Osteoarthritis aka DJD Flashcards
What category of joints are commonly affected by DJD?
Weight-bearing joints (knee, hip, etc.)
What are the risk factors for OA?
1 increased age 2 females (hands and knees) 3 obesity 4 trauma 5 inactivity or excessive activity
What is the eponym used for erosive OA of the hands?
Kellgren’s
What histological substance is altered in DJD causes the nonuniform loss of joint space?
Ground substance (chondroitin sulfate)
What is an enthesophyte?
Ossification in the location where a tendon and/or ligament attaches to bone
What is a geode?
Subchondral cyst
What is another name for intraarticular loose bodies that form from cartilage degradation with DJD?
Joint mice
How does a subchondral cyst form with DJD?
Synovial fluid intrusion through exposed articular plate
What group is more likely to have degeneration of the joints of the hand?
Middle-aged postmenopausal females
Enlarged soft tissue nodes are common in which joints of the hands with DJD?
DIPs primarily and also PIPs
What are the soft tissue nodes seen at the PIPs called?
Bouchard’s nodes
What are the soft tissue nodes seen at the DIPs called?
Heberden’s nodes
Besides the DIPs and PIPs, what other joint of the hand can be targeted by DJD?
1st MCP
What type of arthritis presents as bilateral DJD with central joint erosions?
Erosive DJD (variant of the normal pattern)
What is the radiographic finding associated with erosive DJD at the DIP joint?
“Gull wing” sign
Is inflammation associated with DJD?
NO (compare to RA)
What are the soft tissue nodes seen at the MCPs called?
Haygarth’s nodes
Which form of DJD unusally presents with inflammation?
Erosive osteoarthritis
What is the differential diagnosis for erosive DJD?
Psoriatic arthritis, RA
DJD is likely to target which joint in the foot?
1st MTP
What is the condition where the first MTP presents with symptoms of pain and stiffness?
Hallux rigidus
What forms of joint misalignment/deformities are seen with DJD of the feet?
Metatarsus varus, hallux valgas
What is the lay term for hallux valgas?
Bunion
Which means that the distal aspect goes medial: varus or valgus? Lateral?
Medial = varus Lateral = valgus
How can you tell if hallux valgus is caused by DJD or something like gout/infection?
Soft tissue swelling and redness will be present with gout or an infection
Where is DJD likely to occur in the shoulder?
AC joint (NOT glenohumeral)
If osteophytes and/or joint misalignment are seen in the glenohumeral joint, what is the expected cause instead of something like DJD?
Previous trauma or underlying CPPD
Why are osteophytes from DJD in the AC joint potentially a big issue?
May impinge on rotator cuff tendons leading to tendon calcification and superior migration of humerus
What muscle is responsible for the superior pull of the humeral head as a result of rotator cuff impingement?
Deltoid
Which muscle is most commonly associated with shoulder impingement syndrome?
Supraspinatus
At what specific location do we see enthesopathic changes involved with DJD of the shoulder?
Greater tuberosity of the humeral head
Where is the critical zone for a rotator cuff tear, and why is it so critical?
1 cm superior to the greater tuberosity (least vascular spot)
What is the best tool to diagnose a rotator cuff tear?
MRI
What four muscles make up the rotator cuff muscles?
1 supraspinatus
2 infraspinatus
3 teres minor
4 subscapularis
What is Risser’s sign?
Growth centers of the iliac crest relative to scoliosis progression
How is hydroxyapatite deposition disease different from CPPD in location?
CPPD occurs in cartilage; HADD occurs within tendons and bursae
What is the most common location for HADD?
Supraspinatus tendon (but can also occur in hip, wrist, knee, ankle, and spine)
What is the usual age range of those who develop HADD?
40-70
What is HADD?
Deposition of calcium within tendons and bursae
If HADD is present and the crystals move upon rotation, what is their location?
In tendon
If HADD is present and the crystals do not move upon rotation, what is their location?
In bursa
Which two bursae could be in involved with HADD of the shoulder?
Subacromial (superiorly) and subdeltoid (inferiorly)
What are the 3 compartments of the knee?
Medial tibiofemoral, lateral tibiofemoral, retropatellar
Which compartment of the knee is more likely to develop DJD?
Medial tibiofemoral (medial joint compartment disease)
What is the clinical term for being bowlegged?
Genu varus
What is the clinical term for being knock-kneed?
Genu valgus
Is genu varus or valgus associated with medial joint compartment disease of the knee?
Varus
Where do we see enthesopathic changes of medial joint compartment disease of the knee?
Anterior nonarticular surface of the patella
The popliteal groove indicates which side of the knee?
Lateral
Osteophytes due to DJD of the knee can irritate what important structures?
ACL and PCL
Pelligrini-Steida calcification affects what structure?
Medial tibial collateral ligament (MCL)
What causes Pelligrini-Steida calcification?
Lateral to medial stress/trauma
What is synovial osteochondrometaplasia?
Multiple intra-articular loose bodies (joint mice)
Pigmented villonodular synovitis (PVNS) is common among what population?
Younger patients with unexplained hip pain
Where is PVNS most common?
Knee primarily and hip (could also be in ankle, or elbow)
What is the differential diagnosis for PVNS?
RA
What is pigmented villonodular synovitis?
Slow growing, benign, and locally invasive tumor/metaplasia of the synovium
PVNS of which joint is the most clinically significant?
Hip
Concentric erosions of the femoral neck seen with PVNS produce what sign upon radiography?
Apple core deformity
Which compartment of the hip is most likely to be involved with DJD?
Superior (80%)
What is the name for subchondral cysts found only in the hip?
Eggar’s cysts
What does buttressing of the hip due to DJD mean?
Cortical thickening
At what age does Risser’s sign cap out?
16-18
What is the latin term for a “bad old hip” seen with DJD of the hip?
Malum coxae senilis
What Roentgenometric line is used to assess for acetabular protrusion?
Koehler’s line
What is the condition of bilateral acetabular protrusion?
Otto’s pelvis
What kinds of conditions can cause acetabular protrusion?
OA, RA, bone softening diseases like Paget’s
What is the gender bias associated with acetabular protrusion?
More common in males but more likely to be a normal variant in females
What is the most common cause of acetabular protrusion? Least?
MC = RA LC = OA
