osteoathritis Flashcards
what is osteoarthritis ?
chronic, degenerative and progressive condition affecting synovial joints
-occurs when abnormal load placed on normal joint or normal load placed on abnormal joint
what are the most common joints affected by OA?
knee
then hio
then hand
what is it called when osteoarthritis affects the spine?
spondylysis
is multisite pain common with OA?
yes multisite pain is common - knee, hips, hand and feet in 60-80% of cases
how common is OA in people aged 55 or more or 75 years or more?
-55 years -44-70%
75 years - 85%
what are the biochemical changes to synovial joints that cause OA to occur?
-articular cartilage = water, collagen and proteoglycans
-loss of proteoglycan relative to collagen
-decrease in water content and permeability
-reduction in collagen tensile stiffness and strength
what are the unmodifiable risk factors for OA?
-age
-genetics - 40-80%
-local bony changes eg hip dysplasia
-previous joint trauma - eg All injury, intra - articular fracture
what are the modifiable risk factors of OA?
-obesity
-job / occupation
-excess physical activity eg pro soccer player
what is primary OA?
-idiopathic - spontaneous onset
-small joints eg hand, hip and knee
-may affect more than 1 joint
-strong link with genetics
what is secondary OA?
-often specific to one joint
-post inflammatory arthritis eg RA
-post-traumatic eg fracture of tibial plateau
what are the clinical symptons/ signs with the diagnosis of OA?
-joint pain - achey
-stiffness - morning within 30 mins NB
-may or may not be crepitus
-bony enlargement
-little or no swelling nB
what would you see on a radiological image of OA?
-joint space narrowing
-+/- bony sclerosis
-+/-osteophyte formation
what kind of imaging would you use for OA? is it needed?
xray
MRI]
cdiagnosis can be made without imaging
are lab results normal with OA?
yes
what are the differential diagnoses of OA?
-inlammatory arthritis
-other joint articular disorders eg FAIS, degenerative meniscus injury
-pain referral? eg hip to knee?
what joints in the hand are most likely to have OA?
-PIP
-DEIP
thumb CMC
describe pain w/ osteoarthritis
-activity related pain - worse at the end of the day or after rest
-eased by movement
-as disease progresses, night pain and rest pain are present
cartilage is aneural, so what causes the pain?
lots of other structures within the joint that cause the pain eg muscle, peri-articular structures, ligaments etc
-cartilage dosent case pain
how do you test for stiffness in a physical exam?
-passive ROM to get end feel of joint
other than pain and stiffness, what are other subjective features that might be seen with OA?
-fatigue - tiredness and exhaustion
-psychological health
what examination findings will you get with OA?
-inalmmation / effusion (will be minor in comparison to inflammation arthritis),
-loss of ROM -pain stiffness
-muscle weakness and atrophy
-reduced function - might be specific to body region
-deformity eg kne valgus, varrus, hallux valgus
-joint instability - ligament laxity
how do you manage OA?
-combination of non-pharmacological and pharmacological interventions
-curently no cure for OA
-aim is to manage symptoms, reduce deterioration, & enhance quality of life
-self management NB
what are the 3 pillars of the core recommended management of OA
-exercise
-education and self management
-weight management
what are examples of drugs used for OA? in terms of order
-topical OA - rub on skin- good for patients w/ CV or GI probs
-oral NSAIDS
-intra-articular steroid injections
-paracetamol - no clinical benefit
what are the surgeries normally done for OA?
-osteotomy
-arthroplasty eg THR or TKR
-arthrodesis (rare)
what does the subjective assessment of OA involve for physios?
-symptoms to body chart
-1 joint or multiple joints
-one or multiple joints?
-pain behaviour - eg 24 hr, eggs or eases
-stiffness - swelling?
-functional difficulty eg stairs, STS walking etc
-history of onset and progression over time
-general health - heart disease, BP, diabetes etc
-investigations - imaging?
-medications taken and effect
-management to date and effect
-knowledge and understanding of OA
-outcome measures - WOMAC, KOOS etc
what does the physiotherapy physical assessment of OA involve?
-observation gait, posture , functional difficulties etc
-ROM
-strength
-palpation
-special tests
-physical function / physical performance -squat, Sts, stairs NB, timed tests
-exercise tolerance - eg 6 min walk test
-QOL, psychological health
describe the physiotherapy intervention for OA patients
-education - self management and CBT
-exercise therapy - ROM, strengthening, aerobic, hydrotherapy etc
-physical activity prescription
- weight management
what is bouchards nodes?
bony overgrowths of the PIP joints in the fingers due to OA
what is hand herberdens nodes?
small bony swelling on the PIP joint
