Osteoarthritis Flashcards
1
Q
Describe the following joints:
- Fibrous/Bony?
- Cartiaginous?
- Synovial? 3
A
- Fibrous/Bony
- Minimal to no motion - Cartilaginous
- Limited motion - Synovial
- Freely mobile
- Comprised of 2 or more bones
- May have a meniscus
2
Q
Describe the following shape/anatomy:
- Hip? 2
- Shoulder? 2
- Knee? 2
- Ankle?
A
- HIP
- Ball and socket
- Lots of motion, stable - SHOULDER
- Ball on small tee
- More motion, less stable - KNEE
- Round condyles on flat surface
- Ligaments essential - ANKLE
- Limited plane of motion
3
Q
Whats the most common form of arthritis? Also the leading cause of chronic disability.
A
OSTEOARHTRITIS
4
Q
Osteoarthritis:
- AKA?
- PP?
- Symptoms? 5
- What can you develop?
- How will the muscle and ligament be affected?
A
- aka: degenerative arthritis or joint disease; osteoarthrosis
- Loss of articular cartilage - - > exposed bone
- Pain, tenderness,
- stiffness,
- effusion,
- loss of motion,
- creaking
- Can develop progressive deformity
- Muscular atrophy & ligamentous laxity
5
Q
PREDISPOSING FACTORS
for OA?
7
A
- Age,
- female sex (except around the age of 45),
- previous injury
- Obesity, especially for knees
- Heavy physical labor
- Positive family Hx
- Sports activities
Running does not appear to increase the risk
Monitor symptoms
6
Q
PP of OA:
- In most patients, the trigger is damage to what?
- What react by releasing degradative enzymes?
- Can be caused by what kind of trauma?
- Leads to further cartilage damage - Bone reacts with what? 2
- Degradation of cartilage and bony reaction - Superficial erosions → complete what?
- Joint space __________ and possible deformity
- Hypertrophy/hyperplasia of osteocytes → subchondral sclerosis→ what?
A
- normal articular cartilage
- Chondrocytes
- macro-trauma or repeated micro-trauma
- subchondral sclerosis and osteophytes
- loss of cartilage
- narrowing
- osteophyte formation
7
Q
Features of OA: 5
What areas of the body usually? 4
A
- Joint pain,
- swelling,
- crepitation,
- tenderness,
- effusions
- Hands,
- hips,
- knees,
- spine
8
Q
- What kind of pain do you want to be aware of?
- What are late signs?
- What kind of joint involvement in older pts?
- Middle aged?
- Young pts?
(from what?)
A
- Beware radiating pain and bursitis
- Tenderness on palpation and on passive motion are late signs
- Multiple joint involvement in older patients
- Hip and knee involvement seen in the middle aged
- Single joint involvement in the young (trauma or congenital abnormality)
9
Q
What is the most common joint affected for OA?
A
Hands
10
Q
OA Hands
- What population mostly?
- Genetic?
- Which joints? 2
- What are the osteophytes at each of these called? 2
A
- Middle-aged and elderly women
- Strong family history
- DIP and PIP joints of fingers
- Osteophytes and palpable
- Heberden’s nodes (DIP)
- Bouchard’s nodes (PIP)
11
Q
OA shoulder:
- Will present how?
- Difficulty with what activities? 3
- Often associated with what? 2
A
- Progressive anterior shoulder pain, worse with motion
- Difficulty with
- overhead activities,
- sleeping,
- axillary hygiene - Often seen with
-rotator cuff disease/tears,
-AC joint arthritis
(Spurs and AC arthritis can cause impingement of rotator cuff)
12
Q
OA hip
- Will present how?
- Can radiate where?
- Pain on lateral side of hip is usually what?
- Pain behind hip usually from where?
- Starts how and progresses to what?
- Difficulty with what movements?
- Pain with what?
A
- 10% of patients – pain deep in groin
- Can radiate to anterior thigh, knee and buttock
- Pain on lateral side of hip, usually greater trochanteric bursitis
- Pain behind hip, usually from back
- Starts with prolonged standing/walking can become intolerable
- Difficulty putting on shoes/socks – pain and loss of motion
- Pain with abduction
13
Q
OA knee
- What is a contributing factor?
- Characterized by? 4
- Difficulty with what actions? 3
- Pain with what movements?
- Imaging? 2
A
- 30% of patients – obesity is a contributing factor
- Osteophytes,
- effusions,
- crepitus, and
- limited motion
- Difficulty:
- doing stairs,
- getting out of low chairs,
- off of toilets - Pain with kneeling/squatting – hard to get off the ground
- Imaging – get
-standing views (AP and 45 degree) and
-sunrise view
Supine AP and lateral not adequate
14
Q
OA spine
- Symptoms are from what? 2
- Cervical symptoms? 2
- Can develop what?
- Lumbar symptoms? 2
- Can develop what?
A
- Symptoms from
- facet joint arthritis and
- DDD - Cervical:
- pain and stiffness,
- aching pain down the arm - Can develop cervical cord compression
- Lumbar:
- pain across low back/buttocks
- with LOM flex/ext - Can develop spinal stenosis
15
Q
Dx of OA
What will we see on xray that would indicate this? 5
A
- Joint space narrowing
- Surface irregularity
- Osteophytes
- Subchondral sclerosis
- Subchondral cysts
16
Q
OA NONPHARMALOGIC RX
6
A
- Moderate weight loss
- Exercises
- PT/OT
- Braces
- Heat/Cold
- Rest
17
Q
OA PHARMALOGIC RX
5
A
- Acetaminophen
- NSAIDs (Naproxen/Ibuprofen)
- Tramadol
- Opioids
- Intraarticular injections
18
Q
OA INTRAARTICULAR INJECTIONS
- Both what have been shown to be effective? 2
- Can provide months of relief for many patients
A
- steroids and hyaluronans
19
Q
Glucocorticoids (triamcinolone, methylprednisolone) injections?
- MOA?
- Often used where? 2
- How many can you do?
- Complications? 3
A
- Slow cartilage degradation, provide pain relief
- Often used in
- knee and
- shoulder, less in other joints - Repeated injections have been proven safe
- Post injection flare,
- feeling high,
- possible infection
20
Q
Hyaluronans (synvisc, hyalagen) injections
- What are they?
- Have been used for what? 2
- Disadvantgaes? 3
A
- Macromolecules that absorb water and may protect cartilage
- Have been used for
- knees and
- hips - Series of injections,
- can have a flare,
- possible infection
21
Q
KNEE INJECTION/
ASPIRATION
Steps in the process
6
A
- Thorough skin prep
- Supero-lateral portal (Not antero-medial)
- Patient supine
- Sit with knee at eye level (Little pain when slow)
- Numbing skin (Usually not needed)
- Aspiration/Injection
22
Q
REVIEWS OF NON-SURGICAL Rx
FOR ARTHRITIC KNEE PAIN
1. The following have been shown to help? 3
- The folllowing have not? 5
A
- These have been shown to help
- Intra-articular steroids and hyaluronans
- Gentle exercises, swimming, ice
- Weight loss - Studies show these have not helped
- Orthotics
- Taping
- Acupuncture
- Glucosamine and chondroitin
- Arthroscopic debridement
23
Q
OA SURGICAL TREATMENT
3
A
- ARTHROSCOPIC PROCEDURES
- TOTAL JOINT REPLACEMENT
- CHONDROCYTE GRAFTING
24
Q
OA SURGICAL TREATMENT
- ARTHROSCOPIC PROCEDURES may cause what complication?
- TOTAL JOINT REPLACEMENT: What is it?
- CHONDROCYTE GRAFTING: Possibly useful for what?
A
- May aggravate underlying arthritis
- No studies that show patients do any better - Unicompartmental replacement and resurfacing more controversial
- Perhaps for small, isolated defects.
- No long term studies
25
Q
What is the Gold standard for severe knee, hip, or shoulder joint arthritis?
A
TOTAL JOINT REPLACEMENT
-Not as clear cut for ankle, wrist, elbow
26
Q
Total Knee Replacement:
- Advantages? 3
- Disadvantage? 1
A
- Relieves pain,
- corrects deformity,
- improves function
- Requires significant post-op rehabilitation
27
Q
TOTAL HIP REPLACEMENT
- Advantages? 3
- Disadvantage? 1
- Total shoulder replacement advanatges? 2
A
- Relieves pain,
- restores function
- Relatively quick recovery – out-pt
- Leg length inequality not uncommon
- Relieves pain,
- may improve function
28
Q
LONG TERM ISSUES OF REPLACEMENTS
3
A
- Infections
- Loosening
- Periprosthetic
29
Q
LONG TERM ISSUES OF REPLACEMENTS
INFECTIONS:
1. More susceptible due to implant – examples? 2
(Use Heart Association guide lines for prophylaxis)
2. ________ pain, look for infection
LOOSENING
- May be due to what? 2
- Follow up how?
PERIPROSTHETIC FRACTURES
- Metal creates what?
- Difficult to treat. Avoid what?
A
- dental procedures,
- colonoscopy
- Sudden
- bone resorption or
- macrophage response
- x-rays
- stress risers
- contact sports
