R: Degenerative Bone Disease Flashcards
firstly, what are the 4 main pathophysiological causes of joint pathology?
- cartilage/ synovial composition and function deteriorates
- synovial cell proliferation/ inflammation
- deposition of crystals
- injury and inflammation to periarticular structures
epi of osteoarthritis (OA)?
1/3rd of >45s, w
what is OA?
articular thinning or loss
aetiology of OA?
age, sex, obesity
lifestyle
genetic
prv injuries
pathogenesis of OA?
degradation of cartilage & disordered repair
injury to chondrocytes and matrix
inflammatory changes to subchondral bone
types of OA>
1y: idiopathic
2y: previous injury, gout, RA, perthes, SUFE
common sites of OA?
hip knee, MTPs, cervical spine, lumbar spine, SC, GH, AC jts, elbow, wrist, carpus thumb
s/s of OA?
pain worse on activity, stiffness (<30mins in morning)
what are some exam findings of OA?
crepitus, jt swelling, tenderness, effusion
T/F: Bouchard’s are bony swellings in the distal IPJs due to repeated trauma
F: Bouchard’s= proximal IPJs
Hebreden’s= distal IPJs
dx of OA and common imaging findings?
clinical, imaging
- imaging: LOSS (loss of jt space, subchondral sclerosis, subchondral cyst, osteophytes)
what is the grading scale used for OA?
Kellgren-Lawrence Grading Scale: grade 0= no signs, grade 4= all signs
mx for OA?
physio, wt loss
- Rx: analgesia, pain modulators, steroids, mild opiates
- surgical: arthroscopic washout, loose body removal, jt replacement
s/s of hip OA?
groin pain*, referred down knee, pain at night, worse on activity/standing, restricted hip movement
mx of hip OA?
conservative- steroid injection
surgery- THR (cement hemiarthroplasty indicated for elderly)
which exercises commonly cause knee OA?
running and football
s/s of knee OA?
pain from within knee, stiffness, weakness of surrounding muscles, feeling of instability
flare ups common!
surgical mx of knee OA?
TKR, osteotomy, washout
aetiology of glenohumeral (GH) OA
cuff tear, instability, idiopathic, post-traumatic arthritis
s/s of GH OA?
gradual onset w intermittent exacerbations, reduced ROM- especially external rotation
surgical mx of GH OA?
shoulder replacement (arthroplasty), resurfacing, reverse-polarity arthroplasty
types of arthroplasty?
surface replacement (only head)
TSA (head & stem)
Rotator cuff arthroplasty
what is cervical spondylosis
disc degeneration causing OA of facet joints
s/s of cervical spondylosis
stiffness/pain in neck which may radiate to shoulders
which joint OA is often associated with nerve impingement due to osteophytes requiring surgical decompression?
acromioclavicular (AMC) jt
which are the 2 sites for elbow OA?
ulna-humeral, radio-capitellar sites
how to differentiate between wrist OA and RA?
OA= monoarticular and localised RA= polyarticular and systemic
s/s of wrist OA?
instability due to SLAC and SNAC
which hand joint is the no1 site for OA?
Distal inter pharyngeal joints (DIPs)
s/s of hand OA (small joints)?
pain, deformity, heberden’s/osler’s nodes
the base of the thumb is the number ___ site for OA
2
what are the 2 tendinopathies associated with OA of phalanxes?
swan neck deformity, boutonniere
why does swan neck deformity occur?
PIP jt becomes attenuated and ligaments/ tendons fall more dorsal to jt centre
hyperextension of DIP jt is….
boutonniere tendinopathy
mx of swan neck/ boutonniere deformities?
splintage or surgery- tendon reposition
