Beetus 4

Question 1

Associated pathologies with DM

Answer 1

• peripheral neuropathy
• atherosclerosis
• infection
• retinopathy
• nephropathy
• MSK problems
• skin ulcerations

Question 2

DM: peripheral neuropathy

Cause

Answer 2

diminished peripheral vascular perfusion

Question 3

DM: peripheral neuropathy onset

Answer 3

Diffuse polyneuropathy progressing distal to proximal

Question 4

DM: atherosclerosis

Answer 4

• increased fat metabolism
• hypoglycemic damage to vessel walls
• poor healing of damage along vessels

Question 5

DM: infection

Answer 5

• impaired wound healing » infection risk

- impaired immune response

Question 6

DM: infection

Why is infection even more likely in this population?

Answer 6

Rapid multiplication of infectious organisms in glucose rich environment

Question 7

DM: retinopathy

What causes it?

Answer 7

Blockage of microvascular perfusion with retinal ischemia and necrosis

Question 8

DM: retinopathy (% of population)

Answer 8

After 20 years, all type I and 60% of type II have some degree of retinopathy

Question 9

DM: nephropathy

DM is the most common cause of this

Answer 9

End stage renal disease

Question 10

DM: nephropathy

What accelerates the damage?

Answer 10

Smoking

Question 11

DM: MSK problems

Answer 11

• Dec ROM/strength
• flexor tenosynovitis
• Dupuytren’s contracture
• CTS
• adhesive capsulitis
• CRPS
• DISH
• OP
• Charcot’s arthropathy
• subluxation of tarsal and metatarsal joints

Question 12

Flexor tenosynovitis

Answer 12

Inflammation and fibrotic changes of flexor tendons of the hand

Question 13

Dupuytren’s contracture

Answer 13

• flexion contracture with thickening of the palmar fascia

- most commonly involved in 3rd and 4th digits in diabetic population

Question 14

Dupuytren’s contracture: how is it different in the diabetic population?

Answer 14

Diabetic: 3rd and 4th digits

Other causes: 4th and 5th digits

Question 15

How is CTS different in the diabetic pt?

Answer 15

More neuropathic than entrapment

Question 16

DM: adhesive capsulitis

Answer 16

Thickening and stiffening of the GH capsule

Question 17

CRPS =

Answer 17

Complex regional pain syndrome

Question 18

RSD =

Answer 18

Reflex sympathetic dystrophy (former name for CRPS)

Question 19

DISH =

Answer 19

Diffuse idiopathic skeletal hyperostosis

Question 20

What is DISH?

Answer 20

• Osteophytes grow and fuse from adjacent vertebrae

- most common in t-spine, but seen in other joints/areas

Question 21

DM: When does OP occur?

Answer 21

• generalized OP within 5 years of DM I onset

- less pronounced in DM II (get microfractures and decreased bone repair)

Question 22

Charcot’s arthropathy

Answer 22

Loss of sensation with repeated trauma to joints

Question 23

DM: skin ulceration

Shear forces increased due to

Answer 23

• orthopedic changes
• previous scarring
• subcutaneous stiffness
• loss of local fat pads

Question 24

What leads to skin ulceration in a diabetic pt?

Answer 24

• neuropathy
• decreased vascular perfusion
• increased shear forces
• lack of normal sweating
• dry and elastic skin
• decreased healing (lack of vascularization)