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Ortho Path 300 > Joint pathologies > Flashcards

Joint pathologies Flashcards

0
Q

Types of synovial joints

A 
Planar (navicular/cuneiform)
Hinge (humerus/ulna)
Pivot (radius/ulna)
Condyloid (radius/carpals)
Saddle (carpal/metacarpal 1)
Ball and socket (acetabular/femur)
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1
Q

Synovial joints

A

Diarthotic
Most moveable joints
Surrounded by capsule, lubricated by synovial fluid.

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2
Q

Cartilage

A

Avascular CT
No nerve supply
Dense network of collagen and elastic fibres embedded in chondroitin sulfate

Surrounded by perichondrium

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3
Q

Hyaline cartilage

A

Most abundant but weakest

Fine collagen fibres embedded in gem-type matrix

Provides flexibility and support

Reduces friction and absorbs shock.

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4
Q

Reactions of articular cartilage

A

Destruction (trauma, compression, corticosteroids, inflammation/infection)

Degeneration (time, premature aging, previous destruction, joint incongruity/irregularity).

Peripheral proliferation (bone spurs, osteoarthritis)

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5
Q

Reactions of Synovial Membrane

A

Effusion (increased production of synovial fluid)

Thickening of membrane (hypertrophy)

Adhesions post-injury.

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6
Q

Reactions of joint capsules and ligaments.

A

Joint laxity (post-injury, congenital, pregnancy, infection)

Joint contracture (disuse, congenital, infection, arthritis, muscle contractures)

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7
Q

Joint deformity

A

Displacement (subluxation, dislocation)

Excessive mobility restricted mobility

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8
Q

Gout

A

Metabolic arthritis

Monosodium urate (uric acid) crystals deposited in tissues, accompanied by attacks of acute arthritis.

Most common in big toe

Result of urate overproduction or decreased excretion

DDX. Septic arthritis, RA, neoplasm

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9
Q

Pathogenesis of gout

A

Normally, purines break down into uric acid, which is dissolved, passed through kidneys and excreted.

In gout, uric acid precipates into blood (poor kidney function or overproduction) and deposits in tissue.

    • especially articular cartilage.
    • triggers inflammatory response. (–> necrosis and proliferation of fibrous tissue).
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10
Q

Types of gout

A

Primary hyperuricemia (inherited)

Secondary hyperuricemia (secondary to a different metabolic disorder, or cancer/chemo)

Idiopathic

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11
Q

Tophi

A

Nodular masses of uric acid depositing in soft tissues of the body.

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13
Q

Traumatic Arthritis

A

Damage to articular cartilage – cartilage replaced by scar tissue – alters how joint works.

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14
Q

Loose bodies

A

“Joint mice”
Small pieces of bone or cartilage in joint space
Due to trauma, repetitive action, etc.

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15
Q

Hemarthrosis

A

Bleeding in joint spaces

Acute or chronic
May be complication of anticoagulant treatment.

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16
Q

Infectious arthritis

A

“Septic arthritis”

Joint inflammation as a result of infection

Most common in adults: staphylococcus aureus.

Medical emergency.

Most common in kids: haemophilia influenza

Most common in those getting lucky: neisseria gonorrhoea

Bacteria adheres to synovium –> breakdown of articular cartilage

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17
Q

Psoriatic arthritis

A

1/20 people with psoriasis develop psoriatic arthritis

Primarily affects DIPs of fingers and toes. Can also affect spine.

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18
Q

Charcots arthropathy

A

Charcot joint, Charcot foot, neuropathic arthropathy.

Progressive degeneration of stress bearing portion of foot

Associated with diabetic neuropathy

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19
Q

Pseudogout

A

Just like regular gout, but crystals formed from calcium pyrophosphate dihedral salt, not uric acid.

20
Q

Loose Bodies

A

“Joint Mice”

Small pieces of bone or cartilage in the joint space

21
Q

Hemathrosis

A

Bleeding into joint space

Acute or chronic

Can be complication of anticoagulant meds

22
Q

Infectious Arthritis

A

“Septic arthritis”

Joint inflammation as a result of infection

Medical emergency. Fast acting.

23
Q

Most common bacterial pathogens involved in infectious arthritis

A

Adults: staphylococcus aureus

Kids: haemophilius infulenza

Those getting lucky: neisseria gonorrhoea

Elderly, IV drug users: esherichia coli

Strep, gonococcus

24
Q

Pott’s Disease

A

Infectious arthritis of the spine

Caused by m. tuberculosis

25
Q

Psoriatic arthritis

A

1/20 people with psoriasis will develop psoriatic arthritis.

Primarily affects distal joints; can affect spine

26
Q

Charcots arthopathy

A

Charcot joint, Charcot foot, neuropathic arthropathy.

Progressive degeneration of the stress bearing portion of a joint.

Most commonly associated with diabetic neuropathy.

27
Q

Osteoarthritis

A

“Degenerative joint disease”
Most common joint disorder
Prevalence increases with age

Gradual loss of articular cartilage, with thickening of subchondral bone, osteophytes at joint margins, and mild nonspecific synovial inflammation.

Idiopathic, unless secondary.

28
Q

How normal cartilage ages:

A

Glycosamnioglycans (GAGs) shorten and are replaced by less efficient types. Associated proteoglycans change, and cartilage’s ability to retain water is decreased. Biomechanical nature of the joint is changed.

Fissures may develop in cartilage mostly stress fractures of collagen network.

29
Q

Three abnormalities of osteoarthritis

A

Reduced joint space
Formation of osteophytes
Sclerosis of subchondral bone.

30
Q

Stages of OA pathogenesis

A

Phase 1. Edema and microcracks
Phase 2. Fissuring and Pitting
Phase 3. Erosion

31
Q

Phase 1 of OA pathogenesis

A

Edema and microcracks

  • edema of ECM
  • cartilage loses its smooth appearance and develops micro cracks.
  • cartilage softens and thins; loss of joint space
  • Focal loss of chondrocytes (thus unable to repair).
32
Q

Phase 2 of OA pathogenesis

A

Fissuring and Pitting

  • microcracks deepen perpendicularly; along collagen fibres
  • vertical clefts form in cartilage above subchondral bone
33
Q

Phase 3 of OA pathogenesis

A

Erosion

  • Fissures cause fragments of cartilage to detach, causing
  • -> osteocartilaginous loose bodies
    • synovial inflammation (more focal than rheumatoid synovitis) –> synovial hypertrophy and capsular thickening
  • -> uncovering subchondral bone
    - sclerosing of subchondral bone; subchondral cysts; osteophyte formation
34
Q

Symptoms of OA

A

Pain, usually relieved with rest.
Morning stiffness – less than 30 minutes

Commonly located at hand; knee (high association with obesity); spine; hip

Heberden’s nodes at DIPs; Bouchard’s nodes at PIPs.

35
Q

Rheumatoid Arthritis

A

Systemic inflammatory autoimmune disease that predominantly manifests as chronic progressive synovial inflammation and destruction of joint architecture.

Results in hyperplasia, edema, fibrin exudation of synovial fibroblasts and structural damage of cartilage, bone and ligaments.

Extra-articular manifestation can affect a variety of organs and is a significant factor in morbidity and mortality

Damage usually symmetrical and uniform

3:1 women:men

36
Q

Pannus formation

A

Pannus – abnormal layer of fibrovascular or granulation tissue

In RA, the synovial membrane hypertrophies and extends into (and destroys) surrounding cartilage and bone (=pannus formation)

37
Q

Tenosynovitis

A

Inflammation of synovium around a tendon.

Common in RA

38
Q

Swan neck

A

Hand deformity seen in RA

PIP hyperextended; DIP flexed

39
Q

Boutonniere Deformity

A

In hand. Seen in RA

PIP flexed; DIP hyperextended

40
Q

Baker’s Cyst

A

“Popliteal Cyst”

Seen in RA

41
Q

Deformities associated with RA

A 
Valgus knee
Swan neck 
Boutonniere
Baker's Cyse
Ulnar drift
42
Q

Ankylosing Spondylitis

A

Systemic disorder characterized by inflammation of the axial skeleton.

Enthesitis central feature.

ankylosis – immobility and fixation of a joint
spondylitis – inflammation of vertebrae

Male dominant.

Insidious.
Onset 20-40

May result in fusion of joint.

43
Q

Seronegative spondyloarthopathy

A

seronegative – test negative for rheumatoid factor (RF)

Include ankylosing spondylitis, psoriatic, reactive and enteropathic arthropathies.

44
Q

Enthesitis

A

Inflammation of the enthesis ( connection between tendon/ligament and bone)

Key feature of AS

Inflammation of ligament –>fibrosis, bony erosions and reactive bone growth and spurring

45
Q

Signs and symptoms of AS

A

Fixed, flattened chest
Pain diminishes as vertebrae fuse
Muscle wasting, fatigue

Possible osteoporosis, stenosis

Bamboo spine (fused vertebrae)
Dagger sign -- SPs fuse

Ortho Path 300 (7 decks)

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