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MSK > Osteoarthritis > Flashcards

Osteoarthritis Flashcards

1
Q

How common is OA

A

Affects 8 million people
1/2 of all people over 70
The higher the age the more common it becomes - typically in over 45s

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2
Q

What is OA

A

Thinning or loss of the articular cartilage within a joint - degenerative disease of cartilage
Main sign is loss of joint space

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3
Q

Which sex is OA most common in

A

Female

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4
Q

Describe the progress of OA

A

Cartilage starts breaking down - thins and cracks form in surface
Gaps in cartilage expand until they reach bone
Synovial fluid leaks in and causes more damage and may cause cysts

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5
Q

What are the types of OA

A

Idiopathic (primary)

Secondary - occurs due to previous injury, RA, crystal deposition etc

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6
Q

In which joints does OA present in

A

Weight bearing - hips, knees, spine
Joints that are used often - hand, neck
Sometimes affect joints with previous injury

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7
Q

What are the clinical presentations of OA

A

Pain - worse on activity
Stiffness - in morning lasting under 30 mins
Reduced range of movement

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8
Q

What signs of OA may you find on examination

A

Crepitus
Joint swelling - bony enlargements
Joint tenderness
Joint effusion

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9
Q

How does OA present in the hands

A

Thumb base is often one of the first sites
Affects DIP, PIP, CMC
May see bony enlargements at DIPs
Squaring of the hand at thumb

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10
Q

How does OA present in the knees

A 
osteophytes 
effusions 
crepitus 
restricted movement 
deformity 
Bakers cyst
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11
Q

What are Genu varus and valgus deformities

A

Valgus- knees come together (curve inward)

Varus- knees bend out the way

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12
Q

What is Baker’s cyst

A

Cause by any fluid accumulation in the joint

Can be OA but also many other conditions

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13
Q

How does OA present in the hip

A

Pain - may be felt in groin or radiate to/from back and knee
Restricted movement in hip
Start up pain

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14
Q

How does OA present in the cervical spine

A

Pain

Restriction of movement in the neck

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15
Q

How does OA present in the lumbar spine

A

Pain when standing or walking
Osteophytes can cause spinal stenosis
If nerve roots are pinched you can get neuralgic pain in the limbs

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16
Q

What signs of OA can be seen on imaging

A

Loss of joint space
Subchondral sclerosis
Subchondral cysts
Osteophytes

17
Q

How is OA graded

A

From 0-4
0 - no radiological finding
1- minute osteophytes
2- definite osteophytes with normal joint space
3- definite osteophytes with some space narrowing
4- definite osteophytes with severe narrowing and subchondral sclerosis

18
Q

How does OA usually progress in knees

A

in 1/3 the symptoms improve
1/3 symptoms stay the same
1/3 deteriorate

19
Q

How does OA usually progress in hands

A

In small joints, pain often improves over 2 years but swelling gets worse

20
Q

How does OA usually progress in hips

A

symptoms improve in 10% of patients

allows them to come of surgical list so don’t rush a replacement

21
Q

What are some non-pharmacological treatments for OA

A

Weight loss
Exercise - need to stay mobile and strong
Walking stick
Insoles - correct imbalance to take pressure off worn part
Physio - muscle strengthening

22
Q

What are some pharmacologic treatments for OA

A

Analgesia - e.g. paracetamol
NSAIDs - topical or systemic for symptom relief
Pain modulators - amitriptyline, gabapentin (anticonvulsants)
Intra-articular steroids

23
Q

What are some surgical treatments for OA

A

Arthroscopic wash out - removes any debris etc
Joint replacement - most definitive
Arthrodesis - joint fusion
Osteotomy

24
Q

OA is usually symmetrical - true or false

A

False

Joint involvement is often asymmetrical

25
Q

What are the radiographic features of OA

A

Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis

Joint deformity can occur in late stages due to weakened bone

26
Q

What causes subchondral sclerosis

A

Increase in bone cellularity and vascularity causes excess bone turnover

27
Q

What causes subchondral cysts

A

Synovial fluid leaks into damaged bones and forms a cyst

28
Q

What causes osteophyte formation

A

Periosteal stimulation at joint margins

29
Q

What pathologies can lead to OA

A 
DDH 
SUFE
Septic arthritis 
AVN 
FAI 
Trauma - fractures, meniscal tears or cartilage 
Crystal arthropathy 
etc.
30
Q

How is OA diagnosed

A

Radiographs

31
Q

How does weight loss and walking aids help in treatment of OA

A

Reduce the body mass putting pressure on the joint

32
Q

What is the indication for joint replacement

A

Severe pain

Impacting quality of life

33
Q

When would you use an uncemented prothesis in the hip

A

Younger patients

34
Q

When would you use a cemented prothesis in the hip

A

Older patients

MSK (21 decks)

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