Flashcards in Musculokeletal Deck (42)
What proportion of the population don't have musculoskeletal symptoms?
What are the leading causes of sickness absence from work?
Back, neck and upper limb pain
Name 5 bone diseases
Name 5 joint disorders
Name 5 disorders of muscle
Name 4 connective tissue disorders
What gait to people with severe OA have?
Weight bears on unaffected side
Decreased swing phase on unaffected side
What are the 4 changes seen on xray in OA?
Joint space narrowing
Features of OA
Pathophysiology of OA
-> increased load and microtrauma
-> remodelling of adjacent bone (osteophytes)
2º synovial inflammation and crystal deposition
Risk factors for OA
Ligament rupture/fracture through joint/malalignment
Assessment in OA
Effects on activities of daily living
(family duties, hobbies, sleep, occupation)
Pain medication, waking at night?
Self help strategies
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)
What is DEXA?
Dual energy xray absorptometry
What is normal with a DEXA scan?
T score of more than -1
What DEXA reading counts as osteoporosis?
Less than -2.5
Who should have a DEXA scan? (Give 8 indications)
Prior low trauma fracture
Height loss & kyphosis on examination
Vertebral deformity on spine xray
FH of fracture
Heavy smokers/excess alcohol/malabsorption
What is FRAX?
Osteoporosis fracture predicting system
Age, DOB, sex, weight, height
Parental hip fracture?
Alcohol>3units per day
Femoral neck BMD
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)
Why is HRT not recommended for osteoporosis anymore?
Increases risk of CHD, stroke, breast cancer and VTE
What is recommended for treatment of osteoporosis?
Dietary calcium, Vit D
Weight bearing exercise
What are the revision rates for arthroplasty?
5% at 7rs
15% at 7yrs is metal on metal
How do you engineer tissue?
Bone stem cells + inductive agents + conductive scaffold/forces
Where can you derive stem cells for bone grafts?
Adult derived skeletal stem cells
Trabecular bone periosteum
Placental/umbilical cord blood
What can bone stem cells form?
Cartilage, bone and fat
Dependent on growth factors (BMPs, VEGF)
Positives and negatives of allogenic bone grafts
Off the shelf
Risk ratio life threatening situations
Reduced manufacturing costs
Positives and negatives of autologous bone grafts
No infectious disease risk
Patient specific therapy
High manufacturing costs
Disease/previous therapy issues
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
What are osteoblasts derived from?
Mesenchymal stem cells