PBL Week 5: Bone Disease and Anatomy

This week’s scenario was on osteoarthritis and we had lectures giving us an introduction to the anatomy of the hip. Not going to lie, I was a bit overwhelmed by all the different anatomical terms we need to learn, and this is just the hip!

Getting to go to the hospital for the first time was very fun; I came prepared with ‘smart’ clothes so I felt very professional and like a proper medical student. We were taught how to carry out an hip examination, got to meet an osteoarthritis patient who’s had THREE hip replacements, and also had a talk on the radiology of the hip. By the end of the day I felt better and more comfortable with the anatomy of the hip and it doesn’t seem as daunting anymore, I can do it!

(By the way, if anyone fancies getting me a skeleton for Christmas I’d totally appreciate it xoxo)

As usual, we brainstormed in our PBL session and this week, my objective was ‘What are the different investigations for osteoarthritis?’ This week involved a tiny bit of drama that I won’t go into, but I’ll just say that I was only trying to look out for someone/ be nice, so having that thrown back in my face sucked.

Anyways, here’s my PBL work!

What Are The Different Investigations For Osteoarthritis?

1)    MEDICAL HISTORY

–       Doctor asks about presence & duration of symptoms & effect on daily activities

–       Common symptoms include;

  • Morning and prolonged joint stiffness
  • Night pain leading to disturbed sleep

2)    PHYSICAL EXAMINATION

–       Doctor checks for joint swelling, abnormalities in range of motion and tenderness

–       Doctor examines:

  • Patient’s stance
  • How patient walks: Antalgic Gait– patient limps

Short Leg Gait– shoulder drops as they take step on short leg

Trendelenburg Gait– patient swings to one side- abductor muscle weakness.

–       Leg length

–       Movements

  • Flexion + Extension (Thomas’ test to check for lack of extension)
  • Abduction + Adduction
  • Internal & External rotation

–       Resistance movements (holding body parts down as they repeat movements)

  • Abduction, adduction, flexion + extension

–       Trendelenburg Test (Positive is instability & squeezing doctor’s hand while standing on one leg).

3)    XRAYS

–       Look for:

  • Narrowing of joint space between two bones (cartilage lost)
  • Bony outgrowths (Osteophytes)
  • Abnormal hardening of bone between cartilage surface (Sclerosis)
  • Presence of cysts- abnormal sacs in the bone near the joint containing a liquid substance.

–       Remember: Xrays aren’t very good at spotting early osteoarthritis features because they aren’t as obvious.

4)    LAB TESTS

–       Erthyrocyte Sedimentation Rate (ESR)

  • Blood test establishing inflammation within body
  • High ESR might indicate inflammatory condition as cause of arthritis

–       Rheumatoid Factor

  • Antibody present in people with rheumatoid arthritis
  • Helps distinguish between rheumatoid and osteo arthritis.

–       Synovial Fluid Analysis

  • Fluid secreted by membranes in joint cavities and acts as lubricant
  • In osteoarthritis, fluid is clear and viscous
  • There are few inflammatory cells
  • White blood cells less than 500 cells per mm² for osteoarthritis but greater than 2000 for inflammation due to gout, infection & other forms of inflammatory arthritis
  • Joint fluid removal (Athrocenthesis) can help relieve pain, swelling & inflammation.

5)    OTHER INVESTIGATIONS

–       Used when other results are inconclusive

–       Magnetic Resonance Imaging (MRI)

  • Gives more detailed view of soft tissues and cartilage
  • Picks up fractures that don’t show on x-ray

–       Anthroscopy

  • Thin lighted tube moved into joint spaces
  • Allows direct inspection of joint structures
  • Especially useful for detecting damaged cartilage, as this doesn’t show on x-ray.

References

Arden, E. Arden, N. Hunter, D (2008). Osteoarthritis: The Facts. Oxford: Oxford University Press. 39-45.

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