Bone and joint diseases

A.Y. 2021/2022
7
Max ECTS
72
Overall hours
SSD
MED/16 MED/33 MED/34
Language
English
Learning objectives
The course will highlight the main clinical features of orthopaedics, rheumatology /clinical immunology/allergy and physical rehabilitation medicine to provide a comprehensive overview of the basic clinical presentations and treatment options of patient presenting with clinical history and evaluation suggesting orthopaedics or rheumatological problems. Further, the course will provide a comprehensive view of the semantics of the associated conditions and determine their common mechanisms and unique features.
The module of Orthopaedics introduces the students to clinical practice on patient evaluation and interpretations of specific investigations i.e. X-ray, CT scans, MRI for all different pathologies. Students are trained to the most updated knowledge on the commonest orthopaedic problems. The module of rheumatology, clinical immunology, and allergy tackles the approach to patients with an inflammatory, immune, allergic disease through a multidisciplinary approach based on history, physical examination, laboratory tests, and imaging. The characteristics of autoimmunity and chronic inflammation will be discussed, along with a general approach to the main complaints of patients with these conditions. The array of classification criteria included in the practice of rheumatology is one of the bases of the block, as well illustrated by rheumatoid and seronegative arthritis. Of note, clinical immunology is largely overlapping with rheumatology and manifests some peculiar interests such as immune deficiencies and shared grounds such as connective tissue diseases. Finally, the approach to allergies is discussed with a specific interest for the diagnostic tools and therapeutic approaches. Attention will be dedicated also to the numerous comorbidities shared by immune-mediated diseases, including cardiovascular disease and reproductive defects.
The module of Physical and Rehabilitation Medicine introduces the students to the basic techniques of assessment of passive mobility, strength and coordination, and to the essentials of treatment of orthopaedic and rheumatic disorders with therapeutic exercise and physical agents.
Expected learning outcomes
Students are expected to:
- Provide general terminology, anatomy, biomechanics, and function of the body major joints.
- Learn to recognize the most common articular problems from patients' complaints, clinical history and patients' physical examination.
- Learn to recognize the most common trauma problems and limb or life threatening injuries (trauma emergencies)
- Understand the pathological joints biomechanics and identify them on correct further investigations (XRAY; CT; MRI etc.)
- Reach the ability to recognize the entity of the disease (classifications) and start a correct therapeutic approach accordingly.
- Reach some basic understanding of the difference between a growing and a mature skeleton.
- Recognize some of the most common congenital deformities.
- Provide the general terminology and reporting for the major complaints of patients in a rheumatology clinic;
- Understand the main groups of serum autoantibodies and laboratory tests to be used in clinical practice;
- Understand the mechanisms of action of the main anti-inflammatory, disease-modifying, and anti-allergy medications and their adverse events;
- Apply the classification criteria for the discussed conditions;
- Understand the limits and strengths and provide a basic understanding of the imaging techniques (ultrasound, X rays, MRI, and CT scans) used in rheumatology;
- Provide a general approach to the diagnosis, management, and treatment of patients with a rheumatological, immunological, or allergic disease.
- Learn the correct kinesiology definition of joint movements;
- Learn how to assess joint mobility;
- Learn how to assess force, based on knowledge of muscle anatomy and physiology, and of the joint leverage;
- Learn the basic physiology of walking and how to steer its clinical observation;
- Learn the basic criteria for personalized prescription of therapeutic exercise and therapies with physical agents;
- Basic physiology of human walking with some hints on diagnosis of walking impairments.
Course syllabus and organization

Single session

Responsible
More specific information on the delivery modes of training activities for academic year 2021/22 will be provided over the coming months, based on the evolution of the public health situation.
Prerequisites for admission
To take the Bone and Joint Diseases exam, students must have already passed all the exams of the first and second year (Fundamentals of Basic Sciences, Cells, Molecules and Genes 1 and 2, Human Body, Functions and Mechanisms of Diseases).
Assessment methods and Criteria
In normal health situation the final assessment will consist of:
a) a written test with 60 multiple-choice questions (30 on orthopaedics, 20 on rheumatology, 10 on physical & rehabilitation medicine) each with only one correct answer. Test duration: one minute will be allowed for each question. The score for each section will be transformed into x/30, proportional to the number of correct answers. No penalties will be given to missing or wrong answers.
b) an oral examination (orthopaedics).
The final mark will take into account the scores achieved in the three sections of the MCQ test and the outcome of the oral test.
During Covid emergency, the final assessment consists in an oral examination of the three modules (orthopaedics, rheumatology, physical & rehabilitation medicine). The final mark will be the average of the scores obtained in the different disciplines weighted by the number of credits in each module.
Reumathology
Course syllabus
ORTHOPAEDICS AND TRAUMA
GENERAL LEARNING GOALS
Provide general terminology, anatomy, biomechanics, and function of the body major joints.
Learn to recognise the most common articular problems from patients' complaints, clinical history and patients' examination.
Learn to recognise the most common trauma problems and limb or life threatening injuries (trauma emergencies)
Understand the pathological joints biomechanics and recognise them on correct further investigations (XRAY; CT; MRI etc.)
Reach the ability to recognise the entity of the disease (classifications) and start a correct therapeutic approach accordingly.
Reach some basic understanding of the difference between a growing and mature skeleton.
Recognise some of the most common congenital deformities.

RHEUMATOLOGY, CLINICAL IMMUNOLOGY, ALLERGY
GENERAL LEARNING GOALS
Provide the general terminology and reporting for the major complaints of patients in a rheumatology clinic;
Understand the main groups of serum autoantibodies and laboratory tests to be used in clinical practice;
Understand the mechanisms of action of the main anti-inflammatory, disease- modifying, and anti-allergy medications and their adverse events;
Apply the classification criteria for the discussed conditions;
Understand the limits and strengths and provide a basic understanding of the imaging techniques (ultrasound, X rays, MRI, and CT scans) used in rheumatology;
Provide a general approach to the diagnosis, management, and treatment of patients with a rheumatological, immunological, or allergic disease.

PHYSICAL AND REHABILITATION MEDICINE
GENERAL LEARNING GOALS
Learn what is physical and rehabilitation medicine;
Learn the concepts of disability and functioning;
Learn the basic knowledge and skills of physical and rehabilitation medicine;
Learn the fields of implementation of physical and rehabilitation medicine;
Learn the the principles of an evidence medicine approach in physical and rehabilitation medicine.

PROGRAM
Lesson 1a. OTHOPEDICS Birth and decay of human frame Part 1: birth
Learn basic bones anatomy and architecture
Understand bone structure and cells devoted to bone remodelling
Describe the most important steps of foetal development of the musculoskeletal system
Understand the different ossification mechanism and bone formation
Understand the changing from neonatal to adult bone configuration
Lesson 1b. RHEUMATOLOGY Birth and decay of human frame Part 2: decay
Describe the structure of cell membrane and the mechanisms of transport across the cell membrane
Describe the mechanisms of bone loss leading to osteopenia and osteoporosis
Understand the major imaging (X ray, DEXA) and laboratory (Ca, P, PTH, etc) findings that are helpful in the management of patients with bone loss
Describe the treatment options in terms of bisphosphonates, calcium and vitamin D supplementation, and other options, including the potential side effects
Lesson 2a. OTHOPEDICS Congenital malformations Part 1
Describe the deformities in club foot and principles of treatment
Understand the articular malformation associated with DDH; early diagnosis and treatment
Describe the spine normal and abnormal curvatures with special regards to scoliosis
Lesson 2b. OTHOPEDICS Congenital malformations Part 2
Understand the pathology associated with the most common form of osteochondral dysplasias
Understand conservative and surgical treatment for congenital diseases
Lesson 3. OTHOPEDICS Bone fractures: biomechanics, imaging and treatment
Understand the biological and biomechanical principles of fracture healing
Describe the most common devices of fracture fixation
Describe the well-established and new imaging techniques to determine fracture types and healing
Understand emergency in traumatology
Lesson 4. OTHOPEDICS Biomechanics of deformities and correction strategies
Understand Musculoskeletal biomechanics
Describe the major mechanical and anatomical axis of long bones
Understand how abnormal anatomy and biomechanics may play a major role in articular surfaces disruption
Internal and External fixation to correct bone deformities
Lesson 5. RHEUMATOLOGY Approach to the immune system and rheumatology
Describe the major symptoms/syndromes leading to a rheumatological evaluation
Understand the major imaging (X ray, CT, MRI, ultrasound), invasive (arthrocentesis, etc), and laboratory (autoantibody, CRP) findings that are helpful in the management of patients with a rheumatological condition
Lesson 5a. RHEUMATOLOGY Laboratory diagnosis and new therapies
Describe the major laboratory abnormalities leading to a rheumatological evaluation
Discuss the limits and advantages (specificity, sensitivity, predictive value) of laboratory tests
Understand the major pathogenic mechanisms of immune-mediated diseases and the groups of therapeutic options, their mechanisms of action, their advantages and risks
Lesson 5b. RHEUMATOLOGY Clinical cases of rheumatic disease
Understand the clinical and diagnostic workup of patients with a suspected rheumatic condition
Lesson 6. RHEUMATOLOGY The mechanisms of localized and generalized pain
Understand the mechanisms and pathways leading to pain sensitivity
Describe the approach to localized and generalized pain syndromes
Understand the features of fibromyalgia with particular attention to the differential diagnosis and therapeutic approaches
Lesson 7. RHEUMATOLOGY The role of inflammation in arthritis and spondyloarthritis
Describe the major symptoms/syndromes leading to the suspect of arthritis
Describe the groups of arthritis and their peculiar features
Understand the epidemiology, pathogenesis, and differential diagnosis of rheumatoid arthritis, seronegative arthritis (including psoriatic, reactive, enteropathic, and ankylosing spondylitis), microcristalline arthritis
Understand the therapeutic approach to rheumatoid arthritis, seronegative arthritis (including psoriatic, reactive, enteropathic, and ankylosing spondylitis), microcristalline arthritis
Understand the differential diagnosis of rheumatoid arthritis, seronegative arthritis (including psoriatic, reactive, enteropathic, and ankylosing spondylitis), microcristalline arthritis
Understand the major imaging (X ray, CT, MRI, ultrasound), invasive (arthrocentesis, etc), and laboratory (autoantibody, CRP) findings that are helpful in the diagnosis and management of patients
Lesson 8. RHEUMATOLOGY Connective tissue diseases
Describe the major symptoms/syndromes leading to the suspect of connective tissue disease
Describe the groups of connective tissue disease (i.e. systemic lupus, scleroderma, inflammatory myositis, Siögren syndrome, undifferentiated and mixed connective tissue disease) and their peculiar features
Understand the epidemiology, pathogenesis, and differential diagnosis of systemic lupus, scleroderma, inflammatory myositis, Siögren syndrome, undifferentiated and mixed connective tissue disease
Understand the therapeutic approach to systemic lupus, scleroderma, inflammatory myositis, Siögren syndrome, undifferentiated and mixed connective tissue disease
Understand the differential diagnosis of systemic lupus, scleroderma, inflammatory myositis, Siögren syndrome, undifferentiated and mixed connective tissue disease
Understand the major imaging (X ray, CT, MRI, ultrasound), invasive (arthrocentesis, etc), and laboratory (autoantibody, CRP) findings that are helpful in the diagnosis and management of patients with systemic lupus, scleroderma, inflammatory myositis, Siögren syndrome, undifferentiated and mixed connective tissue disease
Understand the cardiovascular, neoplastic, obstetric, and thrombotic complications of systemic lupus, scleroderma, inflammatory myositis, Siögren syndrome, undifferentiated and mixed connective tissue disease
Lesson 9a. OTHOPEDICS Articular cartilage disease: surgery for cartilage
Learn basic cartilage macro and micro anatomy and biomechanics
Describe the principles of cartilage surgery, rationale, surgical steps
Results of surgery for cartilage damage
Lesson 9b. OTHOPEDICS Articular cartilage disease: osteoarthritis
Describe the principles of cartilage degeneration: mechanical and biochemical
Describe the major symptoms/syndromes leading to the suspect of osteoarthritis and its complications
Describe the risk factors for osteoarthritis
Understand the differential diagnosis of osteoarthritis
Understand the epidemiology, pathogenesis, and differential diagnosis of osteoarthritis
Understand the therapeutic approach to osteoarthritis, including non- pharmacological treatments
Understand the major imaging (X ray, CT, MRI, ultrasound), invasive (arthrocentesis, etc), and laboratory (autoantibody, CRP) findings that are helpful in the diagnosis and management of patients with osteoarthritis
Understand the cardiovascular and metabolic comorbidities of osteoarthritis
Lesson 10. OTHOPEDICS Bone and soft tissue tumors
Understand the classification of tumors involving the musculoskeletal system
Understand the epidemiology and the staging of tumors
Describe selected tumors (osteosarcoma, chondrosarcoma, Ewing sarcoma) and bone metastasis
Describe the principle of treatment and the therapeutic advances
Lesson 11. OTHOPEDICS Joint biomechanics and semeiotics: the hip
Understand signs and symptoms of early joint compromise
Describe CAM and Pincer lesion and their treatment
Describe principles of total hip replacement
Understand the major imaging (X ray, CT, MRI, ultrasound) of FAI - Hip arthritis and THR
Lesson 12. OTHOPEDICS Tendons and muscular abuse: sport medicine
Describe the macroscopic and microscopic structures of ligament and tendons
Understand the biomechanics of the muscular tendon unit
Describe damage mechanism and soft tissue repair biology
Describe the typical tendon abusers lesions in children and adults
Describe basic principles of treatment
Lesson 13. OTHOPEDICS Joint biomechanics and semeiotics: the shoulder
Describe basic anatomy of the intrinsic and extrinsic muscles of the shoulder girdle
Understand the biomechanics of the multiple joints complex of the shoulder
Understand the shoulder malfunction and consequent pathology (acute and cronic)
Describe the principles of clinical semeiotic and instrumental diagnosis of shoulder pain
Describe principles of conservative and surgical treatment of shoulder affections
Lesson 14. OTHOPEDICS Joint biomechanics and semeiotics: the knee
Describe the basic anatomy of ligaments and tendons of the knee joint
Understand the biomechanics of the multiple structures complex of the knee
Understand the knee malfunction and consequent pathology (acute and cronic)
Describe the principles of clinical semeiotic and instrumental diagnosis of knee pain
Describe the principles of conservative and surgical treatment of knee affections
Lesson 15. OTHOPEDICS Joint biomechanics and semeiotics: the elbow, wrist and hand
Describe the basic anatomy of the intrinsic and extrinsic muscles of the hand/wrist/elbow
Understand the biomechanics of the multiple joints complex of the hand/wrist/elbow
Describe the principles of clinical semeiotic and instrumental diagnosis of hand pain, wrist/elbow pain
Understand the pathogenesis of De Quervain and Dupuytren disease
Describe the median nerve compression in the carpal tunnel syndrome
Describe principles of conservative and surgical treatment of hand affections
Describe tennis elbow - golf elbow and elbow instabilities
Describe ulnar nerve entrapment syndrome at the elbow
Lesson 16. OTHOPEDICS Joint biomechanics and semeiotics: the foot and ankle
Describe the basic anatomy of the foot-ankle
Understand the biomechanics of the multiple joints complex
Understand the principles of gait analysis
Describe the principles of clinical semeiotic and instrumental diagnosis of foot- ankle pain
Describe the principles of conservative and surgical treatment of foot affections as Pes Planus, hallux deformities, pes cavus
Describe how to treat an ankle sprain
Understand the major imaging (X ray, CT, MRI, ultrasound) of foot and ankle
Lesson 17. RHEUMATOLOGY Vasculitidies
Describe the major symptoms/syndromes leading to the suspect of vasculitis
Understand the new classification of vasculitidies
Understand the epidemiology, pathogenesis, and differential diagnosis of vasculitidies
Understand the therapeutic approach to vasculitidies, including non- pharmacological treatments
Understand the major imaging (X ray, CT, MRI, ultrasound), invasive (vascular biopsy, etc), and laboratory (autoantibody, CRP) findings that are helpful in the diagnosis and management of patients with vasculitidies
Understand the systemic complications and sequelae of vasculitidies
Lesson 18. RHEUMATOLOGY Immunodeficiencies and allergies
Describe the major symptoms/syndromes leading to the suspect of acquired and congenital immunodeficiency
Understand the classification of acquired and congenital immunodeficiency
Understand the epidemiology, pathogenesis, and differential diagnosis of acquired and congenital immunodeficiency
Understand the therapeutic approach to acquired and congenital immunodeficiency, including the prevention of infections
Understand the major laboratory findings that are helpful in the diagnosis and management of patients with acquired and congenital immunodeficiency
Describe the major acute and chronic symptoms/syndromes leading to the suspect of allergy
Describe the diagnostic workup of patients with urticaria
Understand the immunological mechanisms of allergy and the classes of allergens
Understand the epidemiology, pathogenesis, and differential diagnosis of allergy
Understand the therapeutic approach to allergy, including vaccines
Understand the major laboratory and clinical test findings that are helpful in the diagnosis and management of patients with allergy
Lesson 19. PHYSICAL AND REHABILITATION MEDICINE approach. Why and what
The White Book of Physical and Rehabilitation Medicine in Europe
Introductions, Executive Summary, and Methodology
Definitions and concepts of Physical and Rehabilitation Medicine
Why rehabilitation is needed by individual and society
A primary medical specialty: the fundamentals of PRMLesson 20. PHYSICAL AND REHABILITATION MEDICINE approach. Who and how
History of the specialty: where PRM comes from
The PRM organizations in Europe: structure and activities
Knowledge and skills of PRM physicians
The clinical field of competence: PRM in practice
Lesson 21. PHYSICAL AND REHABILITATION MEDICINE in the health care system and basis of PRM approach
The PRM specialty in the healthcare system and society
Education and continuous professional development: shaping the future of PRM
Science and research in PRM: specificities and challenges
Evidence based medicine in PRM
Basis of PRM in main musculoskeletal diseases of rehabilitation interest
Basis of PRM in main neurological diseases of rehabilitation interest
Basis of PRM inv the other main diseases of rehabilitation interest
Lesson 22. RHEUMATOLOGY Sport / diet and the immune system in health and rheumatic disease
Understand the physical and dietary approach to patients with rheumatic conditions;
Understand the effects of physical activity and nutrients on the immune system
Teaching methods
Lectures, Clinical examination, OR exposure, Videos, clinical clerkship
Teaching Resources
ORTOPEDICS:
· Orthopaedics and Traumatology Pocketbook of orthopaedics and fractures - McRae
Essential orthopaedics and trauma - Dandy, Edwards
Rheumatology, orthopaedics and trauma at a glance - Swales, Bulstrode
Adam's Outline of orthopaedics - Hamblen, Simpson
RHEUMATOLOGY:
Oxford Textbook of Rheumatology, 4th edition, 2013; Edited by Richard A. Watts, Philip G. Conaghan, Christopher Denton, Helen Foster, John Isaacs, and Ulf Müller-Ladner
EULAR Textbook on Rheumatic Diseases: http://www.eular.org/index.cfm?framePage=/edu_textbook.cfm
Review articles provided throughout the course
CLINICAL IMMUNOLOGY, ALLERGY:
Specific sections on the Harrison's principles of Internal Medicine
PHYSICAL AND REHABILITATION MEDICINE
European Physical and Rehabilitation Medicine Bodies. The White Book of Physical and Rehabilitation Medicine in Europe. Editors: Stefano Negrini, Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner, Carlotte Kiekens, Saša Moslavac, Enrique Varela-Donoso, Anthony B. Ward, Mauro ZampoliniEur J Phys Rehabil Med, 2018.
European Union of Medical Specialists (UEMS) Board and Section of Physical and Rehabilitation Medicine. Physical and rehabilitation medicine for medical students. Editors: Maria Gabriella Ceravolo, Nicolas Christodoulou. Edi Ermes 2019.
Orthopedics
Course syllabus
The course is based on a strong integration of different disciplines, thus the program of the single disciplines cannot be extracted form the program of the whole course which is reported in module Reumathology.
Teaching methods
Lectures, Clinical examination, OR exposure, Videos, clinical clerkship
Teaching Resources
ORTOPEDICS:
· Orthopaedics and Traumatology Pocketbook of orthopaedics and fractures - McRae
Essential orthopaedics and trauma - Dandy, Edwards
Rheumatology, orthopaedics and trauma at a glance - Swales, Bulstrode
Adam's Outline of orthopaedics - Hamblen, Simpson
RHEUMATOLOGY:
Oxford Textbook of Rheumatology, 4th edition, 2013; Edited by Richard A. Watts, Philip G. Conaghan, Christopher Denton, Helen Foster, John Isaacs, and Ulf Müller-Ladner
EULAR Textbook on Rheumatic Diseases: http://www.eular.org/index.cfm?framePage=/edu_textbook.cfm
Review articles provided throughout the course
CLINICAL IMMUNOLOGY, ALLERGY:
Specific sections on the Harrison's principles of Internal Medicine
PHYSICAL AND REHABILITATION MEDICINE
European Physical and Rehabilitation Medicine Bodies. The White Book of Physical and Rehabilitation Medicine in Europe. Editors: Stefano Negrini, Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner, Carlotte Kiekens, Saša Moslavac, Enrique Varela-Donoso, Anthony B. Ward, Mauro ZampoliniEur J Phys Rehabil Med, 2018.
European Union of Medical Specialists (UEMS) Board and Section of Physical and Rehabilitation Medicine. Physical and rehabilitation medicine for medical students. Editors: Maria Gabriella Ceravolo, Nicolas Christodoulou. Edi Ermes 2019.
Rehabilitation medicine
Course syllabus
The course is based on a strong integration of different disciplines, thus the program of the single disciplines cannot be extracted form the program of the whole course which is reported in module Reumathology.
Teaching methods
Lectures, Clinical examination, OR exposure, Videos, clinical clerkship
Teaching Resources
ORTOPEDICS:
· Orthopaedics and Traumatology Pocketbook of orthopaedics and fractures - McRae
Essential orthopaedics and trauma - Dandy, Edwards
Rheumatology, orthopaedics and trauma at a glance - Swales, Bulstrode
Adam's Outline of orthopaedics - Hamblen, Simpson
RHEUMATOLOGY:
Oxford Textbook of Rheumatology, 4th edition, 2013; Edited by Richard A. Watts, Philip G. Conaghan, Christopher Denton, Helen Foster, John Isaacs, and Ulf Müller-Ladner
EULAR Textbook on Rheumatic Diseases: http://www.eular.org/index.cfm?framePage=/edu_textbook.cfm
Review articles provided throughout the course
CLINICAL IMMUNOLOGY, ALLERGY:
Specific sections on the Harrison's principles of Internal Medicine
PHYSICAL AND REHABILITATION MEDICINE
European Physical and Rehabilitation Medicine Bodies. The White Book of Physical and Rehabilitation Medicine in Europe. Editors: Stefano Negrini, Pedro Cantista, Maria Gabriella Ceravolo, Nicolas Christodoulou, Alain Delarque, Christoph Gutenbrunner, Carlotte Kiekens, Saša Moslavac, Enrique Varela-Donoso, Anthony B. Ward, Mauro ZampoliniEur J Phys Rehabil Med, 2018.
European Union of Medical Specialists (UEMS) Board and Section of Physical and Rehabilitation Medicine. Physical and rehabilitation medicine for medical students. Editors: Maria Gabriella Ceravolo, Nicolas Christodoulou. Edi Ermes 2019.
Orthopedics
MED/33 - ORTHOPAEDICS - University credits: 4
Lessons: 48 hours
Rehabilitation medicine
MED/34 - PHYSICAL AND REHABILITATION MEDICINE - University credits: 1
Lessons: 12 hours
Professor: Negrini Stefano
Reumathology
MED/16 - RHEUMATOLOGY - University credits: 2
Lessons: 12 hours
Professor(s)
Reception:
Appointments can be arranged by email
Reception:
Appointments can be arranged by email
Reception:
Upon email contact
IRCCS Istituto Ortopedico Galeazzi, Radiology Unit, floor -2