Clinical skills principles Flashcards
(20 cards)
what are the ways in which infection can spread to the joint?
- through skin in itself
- through blood
- infect bone itself
what are the criteria for diagnosing septic arthritis?
- if they CAN NOT weight bear on the joint
- if ESR (erythrocyte sedimentation rate) is greater than 40mm/hr
- if WBC is greater than 12000/mm3
- temperature hihger than 38.5 degrees celsius
what are the difference between CRP and ESR in diagnoses
- CRP- made in liver. shows acute inflammation
- ESR- shows more long term inflammation as it shows sedimentation rate
what affects the differentials?
- Patient history
- History presentation complaint
- family history, social history, allergy? job?
what possible investigations may be performed?
- X-ray or MRI
- Blood test for CRP or ESR
- synovial fluid examnation
- check joint movement
- check if they weight bear
- examine for nerve in lower limb
What are the possible outcomes in bone or joint disorders?
infection
trauma
synovitis
bursaitis
fracture
What is hallux Valgus and it’s presentations
First MTP joint is laterally deviated (subluxed) more than 15 degrees. The metatarsal is abducted whilst the phanlangeals adducts
There’s pain and formation of bunions , the pain is dull NOT SHARP. Hence pain is mild
pain is relieved without wearing shoes, no erythema
Treatment is normally conservative like analgesics or orthotics. Also could be treated with surgery
What are the features of septic arthritis
Bacteria enter joint from bone, skin or blood. Toxins are released. Can cause fever and has signs of sepsis
Chondrocyte proteases digest collagen in joints and results in inflammation.
it is usually non-gonococcal where only one joint is affected. Caused by s.aureus instead.
Diagnosis can be done by joint aspiration and look for wbc and esr.
Treatment
- painkillers
- arthrocentesis
- arthtotomy
What Is osteomyelitis and give relevant points like treatment and symptoms
Infection of bone via blood (caused by microbes, trauma or surgery).
it can be acute and chronic. Acute can be resolved if bone is healthy whereas chronic lead to formation of sequestrum as bone is necrotic.
there’s increased CRP, esr, and wbc
theres thickening and elevation of periosteum along sided loss of trabeculae.
Can be caused by S.aureus
What are the features of gout?
1st metartarsal normally affected but not exclusively..
increased serum Uric acid lead to deposition of mono sodium urate crystals in joints. This can lead to formation of tophi.
Gout can be exacerbated by alcohol consumption
Can lead to arthritis and very painful
treatment involves trying to reduce uric acid and get rid of crystals
What are the features of ankylosing spondylitis
A Beckterew disease
seronegative and not linked to any antibody (linked to HLA-B27 gene)
Affects intervertebral discs, facet joints and sacro iliac joints
theres fibrosis and ossification of joints and discs - fibrin replaces collagen
on x-ray it is characteristised as bamboo spine
What is the role of the ACL, MCL, LCL and PCL
Anterior cruciate ligament- prevents excessive anterior translation of the tibia on the femur
posteriror cruciate ligament- prevents excessive posterior translation of the tibia on the femur
MCL- prevents valgus
LCL- prevents varus deformity
What is the INITIAL management principles for SOFT tissue injury
PRICE framework
Protect , Rest, Ice, Compress and Elevate
DONT USE NSAIDS- we need inflammatory process for healing at this initial stage
What is the principles for treatment of an ACL rupture
Non -operative - use brace or crutches for less active people
operative- repair it or replace it
Regardless of the method of treating, the patient will still need physio and strengthening exercises
What is the function of the Achilles’ tendon and what are the signs of it’s injury
Allows plantar flexion
plays a crucial role in the toe-off phase of gait
Consequences of injury
- difficulty walking,limping
- pain
- when prone and feet s off the ground, the affected side is left on dorsi flexion
- thickening and tenderness of the affected side
How does bacteria inflammation change synovial fluid
The normal clear straw coloured joint lubriactting fluid would have changed in colour and consistency
look turbid or cloudy, pus, increased viscosity, darker and large volume of effusions
What are the causative bacteria and risk factors for septic arthritis
What are the functions of type 3, 5 and 10 collagen
Type 3- support structure of muscle, organs and arteries
type 5- for hair , placental, liver, lungs
type 10- beneficial new bone formation for articular cartilage
What’s the difference between hallux valgus and hallux rigidis
Hallux rigidis is osteoarthritis of the 1st MTPJ joint- presents with stiff pain rather than dull pain with bunio formation.
hallux valgus - bunion is formed , pain is dulled
What are the treatment procedures for hallux valgus
