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Flashcards in Musculokeletal Deck (42)
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1

What proportion of the population don't have musculoskeletal symptoms?

42%

2

What are the leading causes of sickness absence from work?

Back, neck and upper limb pain

3

Name 5 bone diseases

Osteoporosis
Osteomalacia/rickets
Bone malignancy
Paget's disease
Osteomyelitis

4

Name 5 joint disorders

Osteoarthritis
Inflammatory arthritis
Crystal arthritis
Septic arthritis
Haemarthosis

5

Name 5 disorders of muscle

Polymyalgia rheumatica
Polymyositis
Dermatomyositis
Pyomyositis (abscesses)
Neurological issues

6

Name 4 connective tissue disorders

SLE
Systemic sclerosis
Sjogren's syndrome
Vasculitis

7

What gait to people with severe OA have?

Antalgic gait
Weight bears on unaffected side
Decreased swing phase on unaffected side

8

What are the 4 changes seen on xray in OA?

Joint space narrowing
Sclerosis
Subchondral cysts
Osteophytes

9

Features of OA

Morning stiffness50yrs
Bony enlargements/tenderness
Symmetrical, polyarticular

10

Pathophysiology of OA

Ligament damage
-> instability/malalignment
-> increased load and microtrauma
-> remodelling of adjacent bone (osteophytes)
2º synovial inflammation and crystal deposition

11

Risk factors for OA

FH
Obesity
Ligament rupture/fracture through joint/malalignment
Occupation

12

Assessment in OA

Effects on activities of daily living
(family duties, hobbies, sleep, occupation)
Pain medication, waking at night?
Self help strategies
Beliefs/expectations/mood

13

Management of OA

Physio, exercise, weight loss
Local heat and cold
Supports, braces, insoles
Paracetamol and topical NSAIDs
Capsaicin, oral NSAIDs, opioids
Intra-articular joint injections
TENS (transcutaneous electrical nerve stimulation)
Joint arthroplasty

14

What is DEXA?

Dual energy xray absorptometry

15

What is normal with a DEXA scan?

T score of more than -1

16

What DEXA reading counts as osteoporosis?

Less than -2.5

17

Who should have a DEXA scan? (Give 8 indications)

Prior low trauma fracture
Height loss & kyphosis on examination
Vertebral deformity on spine xray
Steroid users
FH of fracture
Early menopause
Heavy smokers/excess alcohol/malabsorption
FRAX score

18

What is FRAX?

Osteoporosis fracture predicting system
Age, DOB, sex, weight, height
Previous fracture?
Parental hip fracture?
Current smoker?
Glucocorticoids?
RA?
2º osteoporosis?
Alcohol>3units per day
Femoral neck BMD

19

What does a FRAX score of 10% in a 80 yr old mean?

10 year probability of major osteoporotic fracture is 10%
Not within treatment level (Needs to be >30% in over 80yr olds)

20

Why is HRT not recommended for osteoporosis anymore?

Increases risk of CHD, stroke, breast cancer and VTE

21

What is recommended for treatment of osteoporosis?

Raloxifene
Bisphosphonates
Synthetic parathyroid
Dietary calcium, Vit D
Weight bearing exercise
Smoking cessation
Alcohol restriction

22

What are the revision rates for arthroplasty?

5% at 7rs
15% at 7yrs is metal on metal

23

How do you engineer tissue?

Bone stem cells + inductive agents + conductive scaffold/forces

24

Where can you derive stem cells for bone grafts?

Embryonic
Induced pluripotent
Adult derived skeletal stem cells
Trabecular bone periosteum
Placental/umbilical cord blood
Foetal derived

25

What can bone stem cells form?

Cartilage, bone and fat
Dependent on growth factors (BMPs, VEGF)

26

Positives and negatives of allogenic bone grafts

Off the shelf
Risk ratio life threatening situations
Reduced manufacturing costs
Process favoured

27

Positives and negatives of autologous bone grafts

No infectious disease risk
Patient specific therapy
High manufacturing costs
Custom variability
Disease/previous therapy issues

28

How has CAD CAM aided bone grafts?

3D printed hydroxyapatite scaffolds
Bone stem cells can proliferate
= bone formation
3D printed titanium constructs for hip revisions and osteointegration tailored to individual's bone

29

What are osteoblasts derived from?

Mesenchymal stem cells

30

What are the most abundant cells in bone? Function?

Osteocytes
Can perceive changes in mechanical forces and transmit signals to other cells
Central in bone remodelling