Orthopedic Pathology 5 Joint Pathologies Flashcards
Planar joint
Ex: Navicular and the second and third cuneiforms of the tarsus in the foot
Synovial Joint
Are diathroses or diathrodial joint
Most common and most movable joint in body
Capsule surrounds the articulating surfaces of a synovial joint
Lubricating synovial fluid within the capsule
Hinge joint
Ex: Trochlea of humerus and trochlear notch of ulna at the elbow
Pivot joint
Head of radius and radial notch of ulna (annular ligament attached to Ulna is holding radius)
Condyloid joint
Between radius and scaphoid and lunate bones of the carpus
Saddle joint
Between trapezium of carpus (wrist) and metacarpal of thumb
Ball and socket joint
Acetabular femoral joint
Cartilage
Avascular CT
No nerve supply
Consists of a dense network of collagen fibers and elastic fibers embedded in chondroitin sulfate
Surrounded by perichondrium
Hyaline cartilage
The most abundant but weakest type of cartilage
Fine collagen fibers embedded in a gel type matrix
provides flexibility and support
reduces friction and absorbs shock at joint
Reaction of Articular cartilage
Destruction - actively being damaged (trauma), RA, infections, AS, continual compression such as overweight, immobilization, poor posture, corticosteroid injections
Degeneration - overtime, premature aging by overuse, previous destruction, incongruity of joint or irregular joint surface
Peripheral proliferation - osteophyte (bone spur) formation, OA
Reactions to Synovial Membrane
Increase production of fluid from synovial membrane - effusion (extra synovial fluid)
Thickening of membrane - hypertrophy
Adhesions post injury
Reactions of joint capsule and ligaments
Joint laxity - after injury, congenital (Trisomy21, Marfan’s), pregnancy (hormone relaxin), infection
Joint Contractures - disuse, congenital, infection, arthritis, due to muscle Contractures
Joint Deformity
Displacement of the joint - subluxation, dislocation
Excessive Mobility
Restricted Mobility
Gout
AKA metabolic arthritis
A group of disorders in which crystals of monosodium urate (uric acid) are deposited in the tissue, accompanied by attacks of acute arthritis
Marked by an elevated level of serum uric acid and the deposition of urate crystals in the joints, soft tissue and kidneys
Pathogenesis of Gout
Normal
- Uric acid is normally formed with the break down of purines
- Uric acids dissolves in the blood, passes through the kidneys and is then excreted
Abnormal
- With too much production or with poor kidney function uric acid may precipitate out of blood and accumulate in body tissues
- Crystals frequently collect on articular cartilage
- These trigger and inflammatory response resulting in local tissue necrosis and proliferation of fibrous tissue
Three groups of Gout
Primary Hyperuricemia
- inherited disorder of uric acid metabolism
Secondary Hyperuricemia
-Occurs as a result of some other metabolic problem
-Increased DNA trunover d/t Leukemia, lymphoma, chemotherapy
Ideopathic hyperuricemia
Cause of Gout
Can be the result of urate overproduction or decreased urinary excretio of uric acid
Diet rich in purines
- nitrogen containing compounds found in food
- Purine-containing foods: red meats, organ meats, shelfish, sweet breads, dairy, beer
Male>female 9:1
Usually 40-50 years
Risk factors of Gout
Obesity Excessive weight gain, especially with puberty Moderate-heavy alcohol intake Hypertension Abnormal kidney function Certain medications Certain diseases - lymphoma, leukemia, hemoglobin disorders, increased nuclear-protein turnover Decreased thyroid function Dehydration Excessive dining
Signs/Symptoms of Gout
Most common - first MTP joint
Can also affect wrists, fingers, knees, elbows and ankles
Rapid onset pain, swelling, heat, redness, tenderness, +/- fever
Nodular masses of uric acid depositing in soft tissues of body - tophi (massive uric acid deposit)
Tends to be unilateral
Diagnosis of Gout
Differential diagnosis septic arthritis, RA, neoplasm (new growth=cancer/tumor)
Made when
- Monosodium urate crystals (tophi) are found within synovial fluid, connective tissue or articular cartilage
- Serum uric acid levels are elevated
Treatment of Gout
Goals of intervention
- To end acute attacks and prevent recurrent attacks (NSAIDS, Cholchicine)
- correct the hyperuricemia
Adequate fluid intake
Weight reduction
Dietary changes
Decrease alcohol (increases purine catabolism)
NSAIDS, corticosteroid injections, colchicine
Uric acid inhibitor
Pseudogout
Is a joint disease that causes attacks of arthritis
Involves the formation of crystals in the joint - Salt - calcium pyrophosphate dihydrate
Leads to joint swelling and pain in the knees, wrists, ankles, etc.
Mainly affects elderly
Younger patients with hemochromatosis, parathyroid or thyroid disease
Diagnosis of Pseudogout
Joint fluid, WBC, Calcium crystals, Xray
Treatment of Pseudogout
NSAIDS, steroids
Aspiration of fluids (suck the fluid out)
Traumatic Arthritis
Caused from blunt, penetrating or repeated trauma
From inappropriate motion of joint
Symptoms of Traumatic arthritis
Pain, swelling, tenderness, joint instability, bleeding
Traumatic arthritis pathogenesis
Injury to a joint such as a bad sprain or fracture can cause damage to the articular cartilage
- This damage does not appear until months later
- Cartilage is replaced with scar tissue that can not support weight and is not as smooth
The injury could alter how the joint works
-This can increase force on the articular cartilage
Loose bodies
Aka joint mice
Small pieces of bone or cartilage in the joint space (any joint, elbow)
Due to trauma, repetitive action, injury, wear and tear, aging, DJD, etc
May cause pain, clicking, sticking, locking, crepitus
Visible on x-ray
Hemarthrosis
Bleeding into joint spaces
Acute - trauma/surgery (ACL)
Chronic - inherited condition, infection
Can be complications of anticoagulant treatment -e.g. aspirin, warferin, coumadin
Signs/Symptoms of Hemarthrosis
Marked inflammation, pain, swelling, redness, abnormal functioning
Blood damages cartilage and erodes subchondral bone
Treatment of Hemarthrosis
Manage bleeding
Immobilization, analgesic, aspirate joint, monitor meds
Gradually return to ADL’s
Infectious Arthritis
AKA septic arthritis,
Joint inflammation as a result of infection can be due to bacteria, fungus, virus)
Common Bacterial pathogens
Staphylococcus aureus - the most common cause in adults
Haemophilus influenzae - the most common cause in children
Neisseria gonorrhoea - in sexually active young adults
Escherichia coli - in the elderly, IV drug user and the seriously ill
M. Tuberculosis - cause septic spinal arthritis (Pott’s disease)
Streptococcus
Gonococcus
How does an infection get into the joint
Septicema - blood borne Direct infection - needle users latrogenic - medical treatment Catheters Trauma Immunocompromised patients
Pathology of infectious arthritis
Bacteria adheres to synovium
-leads to scar tissue and synovium proliferation
-Hydolysis of proteoglycans and collagen (breaks down articular cartilage)
Cartilage and bone destruction occur
-takes a very short time for joint death and direct pressure necrosis
Clinical manifestations of infectious arthritis
Acute onset of joint pain, swelling, tenderness, loss of motion
males = females
Fever, chills
Pus
Skin lesions
Polyarthralgia
Joints primarily affected - shoulders, knee, hips
Diagnosis of Infectious arthritis
PE - Pain, swelling, redness in joint
History - Sexually Transmitted Infections (STI)’s, IV drug use, Immuno Complex state, surgery, trauma
Blood test - increased WBC count, high RBC sedimantation rate
Fever
Aspirate and culture synovial fluid
X-ray
Treatment of Infectious Arthritis
Medical emergency
Antibiotic via IV
Drain infected joint to decrease pain
Rest
Prognosis of Infectious Arthritis
Acute nongonococcal bacterial arthritis can destroy articular cartilage, permanently damaging the joint within hours or days
Psoriatic arthritis
Is an arthritis often associated with psoriasis of the skin
1 in 20 will develop arthritis with the skin condition
Idiopathic
Primarily affects distal joints of fingers and toes
When spine is affected (L/S and sacrum)
Stiffness burning pain
Psoriatic arthritis diagnosis
PE, joint swelling skin soreness
Psoriatic arthritis treatment
NSAIDS Antirheumatic drugs (Methotrexate) Steroids Surgery RMT, PT, Chiro
Charcots arthropathy
- AKA Charcot joint, Charcot foot, neuropathic arthropathy
- Progressive degeneration of the stress-bearing portion of a joint
- Most commonly associated with diabetic neuropathy
- Most commonly occurs in the foot
- involves bone destruction and reabsorption leading to deformity, dislocation, ulcerations, bone fragments and an unstable joint
Cause of Charcots Arthropathy
Any condition that decreases peripheral sensation, proprioception and fine motor control
DM neuropathy m/c
Signs and Symptoms of Charcots arthropathy
swelling, warmth, redness, subluxation/dislocation, deformity, fractures, collapsed arch, calluses, foot ulcers, joint infections, hemarthrosis, septicemia
Most commonly foot deformity
- 60% Tarsal metatarsal joint (more medial than lateral)
- 30% Metatarsal pharyngeal joint
Treatment of Charcots arthropathy
proper footwear Orthotics Rest Surgery Antibiotics
