OA and treatment Flashcards
what is OA
and what it causes
OA is a long-term chronic disease characterized by the deterioration of (articular) cartilage in joints which results in bones rubbing together and creating stiffness, pain, and impaired movement.
does inflammation occur in OA
Yes, Degenerative disease of chondral cartilage
Inflammation occurs late in disease cf. rheumatoid
what is the order of progression (very brief summary)
(mechanical stress to then inflammation -> primary OA secondary inflammation) wear and tear degrades articular cartilage lose joint space then inflammation
compare it to RA
inflammation first then wear and tear
endogenous predispositions to OA
age
gender
high BMI (educating weight loss key part of conservitive treatment)
external risk factors
trauma
overload
(preventing high stress excerises)
what is the function of meniscus cartilage
shock absorber
how should the articlar cartilage and the whole joint look like
smooth shiny white
what are the main risk factors of OA
Age, excess weight/obesity
what are other risk factord
mechanical constraints(intense sport) hereditary female gender/menopause oestrogen defiency metabolic syndrome cruitate ligament rupture
what portions of teh spine does OA effect
lumbar and cervical spine
What joints in teh hand
DIP PIP
what main joints effected
big joints (knee hip spine and fingers)
if other joint affected like ankle
maybe due to other conditions
RA affects ehich joints in teh hands
NOT THE DIP PIP
metacarpal phalangeal joints
OA signs/symptoms
Pain is related to use Pain gets worse during the day Minimal morning stiffness (<20 min) and after inactivity (gelling) Range of motion decreases more stiffnes at the end of the day Joint instability Bony enlargement Restricted movement Crepitus Variable swelling and/or instability
what is the assessment carried out
Look
Feel
Move
Special tests
what can you look fpr
alignment of the knee and knee scar indicating kneee surgey
what do you feel
may have fluid around the joints, so a bubble of fluid that can be moved around
what do you move
the knee while patinet is lying down
angle of flexion
what is the special test
anterior draw
what is the significance of the test
cruitiate ligament not wotking
why is that significant
can cause artitits by increase in wear and tear
what lab/blood test can be doen
none
what else can you anaylse
Cartilage degradation products in serum and joint fluid
what changes can be seen in a x ray
loss of joint space
sclerosis
osteophytes
sunchondral cyst
what is scelrosis
Sclerosis- thickening of bone- shown by the white –
what is subchondral cyst
a fluid-filled space inside a joint that extends from one of the bones that forms the joint.
shown as dark region
osteophytes
are cartilage-capped bony proliferations (spurs)
what is conservative OA manadgement
Weight loss Analgesics: oral/topical NSAIDS, Physiotherapy Walking aids Avoidance of exacerbating activity Injections (steroid/viscosupplementation)
what injections can be given
Steroids
Lubrication gel
Platelet rich plasma
???stem cells (not a lot of evidence)
operations
Operative Replace (knee/hip) Realign (knee/big toe) Excise (toe) Fuse (big toe) ?arthroscopy if loose bone in joint Denervate (wrist)
what q to ask to distinguish between OA and RA
the pain throughout the day
worse or better after movement
one knee both knee
what is important to ask if yiu want to do a surgery or injection
what med they take to see if their are any blood thinners
outline the transition from a meniscal tear to OA
Injury meniscal tear surgery/removal increased pressure articular cartilage wear loss of joint space OA
what is seen on the DIP with patients of OA
heberdens nodes
what about PIP
bouchards nodes
what are they caused by
osteophytes
what do patients with hip joint problem present with
deep groin pain taht radiates into thhe medial thigh
knee pain
steriod treatment
Steriord help as an antilinflammaoty for 2/3 months maybe up to a year
But too much steroids can cause adverse side effects like infection, and actually cause A because inflammation in needed to heal and thus may not heal
what is the platelet therapy
Blood centrifugated to get platelets
Platelets have lots of anti inflammatory mediators
Injected to the knee
Helping cartilage effects
what sort of bones are bouchards and heberedens
cortical
4 core points of physiotherapy
Muscle strength
Conditioning
Proprioception
Massage/muscle stretching
