osteoarthritis

wokay, so today we formally start the group discussion. todays case was a patient with bilateral knee pain worse on the left. i'l write down what i remember in hopes that all this becomes long term memory.

right.

bilateral knee pain- ask all the relevent questions

any swelling? any deformity?reduced quality of life?wear and tear?NSAIDS?

risk factors-female, fat, workload, past trauma, gout

rule out-morning stiffness+hand joints= RA, diet+toe swelling= GOUT fever+DM= septic arthritis

physical:

gait-deformities ( varus/valgus )-swellings ( rule out bakers cyst )

square pelvis ( shortening )-fixed flexion deformity

knee joint-crepitus-milk patella-examine swelling

range of movement

special tests-varus and vulgus test

sensory, pulses

ix:

blood:

RA-rheumatoid factor, anti-nuclear antibodies,ESR

Gout-uric acid

imaging:

x-ray: knee joint AP and lateral view ( 4signs-osteophytes,subchondral cyst,subchondral sclerosis, narrowing joint space )

negatively bipheringent crystals-rhombus shaped- gout

management:

1. nonpharmacological ( walking stick, rest, lose weight )

2. pain relief ( usually NSAIDS )

3. intra0articular injections ( hyaluronic acid )

4. Joint debribement ( realignment/osteotomy )

5. knee replacement ( bipolar/unipolar )

that's all for tonight. coz we covered one case only. tomorrow ONG!