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Medicine 2 > MST Week 5 (osteoarthritis And Rheumatoid Arthritis) > Flashcards

MST Week 5 (osteoarthritis And Rheumatoid Arthritis) Flashcards

1
Q

What are synovial joints

A

All the joints of the lower limb (hip, knee and ankle) are synovial joints

The 2 articulating bones are separated by a joint cavity

Bearing surfaces have an articulate cartilage converting

They are richly innervated

Each has an anastomosis (blood supply)

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2
Q

Describe the hip joint

A

Strong and stable joint (ball and socket is deep)

Ball and socket synovial joint

Wide range of movements

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3
Q

Possible movements in the hip joint

A

Flexion / extension

Abduction / adduction

Inward / outward rotation

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4
Q

Describe the functions of the different ligaments of the hip

A

Illiofemoral ligament - prevents hyperextension. Strong

Pubofemoral ligament - prevents excessive abduction

Ischiofemoral ligament - weak

Work together to keep the femoral head in acetabulum (reinforced by muscles)

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5
Q

How does shentons line help diagnose fractures of the hip

A

It should be a curved, continuous smooth line on a scan so if its not, that is a good indicator

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6
Q

Action of hamstrings on posterior compartment of thigh

A

3 muscles: biceps femoris, semitendinous, semimembranosus

Extension of hip and flexion of knee

So cross hip joint ( attach to ischial tuberosity)

Innervated by sciatic nerve

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7
Q

Damage to superior gluteal nerve

A

Normally the gluteus medius and minimus contract to keep pelvis level when contralateral foot is off floor

When damaged, the gluteus medius and minimus do not contract to keep pelvis level

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8
Q

Describe the knee joint

A

Quite strong and stable

Hinge synovial joint

Primarily flexion and extension
Limited rotation

In full extension and foot on ground the knee is ‘locked’ due to some medial rotation - forms a strong column for weight bearing

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9
Q

Function of knee ligaments

A

Anterior cruciate ligament - limits posterior rolling of femur on tibia and hyper extension

Posterior cruciate ligament- limits anterior rolling of femur on tibia and hyper extension

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10
Q

How can you test the collateral ligaments

A

1) take leg in the hands with knee straight
2) gently abduct the knee to test fibular collateral
3) gently adduct the knee to test tibial collateral
4) there should be little movement

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11
Q

How do you test the cruciate ligaments

A

1) patient lies with knee flex at 90 degrees
2) sit on the foot of the leg to be tested
3) pull the leg forward from the tibia this test the anterior cruciate
4) push the leg back this tests the posterior cruciate
5) it is called the drawer test
6) there should be little movement

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12
Q

Function of the menisci

A

Important in shock absorption

Medial meniscus is less mobile than the lateral meniscus

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13
Q

How do you unlock the knee

A

In full extension and foot on the ground the knee is ‘locked’ due to some medial rotation of femur on the tibia

Many muscles can relax in this position

To ‘unlock’ the knee- popliteus contracts to laterally rotate the femur on the tibia by 5 degrees

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14
Q

What is bursitis

A

Many bursae around the knee
Can get inflamed
Become distended and form a painful swelling

Can also form cysts in the popliteal region = bakers cysts
Maybe from bursa, can also be sacs from synovial membrane

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15
Q

Describe the ankle joint

A

Stronger and more stable during dorsiflexion
Relatively unstable during plantarflexion
Hinge type synovial joint
Tibia / fibula forms a mortise into which body of talus fits

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16
Q

Function of the ankle joint

A

Allows dorsiflexion and plantarflexion with small amounts of other movements allowed in plantarflexion due to instability eg Evers ion and inversion

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17
Q

Describe ankle sprains

A

Anterior talofibular ligament: the one most likely to be damaged in an ankle sprain, can be partially or fully torn

The calcaenofibular ligament may also be torn

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18
Q

Dislocation of the ankle joint

A

Called a pott fracture
Due to foot being forcibly exerted
Medial ligaments strong- can fracture medial malleolus
Talus moves in a lateral direction- fracturing lateral malleolus or fibula

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19
Q

What are the 7 tarsal bones of the foot

A 
Talus 
Calcaenus 
Navicular 
Cuboid 
3 cuneiforms: medial, intermediate, lateral
20
Q

What is hilton law

A

The nerve supplying the muscles that cross over and act on a joint, also innervate that joint

21
Q

Benefits and drawbacks of X-rays

A

Quick and inexpensive
Usually detect most fractures
Low radiation dose

Dependent on skill of doctor
Overlapping structures can cause subtle injuries to be missed

Poor examination for soft tissue pathology

22
Q

Benefits of CT scans

A

Relatively quick for scanning large areas of the body and readily available

Provides good anatomical information in multiple planes

Greater sensitivity for detection of fractures

23
Q

Cons of CT scans

A

Larger doses of radiation compared to X-ray

Prone to metal artefact which obscures images

Contrast resolution is relatively poor for soft tissues

24
Q

Benefits of MRI

A

Excellent anatomical detail of soft tissues

Multiple planes and sequences allows detection of subtle abnormalities

Radiation sparing investigation

25
Q

Cons of MRI

A

Time consuming and expensive

Cannot be used in all patients (pacemaker of metal work, claustrophobic)

Limited anatomical information of bony structures

26
Q

Benefits of ultrasound

A

Quick, inexpensive and radiation sparing

Allows real time assessment

Excellent for assessment of superficial soft tissues, vessels and some joints

27
Q

Cons of ultrasound

A

Highly user dependent

Poor assessment of deep structure and bone

Limited field of view at any time

28
Q

What is contrast imaging

A

Contrast can be administered into joint spaces or vessels to allow for more depth in assessment or to assist with interventions

29
Q

Limb imaging modalities

A

Bones: X-ray, CT and MRI

Soft tissues: US and MRI

Vessels: fluoroscopy, US, CT and MRI

30
Q

What scans are used for trauma, infection and malignancy of bones

A

Trauma: X-ray, CT
Infection: X-ray, MRI
Malignancy: X-ray, MRI

31
Q

What scans are used for arthritis, infection and dislocation of a joint

A

Arthritis: X-ray, US, MRI
Infection: X-ray, US, MRI
Dislocation: X-ray, CT

32
Q

What is the diaphysis

A

Shaft / largest part of the long bone

33
Q

What is metaphysis

A

Wide portions of long bone either side of the diaphysis

Region where bone growth occurs

34
Q

What is epiphysis

A

Rounded ends of the long bone

Contributes to the joint surface

35
Q

What is physis

A

Also known as growth plate

Ossifies once individual is skeletally mature

36
Q

What is apophysis

A

Site of tendon / ligament attachment which eventually ossifies

37
Q

What is sesamoid bone

A

Bone with ossifies within a tendon

38
Q

What is a synovial joint

A

2 articulating bones lined with hyaline cartilage

Surrounded by synovial lined capsule

Peri-articular soft tissues are low density on X-ray (can appear more conspicuous when there is an abnormality)

39
Q

What are the elbow lateral lines

A

Anterior humeral line: should pass through the middle third of capitellum

Radiocapitellar line: should intersect the capitellum

Anterior fat pad: small volume anterior fat pad is usually normal
Posterior fat pad is always pathological

40
Q

What is osteoarthritis

A

98% of us will get it if we live long enough

Frequent X-ray report (not all symptomatic)

41
Q

Characteristics of OA

A

Muscle weakness
Angiogenesis
Neural in growth
CNS adaptation

42
Q

What is central tolerance

A

Generated in the primary lymphoid organs

Occurs in the bone marrow for B cells and in the thymus for T cells

For immature lymphocytes, strong interaction with antigen induces apoptosis rather than activation
Leads to clonal detection of immature auto reactive lymphocytes that interact with autoantigens in the primary lymphoid organs

43
Q

What is peripheral tolerance

A

Ignorance - tissue antigens that are not exposed to lymphocytes or are presented in such small amounts that they cannot activate lymphocytes

44
Q

What are anti-citrullinated protein antigen antibodies

A

Present in about 85% of RA patients
Rare in other diseases and healthy individuals
Citrulline is formed by the enzymatic de-imination of arginine in proteins

45
Q

What is osteoarthritis

A

Degenerative joint disease

Non inflammatory

Loss of articular cartilage

Results in new bone formation at joint margins

46
Q

What joints are commonly involved in osteoarthritis

A 
Hips 
Knees
Spine
Ankle
Shoulder
Wrist
Base of thumb (1st carpometacarpal)
47
Q

What is a full gait cycle

A

A single stance phase followed by a single swing phase

Starts with the heel strike (first foot contact) of one leg

Medicine 2 (16 decks)

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