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CBL Year 2 > Joint pain > Flashcards

Joint pain Flashcards

1
Q

Three types of joints

A

fibrous
cartilaginous
synovial

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2
Q

fibrous joints

A

sutures
syndesmosis
gomphoses

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3
Q

two types of cartilaginous joints

A

synchondroses

symphyses

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4
Q

describe synchondroses

A

advancing centres of ossification separated by hyaline cartilage
most are temporary and fuse in adulthood (e.g. epiphyseal growth plates)
some persist throughout life (e.g. costal cartilages) which allow some flexibility of rib cage

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5
Q

describe symphyses

A

fibro-cartilage pads between a.c. of adjacent bones
allows slight movement
symphysis pubis allows expansion of pelvis in childbirth
some symphyses fuse during growth (e.g. sacral and coccygeal discs)

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6
Q

6 types of synovial joints

A
  1. plane
  2. hinge
  3. pivot
  4. ellipsoid
  5. saddle
  6. ball and socket
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7
Q

example of a plane joint

A

joint between metacarpal bones of hand

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8
Q

example of a hinge joint

A

elbow
knee
interphalangeal joint
tibiotalar joint of ankle

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9
Q

example of pivot joint

A

the joint of the first and second vertebrae of the neck that allows the head to move back and forth
The joint of the wrist that allows the palm of the hand to be turned up and down is also a pivot joint.

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10
Q

example of the ellipsoid joint

A

the wrist

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11
Q

example of the saddle joint

A

trapeziometacarpal joint at the base of your thumb. It connects the trapezium and the metacarpal bone of your thumb.

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12
Q

example of ball and socket joint

A

your shoulder joint and your hip joint.

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13
Q

what is a plane joint

A

called gliding joint or arthrodial joint, in anatomy, type of structure in the body formed between two bones in which the articular, or free, surfaces of the bones are flat or nearly flat, enabling the bones to slide over each other.

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14
Q

what is a hinge joint

A

a type of synovial joint that exists in the body and serves to allow motion primarily in one plane. [1] The hinge joint is made up of two or more bones with articular surfaces that are covered by hyaline cartilage and lubricated by synovial fluid.

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15
Q

what is a pivot joint

A

a freely moveable joint (diarthrosis) that allows only rotary movement around a single axis. The moving bone rotates within a ring that is formed from a second bone and adjoining ligament.

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16
Q

what is a ellipsoid joint

A

a biaxial joint. An ellipsoid joint allows movements in all angular motions. The movement of ellipsoid joints is in two plains, back and front, and side to side.

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17
Q

what is the saddle joint

A

The saddle joint gets its name because the bone forming one part of the joint is concave (turned inward) at one end and looks like a saddle. The other bone’s end is convex (turned outward), and looks like a rider in a saddle.

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18
Q

what is a ball and socket joint

A

joint in which the rounded surface of a bone moves within a depression on another bone, allowing greater freedom of movement than any other kind of joint.

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19
Q

2 layers of a joint capsule described

A
  1. outer fibrous capsule:
    - blends with periosteum and tendons
    - composed of dense irregular connective tissue
    - highly innervated
  2. inner synovial membrane (synovium)
    - lines joint cavity except for articular surfaces
    - produces constituents of synovial fluid
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20
Q

2 main layers of synovium

A
  1. supporting layer or stroma (sub-intima)

2. lining of synovial cells in contact with synvoial fluid

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21
Q

2 types of synovial cell

A

type A: derived from bone marrow
secretory and phagocytic functions

type B: type of fibroblast
role in synthesis of hyaluronic acid (HA) and proteins

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22
Q

describe articular cartilage

A
  • contains cells, fibres and matrix arranged in zones
  • cells are chondrocytes ; density varies with age, morphology changes with different zones
  • fibres are collagen
  • matrix composed mostly of large aggregated proteoglycans
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23
Q

describe subchondral bone

A
  • cortical bone plate supported by trabecular bone
  • in children perforated by blood vessels where it provides route for nutrient exchange
  • shows biochemical and structural changes in some joint diseases
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24
Q

describe ligaments

A
  • regions of fibrous capsule thicken to form ligaments
  • composed of dense regular CT comprising parallel collagen fibres
  • this structural arrangement give ligaments great tensile strength along their length
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25
Q

describe menisci

A

discs or pads of fibrous-cartilage

located within capsule, provide extra strength and support

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26
Q

describe bursae

A

often found where tendon passes over bone

modified bursae form tendon sheaths around tendons

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27
Q

describe synovial fluid

A

fills joint cavity and bursae

important role in lubrication and cartilage nutrition

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28
Q

describe the mechanical function of synovial joints

A
  • synovial joints allow movement whilst providing stability
  • shape of articulating surfaces influences type and range of movement
  • increased mobility associated with reduced stability
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29
Q

what improves the stability of synovial joints

A
  • capsule and ligaments surrounding joints
  • internal ligaments e.g. cruciate in knee
  • attachment of muscles and tendons across joint
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30
Q

high compressive and shear forces act on cartilage

- what does this lead to

A
  • loss of energy
  • increase in temperature
  • wear and tear at bearing surface
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31
Q

two main types of lubrication in synovial joints

A

fluid-film

boundary

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32
Q

what does failure of joint lubrication lead to

A

increased friction and fibrillation of cartilage surface

roughened, fibrillated surfaces result in increased friction and wear and may lead to further cartilage damage

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33
Q

effects of mechanical loading on joints

A

-causes fluid changes in cartilage

-

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34
Q

cartilage surface changes in osteoarthritis

A

fibrillation
erosion
cracks

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35
Q

what is fibrillation of cartilage

A

In such areas there is fraying and splitting of the cartilage, frequently accompanied by its local disintegration and erosion.

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36
Q

changes in cartilage in osteoarthritis

A 
cartilage softening
chondrocyte necrosis
regeneration
cell cluster
cell proliferation
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37
Q

changes in the bone in osteoarthritis

A 
joint space narrowing
marginal osteophytes 
sclerosis
eburnation
focal pressure necrosis and subarticular cysts
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38
Q

what is sclerosis of the bone

A

an abnormal increase in density and hardening of bone

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39
Q

changes in synovium in osteoarthritis

A

mild to moderate inflammation

neovascularisation

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40
Q

what is eburnation

A

the appearance of bone following a degenerative process in which subchondral or otherwise exposed bone acquires a non-anatomical sclerotic, microimpacted, and “polished” articular surface

Eburnation describes a degenerative process of bone commonly found in patients with osteoarthritis or non-union of fractures

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41
Q

clinical signs of osteoarthritis

A 
swelling
muscle wastage
bony swelling
joint effusions
tenderness
warmth 
reduced motion
crepitus 
instability
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42
Q

symptoms of osteoarthritis

A 
onset slow and insidious 
use-related pain
joint stiffness after inactivity 
reduced range of joint motion
functional limitation
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43
Q

what is a compression fracture

A

A type of break in a bone caused by pressure and in which the bone collapses. Compression fractures usually occur in the spine (backbone) and in bones made weak by cancer or by osteoporosis (a decrease in bone mass and density).

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44
Q

describe tensile forces on bones

A

A force that pulls apart both the axial ends is an example of tensile force. For tensile force to result in fracture, one end of a bone must be in a fixed position while the other end is forced away from the fixed end.

This will create a separation or avulsion fracture.

Common areas for this to occur include the tibial tuberosity, greater trochanter, and olecranon.

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45
Q

describe torsional forces on bones

A

his kind of force will be a force that tries to twist the bone along its long axis. This usually is a result of one end of a bone being placed in a fixed position while the other end of the bone is forced to rotate. Torsional forces generally result in short or long spiral fractures.

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46
Q

how long does a bone remodelling cycle take

A

3-4 months

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47
Q

describe a bone remodelling cycle (steps)

A
  • initiation
  • Resorption (-2 week process)
  • osteoclast
  • -osteoblast formation
  • remodelling complete
  • resting stage
  • starts again
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48
Q

what is pycnodysostosis

A

a rare genetic disorder characterized by distinctive facial features and skeletal malformations. Affected individuals may have osteosclerosis, a condition characterized by abnormal hardening and increased density of bone.

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49
Q

what is osteoporosis

A

medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.

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50
Q

what are bisphosphonate drugs (used for osteoporosis)

A

are a class of drugs that have been used commonly for more than two decades for the treatment and prevention of osteoporosis. Bisphosphonates slow bone resorption by reducing osteoclast function.

on an empty stomach with a full glass of water. Stand or sit upright for 30 minutes after taking them. You’ll also need to wait between 30 minutes and 2 hours before eating food or drinking any other fluids.

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51
Q

physiology of bone remodelling

A

consists of three consecutive phases: resorption, during which osteoclasts digest old bone; reversal, when mononuclear cells appear on the bone surface; and formation, when osteoblasts lay down new bone until the resorbed bone is completely replaced.

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52
Q

difference between anabolic and bisphosphonates used to treat osteoporosis

A

bisphosphonates - decrease osteoclast resorption (alendronic acid.)
anabolic drugs - promote new bone formation (teriparatide)

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53
Q

(Joint Pain Case)
66 year old man who is struggling with pain and stiffness in his left knee
recently retired and plays golf regularly but his pain is limiting his ability to enjoy a full round with his friends
no abnormality upon examination
Does he need imaging?
What do you think it is?

A

doesn’t need imaging

most likely osteoarthritis

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54
Q

(Joint Pain Case)
19 year old man with knee pain and swelling following a football game
he was tackled by another player with a twisting injury and direct impact to his left knee
on examination there is a large effusion and a positive Lachmans test
what does a Lachmans test test for?
What imaging would he need?

A

Lachman’s test tests for an ACL injury

Xray is first line for imaging but might require an MRI to look at the soft tissue and ligaments

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55
Q

How to perform a Lachman’s test

A

its an alternative test assessing for laxity or rupture of the anterior cruciate ligament (ACL)

  1. Flex the patient’s knee to 30°.
  2. Hold the lower leg with your dominant hand with your thumb on the tibial tuberosity and your fingers over the calf.
  3. With the non-dominant hand, hold the thigh just above the patella.
  4. Use the dominant hand to pull the tibia forwards on the femur while the other hand stabilises the femur.

Significant anterior movement of the tibia on the femur suggests ACL laxity or rupture.

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56
Q

what does ACL laxity mean

A

loose knee ligaments

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57
Q

limitations of plain radiographs

A

poor soft tissue definition
early changes are often occult ( not accompanied by readily discernible signs or symptoms.)
2D representation of 3D structure

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58
Q

limitations of MRI

A

slow, expensive and claustrophobic
can overestimate severity of benign lesions
not everyone can have an MRI

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59
Q

Osteoarthritis classically results in LOSS (what does the acronym stand for) think on radiographs

A

Loss of joint space
osteophytes
subchondral sclerosis
subchondral cysts

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60
Q

what is subchondral sclerosis

A

under the cartilage bone growth (DENSE)

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61
Q

what are subchondral cysts

A

as subchondral bone takes more stress it grinds against the bone which eventually forms cysts

indicative of more severe osteoarthritis

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62
Q

define osteophyte

A

a bony projection associated with the degeneration of cartilage at joints.

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63
Q

brief description of rheumatoid arthritis

A

chronic autoimmune inflammatory disease
affects the synovium/ joints but onset can be insidious and may present with systemic symptoms of tiredness, malaise, and ache

64
Q

radiological manifestations of rheumatoid arthritis

A
  • soft tissue swelling due to joint effusion and synovitis

- symmetrical joint involvement (joint space loss, and marginal erosions)

65
Q

what is osteopenia

A

one loss before osteoporosis (osteopenia)
The stage before osteoporosis is called osteopenia. This is when a bone density scan shows you have lower bone density than the average for your age, but not low enough to be classed as osteoporosis. Osteopenia does not always lead to osteoporosis

66
Q

what is chondrocalcinois

A

non specific term for calcium deposition within articular hyaline and fibrocartilage

67
Q

what is an aneurysmal bone cyst

A

a benign, blood-filled lesion in the bone that tends to expand or grow. While it is referred to as a cyst, it is a true benign bone tumor surrounded by a thin wall of bone. Aneurysmal bone cysts (ABCs) can occur in any bone, but are most commonly found around the knee, pelvis or spine.

68
Q

what is osteosarcoma

A

he most common type of cancer that starts in the bones. The cancer cells in these tumors look like early forms of bone cells that normally help make new bone tissue, but the bone tissue in an osteosarcoma is not as strong as that in normal bones.

69
Q

what does a lower motor neurone lesion correspond to

A

to a lesion in the peripheral nervous system

70
Q

Lower motor neurone neurological examination overview

A 
inspection
screening tests - gaits
tone "floppiness"
power
reflexes
sensation
co-ordination
71
Q

difference between radiculopathy and neuropathy

A

Peripheral neuropathy is the damage of the peripheral nervous system, such as carpal tunnel syndrome that involves trapped nerves in the wrist. Radiculopathy is the pinching of the nerves at the root, which sometimes can also produce pain, weakness and numbness in the wrist and hand.

72
Q

Rombergs Test

A

stand with feet together and eyes closed
tests proprioception
positive test = loss of balance

73
Q

what could an abnormal heel-shin test be due to

A

lower limb weakness
impaired joint proprioception
cerebellar disorder

74
Q

describe inspection in a lower limb neurological exam

A
  • how they walk into a room/get on a couch
  • general: IV track marks, body habits, scars, etc.
  • muscle activity: wasting, fasciculation, jerking
  • limb posture: pyramidal, contractures
75
Q

what are pyramidal findings on a neurological exam

A

motor abnormalities on neurological exam (e.g., hyperreflexia, focal weakness, extensor response). Extrapyramidal findings in sJCD typically include rigidity, slowed movement (bradykinesia), tremor, or dystonia, typically due to problems in the basal ganglia or its connections.

with pyramidal meaning
relating to or denoting a tract of motor nerves within the pyramid of the medulla oblongata.

76
Q

what is an antalgic gait

A

An antalgic gait is an abnormal gait pattern which develops as a result of pain. Typically the stance phase is reduced on the affected leg resulting in a limping appearance.

77
Q

difference between rigidity and spacisity

A

Spasticity refers to a condition, which leads to an abnormal increase in muscle tone, interfering with movement and speech, while rigidity refers to a condition of muscles characterized by the inability to relax normally. Thus, this is the main difference between spasticity and rigidity.

Whereas spasticity arises as a result of damage to the corticoreticulospinal (pyramidal) tracts, rigidity is caused by dysfunction of extrapyramidal pathways, most commonly the basal ganglia, but also as a result of lesions of the mesencephalon and spinal cord.

78
Q

MRC scale for muscle

A

grade 0 - no muscle movement
grade 1 - flicker or trace of muscle movement
grade 2 - active movement with gravity eliminated
grade 3 - active movement against gravity
grade 4 - active movement against gravity and resistance
grade 5 - normal power

79
Q

who should we assess for osteoporosis

A 
women over 65
men over 75
women 50-64 and men 50-74 if:
-previous fracture
-glucocorticoids
-history of falls
-family history of hip fracture 
-other causes of secondary osteoporosis
-low BMI
-excessive alcohol or smoking history
80
Q

what is a FRAX score

A
  • provides an estimate of future fracture risk
  • incorporates risk factors
  • uses 9 prospective population based cohorts
  • can be used with or without DXA
81
Q

what is DXA

A

dual x-ray absorptimetry

  • provides an assessment of bone mineral density
  • usually assesses he lumbar spine and hips
  • lowest value taken
  • results provided as a T score
  • can also carry out a vertebral fracture assessment (VFA)
82
Q

WHO T score for osteopenia

A

between -1 and -2.5

83
Q

WHO T score for osteoporosis

A

less than -2.5

84
Q

investigations in patients at high risk of fractures

A

blood tests

  • vit d
  • thyroid function
  • coeliac disease
  • testosterone deficiency
  • PTH
  • Serum calcium

Other cause

  • myeloma screen
  • evidence of metastatic malignancy
85
Q

impact of vertebral fractures

A

pain
disability
loss of independence
lack of self esteem

86
Q

treating osteoporosis

A

lifestyle advice:
modification of risk factors

exercise:
weight bearing activity

medications:
including optimising calcium and vitamin D

87
Q

how to take bisphosphonates

A

on an empty stomach

upright with a glass of water 30 mins before food/drink/supplements

88
Q

what is vitamin d deficiency called in children and adults

A

children - Rickets

adults - osteomalacia

89
Q

severe vitamin d deficiency clinical features

raised what and low what?on blood test

A 
bone pain and muscle weakness / bone tenderness / waddling gait
raised PTH
raised ALP
25 - hydroxyvitamin D very low
calcium and phosphate may be low
90
Q

what is Pagets disease

A

disease of bone interferes with your body’s normal recycling process, in which new bone tissue gradually replaces old bone tissue. Over time, bones can become fragile and misshapen. The pelvis, skull, spine and legs are most commonly affecte

91
Q

role of PTH in bone remodelling

A

PTH enhances the number and the activation of osteoblast through 4 pathways: increasing osteoblast proliferation and differentiation, decreasing osteoblast apoptosis and reducing the negative effects of peroxisome proliferator activator (PPAR)γ receptor on osteoblast differentiation.

92
Q

what do cervical vertebrates have (spine)

A

cervical spine has vertebral foramen for the vertebral arteries

93
Q

describe compression fractures

A
  • vertical pressure
  • loss of vertebral height
  • causes - trauma or previous weakening (weakening caused by osteoporosis, osteogenesis imperfecta, metastatic lytic lesions, or infection)
  • best seen on the lateral view X-ray
  • stable vs. unstable depending on amount of columns affected
94
Q

treatment for compression fractures

A
  • can be treated conservatively if stable
  • treat underlying condition (osteoporosis)
  • vertebroplasty can be considered if ongoing pain
  • needs urgent surgical review if unstable
95
Q

wedge fractures (spine)

A

typically osteoporotic fractures
single column
stable fractures

(this fracture usually occurs in the front of the vertebra, collapsing the bone in the front of the spine and leaving the back of the same bone unchanged, which results in the vertebra taking on a wedge shape.)

96
Q

burst fracture (Spine)

A

usually traumatic
more than 1 column involved
unstable
usually seen on a CT rather than a radiograph due to trauma protocols

97
Q

types of clinical pain

A 
inflammatory pain
cutaneous pain
post-operative pain
cancer pain
neuropathic pain
visceral pain
migraine/headache
98
Q

descriptors of pain

A

duration: acute/chronic (> 3 months)
pathology: inflammatory , traumatic, neuropathic
trigger: stimulus evoked, spontaneous, delayed
origin: somatic - skin/muscle/bone, visceral - heart/kidneys/GI
characteristics: shooting, lacinating, electric, burning, freezing, cramping, aching

99
Q

what is nociception

A

detection of a stimulus which is potentially (or actually) damaging
can have nociception without pain or pain without nociception

100
Q

treatment options for acute pain

A

Acetaminophen is the first-line treatment for most mild to moderate acute pain. Ibuprofen and naproxen (Naprosyn) are good, first-line NSAIDs for mild to moderate acute pain based on effectiveness, adverse effect profile, cost, and over-the-counter availability.

101
Q

normal curvature of spine for C1-C7

A

lordotic - in towards the body - allows movement

102
Q

normal curvature for thoracic spine

A

kyphotic - little movement because fixed to the ribs

103
Q

normal curvature for lumbar spine

A

lordotic - allows movement (like bending forward and backward)

104
Q

(joint pain case) symptoms that suggest life threatening pathology

A 
weight loss
lethargy
night sweats
fevers
rest pain
progressive severe pain
105
Q

(joint pain case) symptoms that suggest limb threatening pathology

A 
sphincter disturbance (incontinence, retention, sexual disturbance) 
bilateral leg pain
106
Q

clinical signs that raise concern in joint pain

A

saddle anaesthesia
objective neurological deficit - sensory/motor/both
(reduced anal tone)
cachexia

107
Q

specific diagnoses for back pain

A 
herniated disc
cauda equina syndrome
degenerative spinal stenosis
spinal tumours
spinal infection
spinal trauma
inflammatory arthropathy 
extraspinal disease
108
Q

describe herniated intervertebral disc

A

very common
presents with leg pain
most patients improve with conservative measures alone
surgery for those that pain is prolonged for or difficult to control

109
Q

cauda equina syndrome basics

A

surgical emergency
back pain: acute onset, painless urinary incontinence/retention, bilateral (or unilateral) leg radiculopathy, motor deficit, saddle anaesthesia, sexual dysfunction
symptoms are not specific or sensitive, if missed patients are often left with lifelong disability
get an MRI ASAP
discuss early with spinal surgeons

110
Q

what is degenerative spinal stenosis

A

is a common cause of disabling back and lower extremity pain among older persons. The process usually begins with degeneration of the intervertebral disks and facet joints, resulting in narrowing of the spinal canal and neural foramina.

111
Q

two causes of spinal infection

A

discitis

vertebral osteomyelitis

112
Q

what is discitis

A

nfection of the discs between the vertebra of the spine. Like appendicitis, discitis is usually a bacterial infection but may be viral.

113
Q

what is vertebral osteomyelitis

A

is a rare spinal infection. Osteomyelitis, the name for a painful bone infection that develops from bacteria or fungi, is itself rare. Vertebral osteomyelitis can happen as the result of an injury to your spine or after surgery.

114
Q

what is a dermatome

A

an area of skin in which sensory nerves derive from a single spinal nerve root

115
Q

what is a myotome

A

myotome refers to the muscles served by a spinal nerve root.

116
Q

describe inflammatory joint pain

A 
heavy leaden, burning, throbbing
presents/worsens with rest
improves with movement, stretching, cracking
significant stiffness
red, hot and swollen
flares or attacks
117
Q

describe mechanical joint pain

A 
sometimes absent
sharp or grinding 
most tolerable at rest
worsens with movement
reproduced with specific movement
occasionally swollen
118
Q

examples of inflammatory joint pain

A

rheumatoid arthritis
Psoriatic joint pain
gout
septic arthritis

119
Q

examples of mechanical joint pain

A

osteoarthritis
cartilage tear
tendon/ligaments

120
Q

where can hip synovitis pain be referred to

A

to the groin/outer thigh pain radiating to the knee

121
Q

carpel tunnel syndrome referred pain

A

pain or paraesthesia can be reported in all fingers but detailed assessment then is needed to disclose the 5th finger sparing

122
Q

describe bone pain

A

generally constant despite movement or change in posture unlike muscular, synovial, ligament or tendon pain
often disturbs sleep

123
Q

what is GALS and what does it stand for

A

a screen tool for joint examination

gait. arms, legs, spine

124
Q

describe the G in GALS

A

gait
observe gait
observe patient in anatomical position

125
Q

Describe the A in GALS

A 
Arms
observe movement -hands behind head
observe back of hands and wrists
observe palms
assess power grip and grip strength
assess fine precision pinch
squeeze MCPJs
126
Q

describe L in GALS

A 
legs
assess full flexion and extension
assess internal rotation of the hips
perform patellar tap
inspect feet
Squeeze MTPJs
127
Q

describe S in GALS

A

spine
inspect spine
assess lateral flexion of the neck
assess lumbar spine movement

128
Q

causes of gout

A 
male gender
increasing age in women
ethnicity
being overweight
alcohol use (beer being the highest risk)
renal insufficiency 
hypertension
129
Q

causes of psuedogout

A 
acute illness chest or urinary infection 
joint trauma
chondrocalcinosis
hyperparathyroidism
chronic vitamin d deficiency
hypomagnesaemia 
hypophosphatasia
haemochromatosis
130
Q

difference between gout and psuedogout

think about what crystals they form

A

Pseudogout and gout are both types of arthritis, and they’re both caused by the accumulation of crystals in the joints. While pseudogout is caused by calcium pyrophosphate crystals, gout is caused by urate (uric acid) crystals.

131
Q

clinical presentation of gout

A

characterized by sudden, severe attacks of pain, swelling, redness and tenderness in one or more joints, most often in the big toe. An attack of gout can occur suddenly, often waking you up in the middle of the night with the sensation that your big toe is on fire.

132
Q

clinical presentation of pseudogout

A

Physical examination findings show an acutely inflamed joint with swelling, effusion, warmth, tenderness, and pain on range of motion similar to acute gouty arthritis. This typically occurs in the knee but may be present in the wrists, shoulders, ankles, hands, and feet.

133
Q

clinical presentation of housemaids knee

A

aka prepateller bursitis
Tenderness and swelling superficial to the patella. Erythema and localised warmth of the skin over the patella. Reduced knee movement. Fever, tachycardia or signs of systemic upset may indicate septic bursitis

134
Q

clinical presentation of a ruptured bakers cyst

A

A Baker’s cyst can sometimes rupture (burst), resulting in fluid leaking down into your calf. This causes a sharp pain in your calf, which becomes swollen, tight and red, but redness can be harder to see on brown and black skin. The fluid will gradually be reabsorbed into the body within a few weeks.

135
Q

what is a bakers cyst

A

A Baker’s cyst can form when joint-lubricating fluid fills a cushioning pouch (bursa) at the back of your knee. A Baker’s cyst is a fluid-filled cyst that causes a bulge and a feeling of tightness behind your knee.

136
Q

what is a housemaids knee

A

Housemaids knee is a swelling in the sac at the front of the knee called the prepatellar bursa. This sac sits on top of the knee cap. The prepatellar bursa is one of four bursae in the knee. Less frequently, other bursae are affected.

137
Q 
rheumatoid arthritis 
gender it affects
age it affects
genetics 
environment
A

gender - before menopause it is 3 times more likely in women than men

age - mean age of onset is 30-50 but can affect any age

genetics - strong associations with HLA-DR4 and HLA-DR1

environment - smoking, infection, diet or hormonal

138
Q

some hand clinical features of rheumatoid arthritis

A 
ulnar deviation
Boutonniere deformity
z shaped thumb
swan neck deformity
MCP subluxation
139
Q

what is subluxation

A

A dislocation occurs when the bones in a joint become separated or knocked out of their usual positions. Any joint in the body can become dislocated. If the joint is partially dislocated, it is called a subluxation.

140
Q

what is a Boutonniere deformity

A

Boutonnière deformity is the result of an injury to the tendons that straightens the middle joint of your finger. The result is that the middle joint of the injured finger will not straighten, while the fingertip bends back.

141
Q

what are spondyloarthropathies

A
  • collective name given to seronegative inflammatory arthridites that are different to rheumatoid in their clinical features, because of different underlying pathophysiology
  • are not a small joint polyarthropathy of the hands and feet
  • may be symmetrical or asymmetrical
  • may involve the spine
  • often involves tendons rather than joints
142
Q 
psoriatic arthritis
gender
age
genetics
environmental
A 
is a spondyloarthropathy
gender - affects men and women equally
age - 30-50 but can affect any age
genetics - association with caucasians and HLA - B27
environment - HIV
143
Q 
enteropathic associated arthritis 
prevalence
gender
age
genetics
environmental risk factors
A

is a spondyloarthropathy
associated with bowel
prevalence: 1 in 5 people with IBD
gender: equal
age: 15-40 but older people can also be affected
genetics: more common in people of jewish descent
environment: bovine mycobacterium (drinking unpasteurised milk) , smoking

144
Q 
ankylosing spondlyitis
prevalence 
gender 
age 
genetics
environmental risk factors
A

is a spondyloarthropathy

prevalence: 1 in 1000
gender: 3x more common in men than women
age: peak age of onset is 17-35
genetics: 90% carry the HLA-B27 gene
environment: unknown

145
Q 
systemic lupus erythematous
prevalence
gender
age
genetics
environmental risk factors
A

an inflammatory arthritis
prevalence: 1 in 10,000
gender: 10x common in women than men
age: mean onset is 20-40
genetics: more common in afro-carribeans and asians, associated with HLA - DR2 and HLA - DR3
environmental risk factors: sun, smoking and medications such as isoniazid, phenytoin, carbamazepine, and sulphasalazine

146
Q

what is systemic lupus erythematous

A

Lupus is a condition that affects the immune system. It can cause problems with your skin, joints, kidneys and other organs.Symptoms of lupus include joint and muscle pain, extreme tiredness and a rash on your face.
There’s currently no cure for lupus, but the symptoms can often be treated with medicines that reduce inflammation in your body, such as steroids.
Lupus is caused by your immune system mistakenly attacking healthy parts of your body. It’s not fully understood why this happens.

147
Q 
define pannus
(what disease is it associated with)
A

a type of extra growth in your joints that can cause pain, swelling, and damage to your bones, cartilage, and other tissue. It most often results from rheumatoid arthritis, an inflammatory disease that affects your joints, though other inflammatory diseases are also sometimes to blame.

148
Q

what is an ANA test

A

an antinuclear test
generic test
can test for lupus

An ANA test detects antinuclear antibodies (ANA) in your blood. Your immune system normally makes antibodies to help you fight infection. In contrast, antinuclear antibodies often attack your body’s own tissues — specifically targeting each cell’s nucleus.

149
Q

reactive arthritis

A

a bowel, urogenital, or upper respiratory tract infection that triggers a sudden onset inflammatory arthritis
occurs around 7-10 days post infection
seronegative, often not symmetrical, often involving larger joints, often HLA - B27 positive
settles after 6-9 months

150
Q

blood tests to aid in diagnosis of inflammatory joint pain

A

inflammatory markers: ESR, CRP, PV
FBC
uric acid levels

151
Q

why is PV blood test raised in inflammatory joint pain

A

PV - plasma viscosity
it is a general measure of how much protein is in the serum
raised in inflammatory joint pain because of the antibodies produced

152
Q

common causes of hyperuricaemia

A

diuretic medications
increasing age
diet

153
Q

what is hyperuricaemia associated with

A 
hypertension
obesity
alcohol intake
diabetes
genetics

Hyperuricaemia or hyperuricemia is an abnormally high level of uric acid in the blood

(associated with gout)

154
Q

which colour of synovial fluid is indicative of an inflamed joint

A

yellow and not clear

155
Q

causes of hemarthrosis

A

-trauma or injury, like a sprain, fracture, or torn ligament.
surgery, including arthroscopic surgery.
-a bleeding disorder, such as hemophilia.
-medications used to prevent blood clots (blood thinners) such as warfarin.
-certain infections.

CBL Year 2 (14 decks)

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