R: Degenerative Bone Disease

Question 1

firstly, what are the 4 main pathophysiological causes of joint pathology?

Answer 1

1. cartilage/ synovial composition and function deteriorates
2. synovial cell proliferation/ inflammation
3. deposition of crystals
4. injury and inflammation to periarticular structures

Question 2

epi of osteoarthritis (OA)?

Answer 2

1/3rd of >45s, w

Question 3

what is OA?

Answer 3

articular thinning or loss

Question 4

aetiology of OA?

Answer 4

age, sex, obesity
lifestyle
genetic
prv injuries

Question 5

pathogenesis of OA?

Answer 5

degradation of cartilage & disordered repair
injury to chondrocytes and matrix
inflammatory changes to subchondral bone

Question 6

types of OA>

Answer 6

1y: idiopathic
2y: previous injury, gout, RA, perthes, SUFE

Question 7

common sites of OA?

Answer 7

hip knee, MTPs, cervical spine, lumbar spine, SC, GH, AC jts, elbow, wrist, carpus thumb

Question 8

s/s of OA?

Answer 8

pain worse on activity, stiffness (<30mins in morning)

Question 9

what are some exam findings of OA?

Answer 9

crepitus, jt swelling, tenderness, effusion

Question 10

T/F: Bouchard’s are bony swellings in the distal IPJs due to repeated trauma

Answer 10

F: Bouchard’s= proximal IPJs

Hebreden’s= distal IPJs

Question 11

dx of OA and common imaging findings?

Answer 11

clinical, imaging

- imaging: LOSS (loss of jt space, subchondral sclerosis, subchondral cyst, osteophytes)

Question 12

what is the grading scale used for OA?

Answer 12

Kellgren-Lawrence Grading Scale: grade 0= no signs, grade 4= all signs

Question 13

mx for OA?

Answer 13

physio, wt loss

• Rx: analgesia, pain modulators, steroids, mild opiates
• surgical: arthroscopic washout, loose body removal, jt replacement

Question 14

s/s of hip OA?

Answer 14

groin pain*, referred down knee, pain at night, worse on activity/standing, restricted hip movement

Question 15

mx of hip OA?

Answer 15

conservative- steroid injection

surgery- THR (cement hemiarthroplasty indicated for elderly)

Question 16

which exercises commonly cause knee OA?

Answer 16

running and football

Question 17

s/s of knee OA?

Answer 17

pain from within knee, stiffness, weakness of surrounding muscles, feeling of instability
flare ups common!

Question 18

surgical mx of knee OA?

Answer 18

TKR, osteotomy, washout

Question 19

aetiology of glenohumeral (GH) OA

Answer 19

cuff tear, instability, idiopathic, post-traumatic arthritis

Question 20

s/s of GH OA?

Answer 20

gradual onset w intermittent exacerbations, reduced ROM- especially external rotation

Question 21

surgical mx of GH OA?

Answer 21

shoulder replacement (arthroplasty), resurfacing, reverse-polarity arthroplasty

Question 22

types of arthroplasty?

Answer 22

surface replacement (only head)
TSA (head & stem)
Rotator cuff arthroplasty

Question 23

what is cervical spondylosis

Answer 23

disc degeneration causing OA of facet joints

Question 24

s/s of cervical spondylosis

Answer 24

stiffness/pain in neck which may radiate to shoulders

Question 25

which joint OA is often associated with nerve impingement due to osteophytes requiring surgical decompression?

Answer 25

acromioclavicular (AMC) jt

Question 26

which are the 2 sites for elbow OA?

Answer 26

ulna-humeral, radio-capitellar sites

Question 27

how to differentiate between wrist OA and RA?

Answer 27

``` OA= monoarticular and localised RA= polyarticular and systemic ```

Question 28

s/s of wrist OA?

Answer 28

instability due to SLAC and SNAC

Question 29

which hand joint is the no1 site for OA?

Answer 29

Distal inter pharyngeal joints (DIPs)

Question 30

s/s of hand OA (small joints)?

Answer 30

pain, deformity, heberden's/osler's nodes

Question 31

the base of the thumb is the number ___ site for OA

Answer 31

2

Question 32

what are the 2 tendinopathies associated with OA of phalanxes?

Answer 32

swan neck deformity, boutonniere

Question 33

why does swan neck deformity occur?

Answer 33

PIP jt becomes attenuated and ligaments/ tendons fall more dorsal to jt centre

Question 34

hyperextension of DIP jt is....

Answer 34

boutonniere tendinopathy

Question 35

mx of swan neck/ boutonniere deformities?

Answer 35

splintage or surgery- tendon reposition