How to Treat MSK Conditions Flashcards by Meley Gdey

what is a osteogenic cell?

bone ‘stem cell’

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what is a osteoblast cell?

bone forming cell

catalyse the mineralisation of osteoid

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osteoblasts secrete?

osteoid

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what is a osteocyte cell?

mature bone cell
formed when an osteoblast becomes imbedded in its secretions
sense mechanical strain to direct osteoclast and osteoblast activity

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what is a osteoclast cell?

‘Bone breaking’
Dissolve and resorb bone by phagocytosis
Derived from bone marrow

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list some functions of bone

protection
support
resist stresses produce by weight of movement

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repeated structural units of bone are called?

osteons

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osteons are composed of?

concentric lamellae around a central Haversian canal

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Haversian canals contain?

contain blood vessels, nerves and lymphatics

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what are lacunae?

small spaces containing osteocytes

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Tiny ______ radiate from lacunae filled with ___________.

Canaliculi

extracellular fluid.

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What is a Volkmans canal?

transverse perforating canals

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what is the periosteum?

connective tissue covering

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the medullary cavity contains?

yellow bone marrow

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outline the mechanisms of bone fracture

trauma: high or low energy
stress: abnormal stresses on normal bone
pathological: normal stresses on abnormal bone

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give examples of pathological causes of fracture

osteoporosis
malignancy (primary, bone mets)
vitamin D deficiency (osteomalacia, rickets)
osteomyelitis
osteogenesis imperfecta
pagets

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what is Wolff’s Law?

bone grows and remodels in response to the forces that are placed on it

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clinical signs of fracture

pain 
swelling
crepitus
deformity
adjacent structural injury: nerves, vessels, ligament, tendon

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investigations for suspected fracture

radiograph
CT
MRI
bone scan

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how to describe a fracture radiograph

location
pieces
pattern
displaced/undisplaced
translated/angulated
X/Y/Z plane

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general fracture complications?

fat embolus
DVT
PE
infection
sepsis
prolonged immobility (UTI, chest infections, sores)

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urgent local complications of fractures

local visceral injury
vascular injury
nerve injury
compartment syndrome
haemarthrosis
infection
gas gangrene

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less urgent local complications of fractures

fracture blisters
plaster sores
pressure sores
nerve entrapment
myositis ossificans
ligament injury
tendon lesions
joint stiffness
algodystrophy

late local complications of fractures

delayed union
malunion
non-union
avascular necrosis
muscle contracture
joint instability
osteoarthritis

common causes of fractured NOF

osteoporosis trauma combination

important things t o get from history of patient w/ fractured NOF

age comorbidity preinjury mobility social hx: relatives, stairs

list types of NOF by location

``` Subcapital (intracapsular) Transcervical (extracapsular) Intertrochanteric (extracapsular) subtrochanteric 3 part intertrochanteric ```

how are synovial joints stabilised?

muscles/tendons ligaments bone surface congruity

main components of a synovial joints

synovium: cell lining contains macrophage-like phagocytic cells + type I collagen synovial fluid: hyaluronic acid rich articular cartilage: type II collagen, aggrecan

cartilage is composed of?

specialised cells (chondrocytes) and ECM

is cartilage vascularised?

no its avascular

what is aggrecan?

proteoglycan that possesses many chondroitin sulfate and keratin sulfate chains

aggrecan is characterised?

its ability to interact with hyaluronan (HA) to form large proteoglycan aggregates

two major divisions of arthritis?

``` osteoarthritis (degenerative) inflammatory arthritis (main type is RA) ```

radiographic changes in rheumatoid arthritis

joint space narrowing osteopenia bony erosions

radiographic changes in osteoarthritis

joint space narrowing subchondral sclerosis osteophytes

what are Heberden's nodes?

osteophytes at the distal inter-phalangeal joints

what are Bouchard's nodes?

osteophytes at the proximal inter-phalangeal joints

inflammatory mediators in arthritis include?

matrix metalloproteinases (MMPs) and aggrecanases, and inflammatory cytokines, including interleukin (IL)-1β and tumor necrosis factor α (TNFα)

main risk factors for OA

age, obesity, mechanical constraints, hereditary, female gender, menopause, osteonecrosis, oestrogen deficiency, metabolic syndrome, adv hip OA caused by RA or spondylarthritis

other risk factors for OA

infectious disease involving bone, RA sequelae, metabolic diseases, injury

what to look out for on assessment for msk conditions

inspection: alignment, gait palpation: effusion? angle of flexion special tests: anterior drawer?

conservative OA management

``` analgesics physiotherapy walking aids avoidance of exacerbating activity injections (steroids) ```

operative OA management

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

cause of septic arthritis

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

risk factors for septic arthritis

immunosuppressed, pre-existing joint damage, intravenous drug use (IVDU)

is septic arthritis a medical emergency?

yes, if untreated, it can rapidly destroy a joint

how many joints are usually affected in septic arthritis?

1, monoarthritic

when should you consider septic arthritis?

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

diagnosis of septic arthritis

joint aspiration. Send sample for urgent Gram stain and culture

common organisms that cause septic arthritis

Staphylococcus aureus, Streptococci, Gonococcus

what about gonococcal septic arthritis is an exception?

often affects multiple joints (polyarthritis) | -It is less likely to cause joint destruction

treatment of septic arthritis

surgical wash-out (‘lavage’) and intravenous antibiotics

radiological investigations for septic arthritis

``` Plain films MRI scans: bony architecture/collections CT if MRI not available Bone scans: multifocal disease Labelled White cell scans ```

bloods for septic arthritis

CRP: acute marker ESR slower response WCC TB culture/PCR

treatment for osteomyelitis

Antibiotics: iv weeks Surgical drainage: especially collections/sequestrum Chronic: antibiotic suppression/dressings ??amputation

treatment for septic arthritis

``` Surgery: joint washout and drainage (repeated if required) Iv antibiotics (days/weeks) Immobilise joint in acute phase Physiotherapy once over acute phase ```