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
