A 60 years old obese female presented to your clinic after cannot bear the pain of the knee joint. The pain has been present since 2 years ago, gradually increase in intensity and associated with morning stiffness. Bilateral lower limb X ray was taken.
1) What other history you would like to obtain?
2) Name three differential diagnosis
3) Name two abnormalities in picture A
4) What other clinical signs you would like to elicit?
5) Outline the radiological finding in picture B
6) Name two management for this patient
1)
- Is it aggravated by movement (OA worsen with movement, RA relieve by movement)
- Any family history of rheumatoid arthritis?
- Occupational involving handling heavy object?
- Any pain on climbing stairs (rule out involvement of patellofemoral joint)
- Any history of infection with TB (rule out tuberculous arthritis)
2)
- Osteoarthritis (most common in elder female+obese)
- Rheumatoid arthritis
- Septic arthritis
3)
- Bilateral knee joint swelling
- Genu valrus
4)
- Joint crepitus
- Limited range of movement on knee.
- Osteophytes formation (Irregular and protuberant feeling at edge of articular ligament)
- Antalgic gait
5)
- Decreased joint space at weight beiring site
- Osteophytes formation
- Subchondral cyst (not seen in this x ray)
- Subchondral sclerosis
- Loose bodies (calcified cartilage, free lying bone in joint space; also not seen in this x ray)
6) Depend whether mild, moderate or severe
- Analgesic (NSAIDS, opiods, opiods+paracetamol)
- Load reduction (weight loss, cane)
- Glucosamine
- Arthroscopic debridement
- Arthroplasty
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