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Musculoskeletal > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

What is osteoarthritis?

A

Osteoarthritis is a chronic disease involving the imbalance between wear and repair of articular cartilage, leading to progressive cartilage loss and accompanying periarticular change

It is often referred to as “wear and tear”

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2
Q

How many people in the UK are thought to have osteoarthritis?

A

8.5 million people

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3
Q

What are the most commonly affected joints in osteoarthritis?

A

Knees (Thumb bases and IPJs)
Hands
Hips
Neck
Lower back

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4
Q

What types of factors increase risk of osteoarthritis?

A

Genetic factors
Constitutional factors
Bio-mechanical factors

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5
Q

What are some constitutional factors that increase risk of osteoarthritis?

A

Female
Ageing
Obesity

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6
Q

What are some bio-mechanical factors that increase risk of osteoarthritis?

A
  • Joint injury
  • Occupational or recreational usage
  • Joint laxity
  • Prior joint trauma or malalignment
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7
Q

What are some forms of joint trauma that increase risk of knee osteoarthritis?

A

PCL rupture
ACL rupture

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8
Q

Describe the pathophysiology of osteoarthritis

A

Osteoarthritis is a metabolically active, dynamic process that involves all joint tissues (joint tissues, cartilage, bone, synovium, ligaments and muscles)

A mixture of biomechanical and genetic features leads to localised loss of hyaline cartilage and remodelling of adjacent bone with new osteophyte formation at the joint margins

This is a combination of both tissue loss and tissue synthesis

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9
Q

What are the distribution patterns of osteoarthritis?

A

Locaslised:
Affecting hips, knees, fingers and the facet joints of lower cervical and lower lumbar vertebrae

Generalised:
Affecting either the spinal or hand joints and at least 2 other joint regions

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10
Q

What are some symptoms of osteoarthritis?

A
  • Pain, worse with joint use
  • Morning stiffness lasting less than 1 hour
  • Inactivity gelling
  • Instability
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11
Q

What will examination show in osteoarthritis?

A
  • Joint line tenderness
  • Crepitus
  • Joint effusion
  • Bony swelling
  • Deformity
  • Limitation of motion
  • Poor grip in thumb OA
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12
Q

What are the 2 main bony swellings in osteoarthritis?

A

Heberden’s nodes
Bouchard’s nodes

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13
Q

What are Heberden’s nodes?

A

Bony swellings of the DIP joints

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14
Q

What are Bouchard’s nodes?

A

Bony swellings of the PIP joints

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15
Q

How can osteoarthritis affect thumb position?

A

Osteoarthritis in the base of the thumb will also cause squaring of the thumb, as it becomes pressed into the hand

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16
Q

What are some other clinical signs of osteoarthritis in the knee?

A

Genu varus (Knock kneeing)
Valgus deformities
Baker’s cysts, which are small, fluid-filled lumps found on the back of the knee, at the popliteal fossa

17
Q

What are some other clinical signs osteoarthritis of the hip?

A

The pain may radiate to the groin or knee

18
Q

What are some other clinical signs osteoarthritis of the cervical spine?

A

It can restrict movement of the head, cause pain and may cause occipital headaches

19
Q

What are some other clinical signs osteoarthritis of the facet joints?

A

Osteophytes impinging on exiting nerve roots, resulting in nerve root symptoms and sciatica

20
Q

What tests are required in the diagnosis of osteoarthritis?

A

History and examination, with no specific laboratory tests available

Radiological imaging such as x-rays, MRI scans and US scans can be used

21
Q

What are the 4 main radiographic features of osteoarthritis?

A

LOSS:
- L - Loss of joint space
- O - Osteophytes
- S - Subchondral sclerosis (Increased density)
- S - Subchondral cysts (Fluid-filled holes)

22
Q

What is shown on this X-ray?

A

Subchondral sclerosis (Black arrows)
Loss of joint space (Orange arrow) in the hip

23
Q

What is shown on this X-ray?

A

Subchondral cysts (Black arrows)
Osteophytes (White arrows)

24
Q

What is shown on this X-ray?

A

Asymmetry in osteoarthritis

25
Q

What are some non-pharmacological management strategies in osteoarthritis?

A
  • Education
  • Lifestyle management
  • Physiotherapy
  • Occupational therapy
26
Q

What are some pharmacological management options in osteoarthritis?

A

Analgesia
Intra-articular steroid injections

27
Q

Describe the pain ladder used in osteoarthritis?

A

Mild pain is treated using NSAIDs (+PPI in elderly) or paracetamol

Moderate pain requires addition of a weak opioid

Severe pain requires addition of a strong opioid

28
Q

What surgical management can be used in severe osteoarthritis?

A

Joint replacement
Arthroscopic surgery
Removal of loose bodies

29
Q

What management in required in nerve root entrapment by osteophytes?

A

surgical decompression, with trimming of the impinging osteophytes

30
Q

When would total knee replacement be considered in patients with knee osteoarthritis?

A

In an appropriate patient, with at least moderately severe OA on x-ray and which significant pain that is uncontrolled by conservative management

31
Q

What are some limitations of total knee replacement?

A

These replacements don’t act like a normal knee and don’t last forever

They often don’t improve stiffness

Replacements are based on male knees and so don’t always act normally

32
Q

What is the problem with revising a replacement?

A

The problems with revising a knee replacement is that because it is a much bigger surgery with more blood loss and higher risk of complications

Revision knees also don’t work as well as the first knee replacement

33
Q

What surgical option is used in cases of unicompartmental (Only medial or lateral) knee osteoarthritis?

A

Unicompartmental knee replacement in which only a small region of the knee is replaced

34
Q

What is involved in a total knee replacement?

A

They involve replacement of the femoral condyles with a metal alloy and replacement of the tibial head with a polyethylene mould

35
Q

How will patients with glenohumeral arthritis present?

A

Patients will usually present with gradual onset of pain and stiffness at rest or at night, with intermittent exacerbations

36
Q

What are some signs of glenohumeral arthritis?

A

Muscle wastage
Asymmetry
Global restriction of ROM

37
Q

What are some non-operative treatments for glenohumeral osteoarthritis?

A

Analgesia
Physiotherapy
GH steroid injection

38
Q

What are some operative treatment options for glenohumeral osteoarthritis?

A
  • Shoulder replacement (Arthroplasty)
  • Resurfacing
  • Total shoulder arthroplasty
  • Reverse polarity shoulder arthroplasty
39
Q
A

Musculoskeletal (123 decks)

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