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47 Cards in this Set
- Front
- Back
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What is osteoarthritis? |
protective articular caritlage on the ends of bones wears down over time (progressive) irreversible |
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Which joints does osteoarthritis affect and which are MC? |
weight bearing joints MC = knee and hip
med. and lat. femoro-tibial, and patellofemoral compartments- tricompartment syndrome of the knee |
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Which joints does osteoarthritis not affect? |
wrist, MCP, ankle, and elbow |
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What is osteoarthritis associated with? |
-genetic predisposition -W>M -age, obesity, trauma, metabolic (acromegaly, gout, hyperparathyroid), hyperparathyroidism, hemochromatosis, charcot joint -congenital defects: subcaptial femoral epiphysis (SCFE), congenital hip dysplasia -acquired: epiphysis dysplasia |
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S/S of osteoarthritis |
-Herberdens nodes at DIP -Bouchards nodes at PIP -fusiform swelling of joints -loss of ROM -effusions -crepitus -pain -start up pain- gets better as the day goes on (lasts about 30m) -Genu algum; severe lat. wear of knee jt causing laxity of med. ligament causing knock knee -Genu varum; sever med. wear of knee jt causing laxity of lat. ligament (bow legged) |
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Dx of osteoarthritis |
lab studies- -fluid analysis: synovial fluid debris, absent of crystals, absent of white cells/organism -serum lab
radiographic findings- -narrowing of joint space -osteophytes, chondral irregularity, boney cystic changes, articular surface sclerosis -osteophytes are secondary bone growth, its the born trying to fix itself |
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Tx for osteoarthritis |
-bracing -medical management -pt education (wt. loss, activity precaution) -exercise (brace PRN) -cold therapy first then heat -NSAID (decrease prostaglandins) -COX-2 Celecoxib (Celebrex), Meloxicam (Mobic): inhibits Cox-1 &2 enzyme and decreasing the conversation of arachidonic acid to PGs; Celebrex is only one that is Cox-2 specific -cortisone injections: 6-8wks (can repeat) -hyaluronic acid injections: Hyalgan, Supartz, OrthoVisc, Synvisc, Eufflexa are all only approved for knee injections -Arthroplasty -surgical management: conservative fails then total joint arthroplasty on knee, hip, shoulder, elbow, or ankle |
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What is rheumatoid arthritis? |
systemic autoimmune disorder causing inflm synovitis that erodes and destroys articular cartilage |
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What are extra-articular manifestations of rheumatoid arthritis? |
-Heart: pericarditis, vasculitis, valvular, and valve ring nodules, myocarditis -Lung: pleural effusion, bronchiolitis -Skin: fragility, nodules, "onion skin" from prednisone -Neuro: neuropathy, cervical myelopathy, peripheral neuropathy -Hematology: anemia, thrombocytosis -Bone: osteopenia -Eye: sicca, episcleritis, scleromalacia, perforans (sicca = sjorgens: AI disease that destroys exocrine glands that produce tears and saliva) -Kidney: amyloidosis, vasculitis |
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What is the etiology behind rheumatoid arthritis? |
genetic predisposition + trigger F>M 35-50 y/o RA in men <40 is unusual HLA-DR4 = increased incidence and severity
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What joints does rheumatoid arthritis MC affect? |
hands, wrist, shoulder, elbows
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S/S of rheumatoid arthritis |
-bilat symmetric polyarthritis -malaise and fatigue -stiffness (esp in morning- lasts 30m) -pain and tenderness -effusion -symmetric arthritis -rheumatoid nodules -deformity of hand and finger (ulnar dev., swan neck, boutonniere) |
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Dx of rheumatoid arthritis |
-sx present for >6wks -4/7 criteria -acute phase: ESR, CRP, plts -CBC: anemia (normochromic, normochytic) |
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Dx Criteria for RA |
-morning stiffness -arthritis >3 jts for >6wks -arthritis of hand its >6wks -symmetric arthritis for >6wks -rheumatoid nodules - +serum rheumatic factor -radiographic changes |
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Osteoarthritis VS RA -onset -inflm -location -findings -bone changes -labs -tx goal |
OA -gradual - - -DIP/WB jts -herberden's nodes -osteophytes -nl -pain control
RA -gradual - + -MCP/PIP jts -ulnar deviation, swan neck -periarticular osteoporosis and erosions - + Rf, ESR, anemia -control inflm |
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What is septic arthritis caused by? |
-destruction of synovium and cartilage -hematogenously or direct inoculation |
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Who usually gets septic arthritis? |
-children after URI -adults with RA -adults with gonococci infx -adults <30 neisseria ghonorrhea |
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What is the MC bacteria that causes septic arthritis? |
staph aureus |
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S/S of septic arthritis in an infant or child |
-acutely ill -high fever -tachycardia -irritability and pain with motion of jt -child who previously has been walking and now refuses |
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S/S of septic arthritis in adults |
-sepsis is secondary to total jt arthroplasty -vague discomfort -limited jt motion -swelling, deformity -redness -warm -holds it in position of comfort (flex) |
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how do dx septic arthritis |
-DDx: slipped capital femoral epiphysis -CBC -ESR -CRP -AP/LAT X-rays -blood cultures -jt aspiration for fluid analysis -gram stain and culture |
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tx for septic arthritis |
-abx broad spectrum until culture are back (Amoxicillin, Ciprofloxacin) -surgical decompression and drainage by arthroscopy or open arthrotomy (esp in hip infix to prevent osteonecrosis) |
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What is gout? |
deposition of crystals in synovium and other tissues causing an inflm process (monosodium irate crystals) |
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What are joints that gout affects and which is the most common? |
MC = great toe ankle, knee, wrist, elbow |
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What foods have an elevated uric acid level? |
meats, seafood, cheeses, red wine, and beer |
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What is pseudo gout and who and where do pts get it? |
-deposit of Ca Pyrophosphate crystals within the joint -older ppl -MC = knee -acute and painful |
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Risk factors for gout? |
-older -jt trauma -gentic disorder (younger pts) -mineral imbalance (excessive Ca or Fe, too little Mg) -underactive thyroid or overactive parathyroid |
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S/S of gout |
-severe pain -last for d-wks -hot red joint -acute onset -awakens from sleep |
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Dx of gout |
-thyroid level -PTH level -mineral levels -uric acid -needle aspiration to check for crystals (negatively birefringent crystals) -radiographic: jt damage along with crystal deposits in cartilage |
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tx for gout |
-acute attack: Colchincine, Colcrys, Indomethacin, Indocin, NSAIDS, alopuranol (for chronic) -Colchincine 0.6mg PO q2h til 1 of 3 occurs: pain goes away, diarrhea, or vomiting -Indomethacin 50-200mg PO BID or TID -jt drainage -ice pack (reduce inflm) -home remedy = eat dark cherry |
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What are some causes of ant. hip pain for different age groups? |
Adolescents: apophyseal avulsion or SCFE (10-12 y/o AA or hispanic male) Young Adults: muscle or tendon sprain Middle Aged and Older Adults: OA, RA, fx Femoral neck stress fx: constant groin pain; can lead to worse fx if not tx |
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Dx for hip pain |
bone scan with radioactive dye to show femoral stress fx MRI to confirm CT to r/o femoral neck fx |
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tx for hip pain |
percutaneous pinning of non-displaced femoral neck fx |
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What is a hemiarthroplasty? |
partial hip replacement for femoral neck fx |
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What are the two types of hemiarthroplasties? |
Uni-polar: ball moves as 1 peeve in 1 plane Bi-polar: ball moves as 2 pieces in 2 planes |
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What is an intertrochanteric fx? |
when fx goes from greater to lesser trochanter |
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What is the MC type of hip fracture in elderly pts who fall? |
intertrochanteric fx |
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S/S of intertrochanteric fx |
pain legs will be ext. rotated and short |
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dx of intertrochanteric fx |
xray |
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tx for intertrochanteric fx |
ORIF screws and compression plate |
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How do femur fx happen? |
falls or high velocity trauma |
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S/S of femur fx |
severe pain difficulty with weight bearing affected is shortened (if comminuted) and ex rotated dehydration (mild)- fallen and can't get up |
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dx of a femur fx |
xray |
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tx for femur fx |
plate intermedullary nailing retrograde nail for distal femur fx |
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What is slipped capital femoral epiphysis? |
head of femur slips out of acetabulum |
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Who gets SCFE and which leg is most common? |
adolescent males 10-17 y/o and females 8-15 y/o Left hip = MC bilat 25% of the time
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when is SCFE considered acute or chronic? |
-acute: sx <3wks and sudden onset of sever hip pain inability to wt bear on affected leg -chronic: gradual onset pain >3wk, pain intermittent in hip or knee -acute-on-chronic: sudden increase in pain and inability to wt bear after minor tx |
