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Flashcards in Musculoskeletal disorders? Deck (28):
1

What is antalgic gait?

a limp with weight bearing on the unaffected side, decreased swing phase of unaffected limb

2

Radiographic features of arthritis?

Joint space narrowing
Subchondral cysts
Osteophytes
Sclerosis

3

Clinical features of osteoarthritis?

Morning stiffness

4

Who does OA affect commonly?

Women

5

Management of OA?

Line 1: Education advice, weight loss support, strengthening exercises

Line 2: Paracetamol, topical NSAIDS

Line 3: Oral NSAIDs, opioids, capsaicin, injections, arthroplasty, supports/assisting devices

6

What is a T score?

Measurement of bone mineral density

7

T score in osteoporosis and osteopaenia?

T score of -1.0 to -2.5 - osteopaenia
T score of less than -2.5 - osteoporosis

8

What is osteopenia?

Slightly reduced bone mineral density

9

In what situations should you give a DEXA scan?

• Low trauma (osteoporotic) #
• Height loss/kyphotic
• Vertebral deformity on X ray
• FHx of #
• Steroid use
• Early menopause
• Low BMI
• Heavy smoker/excess alcohol/ malabsorption

10

Treatment choices for osteoporosis? Examples?

SERMs (Selective Estrogen Receptor Modulator) e.g. raloxifene

Bisphosphonates e.g. alendronate

Teriparatide is a synthetic parathyroid hormone

Denosumab

HRT

Exercise

Calcitonin

11

Mode of action of SERMs and Bisphosphonates?

SERMs - inhibit bone resorption by stimulating oestrogen receptor in bone

Bisphosphonates - bind to hydroxyapetite and inhibit osteoclast bone resorption

12

Risks associated with bisphosphonates?

Oesophageal ulcers

13

Risks associated with SERMs?

Risk of VTE

Worsen peri-menopausal vasomotor symptoms

14

When would you use a SERM?

Healthy post menopausal women worried about breast cancer, with vertebral osteoporosis (not effective in hip)

15

Teriparatide mode of action?

synthetic parathyroid hormone - increases formation more than it increases bone resorption.

16

Denosumab mode of action?

Inhibits formation of osteoclasts.

17

When would you use Teriparatide?

Steroid induced osteoporosis

18

Basic process of bone formation?

Bones initially appear as flat layers of CT

Mesenchymal stem cells in the CT differentiate to form osteoblasts

Bone matrix builds up to form trabeculae

Trapped osteoblasts become osteocytes

19

Basic process of cartilage formation?

Development of primary ossification centre at diaphysis

Marrow cavity formed by death of chondrocytes within bony collar

Longitudinal bone growth formed by chondrocyte hypertrophy at growth plate

20

Why does bone remodelling occur?

Adaptation to mechanical loading

Enabling fracture healing

Prevents “bone fatigue” by continually renewing matrix

21

Patho-physiology of arthritis?

Focal destruction of articular cartilage

Remodelling of adjacent bone = hypertrophic reaction at joint margins (osteophytes)

Remodelling and repair process (efficient but slow)

22

R/F for osteoarthritis?

Family history (genetics)

Obesity


Ligament rupture
Fracture through joint
Malalignment

Occupational factors

23

OA treatments?

Exercise

Capsaicin

NSAIDS

Opioids

Joint steroid injection

Replacement

TENS machine

24

What is an autologous bone graft, and a allogenic bone graft?

Specific bone graft with the patients human stem cells - autologous

Off the shelf made from an animals stem cells - allogenic

25

Advantages and disadvantages to an autologous bone transplant graft over allogenic?

No infectious disease risk

Patient specific therapy

High mfg. cost

26

Main differences in bone and cartilage?

Inorganic matrix in bone is heavy mineralised, in cartilage it is only mineralised in the growth plate

Bone is 90% collagen 4% proteoglycans, cartilage is 50% collagen and 50% proteoglycans

Cartilage is avascular and bone is vascular

Bone undergoes appositional growth and cartilage interstitial

27

Two types of bone formation?

Intramembranous - on top of a membrane

Endochondral - on top of cartilage

28

R/Fs for osteoporosis?

Age

Female

FH

Asian/caucasian

Cigarettes/Alcohol