How to Treat MSK Conditions

Question 1

What is an osteogenic cell?

Answer 1

A bone stem cell

Question 2

What is an osteoblast?

Answer 2

Bone forming cell

Question 3

What do osteoblasts secrete?

Answer 3

Osteoid

Question 4

What do osteoblasts catalyse the mineralisation of?

Answer 4

Osteoid

Question 5

What are osteocytes?

Answer 5

Mature bone cells

Question 6

What is the role of osteocytes?

Answer 6

Sense mechanical strain to direct osteoclast and osteoblast activity

Question 7

How are osteocytes formed?

Answer 7

When osteoblasts become imbedded in secretion

Question 8

What are osteoclasts?

Answer 8

Bone breaking cells

Question 9

What do osteoclasts do?

Answer 9

Dissolve and resorb bone by phagocytosis

Question 10

What are osteoclasts derived from?

Answer 10

Bone marrow

Question 11

What structure does compact bone have?

Answer 11

Osteons

Question 12

What are osteons?

Answer 12

Repeated structural units made of concentric ‘lamellae’ around a central ‘Haversian Canal’, they have few spaces

Question 13

What is the role of osteons?

Answer 13

Provides protection, support and resists stresses produced by weight of movement

Question 14

What does the haversian canal in an osteon contain?

Answer 14

Blood vessels
Nerves
Lymphatics

Question 15

What are lacunae?

Answer 15

Small spaces containing osteocytes

Question 16

What are Volkman’s canals?

Answer 16

Transverse perforating canals

Question 17

Where is the epiphysis of long bones found?

Answer 17

Near the joint

Question 18

What are the 3 pathologies of fracture?

Answer 18

Trauma
Stress
Pathological

Question 19

How are stress fractures caused?

Answer 19

Abnormal stress on normal bone

Question 20

How are pathological fractures caused?

Answer 20

Normal stress on abnormal bone

Question 21

What are pathological causes of fractures?

Answer 21

Osteoporosis
Malignancy
Vitamin D deficiency
Osteomyelitis
Osteogenesis imperfecta
Paget's disease

Question 22

What are the 3 ways fractures are classified?

Answer 22

Soft tissue integrity: open or closed
Bony fragments: greenstick, simple or comminuted
Movement: displaced or undisplaced

Question 23

What are clinical signs of a fracture?

Answer 23

Pain
Swelling
Crepitus
Deformity

Question 24

How should you describe a fracture?

Answer 24

Location (what bone and what part of it)
Pieces (simple or multifragmentary)
Pattern (transverse, oblique spiral etc)
Displaced or undisplaced

Question 25

What are 2 categories in fracture displacement?

Answer 25

Translation (lateral/medial/proximal/distal) | Angulation (internal or external rotation/varus or valgus/dorsal or volar)

Question 26

What are the 4 principals of fracture management?

Answer 26

Reduce Hold Fix Rehabilitate

Question 27

What do we mean by general fracture complications?

Answer 27

They affect the whole body or the part of the body where the fracture is from

Question 28

What are some common general fracture complications?

Answer 28

``` Fat embolus DVT PE Infection/sepsis Prolonged immobility ```

Question 29

What are urgent local fracture complications?

Answer 29

``` Local visceral injury Vascular injury Nerve injury Compartment syndrome Haemarthrosis Infection Gas gangrene ```

Question 30

What are causes of fractures at the neck of the femur?

Answer 30

Osteoporosis (common in older people) Trauma (common in younger people) Combination of above

Question 31

What are important points in the history of the head of femur fracture?

Answer 31

Age Co morbidities (respiratory/cardiovascular/diabetes/cancer) Pre injury mobility Social history

Question 32

How are extracapsular neck of femur fractures treated?

Answer 32

Internal fixation

Question 33

How are intracapsular neck of femur fractures treated?

Answer 33

If displaced replace if they are above 65 years and reduce and fix if they are younger than 55 If undisplaced fix with screws

Question 34

Why can undisplaced neck of femur fractures be fixed with screws?

Answer 34

There is minimal risk to blood supply and AVN

Question 35

What are the 3 types of joints?

Answer 35

Fibrous Cartilaginous Synovial

Question 36

How are synovial joints stabilised?

Answer 36

Depending on how much bony congruity they have, this relies on the proportion of muscles/tendons to ligament to congruity

Question 37

What is cartilage composed of?

Answer 37

Specialised cells=chondrocytes | Extracellular matrix

Question 38

What specialised cells are present in cartilage?

Answer 38

Chondrocytes

Question 39

What is present in ECM of cartilage?

Answer 39

Water Collagen Proteoglycans (mainly aggrecan)

Question 40

What is blood supply to cartilage like?

Answer 40

Cartilage is avascular

Question 41

What is aggrecan?

Answer 41

A proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains

Question 42

What does aggrecan interact with?

Answer 42

Hyaluronan (HA) to form large proteoglycan aggregates

Question 43

What are the 2 main types of arthritis?

Answer 43

Osteoarthritis (degenerative) | Inflammatory (mainly rheumatoid)

Question 44

How do radiographs of rheumatoid and osteoarthritis differ?

Answer 44

There is no subchondral sclerosis or osetophytes in rheumatoid but there is in oseto There is no osteopenia or bony erosions in osteo but there is in rheumatoid

Question 45

What is arthritis?

Answer 45

A degenerative disease of chondral cartilage

Question 46

When does inflammation occur in arthritis?

Answer 46

Late

Question 47

What are the main risk factors for developing arthritis?

Answer 47

``` Age Excess weight Mechanical stress (sports, profession etc) Hereditary Females (inc menopause) Metabolic syndrome ```

Question 48

What should you ask about in osteoarthritis history?

Answer 48

Pain (exertional/rest/night) Disability (walking/stairs/do their legs give way/) Deformity Previous history (of trauma/infection etc) Treatments given If other joints are affected

Question 49

How should you assess for osteoarthritis?

Answer 49

Look, feel, move

Question 50

What does conservative management of osteoarthritis include?

Answer 50

``` Analgesics Physiotherapy Walking aids Avoidance of exacerbating activity Injections (steroid/viscosupplementation) ```

Question 51

What does operative management of osteoarthritis include?

Answer 51

``` Replace (knee/hip) Realign (knee/big toe) Excise (toe) Fuse (big toe) Synovectomy (Rheumatoid) Denervate (wrist) ```

Question 52

What is infection of the bone called?

Answer 52

Osteomyelitis

Question 53

What are systemic signs of osteomyelitis?

Answer 53

Fevers Weight loss Sweats

Question 54

What are the classifications of osteomyelitis?

Answer 54

Acute or chronic | Primary or secondary

Question 55

What is infection of a joint called?

Answer 55

Septic arthritis

Question 56

How does septic arthritis manifest?

Answer 56

Pain Joint swelling Stiffness

Question 57

What is septic arthritis caused by?

Answer 57

Bacterial infection of a joint (usually caused by spread from the blood)

Question 58

What are risk factors for septic arthritis?

Answer 58

Immunosuppressed Pre-existing joint damage Intravenous drug use (IVDU)

Question 59

How urgent is septic arthritis? Why?

Answer 59

It is a medical emergency, if left untreated it can destroy a joint

Question 60

When should you consider a diagnosis of septic arthritis?

Answer 60

In any patient with an acute painful, red, hot, swelling of a joint, especially if there is fever

Question 61

What test diagnoses septic arthritis?

Answer 61

Joint aspiration

Question 62

What is septic arthritis called if it affects one joint and if it affects multiple?

Answer 62

One=monoarthritis | Multiple= polyarthritis

Question 63

How is septic arthritis treated?

Answer 63

Surgical wash-out (‘lavage’) and intravenous antibiotics | The joint is immobilised in the acute phase then physiotherapy when the acute phase is over

Question 64

How is osteomyelitis treated?

Answer 64

IV antibiotics Surgical drainage If chronic antibiotic suppression or dressings can be used Amputation may be required