Osteoarthritis Flashcards
What happens to fat tissue in the joint space after immobilization in patients with OA?
Increase in fibro-fatty build up in the joint space.
What are some of the results of excessive loading of articular cartilage?
Damage to collagen fiber network
Proteoglycan wash out
Decreased ability to respond to compressive and shear forces
In regards to OA which joint is the most frequently affected and source of complaint?
Hands
Four factors which contribute to joint inflammation
Abnormal mechanical loading
Obesity
Genetics
Aging
What are the 4 stages of changes in the cartilage structure as the degenerative process progresses?
Increased water and decreased proteoglycans
Fibrillation, fissuring, and erosion
Calcification/sclerosis of subchondral bone
Chondrocyte proliferation, hypertrophy, and apoptosis
What is represented in this image?
Bone marrow lesions
What are the common changes in bone structure during the later stages of OA?
Sclerosis (hardening) and cyst formation to the subchondral bone
Bone marrow lesions
Osteonecrosis
Bone attrition (reduction)
Joint deformity
What is the most likely source of pain in the OA?
Synovium
Bone
Nerves
What is the are the things indicated by the arrows and how does that influence OA?
That is infiltration of fragments of bone or cartilage into the synovium
What did Duncan’s 2008 study show in regards to severity of OA and severity of pain?
There is a strong correlation between pain and severity of OA
What are some of the characteristics of Kelgren and Lawrence Level I OA?
Minute osteophytes
Normal joint space
What are some of the characteristics of Kelgren and Lawrence Level II OA?
Identifiable osteophytes
Joint space still maintained (mild)
What are some of the characteristics of Kelgren and Lawrence Level III OA?
Moderate reduction in joint space
What are some of the characteristics of Kelgren and Lawrence Level IV OA?
Severe reduction in joint space (severe)
What is the specificity and sensitivity for Altman’s clinical classification for Knee OA?
Sensitivity 89%
Specificity 88%
A recent Cochrane review should some results of land based exercise for OA. What are those results?
Exercise resulted in short term pain relief sustained for 2-6 months.
What are the precaution for rTSA?
Internal rotation with adduction and extension
The condition of which muscle determines the external rotation following a rTSA?
Teres minor
What is the rate of progression of patients with a negative ER lag sign following a rTSA
Wha is the functional elevation expected?
Quicker progression in terms of arm strength.
Functional elevation of 105º
What are the main risk factors for hip OA?
Age
Previous hx of developmental disorders (developmental dysplasia, congenital dislocation, Legg-Calve-Perthes, Slipped Capital Femoral Epiphysis)
Trauma
High impact athletes (football, hockey)
Obesity (conflicting)
What are the imaging ranges of distance for OA spacing in Hip OA?
Normal: 3-5mm
Significant change <0.5mm change
Moderate OA < 2.5mm (osteophytes likely present)
Severe OA: < 1.5mm (sclerotic hardening)
What are the clinical diagnostic criteria for hip OA?
Hip pain
Erythrocyte sedimentation rate ≤20mm/hr
Pain on internal hip rotation
AM stiffness
Age greater than 50 years
A difference of how many degrees between legs of internal rotation of the hip is considered pathological?
15 degrees
What is the pattern of hip ROM limitation from more limited to less limited?
Internal rotation
Abduction
Flexion
What are the 5 items in Sutlive CPR for the diagnosis of hip OA?
Painful squatting
Painful flexion
Scour test that produces groin pain
Painful extension
IR <25º
What manual therapy maneuver is applied in this picture?
Anterior glide of the hip joint.
What manual therapy maneuver is presented here?
Posterior hip glide.
What maneuver is being presented here?
Lateral distraction of the hip.
Which maneuver is this and how much force do you need to be effective?
Long axis distraction of the hip
70lb
What is this test assessing?
Knee flexion with adduction.
Externally rotating and adducting the tibia.
What is this test assessing?
Knee flexion
Tibia IR and abduction
What effects are expected with tibia internal rotation in various decrees of knee flexion?
This motion can add more movement of the tibia without increasing any symptoms to the knee.
Wha is the intension of this maneuver?
Promote knee extension
What maneuver is this?
Medial patellar glide.
What maneuver is this?
Lateral patellar glide.
What is the following technique?
Patellar rotation
What technique is this?
Patellar caudal glide
What maneuver is this?
Patellar superior glide
What maneuvers is this?
Fibular glides - Posterior
What maneuver is this?
Anterior tibial glide.
What is this maneuver testing
Quad flexibility
Besides obesity, female gender, and poor muscular strength what other condition is also associated with symptomatic knee OA?
Lower educational level.
What medication is recommended for patients with mild to moderate pain in knee OA?
Acetaminophen (Tylenol)
Which modality is indicated in the case of knee OA?
TENS
Which kind of injections have demonstrated good results for patients with knee OA?
Hyaluronate
(More effective than corticosteroids)
Which kind of surgery is indicated for medial or lateral compartment pain?
Unicompartmental knee arthroplasty per Zhang et all 2008
Is ACL morphological changes shown on MRI in the presence of knee OA per Altman?
No.
