Locomotor Core Conditions Flashcards by Rhean Rymell

What is the most common form of arthritis?

Osteoarthritis

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Who gets OA?

Women >55

Younger people who suffered injuries

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Causes of OA?

Wear and Tear
Active/inflammatory processes in response to injury
Ligament/tendon problems
Bone/cartilage damage

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What is the difference between primary and secondary OA?

Primary - no known cause

Secondary - known cause (joint damage, systemic disease)

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Risk factors for OA?

Increasing age
Female 
FHx
Previous joint injury/infection 
Intra-articular # or ligament tear 
Joint malalignment 
Slipped upper femoral epiphysis
Congenital dislocation of the hip 
Obesity 
Occupational stress 
Ethnic origin

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Symptoms of OA?

Seen in synovial joints 
Cartilage loss and periarticular bone response
Stiffness in the morning 
Pain 
Loss of ROM 
Grating/crepitus 
Joint effusion 
NO systemic illness 
Bony swelling and deformity
Heberden's and Bouchard's

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Differentials for OA?

Bursitis 
Referred pain from hip/spine
Psoriatic/Rh/infective arthritis
Pseudogout 
Connective tissue disease 
Seronegative arthritis 
Sarcoidosis/endocarditis which can present with arthropathy

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Investigations for OA?

Examination of joint 
Plain XR (osteophytes, narrow joint space, subarticular sclerosis, bone cysts )
BMI/weight 
MRI
FBC, CRP, creatinine, LFTs
Joint aspiration of synovial fluid

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Treatment for OA?

Education 
Weight loss 
Exercise 
NSAIDs (oral/gel)
COX-2 inhibitors (w/PPI)
IA corticosteroid injections 
Arthroscopic lavage (for joint locking)
Joint arthroplasty (if pain, stiffness,

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How many adults int he UK are affected by gout?

1 in 70

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Who gets gout?

M>F
Post menopausal women
People of Asian/Pacific island populations have more severe disease

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Causes of gout?

Hyperuricaemia
Kidneys usually excrete uric acid but an excess ends up in blood and can deposit crystals in cool temperature joints (distal)

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Risk factors for gout?

Diet rich in red meat
Diuretics 
Niacin 
Male 
Alcohol use 
FHx
Obesity 
HTN
Hyperlipidaemia 
Chronic renal failure 
DM
CHD

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Symptoms of acute sodium urate gout?

Sudden, agonising onset 
Swelling and redness of 1st MTP
Precipitating factor (food, alcohol, dehydration, diuretic)
W/o treatment will last 7 days 
Overlying cellulitis 
Mainly affects the great toe

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Symptoms of chronic polyarticular gout?

Unusual
Long standing diuretics w/renal failure
Men
Allopurinal started too soon after an acute attack

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Symptoms of chronic tophaceous gout?

Sodium urate forms tophi in skin at joints 9usually ear, finger, achilles tendon)
Chronic pain 
Restricted movement 
Crepitus 
Deformity 
Renal impairment/diuretics 
Punched out bone cysts on XR 
Urate renal stones formed

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General symptoms of gout?

Acute pain 
Swollen joints 
Tender
Erythematous 
Peaks in 25 hours 
Fever malaise 
Untreated should resolve in 5-15 days 
Itching and desquamation of overlying skin

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Differentials for acute gout?

Pseudo gout
Septic arthritis
Haemoarthrosis
Palindromic RhA

Differentials for chronic gout?

RhA
Generalised nodal OA
Xanthomatosis w/arthropathy
Multicentric reticulohistiocytosis

Investigations for gout?

Joint fluid microscopy
Serum uric acid (>600micromol/L - check again several weeks later as levels fall quickly after attack)
U+E
Renal function

Treatment for gout?

Ice, elevate
Weight loss, exercise, diet (inc reducing alcohol)
Increase fluid intake
NSAIDs (+PPI)
Colchicine (for pts with HF and anticoag)
Corticosteroids
Allopurinol

Who gets pseudogout?

> 50
M>F
Those with metabolic/familia causes

What causes pseudogout?

Calcium pyrophosphate deposition in synovial fluid of joints
Runs in families

Risk factors for pseudogout?

Male 
Increased age 
FHx 
Hypothyroidism 
Hyperparathyroidism 
Hypercalcaemia 
Mg def 
Haemophilia 
Ochronisis
Amyloidosis
Haemochromatosis

Symptoms of pseudogout?

Bouts of joint pain Swelling of affected joint with fluid build up Chronic arthritis Commonly affects knees (but also ankles, elbows, wrists)

Investigations for pseudogout?

Joint fluid aspiration and analysis | XR - calcification of cartilage and joint cavities

Differentials for pseudo gout?

RhA Gout OA

Treatment for pseudo gout?

``` Synovial fluid drain NSAIDs Colchicine Hydroxychloroquine Methotrexate Interleukin-1-B-antagonists ```

What % of prosthetic joints get infected?

2-10%

Who gets septic arthritis?

Any age Elderly with multiple morbidities Immunosuppressed

Causes of SA?

``` Staph aureus (and other staph) Strep Neisseria gonorrhoea H. flu in children Other gram -ve in the elderly ```

Risk factors for SA?

``` Artificial joint Bacterial infection elsewhere Chronic illness IVDU Immunosuppression Recently injured/surgery Overlying infection of skin/soft tissues ```

Symptoms of SA?

Single, red hot, swollen, painful, immobile joint Medical emergency Fever, rigors, systemic illness Vomiting, hypotension Effusion May be an abscess or loosening of prosthetic joint

Differentials for SA?

``` Gout/pseudogout Vasculitis Drug/reactive/viral arthritis Post infection diarrhoeal syndrome Post meningococcal/gonococcal arthritis Arthritis of intrinsic bowel disease Lyme disease Infective endocarditis ```

Investigations for SA?

FBC, inflammatory markers Aspirate and exam synovial fluid Culture bloods and synovial Swabs of anus, cervix, urethral, pharynx if gonorrhoea suspected Lyme disease test Immunology serology for RhA and vasculitis US CT/MRI for osteomyelitis/periarticular abscesses

Treatment for SA?

Abx - Pencillin + gentamicin, or cephalosporins IV Abx for 2-3 weeks Then oral for 2-4 weeks Joint drainage if not responding Splint in position of function Once infection is controlled immediately mobilise to prevent contractures

How many cases of subacute backpain are prolapsed discs?

<1 in 20

Who gets slipped discs?

30-50 | M>F

Causes of slipped disc?

Annulus fibrosus braks and the nucleus pulposus protrudes Old age decreases water content of discs Sneezing Awkward bending Heavy lifting

Risk factors for slipped disc?

``` Lots of sitting Smoking Overweight Weight bearing sports Traumatic injury to back Lots of lifting ```

Symptoms of slipped disc?

``` Pain in lower back Severe, acute Better when lying flat Worsened by movement/coughing/sneezing Can be asymptomatic if no cord compression Sciatica (lasting, aching pain in leg) Muscle pain/spasm from affected nerve supply Urinary incontinence ```

Symptoms of cauda equina and nerve roots involved?

``` Loss of function of L2-S5 Lower back pain Saddle anaesthesia Paralysis of one or both legs Rectal pain Bowel disturbances Urinary incontinence Inner thigh pain ```

Investigations for slipped disc?

``` Physical exam (peripheral nerves) Straight leg raise (no more than 2/3rds before tingling, pain, numbness) XR MRI for surgery Discography (contrast and XR) ```

Treatment for slipped disc?

``` Exercise and maintain AODL Paracetamol/NSAIDs Codeine Diazepam for muscle spasms Physio Osteopath Surgical removal of prolapse ```