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Musculoskeletal Physiopathology > Noninflammatory Joint Pathologies > Flashcards

Noninflammatory Joint Pathologies Flashcards

1
Q

What is joint degeneration?

A

A disease in which the function or structure of the affected tissues or organs changes for worse over time

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2
Q

Joint degeneration is driven by…

A

the mechanical wear of joints

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3
Q

Joint degeneration is characterized by…

A

progressive destruction of articular cartilage at synovial joints

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4
Q

Is joint degeneration inflammatory?

A

No

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5
Q

What is the most common joint problem in humans?

A

Joint degeneration

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6
Q

Primary joint degeneration is an ___-related pathology

A

age-related

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7
Q

What mutation is a genetic factor related to cartilage formation that may cause joint degeneration?

A

Mutations in type II collagen gene (COL2A1)

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8
Q

___% of 75-79 years of age are affected by joint degeneration

A

85%

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9
Q

Before age 45, joint degeneration is more common in ___

A

men

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10
Q

After age 55, joint degeneration is more common in ___

A

women

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11
Q

What is secondary joint degeneration?

A

Due to an underlying cause

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12
Q

What are some etiologic factors of joint degeneration?

A
  • Increased unit load
  • Disruption of water bonding (decreased resilience)
  • Subchondral stiffening
  • Biochemical changes
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13
Q

Which biochemical changes are etiologic factors for joint degeneration?

A
  • Decreased proteoglycans
  • Glycosaminoglycan chain length reduced
  • Increased fibrillin
  • Increased water binding
  • Collagenase present
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14
Q

How does bone respond to early joint degeneration?

A

Reparative response

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15
Q

With joint degeneration, ___ and ___ will progressively decrease

A

matrix synthesis and cellular replication will decrease

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16
Q

When in joint degeneration might you see reactive inflammation?

A

Later disease

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17
Q

With reactive inflammation later in joint degeneration, local increases in ___ and ___ induce an increase in nitric oxide and PGE2

A

IL-1b and TNF-a

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18
Q

With reactive inflammation later in joint degeneration, local increases in IL-1b and TNF-a induce an increase in ___ and ___

A

nitric oxide and PGE2

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19
Q

The beginning of joint degeneration pathogenesis involves a decrease in ___ leading to ___

A

decrease in proteoglycan synthesis leading to chondrocyte death increasing

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20
Q

In the pathogenesis of joint degeneration, what is the result of decreased proteoglycan synthesis and increased chondrocyte death?

A

Fibrillation or cracking in the surface layers of the articular cartilage

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21
Q

In the pathogenesis of joint degeneration, what are the immediate consequences of fibrillation propagation?

A
  • Synovial fluid fills defects, increasing fissuring
  • Pieces of cartilage may break off
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22
Q

In the pathogenesis of joint degeneration, fibrillation propagation may eventually crack across the tide mark
What are the histological events that occur at this point?

A
  • Neovascularization/angiogenesis
  • Osteoclast activity increases (subchondral resorption)
  • Osteoblastic activity increases (subchondral sclerosing)
  • Fibrocartilage forms
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23
Q

In the pathogenesis of joint degeneration, fibrocartilage forms to fill cracks across the tide mark
What happens if that fibrocartilage plug breaks down?

A
  • Exposes subchondral bone to mechanical erosion
  • Eburnation
  • Subchondral sclerosing
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24
Q

In the pathogenesis of joint degeneration, the fibrocartilage plug made to fill cracks breaks down and may become eburnated bone
What if eburnated bone cracks?

A
  • Cracks fill with synovial fluid
  • Subchondral cysts form and may increase in size
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25
Q

What are three consequences of haphazard remodeling associated with joint degeneration?

A
  1. Osteophytes (bone spurs)
  2. Subchondral sclerosis (joint stiffening, increased bone mass)
  3. Subchondral bone cysts
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26
Q

With joint degeneration, where are osteophytes most likely to develop?

A

Joint margins

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27
Q

Which joints are capable of degenerating?

A

Any and all

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28
Q

Which joints most commonly degenerate?

A

Hands, knees, hips, cervical and lumbar spine

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29
Q

How do degenerated joints appear externally?

A

May be enlarged (and tender)

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30
Q

How does joint degeneration feel upon palpation?

A

May have crepitus

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31
Q

What are Heberden nodes?

A

Nodes at distal interphalangeal joint seen in joint degeneration of hands

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32
Q

What are Bouchard nodes?

A

Nodes at proximal interphalangeal joint seen in joint degeneration of hands

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33
Q

With joint degeneration, a patient might have ___ pain following ___ and relieved by ___

A

patient might have deep achy pain following activity and relieved by rest

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34
Q

When joint degeneration comes with pain, this is generally a sign of…

A

significant joint destruction

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35
Q

What are some clinical manifestations of joint degeneration?

A
  • Deep achy pain following activity and relieved by rest
  • Short term stiffness in the morning or after inactivity
  • Functional limitations in affected joints
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36
Q

What are some functional limitations in joints affected by degeneration?

A
  • Intra-articular loose bodies
  • Large osteophytes
  • Loss of congruity in joint surfaces
  • Muscle contractures or decreased muscle mass
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37
Q

What are six radiographic findings in joint degeneration?

A
  1. Non-uniform loss of joint space
  2. Subchondral sclerosis
  3. Osteophyte formation
  4. Subchondral cysts
  5. Chondral/osteochondral loose bodies (joint mice)
  6. Subluxation
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38
Q

Disc degeneration is also known as…

A

degenerative disc disease, discogenic spondylosis

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39
Q

What are two tissue based pathologies of disc degeneration?

A
  • Spondylosis deformans
  • Intervertebral osteochondrosis
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40
Q

Spondylosis deformans involves ___ degeneration of the disc

A

annular degeneration

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41
Q

Intervertebral osteochondrosis involves ___ degeneration of the disc

A

nuclear degeneration

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42
Q

How much disc space is lost with spondylosis deformans?

A

Minimal loss

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43
Q

How much disc space is lost with intervertebral osteochondrosis?

A

Prominent loss

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44
Q

How many osteophytes are expected in spondylosis deformans?

A

Prominent osteophytes

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45
Q

How many osteophytes are expected in intervertebral osteochondrosis?

A

Minimal osteophytes

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46
Q

In spondylosis deformans, there are ___ clefts

A

annular vacuum clefts

47
Q

In intervertebral osteochondrosis, there is ___ phenomenon

A

nuclear vacuum phenomenon

48
Q

What is chondromalacia?

A

Softening and breakdown of cartilage, a subcategory of joint degeneration

49
Q

Chondromalacia commonly occurs after…

A

long periods of immobility or inactivity

50
Q

chondromalacia

All synovial joint degeneration will have…

A

cartilage softening

51
Q

Who does chondromalacia patellae affect?

A

Younger population

52
Q

What is a better diagnosis than chondromalacia patellae?

A

Patellofemoral pain syndrome

53
Q

The following are clinical manifestations of which pathology?

  • Dull, aching anterior knee pain and stiffness
  • Grinding sensation with knee flexion
A

Chondromalacia patellae

54
Q

What are the clinical manifestations of chondromalacia patellae?

A
  • Dull, aching anterior knee pain and stiffness
  • Grinding sensation with knee flexion
55
Q

What increases symptoms of chondromalacia patellae?

A
  • Going down stairs
  • Running down hill
  • Squatting
  • Standing after periods of sitting
56
Q

What are possible treatments for chondromalacia?

A
  • Rest
  • Alterations in exercise
  • Adequate pre-exercise warming up and flexibility
  • Weight loss
  • Supportive devices
  • NSAIDs
57
Q

When the force or stress placed on a joint exceeds the ___, the joint may undergo deterioration of the articular cartilage

A

cartilage unit load

58
Q

In the pathogenesis of joint degeneration, a fibrocartilaginous plug will begin to form when…

A

damage crosses the tide mark

59
Q

What is DISH?

A

Diffuse idiopathic skeletal hyperostosis aka Forestiere’s disease (out-dated)

60
Q

What is the etiology of DISH?

A

Unknown etiology but seen generally in patients over age of 50

61
Q

How common is DISH in each sex?

A

Very common: 25% in men over 50; 15% of women over 50

62
Q

What is the main concept of diffuse idiopathic skeletal hyperostosis (DISH)?

A

Hypertrophy and ossification of the anterior longitudinal ligament

63
Q

If a patient has flowing hyperostosis of the anterior longitudinal ligament involving 4 or more adjacent segments, what condition do they have?

A

Diffuse idiopathic skeletal hyperostosis (DISH)

64
Q

DISH

What is an enthesis?
What is an enthesophyte?

A

Insertion of tendon or ligament into bone
Bone growth at the site enthesis is an enthesophyte

65
Q

Up to 50% of patients with DISH will have…

A

ossification of the posterior longitudinal ligament

66
Q

The following are all pathologic features of which condition?

  • Flowing hyperostosis of the ALL
  • Extensive enthesophyte formation
  • Additional ossification of the PLL
A

Diffuse idiopathic skeletal hyperostosis (DISH)

67
Q

What are the pathologic features of DISH?

A
  • Flowing hyperostosis of the ALL
  • Extensive enthesophyte formation
  • Additional ossification of the PLL
68
Q

What are the clinical features of DISH?

A
  • Can be clinically silent
  • Can restrict AROM/PROM; full range to complete ankylosis
  • Back/neck achy pain, stiffness
  • Increased thoracic kyphosis
  • Associated with insulin resistance/diabetes mellitus
69
Q

What is the theory behind the association between insulin resistance/diabetes mellitus and DISH?

A

Pituitary dysfunction

70
Q

DISH

Ankylosis increases possibility of ___

A

spinal fracture

71
Q

The following are all radiographic features of which pathology?

  • Flowing ossification of ALL
  • Lower thoracic spine M/C
  • Enthesopathy
A

Diffuse idiopathic skeletal hyperostosis (DISH)

72
Q

How is DISH differentially diagnosed from seronegative spondyloarthropathies?

A

DISH has preservation of SI joint and facet joints

73
Q

What are some areas DISH may cause enthesopathy besides the spine?

A
  • Nuchal bones (nuchal ligament)
  • Achilles and plantar enthesophytes
  • Pelvic enthesophytes
74
Q

50% of those with DISH have OPLL
Can OPLL be a stand alone condition?

A

Yes

75
Q

Japanese spine disease is the old term for…

A

ossification of the posterior longitudinal ligament (OPLL)

76
Q

Which age group sees OPLL?

A

Those over 50 (degenerative condition)

77
Q

What is the diagnostic criteria for DISH?

A

Must involve 4 or more adjacent segments

78
Q

OPLL does not have to involve DISH
Does OPLL have to involve 4 segments?

A

No

79
Q

If a patient has the following, what is their condition?

  • Hyperostosis of the PLL
  • M/C in the cervical spine (can be any spinal region)
  • Central canal stenosis
A

Ossification of the posterior longitudinal ligament (OPLL)

80
Q

What are some pathologic features of OPLL?

A
  • Idiopathic
  • Hyperostosis of the PLL
  • M/C in cervical spine (can be any spinal region)
  • Central canal stenosis
81
Q

What are some clinical features of OPLL?

A
  • Can be clinically silent
  • Back/neck achy pain, stiffness
  • Can restrict AROM/PROM
  • Symptoms of central canal stenosis
  • Can lead to myelopathy
82
Q

What is the treatment for OPLL?

A

Surgical decompression

83
Q

DISH is likely to cause M/C in ___
OPLL is likely to cause M/C in ___

A

DISH = lower thoracics
OPLL = cervicals

84
Q

What are radiographic features of OPLL?

A
  • Hyperostosis of the POLL (can be more than 5-8mm thick)
  • Parallels the posterior vertebral body margin
  • M/C in cervical spine (but can be anywhere)
85
Q

Synoviochondrometaplasia is also known as…

A

synovial osteochondromatosis, synovial chondromatosis

86
Q

What is synoviochondrometaplasia?

A

Creation of osteochondral loose bodies inside the joint capsule

87
Q

What is the condition that involves creation of osteochondral loose bodies inside the joint capsule?

A

Synoviochondrometaplasia

88
Q

Which form of synoviochondrometaplasia is primary?
Which form is secondary?

A

Idiopathic = primary
Degenerative = secondary

89
Q

What are pathologic features of primary (idiopathic) synoviochondrometaplasia?

A
  • Synovium undergoes metaplasia (forms exuberant synovial villi)
  • Ends of villi form cartilage bodies (eventually can ossify and/or break free)
90
Q

What are the pathologic features of secondary (degenerative) synoviochondrometaplasia?

A
  • Degeneration results in cartilage flaking off
  • Flakes of cartilage act as an accretion site and continue to grow (can eventually ossify)
91
Q

What are some symptoms known as clinical features of synoviochondrometaplasia?

A
  • Joint pain
  • Swelling
  • Crepitus
  • Locking
92
Q

What are some locations known as clinical features of synoviochondrometaplasia?

A
  • Knee M/C (70%)
  • Hip
  • Shoulder
  • Elbow
  • Ankle
  • Wrist
93
Q

What are the radiographic features of primary SCM?

A
  • Loose bodies tend to have similar size and shape (only seen if ossified)
  • None-mild degenerative change (early in disease)
  • 1-100s of loose bodies
94
Q

What are the radiographic features of secondary SCM?

A
  • Loose bodies tend to have different size and shape (only seen if ossified)
  • Pre-existing moderate to severe degenerative change
  • 1-10 loose bodies
95
Q

What is the treatment for primary SCM?

A
  • Loose body resection
  • Partial or complete synovectomy
96
Q

What is the treatment for secondary SCM?

A
  • Conservative management
  • NSAIDs
  • Arthroscopic removal of loose bodies
97
Q

Charcot joint is an old term for which pathology?

A

Neuropathic arthropathy (NA)

98
Q

What is neuropathic arthropathy?

A

Progressive joint destruction secondary to a neurological disorder

99
Q

NA

What are some examples of peripheral neuropathies?

A
  • Diabetes mellitus
  • Alcoholism
  • Multiple sclerosis
  • Charcot-Marie-tooth disease
100
Q

NA

What is an example of a central motor abnormality?

A

Neurosyphilis

101
Q

Which neurological disorders may cause neuropathic arthropathy?

A
  • Peripheral neuropathies
  • Central motor abnormalities
  • Syringomyelia
  • Iatrogenic cases
102
Q

Which joints are most commonly affected by neuropathic arthropathy?

A

Weight bearing joints:

  • Lumbar spine
  • Knee
  • Foot/ankle
103
Q

NA

Which joints are most commonly affected by syringomyelia?

A

Shoulder and upper extremity joints

104
Q

What are the two forms of neuropathic arthropathy?

A

Hypertrophic and atrophic

105
Q

What is hypertrophic neuropathic arthropathy?
What accelerates this?

A

Rapid and severe form of secondary joint degeneration
Progressive articular and subchondral bone destruction is accelerated by absence of pain and proprioception

106
Q

What is atrophic neuropathic arthropathy?
How does it appear?

A

Resorption of bone
Tapered bone ends, missing parts (atrophy of the bones)

107
Q

Which gaits may present with neuropathic arthropathy?

A

Slapping or stomping

108
Q

What are clinical manifestations of neuropathic arthropathy?

A
  • Pain insensitivity
  • Joint enlargement/swelling with warmth
  • Painless insensitivity
  • Crepitus
  • Symptoms worsen over weeks, months, or years
  • Bag of bone appearance
  • Surgically amputated appearance
109
Q

If a patient presents with the following, what pathology is present?

  • Pain insensitivity
  • Joint enlargement/swelling with warmth
  • Painless insensitivity
  • Crepitus
  • Symptoms worsen over weeks, months, or years
  • Bag of bone appearance
  • Surgically amputated appearance
A

Neuropathic arthropathy

110
Q

What are the 6 Ds (3 Di and 3 De) of hypertrophic NA radiographic presentation?

A
  • Distension
  • Dislocation
  • Disorganization
  • Density (subchondral sclerosing)
  • Debris
  • Destruction
111
Q

How does atrophic NA present radiographically?

A
  • Tapered distal margins of bones (licked candy stick appearance)
  • Surgically amputated appearance
112
Q

What is the most common cause of neuropathic arthropathy?

A

Diabetes mellitus

113
Q

What is the most clinically significant component of synoviochondrometaplasia?

A

Loose bodies in joints

114
Q

What is the clinical significance of OPLL?

A

May cause radiculopathy or compression of a nerve root

Musculoskeletal Physiopathology (31 decks)

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