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NYCC MSP > Joint Degeneration (DRAFT) > Flashcards

Joint Degeneration (DRAFT) Flashcards

1
Q

define degeneration

A

disease in which function/structure of affected tissue/organs changes for the worse over time

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2
Q

what factors would increase risk for more severe or earlier clinical presentation of joint degeneration?

A

^mechanical forces

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3
Q

define osteoarthritis

A

implies inflammatory mediation (caused by inflammation)

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4
Q

define osteoarthrosis

A

mechanical breakdown of joints (is not caused by inflammation)

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5
Q

define joint degeneration

A

mechanical breakdown of joint (lacking well-defined SSx)

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6
Q

joint degeneration is characterized by progressive destruction of ____ at ____ joints

A

articular cartilage; synovial joints

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7
Q

what is secondary joint degeneration due to?

A

underlying cause = ^mechanical breakdown
- congenital / acquired incongruity of joints
- trauma
- inflammatory arthritis
- crystal deposits (crystaline arthropathies)
- infection
- metabolic or endocrine diseases

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8
Q

what is the most common joint problem in humans?

A

joint degeneration

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9
Q

what are the general aspects of joint degeneration?

A

cartilage breakdown, non-inflammatory, progressive, age related

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10
Q

what is the etiology of primary joint degeneration?

A

unknown
- aging
- weight bearing joints
- repetitive loading / use of specific joints
- intrinsic cartilage defects
- genetic factors related to cartilage formation (mutations in Type II collagen gene COL2A1)

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11
Q

what are the symptoms of joint degeneration?

A

variable symptoms (has defined signs, not symptoms)

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12
Q

what population is most commonly affected by joint degeneration?

A

85% of 75-79yrs

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13
Q

when is joint degeneration more common in men? women?

A

men: before age 45
women: after age 55

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14
Q

is joint degeneration classified as a physiological process or a pathology?

A

both normal physiological process AND pathology

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15
Q

what are some etiological factors that play into secondary joint degeneration?

A
  • increased unit load
  • disruption of H20 bonding
  • subchondral stiffening
  • biochemical changes
  • early joint degeneration (reparative response)
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16
Q

what are some examples of subchondral stiffening?

A
  • subchondral sclerosis
  • acromegaly
  • Paget’s
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17
Q

describe the biochemical changes that result in joint degeneration.

A
  • decreased proteoglycans: chondrocytes die
  • reduced glycosaminoglycan chain length
  • ^fibrillin
  • ^water binding
  • collagenase present
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18
Q

early joint degeneration is a ____ response

A

Reparative

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19
Q

what is the pathogenesis of joint degeneration?

A
  1. proteoglycan synthesis decreases, chondrocyte death increases
  2. fibrillation/cracking/fissuring in surface layers of articular cartilage
  3. fibrillation propagation
  4. cracks cross tide mark
  5. fibrocartilage plug may be broken down
  6. eburnated bone cracks
  7. osteophytes may develop at joint margins
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20
Q

what happens during the fibrillation propagation step of the pathogenesis of joint degeneration?

A
  • synovial fluid fills defects, increasing fissuring
  • pieces of cartilage may break off
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21
Q

what occurs when cracks cross the tide mark in the pathogenesis of joint degeneration?

A
  • angiogenesis
  • ^osteoclast activity = subchondral resorption
  • ^osteoblastic activity = subchondral sclerosing + subchondral cysts
  • fibrocartilage forms (patching that eventually falls out)
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22
Q

what occurs when the fibrocartilage plug breaks down during joint degeneration?

A
  • exposes subchondral bone to mechanical erosion
  • eburnation
  • subchondral sclerosing
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23
Q

what occurs when eburnated bone cracks during joint degeneration?

A
  • cracks fill w/ synovial fluid
  • subchondral cysts form and may increase in size
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24
Q

what is eburnation?

A

sclerosis + smoothing of 2 bony surfaces rubbing together

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25
Q

what are osteophytes?

A

degenerative out growth at joints

26
Q

what are spondylophytes?

A

osteophytes of the spine, usually reserved for discs

27
Q

how can you differentiate between blastic activity and sclerosis?

A
  • blastic = tumor response (woven bone)
  • sclerosis = stress response (stress line)
    appear different from eachother due to stress line
28
Q

what is uniformity in terms of joint space loss?

A

within a joint

29
Q

what is symmetry in terms of joint space loss?

A

comparing side to side

30
Q

do you think changes seen at joints with joint degeneration will be bilateral?

A

depends:
- hand dominance = asymetric/unilateral
- weight bearing joints (knees) = (generally) bilateral

31
Q

in the knee, which joints wear out faster?

A

medial joints wear out faster than lateral

32
Q

do you think changes seen at joints with joint degeneration will be uniform w/in the joint or symmetrical btwn joints in the same region?

A

depends:
- UE tend toward asymetry
- LE tend toward bilateral

33
Q

what is the preferential location of joint degeneration?

A

any and all joints, but very common in:
- hands
- knees
- hips
- cervical
- lumbar

34
Q

what are the clinical manifestations of joint degeneration?

A

MAY:
- appear enlarged + tender
- have crepitus
- Hands: Herberden and Bouchard Nodes
- deep achy pain following activity + relieved by rest
- short term stiffness in morning / after inactivity
- functional limitations in affected joints

35
Q

with joint degeneration, pain is generally a sign of what?

A

significant joint destruction

36
Q

what are Heberden and Bouchard Nodes?

A

generally painless osteophytes growing off DIP, PIP, and MCPs of the hands

37
Q

Herberden nodes involve what joints of the hands?

A

DIP joint

38
Q

Bouchard nodes involve what joints of the hands?

A

PIP joint

39
Q

Haygarth nodes involve what joints of the hands?

A

MCP joint

40
Q

what are some of the possible functional limitations in affected dgenerative joints?

A
  • intra-articular loose bodies (floating in joint as “sand”)
  • large osteophytes
  • loss of congruity in joint surfaces
  • muscle contractures or decreased muscle mass
41
Q

what are the radiographic findings of joint degeneration?

A

earliest finding: non-uniform loss of joint space (^in wt-bearing jts)
- subchondral sclerosis
- osteophyte formation
- subchondral cysts
- chondral/osteochondral loose bodies
- medical subluxation (eg. spondylolithesis)

42
Q

what is a buzz word name for chondral/osteochondral loose bodies?

A

joint mice (also cartilaginous/osteocartilaginous loose bodies)

43
Q

what is another term for disc degeneration?

A

discogenic spondylosis

44
Q

what are the two different types of disc degeneration?

A

tissue based pathology
- Intervertebral osteochondrosis (IVOC)
- spondylosis deformans

45
Q

what aspect of the disc degenerates in spondylosis deformans? what does this create?

A

annular degeneration = spondylophyte growths

46
Q

what aspect of the disc degenerates in intervertebral osteochondrosis? what does this create?

A

nuclear degeneration = loss of disc space

47
Q

in Spondylosis Deformans there is a (prominent/minimal) loss of disc space.

A

minimal disc space loss

48
Q

in Intervertebral Osteochondrosis there is a (prominent/minimal) loss of disc space.

A

prominent disc space loss

49
Q

in Spondylosis Deformans, ostephytes are (prominent/minimal)

A

prominent osteophytes

50
Q

in Intervertebral Osteochondrosis, ostephytes are (prominent/minimal)

A

minimal osteophytes

51
Q

Spondylosis Deformans creates ____ vacuum ____

A

annular vacuum clefts
(Gas formation)

52
Q

Intervertebral Osteochondrosis creates ____ vacuum ____

A

nuclear vacuum phenomenon

53
Q

what is Chondromalacia?

A
  • softening + breakdown of cartilage
  • subcategory of joint degeneration
54
Q

what occurs during the softening + breakdown of cartilage in Chondromalacia?

A
  • cartilage unit load exceeded
  • common after long periods of immboility/inactivity
55
Q

what is the overworked diagnosis of Chondromalacia? what population does it effect? what is the better diagnosis?

A

Chondromalacia Patellae
- younger pop.
- better diagnosis: Patellofemoral Pain Syndrome

56
Q

T/F all synovial joint degeneration will have cartilage softening.

A

t

57
Q

what are the clinical manifestations of Patellofemoral Pain Syndrome?

A
  • dull, aching anterior knee pain + stiffness
  • grinding sensation w/ knee flexion
58
Q

when are symptoms increased w/ Patellofemoral Pain Syndrome?

A
  • going down stairs
  • running down hill
  • squatting
  • standing after long periods of sitting
59
Q

what is the treatment of Patellofemoral Pain Syndrome?

A
  • rest
  • alterations in exercise
  • adequate pre-exercise warm-up + flexibility
  • weight loss
  • supportive devices
  • NSAIDs
60
Q

when the force or stress placed on a joint exceeds the ____, the joint may undergo deterioration of the articular cartilage.

A

unit load (determines cartilage failing point)

61
Q

T?F a dull aching pain in the anterior knee is commonly indicative of cartilage hardening and sclerosis associated w/ chondromalacia

A

FALSE; cartilage softening

62
Q

in the pathogenesis of joint degeneration, a fibrocartilaginous plug will begin to form when:
a. damage begins in the outer layer of articular cartilage
b. damage crosses the tide mark
c. damage extends into the cancellous subchondral bone
d. to fill a subchondral cyst

A

b. damage crosses the tide mark

NYCC MSP (28 decks)

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