Spinal Osteoarthritis part 1 Flashcards
What are the symptoms of spinal osteoarthritis?
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
What are the demographics associated with spinal osteoarthritis?
Age 25 and up - mostly after 40
Obese
What are the observable and palpable physical findings?
Joint enlargement, abnormal body carriage
Tenderness, muscle hypertoncity + fibrosis, joint swelling
What are the range of motion, strength testing, and neurologic examination physical findings?
Restricted, weakness of muscles crossing the affected joints
Nerve root and spinal cord findings
What are the radiographic findings?
Osteophyte formation
Asymmetric joint space narrowing
Subchondral sclerosis and cyst formation
Chondrocalcinosis
What are the MRI findings?
Neural entrapment of nerve roots or spinal cord
Intervertebral disc: dessication, internal disruption, protrusion
What is the innervation of facet joints?
Posterior primary ramus of nerve root of both that segment, and the segment below
What in the nerve innervation of discs?
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
Spinal facet joints, sacroiliac joints, and uncovertebral (Luska) joints in cervical are all….
Synovial joints
Describe the first event for osteoarthritis of a synovial joint - articular somatic dysfunction.
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
Describe the second event for osteoarthritis of a synovial joint - facet synovitis.
Osteoarthritis is non-inflammatory arthopathy
Small amount of joint inflammation
Describe the third event for osteoarthritis of a synovial joint - cartilage degenerates.
Cartilage things, it frays and surface roughens
Small cartilage breaks off into joint and sands away at joint surface
More intense inflammation response
Describe the fourth event for osteoarthritis of a synovial joint - capsular laxity.
Capsule and ligaments retain original length, even as surface things
Cannot maintain normal apposition of joint surfaces, hypermobility develops
Joints become unstable
Describe the fifth event for osteoarthritis of a synovial joint - facet subluxation.
Instability becomes severe enough, partial dislocation of facet joints occurs
Describe the sixth event for osteoarthritis of a synovial joint - osteophyte formaiton.
Bone spurs - outgrowths of bone most likely due to traction on the periosteum where joint caosule and ligs attach to bone
Describe the seventh event for osteoarthritis of a synovial joint - facet and laminar enlargement.
Bone becomes enlarged
Can result in a radiculitis
Describe the first event for disc degeneration - tearing.
Disc weaken by circumferential (annular) microtears to annulus
Describe the second event for disc degeneration - microtears coalesce to form radial tears.
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
What test will provoke discogenic pain?
Psoas strength test
Describe radial tear formation in lumbar spine.
Carried by sympathetic fibers referred to L2 level
Describe radial tear formation in cervical spine.
Refer to upper thoracics (T1-T4)
Describe the third event for disc degeneration - focal disc bulging.
Annulus is weak enough - local bulging can occur
Can rub against or irritate a nerve root
Leads to radiculitis
What happens in the first subset of the third event for disc degeneration - disc herniation.
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