Ortho

Question 1

Ankylosing Spondylitis Diagnostic Criteria

Rev

Answer 1

Modified New York criteria (1994)
Clinical
1. LBP or stiffness >3m that improves with exercise but not with rest
2. Limitation of lumbar spine mobility (frontal and sagittal)
3. Limitation of Chest expansion

Radiological

1. Unilateral sacroiliitis of grade 3-4
2. Bilateral sacroiliitis of grade 2 or more

Definite AS
Radiological criteria + 1 clinical criterion

Probable AS:
All 3 clinical criteria but no radiological criteria //
Radiological criteria but no clinical criteria

Question 2

AS X ray features (Pelvis, Spine)

Answer 2

AP Pelvic

• Sacroilitis: Erosion, reactive bone, decreased joint space and fusion (Lower portion first)
• Hip joint fusion

Spine

• Paravertebral ossification and syndesmophytosis “Bamboo spine”
• Erosion of vertebrae “squaring of vertebrae”
• Osteoporosis
• Disc and apophyseal joint narrowing

Question 3

AS PE findings

Answer 3

• Decreased lumbar lordosis, increased C and T kyphosis
• Decreased lumbar motion (Schober test <20%)
• Decreased chest expansion
• Positive Patrick’s test (aka FABER test)
• Chin-brow to vertical angle (stand with hip and knee extended)
• Hip and knee contracture, peripheral joint

Question 4

AS Mx

Answer 4

Conservative

• Pharm (symptomatic, ?DMARD)
• Exercise

Operative

• Always hip first
• L-spine
• C-spine C7/T1

Question 5

Galeazzi fracture

Answer 5

Distal radius w/ dislocation of the distal radioulnar joint (DRUJ)

Question 6

Monteggia fracture

Answer 6

Proximal ulna w/ dislocation of the proximal head of radius

Question 7

Colles fracture

Answer 7

Distal radius w/ dorsal displacement

Question 8

Smith fracture

Answer 8

Distal radius w/ ventral displacement

aka Reverse Colles

Question 9

Barton fracture

Answer 9

Distal radius into wrist joint (Intra-articular extension)

Question 10

AS pathogenesis

Answer 10

Fibrosis & ossification of ligament & capsule attachment

Inflammatory arthritis of spine, SIJ & peripheral joint (mainly hip & shoulder)

Cartilage destruction, bony erosion & fusion

Primary @ ligament, tendon & capsule attachment

Fibrinoid necrosis of discovertebral junction

Costovertebral ankylosis

Pulmonary fibrosis, decreased lung function

Extraskeletal tissue: eye, lung, heart, kidney, cauda equina, GIT