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WEEK 3 Joint Disorders Flashcards

1
Q

What is the process of rapid cartilage degeneration resulting in narrowing of joint space & loss of motion?

A

Chondrolysis

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2
Q

What degeneration process of chondrolysis is associated with infection, trauma, & prolonged _____________?

A

Immobilization

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3
Q

Where is chondrolysis most common?

A

Hip (slipped capital femoral epiphysis)

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4
Q

True or False: Chondrolysis occurs more in adolescent males.

A

False (females)

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5
Q

Chondrolysis of the hip causes anterior hip &/or groin pain accompanied with what type of gait?

A

Antalgic

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6
Q

What is the degenerative joint disease that is a slowly evolving articular disease that appears to originate in cartilage & affects underlying bone, soft tissues, & synovial fluid?

A

OA

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7
Q

What is the cause of primary OA? How about secondary?

A
  • Primary: Unknown
  • Secondary: Trauma, infection, hemarthrosis, osteonecrosis, etc.
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8
Q

True or False: OA is the 2nd most common joint disease with 60% in men & 70% in women & most common musculoskeletal disorder.

A

False (most common for both)

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9
Q

Where does OA affect the most?

A
  • Hands
  • Hip
  • Knee
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10
Q

What type of disease is OA a risk factor for?

A

CVD

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11
Q

Inflammatory & procatabolic mediators affect function of chondrocytes within the ____________ cartilage, leading to hypertrophic differentiation & early cell death in OA.

A

Articular

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12
Q

Age-related changes within collagen & ____________ of cartilage along with lifestyle choices further enhance inflammatory response in OA.

A

Proteoglycans

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13
Q

The synovial lining of the joint undergoes hyperplasia secreting synovial fluid which creates joint ___________ that activates joint mechanoreceptors & affects joint nociceptors.

A

Effusion

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14
Q

There’s a general tendency toward increased bone metabolic activity resulting in remodeling of __________ bone in OA.

A

Subchondral

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15
Q

Which type of cartilage is lost in OA?

A

Hyaline

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16
Q

The joint space (narrows/widens) as cartilage thins & sclerosis of subchondral bone occurs as new bone is formed which is also done at joint margins (__________) –> mechanical joint failure.

A
  • Narrows
  • Osteophytes
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17
Q

What is the term for thinning of articular cartilage resulting in exposure of subchondral bone?

A

Fissuring & eburnation

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18
Q

When is joint stiffness felt with OA?

A
  • Short duration (less than 30 min) after periods of inactivity
  • Morning (5-10 min)
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19
Q

What is the term for audible crackling or grating sensation produced when roughened articular or extraarticular surfaces rub together during movement?

A

Crepitus

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20
Q

What is the term for osteophytes affecting DIP? How about PIP?

A
  • DIP: Heberden nodes
  • PIP: Bouchard nodes
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21
Q

To diagnose OA, lab tests are done to rule out which other disease?

A

Rheumatic

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22
Q

What radiographic changes can be seen in OA?

A
  • Joint space widening (early)
  • Subchondral bone sclerosis
  • Subchondral bone cysts
  • Osteophytes
  • Joint space narrowing
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23
Q

Which grade on the Kellgren & Lawrence grading system for the knee is possible osteophytes, no joint space narrowing?

A

1

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24
Q

Which grade on the Kellgren & Lawrence grading system for the knee is definite osteophytes, possible narrowing of joint space?

A

2

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25
Which grade on the Kellgren & Lawrence grading system for the knee is moderate multiple osteophytes, definite joint space narrowing, some sclerosis & possible deformity of bone ends?
3
26
Which grade on the Kellgren & Lawrence grading system for the knee is large osteophytes, marked joint space narrowing, severe sclerosis & definite deformity of bone ends?
4
27
What medications are given to OA patients?
- Acetaminophen - Topical capsaicin, glucosamine/chondroitin - NSAIDs & COX-2 inhibitors - Injections (viscosupplementation, corticosteroid, platelet-rich plasma)
28
For OA patients, which type of strengthening should be done in PT?
Eccentric contraction & closed chain kinetic
29
What is the term for systemic disorders encompassing more than 100 different diseases divided into 10 classifications that are marked by periods of exacerbation & remission?
Rheumatic
30
What is the chronic systemic inflammatory disease that manifests with a wide range of articular & extraarticular findings?
Rheumatic arthritis
31
An articular finding of RA is chronic __________ which perpetuates gradual destruction of joint tissues.
Polyarthritis
32
What are some extraarticular findings of RA?
- CV, pulm, GI systems - Eye lesions, infections, osteoporosis
33
What are the 2 primary risk factors of RA?
Age & female
34
When is the peak onset of RA?
30-60 years
35
Which 2 diseases are associated with RA?
- Graves - Hashimoto
36
Exact pathogenesis of RA is unknown except that joint inflammation is a consequence of massive infiltration into synovial fluid of immune cells, especially which type?
T lymph
37
What is the term for autoantibodies that react with immunoglobulin antibodies found in the blood?
Rheumatoid factor
38
Rheumatoid factor has been found in synovial __________ & synovial membranes.
Fluid
39
In RA, the cells of synovial lining multiply & there's an influx of leukocytes from peripheral circulation & synovium becomes ___________ & synovial lining thickens.
Edematous
40
What is the term for destructive vascular granulation tissue?
Pannus
41
What do the inflammatory cells inside the pannus prevent the synovium from doing?
- Lubricating joint - Providing nutrients to avascular articular cartilage
42
Describe what pannus does as it proliferates.
Dissolves collagen, cartilage, subchondral bone, etc.
43
In RA, the interaction of _________ & immune & nonimmune cells prompt a massive inflammatory response.
Cytokines
44
What is the protein-degrading enzyme that lyses the cartilage & destroys the joint that is secreted when stimulated by cytokines? What does this lead to?
- Matrix metalloproteinases - Articular cartilage destruction & synovial hyperplasia --> tenderness, swelling, pain
45
Elevated cytokines also inhibit bone formation & induce bone resorption by activating __________.
Osteoclasts
46
What is the term for adhesions & fibrous or bony fusion of joint?
Ankylosis
47
Symptoms of RA progress slowly as disease process moves from cartilage degradation to ligamentous __________ to synovial expansion with erosion.
Laxity
48
In RA, multiple joints are usually involved with symmetric, (unilateral/bilateral) presentation.
Bilateral
49
What are the most frequently involved joints in RA?
- Wrist - Knee - Joints of fingers, hands, feet
50
Which deformities in fingers are common in RA?
- Ulnar deviation - Swan neck deformity - Boutonniere deformity
51
Which finger deformity is DIP flexion & PIP hyperextension?
Swan neck
52
Which finger deformity is PIP flexion?
Boutonniere
53
The longer a person has RA, the greater the likelihood of having __________ spine disease.
Cervical
54
Deep, aching cervical pain in RA radiates to what 3 areas?
- Occipital - Retroorbital - Temporal
55
Irritation of C2 nerve root supply to which tracts/nerves lead to facial & ear pain & occipital headaches?
- Spinal trigeminal - Greater auricular - Greater occipital
56
What happens with C1-C2 subluxation (usually anterior) in RA?
- Compress SC --> lots of problems - Head fall forward with neck flexion
57
What is the term for shocklike sensations of torso or extremities with neck flexion?
Positive Lhermitte sign
58
RA causes cervical region to become (lordotic/kyphotic).
Kyphotic
59
Where do granulomatous lesions/rheumatoid nodules usually occur?
- Extensor surface of elbow - Achilles - Extensor surface of fingers - Heart, lungs, GI tract
60
Laxity of the __________ ligament for upper cervical spine & arthritic changes with erosive involvement of lower cervical spine facet joints cause neurologic manifestations in RA.
Transverse
61
Rheumatoid __________ involving medium-sized arteries to muscles can lead to mononeuritis multiplex.
Vasculitis
62
Small vessel vasculitis causes what type of peripheral neuropathy?
Stocking-glove
63
What 3 things will be increased in a synovial fluid analysis?
- WBC - Protein content - Protein antibodies
64
What is the acute-phase reactant that is present in RA?
C-reactive protein
65
True or False: MRI is more sensitive than conventional radiography for detecting early RA.
True
66
What type of drugs are given for RA patients?
- Analgesics - NSAIDs - Corticosteroids - DMARDs - Cytokine inhibitors - Lymphocyte inhibitors
67
What procedure is the primary one done to reduce pain & joint damage in the wrist?
Synovectomy
68
What procedure is the most common soft tissue procedure of the hand?
Tenosynovectomy
69
The same factors that contribute to joint inflammation in RA also accelerate __________ & heart disease.
Atherosclerosis
70
True or False: Joint pain & stiffness for RA is persistent & more bothersome at night.
False (morning)
71
RA affects small joints of feet & hands (symmetrically/asymmetrically) & is not generalized all over the body.
Symmetrically
72
Unexplained joint pain for ___ month(s) or more with systemic symptoms should raise concern for RA.
1

MSK (8 decks)

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