Master the diagnosis and orthopaedic management of gout crystal arthropathy, from acute podagra to chronic tophaceous disease. Learn to confidently identify negatively birefringent monosodium urate crystals and apply essential treatment algorithms. ⏱ Chapters 0:00 Intro 0:19 Essentials 0:45 Stages 1:08 Needle Mnemonic 1:27 Crystals Comparison 1:50 Imaging 2:14 Differential 2:34 Coins 2:54 Ult 3:20 Surgical Music 3:39 Management Algorithm 3:59 Keynumbers 4:17 Complications 4:37 Clinical reasoning — Podagra 4:58 Clinical reasoning — Tophus This in-depth masterclass covers the entire spectrum of gout and crystal-induced arthropathy. We explore the underlying pathophysiology of monosodium urate crystal deposition, break down the four clinical stages of the disease, and compare gout with pseudogout (CPPD). Viewers will learn the diagnostic gold standards, including joint aspiration and dual-energy CT imaging, alongside comprehensive acute medical management and the specific surgical indications for operating on chronic tophaceous deposits. 🦴 IN THIS VIDEO YOU'LL LEARN • How to identify needle-shaped, negatively birefringent monosodium urate crystals under polarised light • The four clinical stages of gout from asymptomatic hyperuricaemia to chronic tophaceous arthropathy • Distinguishing gout from pseudogout based on crystal characteristics and chondrocalcinosis • Interpreting key imaging findings such as the double-contour sign on ultrasound and punched-out erosions on radiographs • Applying the COINS acronym for acute gout flare management including colchicine and NSAIDs • The critical importance of not initiating urate-lowering therapy like allopurinol during an acute attack • Understanding the NLRP3 inflammasome pathway and its role in crystal-induced inflammation • Recognising when surgical intervention is appropriate for chronic tophaceous gout using the MUSIC acronym • The pathological structure of a tophus and how urate-lowering therapy can reverse crystal deposition 📌 KEY TAKEAWAYS ✔️ Joint aspiration showing negatively birefringent, needle-shaped crystals remains the undisputed diagnostic gold standard. ✔️ Never start urate-lowering therapy during an acute gout attack; treat the flare with anti-inflammatories first. ✔️ A high synovial white cell count does not exclude coexisting crystals, so always rule out septic arthritis. ✔️ Dual-energy CT reliably colour-codes urate deposits, but early acute gout may yield false negatives. ✔️ Surgery for tophi is strictly reserved for mechanical obstruction, ulceration, infection, nerve impingement, or cosmetic concerns. 👩⚕️ WHO THIS IS FOR This video is designed for orthopaedic trainees, junior doctors, and medical students seeking a high-yield understanding of metabolic bone disease. It also serves as a detailed resource for clinicians managing acute monoarthritis and patients wanting a deeper look into the orthopaedic management of gout. 📚 RELATED TOPICS: Pseudogout and Calcium Pyrophosphate Deposition Disease (CPPD) · Septic Arthritis vs Acute Gouty Arthritis Differential Diagnosis · NLRP3 Inflammasome and Autoinflammatory Bone Conditions · Pharmacology of Urate-Lowering Therapy: Allopurinol and Febuxostat · Surgical Debridement Techniques for Tophaceous Gout 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #gout #crystalarthropathy #podagra #rheumatology #monosodiumurate #pseudogout #orthopedicsurgery #jointaspiration #medicaleducation #tophaceousgout #acroarthritis #MSUcrystals