Osteoarthritis Flashcards
Hand
What is another term for OA?
Nodal arthritis
RFs for OA?
Prev. trauma to joint
Obesity
Hypermobility of joint
Occupation
What reduces OA risk?
Osteoporosis
Features of OA of the hand?
Usually bilateral (CMC + DIP more than PIP)
Episodic joint pain
Stiffness
Painless nodes (Heberden’s, Bouchard’s)
Thumb squaring
NO FUNCTIONAL IMPAIRMENT
How are joints affected in OA of the hand?
Usually one at a time affected over several years
How is joint pain relieved/exacerbated in OA of the hand?
Relieved - resting
Exacerbated - movement
How does joint stifness in OA of the hand present?
Exacerbated by long periods of inactivity (morning)
How can OA morning stiffness be differentiated from RA morning stiffness?
OA: < 30 mins
RA: > 30 mins
Why does OA of the hand present with thumb squaring?
Bony outgrowth deform CMC of thumb -> fixed thumb adduction
When may functional impairment present in OA of the hand?
Usually no functional impairment
Only if severe DIP involvement -> less grip strength -> disuse atrophy
Ix of OA of the hand?
X-ray (osteophytes, joint space narrowing, etc)
X-ray signs develop before symptoms
How may OA of the knee present?
Pt > 50, often overweight
Pain may be severe
Intermittent swelling, crepitus, movement limitation
What is the most common presentation of OA?
Knee, then hip
lumbar spine
What are RFs of OA specific to the hip?
Developmental dysplasia of the hip
What are features of OA of the hip?
Chronic groin ache after exercise and relieved by rest
What are red flag features suggestive of an alternative cause in suspected OA of the hip?
Rest pain
Night pain
Morning stiffness > 2 hours
What can be used to assess severity of OA of the hip?
Oxford Hip Score
Ix of OA of the hip?
Clinical diagnosis can be made if features typical, otherwise plain x-rays are first-line
Mx of OA of the hip?
Oral analgesia (paracetamol - mild disease, NSAIDs are generally better though)
Intra-articular injections (short-term benefit)
weight loss and exercise
physiotherapy/occupational therapy
DEFINITIVE: THR
Perioperative complications of THR?
VTE, fracture, nerve injury, surgical site infection
Postoperative compliations of THR?
Leg length discrepancy
Posterior dislocation
Aseptic loosening (most common reason for revision)
Prosthetic joint infection
How may posterior dislocation of a THR present?
May occur at extremes of hip flexion
Typically presents acutely with a ‘clunk’
Pain and inability to WB
Examination - internal rotation and shortening
what is the most common joint disease worldwide?
osteoarthritis
when are steroids usually used in OA mx?
usually just to cover during important life event or holiday
there’s a limit to how many injections a pt can have in a year
other surgical procedures for oa aside from arthroplasty?
joint fusion or excision
is thr useful in oa mx?
excellent pain relief but doesn’t improve function of joint much
