommended to provide relief from a condition in which the synovial membrane or the joint lining becomes inflamed and irritated and is not controlled by medication alone.
Instability is abnormal motion of a joint (rotation or translation) resulting in subluxation or dislocation with pain and/or giving way. What are common examples of instability?
Common examples are knee ligament instability and shoulder instability and patellar instability
Most cases of joint instability can be managed with what to strengthen up surrounding muscles and to improve proprioception ?
Can be managed with physiotherapy
Splints, calipers or braces may provide additional support
Cases of significant ligamentous laxity causes soft tissue procedures to be unlikely to work
Name 2 types of significant ligamentous laxity conditions?
This would be Ehler’s Danlos and Marfan’s
What is the mutation in Marfan’s disease?
Mutation in the fibrillin gene which is essential for the elastic fibres in elastin in connective tissues
What is the abnormal formation of elastin and collagen sometimes caused by in Ehler’s Danlos syndrome?
Mutation in type V collagen
Leg length discrepancies can be corrected by either shortening the longer limb or lengthening the short limb using a special external fixator What is this fixator known as?
Ilizarov technique
What is ilizarov technique?
This is an external fixation technique used to lenghten or shorten limb lengths
Peripheral nerves can be trapped at various sites in the upper and lower limbs with the most common sites being the median nerve at the wrist and the ulnar nerve at the elbow What are the syndromes of these nerve compressions known as and what can treatment be?
Median nerve compression at wrist - carpal tunnel syndrome
Ulnar nerve compression at elbow - cubital tunnel syndrome
They can both be treated by decompression surgery
Spinal nerve roots can be compressed by disc material or bony osteophytes causing a radiculopathy which may require spinal decompression or discectomy. What is the herniated part in a disc prolapse?
Herniated gelatinous nucleus polposus
An acute osteomyelitis in the absence of recent surgery usually occurs in children, however immunocompromised adults can also be affected. What two other groups of people are more predisposed to osteomyelitis?
Poorly controlled diabetics
Those who are intravenous drug abusers (PWID)
What is the most common cause of osteomyelitis? What can also cause it in sickle cell anaemia patients?
Most common cause is staph aureus infection
Can also be caused by salmonella in sickle cell anaemia patients
Once infected, enzymes from leucocytes cause local osteolysis and pus forms which impairs local blood flow making the infection very difficult to eradicate
What is the dead fragment of bone which can break of in osteomyleitis known as?
Sequestrum can break off
Osteomyleitis and septic arthritis can often present similarly
Which has pain also at rest as well as movements?
Septic arthritis is also associated with pain at rest
Where is the red swelling in spetic arthritis? Where is the red swelling in osteomyelitis?
Spetic arthritis - over the joint involved
Osteomyelitis - swelling occurs over the area of bone involved
How is the diagnosis of osteomyelitis carried out?
Diagnosis of osteomyelitis carried out by:
MRI is the best imaging modality for establishing the diagnosis of osteomyelitis as it can demonstrate bone marrow oedema, confirm the presence of abscesses and delineate extraosseous disease spread
CT guided bone biopsy - gold standard for pathogen identification and if diagnosis still remains uncertain
If frank pus is aspirated, the clinical picture fits with obvious septic arthritis or a positive Gram stain is found, the treatment is usually surgical washout either via open surgery or using arthroscopic techniques.
What is probably the better technique to reduce the bacterial load in the joint?
Open washout of the joint is probably best
What is the antibiotic usually given in septic arthritis?
This would be IV flucloxacillin after open washout
