Joint Degeneration (DRAFT) Flashcards
define degeneration
disease in which function/structure of affected tissue/organs changes for the worse over time
what factors would increase risk for more severe or earlier clinical presentation of joint degeneration?
^mechanical forces
define osteoarthritis
implies inflammatory mediation (caused by inflammation)
define osteoarthrosis
mechanical breakdown of joints (is not caused by inflammation)
define joint degeneration
mechanical breakdown of joint (lacking well-defined SSx)
joint degeneration is characterized by progressive destruction of ____ at ____ joints
articular cartilage; synovial joints
what is secondary joint degeneration due to?
underlying cause = ^mechanical breakdown
- congenital / acquired incongruity of joints
- trauma
- inflammatory arthritis
- crystal deposits (crystaline arthropathies)
- infection
- metabolic or endocrine diseases
what is the most common joint problem in humans?
joint degeneration
what are the general aspects of joint degeneration?
cartilage breakdown, non-inflammatory, progressive, age related
what is the etiology of primary joint degeneration?
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)
what are the symptoms of joint degeneration?
variable symptoms (has defined signs, not symptoms)
what population is most commonly affected by joint degeneration?
85% of 75-79yrs
when is joint degeneration more common in men? women?
men: before age 45
women: after age 55
is joint degeneration classified as a physiological process or a pathology?
both normal physiological process AND pathology
what are some etiological factors that play into secondary joint degeneration?
- increased unit load
- disruption of H20 bonding
- subchondral stiffening
- biochemical changes
- early joint degeneration (reparative response)
what are some examples of subchondral stiffening?
- subchondral sclerosis
- acromegaly
- Paget’s
describe the biochemical changes that result in joint degeneration.
- decreased proteoglycans: chondrocytes die
- reduced glycosaminoglycan chain length
- ^fibrillin
- ^water binding
- collagenase present
early joint degeneration is a ____ response
Reparative
what is the pathogenesis of joint degeneration?
- proteoglycan synthesis decreases, chondrocyte death increases
- fibrillation/cracking/fissuring in surface layers of articular cartilage
- fibrillation propagation
- cracks cross tide mark
- fibrocartilage plug may be broken down
- eburnated bone cracks
- osteophytes may develop at joint margins
what happens during the fibrillation propagation step of the pathogenesis of joint degeneration?
- synovial fluid fills defects, increasing fissuring
- pieces of cartilage may break off
what occurs when cracks cross the tide mark in the pathogenesis of joint degeneration?
- angiogenesis
- ^osteoclast activity = subchondral resorption
- ^osteoblastic activity = subchondral sclerosing + subchondral cysts
- fibrocartilage forms (patching that eventually falls out)
what occurs when the fibrocartilage plug breaks down during joint degeneration?
- exposes subchondral bone to mechanical erosion
- eburnation
- subchondral sclerosing
what occurs when eburnated bone cracks during joint degeneration?
- cracks fill w/ synovial fluid
- subchondral cysts form and may increase in size
what is eburnation?
sclerosis + smoothing of 2 bony surfaces rubbing together
what are osteophytes?
degenerative out growth at joints
what are spondylophytes?
osteophytes of the spine, usually reserved for discs
how can you differentiate between blastic activity and sclerosis?
- blastic = tumor response (woven bone)
- sclerosis = stress response (stress line)
appear different from eachother due to stress line
what is uniformity in terms of joint space loss?
within a joint
what is symmetry in terms of joint space loss?
comparing side to side
do you think changes seen at joints with joint degeneration will be bilateral?
depends:
- hand dominance = asymetric/unilateral
- weight bearing joints (knees) = (generally) bilateral
in the knee, which joints wear out faster?
medial joints wear out faster than lateral
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?
depends:
- UE tend toward asymetry
- LE tend toward bilateral
what is the preferential location of joint degeneration?
any and all joints, but very common in:
- hands
- knees
- hips
- cervical
- lumbar
what are the clinical manifestations of joint degeneration?
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
with joint degeneration, pain is generally a sign of what?
significant joint destruction
what are Heberden and Bouchard Nodes?
generally painless osteophytes growing off DIP, PIP, and MCPs of the hands
Herberden nodes involve what joints of the hands?
DIP joint
Bouchard nodes involve what joints of the hands?
PIP joint
Haygarth nodes involve what joints of the hands?
MCP joint
what are some of the possible functional limitations in affected dgenerative joints?
- intra-articular loose bodies (floating in joint as “sand”)
- large osteophytes
- loss of congruity in joint surfaces
- muscle contractures or decreased muscle mass
what are the radiographic findings of joint degeneration?
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)
what is a buzz word name for chondral/osteochondral loose bodies?
joint mice (also cartilaginous/osteocartilaginous loose bodies)
what is another term for disc degeneration?
discogenic spondylosis
what are the two different types of disc degeneration?
tissue based pathology
- Intervertebral osteochondrosis (IVOC)
- spondylosis deformans
what aspect of the disc degenerates in spondylosis deformans? what does this create?
annular degeneration = spondylophyte growths
what aspect of the disc degenerates in intervertebral osteochondrosis? what does this create?
nuclear degeneration = loss of disc space
in Spondylosis Deformans there is a (prominent/minimal) loss of disc space.
minimal disc space loss
in Intervertebral Osteochondrosis there is a (prominent/minimal) loss of disc space.
prominent disc space loss
in Spondylosis Deformans, ostephytes are (prominent/minimal)
prominent osteophytes
in Intervertebral Osteochondrosis, ostephytes are (prominent/minimal)
minimal osteophytes
Spondylosis Deformans creates ____ vacuum ____
annular vacuum clefts
(Gas formation)
Intervertebral Osteochondrosis creates ____ vacuum ____
nuclear vacuum phenomenon
what is Chondromalacia?
- softening + breakdown of cartilage
- subcategory of joint degeneration
what occurs during the softening + breakdown of cartilage in Chondromalacia?
- cartilage unit load exceeded
- common after long periods of immboility/inactivity
what is the overworked diagnosis of Chondromalacia? what population does it effect? what is the better diagnosis?
Chondromalacia Patellae
- younger pop.
- better diagnosis: Patellofemoral Pain Syndrome
T/F all synovial joint degeneration will have cartilage softening.
t
what are the clinical manifestations of Patellofemoral Pain Syndrome?
- dull, aching anterior knee pain + stiffness
- grinding sensation w/ knee flexion
when are symptoms increased w/ Patellofemoral Pain Syndrome?
- going down stairs
- running down hill
- squatting
- standing after long periods of sitting
what is the treatment of Patellofemoral Pain Syndrome?
- rest
- alterations in exercise
- adequate pre-exercise warm-up + flexibility
- weight loss
- supportive devices
- NSAIDs
when the force or stress placed on a joint exceeds the ____, the joint may undergo deterioration of the articular cartilage.
unit load (determines cartilage failing point)
T?F a dull aching pain in the anterior knee is commonly indicative of cartilage hardening and sclerosis associated w/ chondromalacia
FALSE; cartilage softening
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
b. damage crosses the tide mark
