osteoarthritis, degenerative disc disease Flashcards
synovial joints are composed of
outer fibrous capsule
interior synovial membranes
articular cartilage
synovial fluid
why do the bones move easily in synovial joints
smooth surfaces of articular cartilage and lubricating synovial fluid
osteoarthritis (OA)
degeneration of joint by aging and stress
obesity and aging are increasing incidence of OA
commonly affected joints by OA
cervical spine L-spine hip knee hand Big toe ( 1st metatarsal phalangeal joint)
which joints are spared in OA?
wrist, elbow and ankle
r/f of OA
age (40 and up) obesity team sports trauma over use of joint heavy occupational work misalignment of pelvis, hip, knee, ankle
what causes OA?
stress applied to joints breakdown of cartilage excessive weight on healthy joints pressure on injured joints chronic disease
pathophysiology of OA
excessive pressure on joint wearing down cartilage and develops cysts
cysts move in cartilage destroying tissue
causing swelling
localized inflammation
osteoblasts cause bony spurs and synovial fluid leaking
loss of cartilage and narrowing of joint space
(problem with bone, cartilage, synovial fluid)
proteoglycans
chondrocytes that synthesize fluid in an effort to repair cartilage
localized joint inflammation is caused by
cytokines and mediators
where do osteophytes form?
at the margin of cartilage loss
what are osteophytes?
small bony projections that develop along the rim of bone adjacent to cartilage loss
what is an important hallmark of OA?
osteophytes
symptoms of OA
deep, achy joint with movement and weight bearing, relieved with rest worse during cold weather stiff in morning crepitus in afternoon joint swelling altered gait limited ROM
OA physical exam
joint deformity, tenderness decreased ROM fingers herbedens nodes bourchards nodes
herbeden’s nodes
swelling at distal interphalangeal joint (DIP)
1st knuckle
Bouchards nodes
swelling at interphalangeal joint (PIP)
2nd knuckle
OA treatment goals
manage pain
maintain mobility
minimize disability
OA pharmacology for mild-mod pain
acetaminophen
topical capsaicin
NSAIDS
OA pharmacology for mod-severe pain
NSAID ( RX strength) Nsaids + colchicine NSAID + tramadol opioids steroid injections
how do NSAIDS work?
reduce the production of prostaglandins
what are prostaglandins?
promote inflammation, pain and fever
glucosamine sulfate
OA dietary supplement
naturally occurs in body
maintains cartilage health
decrease amounts with age
chondroitin sulfate
naturally occurring chemical in cartilage
can slow down cartilage breakdown
DDD is a common cause of
pain, motor weakness, neuropathy
most often occurs in L and C spine
what is DDD
intravertebral disc compression
with age discs dehydrate, bones become compressed, impinging the entering and exiting nerves
impedes movement and sensation in the extremities
may see weakness and paresthesia
Lumbar symptoms of DDD
low back pain, sciatica
pain in butt and thigh
pain worse with sitting, bending, lifting, or twisting
pain eases with walking, position changes, lying down
numbness, tingling, weakness in legs
foot drop
cervical symptoms of DDD
chronic neck pain
radiates to shoulders, down arms
