Unit 5 Case 2: Osteoarthritis Flashcards
definition of osteoarthritis
clinical syndrome of joint pain accompanied by varying degrees of functional limitation and reduced quality of life
2 types of osteoarthritis
primary
secondary
primary osteoarthritis
more generalised
affects various parts of the body
secondary osteoarthritis
occurs after injury
typically injury that causes joint inflammation
histological changes seen in osteoarthritis
chondrocytes proliferate, cluster and form MMP’s
extracellular matrix will lose aggrecan, type 2 collagen degradation and cartilage cracks
cartilage will decrease swelling pressure of proteoglycans, altered collagen synthesis, loss of shock absorption
changes seen in osteoarthritis
different types of arthritis
rheumatoid
psoriatic
gout
rheumatoid arthritis
autoimmune disease
immune system attacks the joints
leads to inflammation
results in severe joint damage if left untreated
psoriatic arthritis
autoimmune inflammatory disease
causes raised, red and white patches of inflamed skin with scales normally on the elbows, knees, scalp and navel
can also swell the fingers and the toes
gout
form of inflammatory arthritis
more centralised
occurs when uric acid crystals build up in joints, results in painful inflammation
most often affects the big toe
healthy synovium
1-2 cells thick
macrophage like synovial cell, synoviocytes type 1
fibroblast like synovial cells type 2
synovial subliming is loose connective tissue with numerous blood and lymphatic vessels, nerves, scattered macrophages and fibroblasts
what is in the image
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symptoms of osteoarthritis
pain
morning stiffness
tenderness
losss of flexibility
bone spurs
grating sensation
swelling
clinical presentation of osteoarthritis
hip tenderness
range of passive and active motion
crepitus with movement
pain when pressure is placed on the hip
gait problems
sign of injury to muscles, tendons and ligaments surrounding the hip
identify features of osteoarthritis on knee joint
identify features of osteoarthritis on hip joint
what is in the image
- heberden nodes
- Bouchard nodes
what is in the image
1st carpometacarpal joint squaring
describe the gait cycle
- initial contact of heel with floor
- weight transferred to this leg
- weight is aligned and balanced on this leg
- heel lifts off floor as foot rises, toes in contact with floor
- foot continues to rise, toes lift off floor
- foot swings forwards and comes back into contact with floor with a heel strike
examples of some different gaits
antalgic
hemiplegic
diplegia
ataxic
myopathic
neuropathic
parkinsonian
choreiform
antalgic gait
abnormal that develops as a result of pain, stance phase reduced on affected limb
means limp
choreiform gait
presents with involuntary movements
myopathic gait
weakness of hip adductors
resulting in a waddling appearance
neuropathic gait
caused by weakness of muscles in distal limb
due to damage to peripheral providing motor innervation
parkinonian gait
caused by rigidity and bradykinesia
because of loss of dopaminergic neurone in basal ganglia nerves
ataxic gait
broad-based, midline, cerebellar disease, vestibular disease
loss of proprioception
diplegic gait
may Be caused by CNS lesion
hemiplegic gait
caused by CNS lesion
unilateral weakness and spasticity
clinical presentation of knee joint osteoarthritis
anatalgic gait
trendelenburg/myopathic/waddling gait
varus and valgus
describe the image
varus: bow legged, knees curve outwards, leaving a wide space
valgus: knock knees, knees touch and feet are significantly apart when standing
hallux valgus
clinical presentation of osteoarthritis in the feet
looks like gout
bunions of feet
clinical presentation of hip joint osteoarthritis
trendelenburg test
c- sign
trendelenburg test
stand on one leg and see if the opposite hip drops
positive sign= contralateral pelvic drop during single leg stance, could be superior nerve damage
C-sign
pain anteriorly and laterally of hip
causes patient to grab the painful area, creates a c shape with their hand
normal range of hip movement flexion
0-125
normal range of hip movement extension
115-0
normal range of hip movement external rotation
0-45
normal range of hip movement internal rotation
0-45
normal range of hip movement abduction
0-45
normal range of hip movement adduction
45-0
subchondral sclerosis
hardening of bone just below the cartilage surface
later stages of osteoarthritis
abnormally white bone along the joint line
common in knees and hips
area just below cartilage layer fills with collagen and becomes denser than healthy bone
avascular necrosis of hip
damage of the blood supply that enters femoral head through neck of the femur bone can lead to the death of the femoral head
causes the femoral head to collapse and begin to flatten
flattening then causes the femoral head to not fit perfectly inside of the socket
joint then wears out
what causes avascular necrosis of the hip
injuries
fractures
hip dislocation
medication, cortisone
excessive alcohol intake
deep-sea divers/ miners under high atmospheric pressure
causes tiny bubbles to form in the blood stream
subchondral cyst
fluid-filled space inside a joint that extends from one of the bones that forms the joint
caused by osteoarthritis
may require aspiration
what are the different risk factors for osteoarthritis
sex
older age
joint injuries
obesity
repeated stress on the joint
genetics
bone deformities
metabolic disorders
sex as a risk factor for osteoarthritis
women are more likely
joint injuries as a risk factor for osteoarthritis
even if this occurred years ago
could be from sports/accidnets etc
obesity as a risk factor for osteoarthritis
extra body weight
extra joint stress
fat tissue produces proteins causing inflammation in/around joints
bone deformities as a risk factor for osteoarthritis
some born with malformed joints/defective cartilage
metabolic disorders as a risk factor for osteoarthritis
diabetes
hemochormatosis (body has too much iron)
constitutional risk factors for osteoarthritis
ageing
hereditary
gender
hormonal status (menopause)
metabolic bone disease (Pagets)
local risk factors for osteoarthritis in the knee
obesity
quadriceps weakness
joint laxity/malalignment
local risk factors for osteoarthritis in the hip
developmental dysplasia
occupation
pharmacological management of osteoarthritis
non-pharmacological management of osteoarthritis
surgical management of osteoarthritis
NICE guidelines for osteoarthritis treatment
exercise and physiotherapy is the first line of treatment
patient education= self management support
weight management
medication management
surgery is last resort
referral to specialist services
NICE guidelines for information giving
chunk and check
discussions
patient decision aids
3 talk model: choice, options, preferences given then to make an informed decision
drugs used in the treatment and management of osteoarthritis
paracetamol
aspirin
curcumin
rosehip extract
naproxen
glucosamine
chondroitin
omeprazole
MOA in separate flashcards
definition of coping
process of using behavioural and cognitive approaches to manage difficult or threatening situations and plays on an integral role in maintaining physical and mental well-being of an individual
what can coping be
emotion focused or problem solving strategies
adaptive or maladaptive strategies
internal coping factors
biological or psychological behaviour
external coping factors
social influences
