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
16
Q
Facet Joint Syndrome
A
- Facet joints form bridges between the consecutive vertebral bodies. Degeneration of the facet joints may be of mechanical or inflammatory origin and can be a major source of back pain.
AKA - pillar joints (cervical spine only); zygapophysial joints, Z-joints
17
Q
Facet joint syndrome - History
A
- One of most common causes of back pain
- Lumbar facets have been reported to account for 15-40% of the cases of low back pain
- Essentially, degeneration of the facet joint is a form of osteoarthritis
- Degeneration fo the facet joint leads to pain on movement and stiffness
- Hypertrophy of the joint capsule can lead to compression of the spinal nerve in the intervertebral canal.
18
Q
Facet joint syndrome - Presentation
A
- Pain from degenerative facet joints is described as a deep achy quality, referred to the paraspinal region
- Pain does not radiate distal to knees or elbows
- Pain worsens on extension of the spine
- Normal sensory and motor functions as long as the spinal nerve is not compressed
19
Q
Facet joint syndrome - Diagnosis
A
- To date, manual tests have not proven diagnostic of joint failure
- one small study did show validity but the results need to be further investigated before generalizations can be made
- Radiographic imaging does not correlate with pain, but can be required to rule out other diseases as the source of pain
- Diagnostic nerve blocks are the gold standard
- blocking the nerve to the joint with anesthetic
- blocking the joint itself with anesthetic
20
Q
Neuropathic Joints
A
- Neuropathic or Charcot joints are severally degenerated joints secondary to the loss of innervation to the joint.
- The denervation results in the loss of proprioception and nociception.
- The degeneration is most likely precipitated by uncontrolled trauma.
- The entire joint architecture may be lost in this process.
AKA - Charcot joints
21
Q
Neuropathic Joints- Risk Factors
A
- Diabetes mellitus
- Syphilis
- Leprosy
- Syringomyelia
- Congenital indifference to pain
- Can be associated with diabetes mellitus, secondary to diabetic neuropathy and denervation of the joint
- Denervation of the joint leaves it vulnerable to wear and tear damage without causing pain
- CUmulative trauma results in destruction of the joint
- Pathognomonic characteristics include fragments of bone and cartilage debris released into the joint with signs of chronic synovitis
22
Q
Ganglion Cysts
A
- typically small and located near a joint; conversely, synovial cysts represent herniated synovial membrane from the joint
23
Q
Ganglion Cysts - History
A
- Arises from a cystic or myxoid degeneration of connective tissue
- cystic cavity lacks a true lining of cells but the cavity contains a clear, mucinous fluid similar to synovial fluid
- Formation is possibly associated with trauma
- Painful cysts are removed surgically
- Note: a ganglion cyst on the dorsum of the wrist has been termed a “bible cyst” since they were often removed by a blow from the family bible
24
Q
Synovial Cysts - History
A
- Arise from synovial lining that’s herniated through the joint capsule.
- An example if a Baker cyst that develop in the popliteal space often in the setting of an arthritis
25
Q
Villonodular Synovitis
A
- Benign neoplasms that develop in the synovial linings of joints, tendon sheaths and bursae
26
Q
Villonodular Synovitis - History
A
- Exuberant proliferation of synovial lining extending into subsynovial tissue
- Contain chromosomal abnormalities indicating that the proliferation is Neoplastic and not reactive
- Typically arise in the 20-40 age range
- Two forms are:
(1) Pigmented villonodular Synovitis - occurs in young adults; males = females
- involves one or more joints diffusely; knee > hip > ankle > calcaneocuboid
- pain, joint locking and recurrent swelling and effusion; progressive loss of range of motion
- Presents as a tangled mat of red-brown folds in the joint synovium
- Joint and bone erosion can occur
(2) Giant cell tumor of tendon sheath (localized nodular tenosynovium)
- occurs in young and middle age adults; females»_space; males
- most common soft tissue tumor of the hand
- most common location is the flexor surface of the middle or ring finger
- discrete nodule on a tendon sheath of the hands or feet
- slow growing painless mass
- wrist and fingers are frequent sites
