OA SCHEMA

Question 1

Important Aspects from the history

Answer 1

• Familial History (especially heberden’s nodes)
• Age: Presents in middle age; common in the elderly
• Secondary OA: Hx of overuse; injury; repeated injury; joint surgery; obesity

Question 2

Joint Pain

Answer 2

• Asymptomatic in the early stages
• earliest suymptom
• Insidious onset; increases over months-years
• may be local or referred
  Joint symptoms aggravated by:
• use (during and after)
• Cold or damp weather
• before or during a change in the weather
• Period of inactivity
• Joint symptoms better for: rest (release becomes less compelte with time)

Question 3

Observation

Answer 3

• Joint involvement is asymmetric
• Mainly the weight bearing joints
• Distal interphalangeal joints of fingers & toes - also affected ( and 1st MTP)
• Multiple joint involvement

Question 4

Joint Stiffness

Answer 4

• Common
• Occurs after inactivity
• lasts <30mins
• Gradually becomes constant and aggressive
• Improves with movement
• can cause slow difficult movement

Question 5

SSx - List

Answer 5

• Joint stiffness
• Claudication
• Joint swelling
• Joint warmth (intermittent)
• Joint deformity (e.g. knee OA can cause ‘bow legs’)
• Crepitus (crunching, creaking, grating sound or sensation)
• Reduced ROM; capsular pattern in affected joints
• Joint tenderness
• Periarticular tenderness
• Joint locking
• Neurological symptoms

Question 6

Joint Swelling

Answer 6

Herberden’s nodes are typical

• Intermittent (synovial effusion)
• Continuous (capsular thickening and osteophytes)