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Orthopaedic Medicine > Joint conditions > Flashcards

Joint conditions Flashcards

(78 cards)

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1
Q

cells in acute disease

A

polymorphs (polymorphonuclear leucocyte)

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2
Q

cells in chronic disease

A

lymphocytes

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3
Q

opening up a joint is called …

A

arthrotomy

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4
Q

what is most joint replacement surgery aimed at achieving

A

pain relief

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5
Q

what is gout

A

inflammation of a joint caused by uric acid crystals being deposited on the cartilaginous surfaces

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6
Q

OA - are most cases primary or secondary

A

primary

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7
Q

what is OA

A

condition of pain and limitation of movement of joints assoc with excessive wear of articular cartilage due to breakdown in balance between wear and repair

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8
Q

non surgical arthritis mx

A

rest and physio
weight loss
use of a stick

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9
Q

eg of an infection that can cause OA

A

TB

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10
Q

eg of a childhood disease that can cause OA

A

Perthes

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11
Q

is it common for arthritis to cause stiffness alone?

A

no this is almost always secondary to pain

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12
Q

when is help from a specialist usually sought out in OA

A

when sleep is disturbed

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13
Q

in the hip, joint loading can reach up to ? times body weight

A

5

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14
Q

what is osteotomy

A

surgical realignment of joint

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15
Q

what is arthrodesis

A

surgical stiffening in a position of function

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16
Q

long term disadvantage of arthrodesis

A

puts stress on adjacent joints

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17
Q

what position would the hip usually be fused at in arthrodesis

A

30 degrees of flexion and some adduction

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18
Q

why is hip fusion more straight forward in males than females

A

any hip fusion is likely to interfere with female sexual activity

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19
Q

is recovery straight forward following hip fusion?

A

no, recovery of up to 6 months, often in a plaster splint

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20
Q

name of operation to replace a joint

A

arthroplasty

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21
Q

what is arthroplasty unlike to alleviate

A

disability due to stiffness caused directly by disease within the joint
(b/c soft tissue distortion of the capsule and ligaments tends to remain after replacement)

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22
Q

how many degrees of flexion should be maintained in the knee

A

90 - for going up and down stairs

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23
Q

why is stability in the knee essential

A

for supporting body weight when standing on one leg

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24
Q

principal indication for operative tx

A

pain

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25
most successful and common joint replacement
hip
26
3 requirements of any joint replacement
- capable of pain free, functional range of motion - able to withstand forces placed upon it without undue wear/becoming loose - same stability as the natural joint
27
in which group of people may osteotomy be a good operation
young people who have retained a good range of motion and have a reasonable preservation of articular cartilage
28
what may the long term plan of action be following arthrodesis to prevent stress on adjacent joints becoming problematic
converting the arthrodesis to arthroplasty in the 5th decade. this is effective in the hip
29
modern knee replacement consists of two new smooth surfaces but what is another vital part of this operation?
balancing the collateral ligaments
30
specific early complications of arthroplasty
dislocation DVT infection
31
what organisms commonly cause infection in joint replacement
staph aureus commensals e.g. staph albus (universally found on skin)
32
general complications of surgery
UTI, chest infection, pressure sores
33
specific late complications of arthroplasty
late infection loosening wear
34
most obvious symptoms of rheumatoid arthritis
deformity of joints severe pain swelling
35
RA - principal joints affected?
small joints of hand and feet
36
is there a pattern in joint involvement in RA?
small joints are affected symmetrically but large joints are not
37
first noticed sign of RA
stiffness worse in mornings and improving throughout the day
38
RA - what type of procedure can be done to try to reduce pain and stiffness in early disease. who in particular is it of value in?
synovectomy particularly of value in the younger patient who retains movement but has pain
39
What is avascular necrosis
bone tissue death through loss of blood supply
40
causes of avascular necrosis
trauma | spontaneous
41
areas at risk of avascular necrosis following trauma
femoral head proximal part of scaphoid proximal part of talus
42
in what situations is avascular necrosis of the femoral head seen
steroid therapy alcohol abuse deep sea divers (Caisson's disease)
43
presentation of avascular necrosis
acute and often severe joint pain, made worse by movement and relieved to some degree by rest
44
why is dx for AN difficult
may not initially be seen on X-ray
45
X-ray signs of AN
bone appears dense (reflecting absence of blood vessels)
46
can AN be reversed?
if blood supply can be re-established naturally
47
what is the bone prone to in AN revascularising phase
distortion because it is very soft >> secondary arthritic changes
48
management of avascular necrosis
non specific rest the affected joint surgery is of NO value in tx underlying condition often surgeon is left to salvage the situation with a joint replacement
49
situations where urate crystals are deposited
diuretic overuse dehydration after chemo for cancer
50
how does septic arthritis present in children
very unpleasant acute illness. high temperature. affectsd joint stiff and tender
51
how does septic arthritis present in adults
less acute. many px die because of delay in recognition
52
most likely cause of septic arthritis with little constitutional upset in a young adult?
gonococcus
53
tx for septic arthritis
surgery and IV abx
54
first guess abx for septic arthritis in children
anti-staphylococcal
55
what is the px at risk of following inadequate tx for septic arthritis
septicaemia | degeneration of articular cartilage >> fibrous or bony fusion of the joint
56
which bacterial infection can cause chronic septic arthritis
TB
57
joint and ? TB are often found together
kidney
58
clinical presentation of chronic septic arthritis
chronic ill heath wt loss considerable muscle wasting around affected joint radiographs show marked thinning of bone
59
is surgery necessary for chronic septic arthritis
rarely
60
meniscal lesions are relatively rare in men/women?
women
61
meniscal lesions - well or poorly localised?
poorly
62
which meniscus is more commonly injured?
medial
63
cleavage lesion of meniscus - common in which age group? what may this cause?
old age | may cause a cyst as the lesion acts like a flap valve that allows build up of synovial fluid
64
name of a vertical meniscal split anchored at both ends
bucket handle tear
65
parrot beak tear
split off one end of the lateral meniscus
66
how are most meniscal lesions repaired nowadays
via arthroscopy
67
advantage of arthroscopy
quick recovery - days!
68
what is osteochondritis dissecans
spontaneous osteochondral fragments - occurs rarely, in adolescents
69
what is a loose body
ostechondral fragment
70
are cruciate ligaments capable of spontaneous healing?
no, if torn the blood supply is lost
71
what does loss of a cruciate result in
loss of anteroposterior stability, particularly in flexion | loss of rotary stability when twisting and turning
72
when may patients experience symptoms of cruciate injury in particular
descending stairs, twisting, turning
73
management of cruciate tear
leave it alone for a while and rehabilitate knee muscles surgery if it interferes with daily life or they want to return to sport
74
why is a replacement cruciate more likely to fail than a natural ligament
it has no sensory receptors to let the brain know if its being over stretched
75
what is dislocation of the patella usually associated with and what does this cause
malformation of either the patella or the lateral femoral condoyle this causes mal tracking (patella moving abrasively on the femur) which is painfull because of associated muscle spasm
76
why would a person with a dislocated patella fall to the ground?
failure of quads to act as an extensor
77
how are minor degrees of patellar mal tracking dealt with
surgical splitting of the vastus lateralis muscle insertion onto the patella, allowing the patella to fall back into a normal relationship with the femur
78
how is recurrent and severe patellar mal-tracking dealt with
medial tightening (plication) of the vastus medialis

Orthopaedic Medicine (5 decks)

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