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Orthopedic Pathology > Orthopedic Pathology 5 Joint Pathologies > Flashcards

Orthopedic Pathology 5 Joint Pathologies Flashcards

(46 cards)

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0
Q

Planar joint

A

Ex: Navicular and the second and third cuneiforms of the tarsus in the foot

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1
Q

Synovial Joint

A

Are diathroses or diathrodial joint
Most common and most movable joint in body
Capsule surrounds the articulating surfaces of a synovial joint
Lubricating synovial fluid within the capsule

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2
Q

Hinge joint

A

Ex: Trochlea of humerus and trochlear notch of ulna at the elbow

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3
Q

Pivot joint

A

Head of radius and radial notch of ulna (annular ligament attached to Ulna is holding radius)

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4
Q

Condyloid joint

A

Between radius and scaphoid and lunate bones of the carpus

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5
Q

Saddle joint

A

Between trapezium of carpus (wrist) and metacarpal of thumb

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6
Q

Ball and socket joint

A

Acetabular femoral joint

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7
Q

Cartilage

A

Avascular CT
No nerve supply
Consists of a dense network of collagen fibers and elastic fibers embedded in chondroitin sulfate
Surrounded by perichondrium

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8
Q

Hyaline cartilage

A

The most abundant but weakest type of cartilage
Fine collagen fibers embedded in a gel type matrix
provides flexibility and support
reduces friction and absorbs shock at joint

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9
Q

Reaction of Articular cartilage

A

Destruction - actively being damaged (trauma), RA, infections, AS, continual compression such as overweight, immobilization, poor posture, corticosteroid injections
Degeneration - overtime, premature aging by overuse, previous destruction, incongruity of joint or irregular joint surface
Peripheral proliferation - osteophyte (bone spur) formation, OA

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10
Q

Reactions to Synovial Membrane

A

Increase production of fluid from synovial membrane - effusion (extra synovial fluid)
Thickening of membrane - hypertrophy
Adhesions post injury

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11
Q

Reactions of joint capsule and ligaments

A

Joint laxity - after injury, congenital (Trisomy21, Marfan’s), pregnancy (hormone relaxin), infection
Joint Contractures - disuse, congenital, infection, arthritis, due to muscle Contractures

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12
Q

Joint Deformity

A

Displacement of the joint - subluxation, dislocation
Excessive Mobility
Restricted Mobility

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13
Q

Gout

A

AKA metabolic arthritis
A group of disorders in which crystals of monosodium urate (uric acid) are deposited in the tissue, accompanied by attacks of acute arthritis
Marked by an elevated level of serum uric acid and the deposition of urate crystals in the joints, soft tissue and kidneys

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14
Q

Pathogenesis of Gout

A

Normal

  • Uric acid is normally formed with the break down of purines
  • Uric acids dissolves in the blood, passes through the kidneys and is then excreted

Abnormal

  • With too much production or with poor kidney function uric acid may precipitate out of blood and accumulate in body tissues
  • Crystals frequently collect on articular cartilage
  • These trigger and inflammatory response resulting in local tissue necrosis and proliferation of fibrous tissue
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15
Q

Three groups of Gout

A

Primary Hyperuricemia
- inherited disorder of uric acid metabolism
Secondary Hyperuricemia
-Occurs as a result of some other metabolic problem
-Increased DNA trunover d/t Leukemia, lymphoma, chemotherapy
Ideopathic hyperuricemia

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16
Q

Cause of Gout

A

Can be the result of urate overproduction or decreased urinary excretio of uric acid

Diet rich in purines

  • nitrogen containing compounds found in food
  • Purine-containing foods: red meats, organ meats, shelfish, sweet breads, dairy, beer

Male>female 9:1
Usually 40-50 years

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17
Q

Risk factors of Gout

A 
Obesity
Excessive weight gain, especially with puberty
Moderate-heavy alcohol intake
Hypertension
Abnormal kidney function
Certain medications
Certain diseases - lymphoma, leukemia, hemoglobin disorders, increased nuclear-protein turnover
Decreased thyroid function
Dehydration
Excessive dining
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18
Q

Signs/Symptoms of Gout

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A

Most common - first MTP joint
Can also affect wrists, fingers, knees, elbows and ankles
Rapid onset pain, swelling, heat, redness, tenderness, +/- fever
Nodular masses of uric acid depositing in soft tissues of body - tophi (massive uric acid deposit)
Tends to be unilateral

19
Q

Diagnosis of Gout

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A

Differential diagnosis septic arthritis, RA, neoplasm (new growth=cancer/tumor)

Made when

  • Monosodium urate crystals (tophi) are found within synovial fluid, connective tissue or articular cartilage
  • Serum uric acid levels are elevated
20
Q

Treatment of Gout

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A

Goals of intervention

  • To end acute attacks and prevent recurrent attacks (NSAIDS, Cholchicine)
  • correct the hyperuricemia

Adequate fluid intake
Weight reduction
Dietary changes
Decrease alcohol (increases purine catabolism)
NSAIDS, corticosteroid injections, colchicine
Uric acid inhibitor

21
Q

Pseudogout

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A

Is a joint disease that causes attacks of arthritis
Involves the formation of crystals in the joint - Salt - calcium pyrophosphate dihydrate
Leads to joint swelling and pain in the knees, wrists, ankles, etc.
Mainly affects elderly
Younger patients with hemochromatosis, parathyroid or thyroid disease

22
Q

Diagnosis of Pseudogout

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A

Joint fluid, WBC, Calcium crystals, Xray

23
Q

Treatment of Pseudogout

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A

NSAIDS, steroids

Aspiration of fluids (suck the fluid out)

24
Traumatic Arthritis
Caused from blunt, penetrating or repeated trauma | From inappropriate motion of joint
25
Symptoms of Traumatic arthritis
Pain, swelling, tenderness, joint instability, bleeding
26
Traumatic arthritis pathogenesis
Injury to a joint such as a bad sprain or fracture can cause damage to the articular cartilage - This damage does not appear until months later - Cartilage is replaced with scar tissue that can not support weight and is not as smooth The injury could alter how the joint works -This can increase force on the articular cartilage
27
Loose bodies
Aka joint mice Small pieces of bone or cartilage in the joint space (any joint, elbow) Due to trauma, repetitive action, injury, wear and tear, aging, DJD, etc May cause pain, clicking, sticking, locking, crepitus Visible on x-ray
28
Hemarthrosis
Bleeding into joint spaces Acute - trauma/surgery (ACL) Chronic - inherited condition, infection Can be complications of anticoagulant treatment -e.g. aspirin, warferin, coumadin
29
Signs/Symptoms of Hemarthrosis
Marked inflammation, pain, swelling, redness, abnormal functioning Blood damages cartilage and erodes subchondral bone
30
Treatment of Hemarthrosis
Manage bleeding Immobilization, analgesic, aspirate joint, monitor meds Gradually return to ADL's
31
Infectious Arthritis
AKA septic arthritis, | Joint inflammation as a result of infection can be due to bacteria, fungus, virus)
32
Common Bacterial pathogens
Staphylococcus aureus - the most common cause in adults Haemophilus influenzae - the most common cause in children Neisseria gonorrhoea - in sexually active young adults Escherichia coli - in the elderly, IV drug user and the seriously ill M. Tuberculosis - cause septic spinal arthritis (Pott's disease) Streptococcus Gonococcus
33
How does an infection get into the joint
``` Septicema - blood borne Direct infection - needle users latrogenic - medical treatment Catheters Trauma Immunocompromised patients ```
34
Pathology of infectious arthritis
Bacteria adheres to synovium -leads to scar tissue and synovium proliferation -Hydolysis of proteoglycans and collagen (breaks down articular cartilage) Cartilage and bone destruction occur -takes a very short time for joint death and direct pressure necrosis
35
Clinical manifestations of infectious arthritis
Acute onset of joint pain, swelling, tenderness, loss of motion males = females Fever, chills Pus Skin lesions Polyarthralgia Joints primarily affected - shoulders, knee, hips
36
Diagnosis of Infectious arthritis
PE - Pain, swelling, redness in joint History - Sexually Transmitted Infections (STI)'s, IV drug use, Immuno Complex state, surgery, trauma Blood test - increased WBC count, high RBC sedimantation rate Fever Aspirate and culture synovial fluid X-ray
37
Treatment of Infectious Arthritis
Medical emergency Antibiotic via IV Drain infected joint to decrease pain Rest
38
Prognosis of Infectious Arthritis
Acute nongonococcal bacterial arthritis can destroy articular cartilage, permanently damaging the joint within hours or days
39
Psoriatic arthritis
Is an arthritis often associated with psoriasis of the skin 1 in 20 will develop arthritis with the skin condition Idiopathic Primarily affects distal joints of fingers and toes When spine is affected (L/S and sacrum) Stiffness burning pain
40
Psoriatic arthritis diagnosis
PE, joint swelling skin soreness
41
Psoriatic arthritis treatment
``` NSAIDS Antirheumatic drugs (Methotrexate) Steroids Surgery RMT, PT, Chiro ```
42
Charcots arthropathy
- AKA Charcot joint, Charcot foot, neuropathic arthropathy - Progressive degeneration of the stress-bearing portion of a joint - Most commonly associated with diabetic neuropathy - Most commonly occurs in the foot - involves bone destruction and reabsorption leading to deformity, dislocation, ulcerations, bone fragments and an unstable joint
43
Cause of Charcots Arthropathy
Any condition that decreases peripheral sensation, proprioception and fine motor control DM neuropathy m/c
44
Signs and Symptoms of Charcots arthropathy
swelling, warmth, redness, subluxation/dislocation, deformity, fractures, collapsed arch, calluses, foot ulcers, joint infections, hemarthrosis, septicemia Most commonly foot deformity - 60% Tarsal metatarsal joint (more medial than lateral) - 30% Metatarsal pharyngeal joint
45
Treatment of Charcots arthropathy
``` proper footwear Orthotics Rest Surgery Antibiotics ```

Orthopedic Pathology (6 decks)

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