Spinal Osteoarthritis part 1

Question 1

What are the symptoms of spinal osteoarthritis?

Answer 1

Pain of insidious onset which can be local or radicular, ranging from a 1 to 6, more pain with use, weather sensitive
Will be stiff after resting (gel phenomenon)
Crepitance with motion
Joint enlargement
Weakness

Question 2

What are the demographics associated with spinal osteoarthritis?

Answer 2

Age 25 and up - mostly after 40

Obese

Question 3

What are the observable and palpable physical findings?

Answer 3

Joint enlargement, abnormal body carriage

Tenderness, muscle hypertoncity + fibrosis, joint swelling

Question 4

What are the range of motion, strength testing, and neurologic examination physical findings?

Answer 4

Restricted, weakness of muscles crossing the affected joints

Nerve root and spinal cord findings

Question 5

What are the radiographic findings?

Answer 5

Osteophyte formation
Asymmetric joint space narrowing
Subchondral sclerosis and cyst formation
Chondrocalcinosis

Question 6

What are the MRI findings?

Answer 6

Neural entrapment of nerve roots or spinal cord

Intervertebral disc: dessication, internal disruption, protrusion

Question 7

What is the innervation of facet joints?

Answer 7

Posterior primary ramus of nerve root of both that segment, and the segment below

Question 8

What in the nerve innervation of discs?

Answer 8

Recurrent meningeal nerve = posterior longitudinal ligament and outer 1/3 of posterior annulus
Visceral afferents: sympathetic fibers make up sensory supply for anterior long lig and outer 1/3 of annulus anterolaterally

Question 9

Spinal facet joints, sacroiliac joints, and uncovertebral (Luska) joints in cervical are all….

Answer 9

Synovial joints

Question 10

Describe the first event for osteoarthritis of a synovial joint - articular somatic dysfunction.

Answer 10

Compression and adherence of joint surfaces - impairs the flow of synovial fluid across the joint surface (nutrition)
Joint motion is critical to proper joint maintenance - no mobile could lead to hylaine cartilage thinning

Question 11

Describe the second event for osteoarthritis of a synovial joint - facet synovitis.

Answer 11

Osteoarthritis is non-inflammatory arthopathy

Small amount of joint inflammation

Question 12

Describe the third event for osteoarthritis of a synovial joint - cartilage degenerates.

Answer 12

Cartilage things, it frays and surface roughens
Small cartilage breaks off into joint and sands away at joint surface
More intense inflammation response

Question 13

Describe the fourth event for osteoarthritis of a synovial joint - capsular laxity.

Answer 13

Capsule and ligaments retain original length, even as surface things
Cannot maintain normal apposition of joint surfaces, hypermobility develops
Joints become unstable

Question 14

Describe the fifth event for osteoarthritis of a synovial joint - facet subluxation.

Answer 14

Instability becomes severe enough, partial dislocation of facet joints occurs

Question 15

Describe the sixth event for osteoarthritis of a synovial joint - osteophyte formaiton.

Answer 15

Bone spurs - outgrowths of bone most likely due to traction on the periosteum where joint caosule and ligs attach to bone

Question 16

Describe the seventh event for osteoarthritis of a synovial joint - facet and laminar enlargement.

Answer 16

Bone becomes enlarged

Can result in a radiculitis

Question 17

Describe the first event for disc degeneration - tearing.

Answer 17

Disc weaken by circumferential (annular) microtears to annulus

Question 18

Describe the second event for disc degeneration - microtears coalesce to form radial tears.

Answer 18

If tear involves the outer 1/3 of annulus fibrosis or lig, can produce pain
Pain poorly localized and lacks local tenderness
Pain increases with coughing or sneezing

Question 19

What test will provoke discogenic pain?

Answer 19

Psoas strength test

Question 20

Describe radial tear formation in lumbar spine.

Answer 20

Carried by sympathetic fibers referred to L2 level

Question 21

Describe radial tear formation in cervical spine.

Answer 21

Refer to upper thoracics (T1-T4)

Question 22

Describe the third event for disc degeneration - focal disc bulging.

Answer 22

Annulus is weak enough - local bulging can occur
Can rub against or irritate a nerve root
Leads to radiculitis

Question 23

What happens in the first subset of the third event for disc degeneration - disc herniation.

Answer 23

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