Week 125 - Osteoarthritis

Question 1

What would you expect from an inflammatory joint problem?

Answer 1

• Pain - diurnal, precipitation.
• Stiffness - Early morning/inactivity, improves with activity.
• Swelling.
• Response to steroids.
• Systemic symptoms?

Question 2

What conditions may cause mono-arthritis?

Answer 2

• Septic arthritis • Crystal arthritis

Question 3

What conditions may cause oligoarthritis (2-4 joints)?

Answer 3

• Osteoarthritis • Psoriatic arthritis • Ankylosing spondylitis

Question 4

What are the risk factors of developing osteoarthritis?

Answer 4

• Smoking • Obesity • Hypermobility • Hereditary

Question 5

What are four pathological changes associated with osteoarthritis?

Answer 5

1) Degeneration of cartilage 2) Sclerosis of subchondral bone 3) Subchondral cysts 4) Marginal osteophytes

Question 6

Which compartment of the knee is most frequently susceptible to OA?

Answer 6

The medial compartment.

Question 7

What is the most common presenting complaint of osteoarthritis?

Answer 7

Pain

Question 8

What are 5 clinical features of OA?

Answer 8

1) Joint pain 2) Joint tenderness 3) Limited movement 4) Crepitus 5) Occasional effusion

Question 9

What is the most likely cause of mono-osteoarthritis?

Answer 9

Previous Trauma

Question 10

In nodal OA what is the name of the nodes located in the proximal-inter-phalangeal joint?

Answer 10

Bouchard’s Nodes

Question 11

In nodal OA what is the name of the nodes located in the distal-inter-phalangeal joint?

Answer 11

Heberden’s Nodes

Question 12

What is the synovial fluid like in osteoarthritis?

Answer 12

Clear and colourless

Question 13

What are the three things that contribute to a diagnosis of osteoarthritis?

Answer 13

Clinical history, examination and radiology.

Question 14

What are the aims of management in osteoarthritis?

Answer 14

1) Treat symptoms 2) Minimise disability 3) Delay structural progression

Question 15

What are the pharmacological treatments of osteoarthritis?

Answer 15

• Patient education • Weight loss • Identify and treat depression • Exercise • Adaptive devices • Support devices

Question 16

What are the pharmacological treatments of OA?

Answer 16

• Analgesics - Paracetamol, NSAIDS • Intra-articular steroids

Question 17

What are coxibs?

Answer 17

These are NSAIDS that selectively inhibit COX2.

Question 18

What are the two main periods of the gait cycle?

Answer 18

• Stance phase (65%)
• Swing phase (35%)

Question 19

What are the components of the stance phase of the gait cycle?

Answer 19

1) Initial contact - This is a period of double stance, usually starts with heel strike, heel rocker motion.
2) Loading response - Double stance, ankle becomes more dorsiflexed, knee begins to flex, hip begins extend, opposite leg is still in contact with floor.
3) **Mid-stance - **Single leg support, maximal weight bearing, toe rocker motion, starts from toe-off of opposite leg.

**4) Terminal-stance - **Begins with heel off, ends with toe-off/push-off, propulsion.

Question 20

What are the components of the swing phase of the gait cycle?

Answer 20

**1) Pre-swing - **Moment at which the stance phase ends.

**2) Mid-swing - **The limb passes anteriorly to the supporting leg.

**3) Terminal-swing - **Ends with heel strike.