Musculoskeletal - Joint - Degenerative Flashcards
1
Q
Osteoarthritis
A
- This is a disease featuring the failure of all components of the joint. Most strikingly effected however is the joint articular surface, which undergoes slow, progressive decomposition and remodeling.
AKA - Degenerative joint disease; Hypertrophic arthritis; Degenerative disc disease (in the spine); generalized arthritis; Kellgren’s syndrome
2
Q
Osteoarthritis - History
A
- Primary OA is idiopathic in nature; Secondary OA is due to a predisposing factor such as repetitive trauma or abnormal stress to the joint
- OA is the most common joint disease in humans
- Approximately 80-90% of individuals older than 65 years have evidence of primary osteoarthritis.
- Among the elderly, knee OA is he leading cause of chronic disability in developed countries; some 100,000 people in the UA are unable to walk independently from bed to bathroom because of OA of the knee or hip.
- Under age of 55, the joint distribution of OA in men and women is similar; in older individuals, hip is more effected in males
- OA is more common in fmeales than males with a range of 2.6 to 1
- Similarly, radiographic evidence of the knee OA and, especially symptomatic knee OA is more common in women than in men
3
Q
Osteoarthritis - Joint Involved
A
- Joints commonly involved:
- Hip
- Knees
- lower lumbar and cervical vertebrae
- interphalengeal joints of fingers
- first carpometacarpal joint of the hand
- first tarsalmetatarsal joint of the feet
- acromioclavicular joint
- facet joints (z-joints) of the vertebral column
- Heberden nodes - osteophytes presenting on distal interphalangeal joints (more common, and in women)
- Bouchard’s Nodes - osteophytes presenting on the proximal interphalangeal joints
4
Q
Osteoarthritis - Risk factors
A
- Age
- Hereditary
- Weight bearing
- Abnormal mechanical stress
- obesity, previous joint deformity, excessive valgus or varus
- smoking
- Occupational
5
Q
Osteoarthritis - Phases
A
- Early changes involve decrease in proteoglycans and an increase in water content with weakening of the collagen network
- IL-1, TNF-a, and NO levels go up in he cartilage; chondrocyte apoptosis is seen the articular cartilage surface
- Loss of tensile strength and resilence; fissuring and cracking of the cartilage
- Deep chondrocytes proliferate producing new cartilage
- Eventually the regressive changes dominate
- Thinning of the cartilage and narrowing of the joint space
- Underlying bone has synovial fluid driven into it under pressure creating cysts
- Remodeling of underlying bone creates subchondrial sclerosis and osteophyte formation
6
Q
Osteoarthritis - Presentation
A
- Deep achy joint pain that worsens with use
- Morning stiffness 30 minutes
- Stiffness after periods of immobility (termed gelling)
- Crepitus
- Limited range of motion
- Joint enlargement
- Joint instability
- Periarticular muscle atrophy
7
Q
Osteoarthritis - Diagnostic Testing
A
- Radiographic imaging: finding can include ABCDEs:
- Abnormal alignment
- Bony subchondrial cysts and sclerosis
- Cartilage is not calcified
- Deformaties such as Heberden and Bouchards node and other osteophytes as well as the gull-wing deformity
- no erosions
- slow progression over the course of years
- Synovial fluid analysis when indicated to rule out other causes
8
Q
Osteoarthritis - Treatment
A
- Treatment is symptomatic and palliative
- Analgesics when needed
- Nutraceuticals have been shown to have some beneficial effects:
- glucosamine
- chondroitin (these are building blocks for cartilage, idea is to make avail for re-building)
9
Q
Osteoarthritis - Management with Complications
A
- viscosupplementation when appropriate (procedure that involves the injection of gel-like substances (hyaluronates) into a joint to supplement the viscous properties of synovial fluid
- Surgical replacement when necessary
10
Q
Osteoarthritis - Prevention/ health promotion
A
- No good means of preventing the disease, nor is there any good way of slowing its progression
- Weight loss
- exercise for strengthening muscle groups
- Ambulatory aids
- topical capsaicin
- parafin baths for hands
- shock-absorbing insoles
11
Q
Degenerative Disk Disease
A
- Degenerative changes in the intervertebral disc that result in the disc slowly loosing height.
- Spondylosis refers to degenerative disk disease.
- The diagnosis of spinal OA should be reserved for patient with involvement of the apophyseal joints, and not only disk degeneration.
- Symptoms of spinal OA include localized pain and stiffness. Nerve root compression by an osteophyte blocking a neural foramen, prolapse of a degenerated disk, or subloxation of an apophyseal joint may cause radicular pain and motor weakness.
AKA - collapsed disc, spondylosis, disc degeneration
12
Q
Degenerative Disk Disease - History
A
- Ubiquitous with age
- COmmon cause of low back and neck pain
- Reduction in the height of the discs
- Often accompanied by the formation of osteophytes anteriorly and posteriorly to the spondylotic disc.
- Anterior and lateral osteophyte development consequent to disc degeneration is termed “spondylosis deformans”
- Narrowing of the vertebral canal, termed spinal stenosis
- Can lead to degenerative spondylolisthesis
13
Q
Degenerative Disk Disease - Presentation
A
- Can be clinically asymptomatic
- Can be present with indisious onset of progressively worsening radicular and or axial back pain
- Can have neurologic signs of radiculopathy
14
Q
Degenerative Disk Disease - Diagnosis
A
- X-ray of spine lateral view
- CT scan of spine
- MR imaging of spine (very effective)
15
Q
Degenerative Disk Disease - Treatment
A
- Surgical disc reduction
