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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
Q

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?

A

3

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26
Q

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?

A

4

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27
Q

What medications are given to OA patients?

A
  • Acetaminophen
  • Topical capsaicin, glucosamine/chondroitin
  • NSAIDs & COX-2 inhibitors
  • Injections (viscosupplementation, corticosteroid, platelet-rich plasma)
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28
Q

For OA patients, which type of strengthening should be done in PT?

A

Eccentric contraction & closed chain kinetic

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29
Q

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?

30
Q

What is the chronic systemic inflammatory disease that manifests with a wide range of articular & extraarticular findings?

A

Rheumatic arthritis

31
Q

An articular finding of RA is chronic __________ which perpetuates gradual destruction of joint tissues.

A

Polyarthritis

32
Q

What are some extraarticular findings of RA?

A
  • CV, pulm, GI systems
  • Eye lesions, infections, osteoporosis
33
Q

What are the 2 primary risk factors of RA?

A

Age & female

34
Q

When is the peak onset of RA?

A

30-60 years

35
Q

Which 2 diseases are associated with RA?

A
  • Graves
  • Hashimoto
36
Q

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?

37
Q

What is the term for autoantibodies that react with immunoglobulin antibodies found in the blood?

A

Rheumatoid factor

38
Q

Rheumatoid factor has been found in synovial __________ & synovial membranes.

39
Q

In RA, the cells of synovial lining multiply & there’s an influx of leukocytes from peripheral circulation & synovium becomes ___________ & synovial lining thickens.

40
Q

What is the term for destructive vascular granulation tissue?

41
Q

What do the inflammatory cells inside the pannus prevent the synovium from doing?

A
  • Lubricating joint
  • Providing nutrients to avascular articular cartilage
42
Q

Describe what pannus does as it proliferates.

A

Dissolves collagen, cartilage, subchondral bone, etc.

43
Q

In RA, the interaction of _________ & immune & nonimmune cells prompt a massive inflammatory response.

44
Q

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?

A
  • Matrix metalloproteinases
  • Articular cartilage destruction & synovial hyperplasia –> tenderness, swelling, pain
45
Q

Elevated cytokines also inhibit bone formation & induce bone resorption by activating __________.

A

Osteoclasts

46
Q

What is the term for adhesions & fibrous or bony fusion of joint?

47
Q

Symptoms of RA progress slowly as disease process moves from cartilage degradation to ligamentous __________ to synovial expansion with erosion.

48
Q

In RA, multiple joints are usually involved with symmetric, (unilateral/bilateral) presentation.

49
Q

What are the most frequently involved joints in RA?

A
  • Wrist
  • Knee
  • Joints of fingers, hands, feet
50
Q

Which deformities in fingers are common in RA?

A
  • Ulnar deviation
  • Swan neck deformity
  • Boutonniere deformity
51
Q

Which finger deformity is DIP flexion & PIP hyperextension?

52
Q

Which finger deformity is PIP flexion?

A

Boutonniere

53
Q

The longer a person has RA, the greater the likelihood of having __________ spine disease.

54
Q

Deep, aching cervical pain in RA radiates to what 3 areas?

A
  • Occipital
  • Retroorbital
  • Temporal
55
Q

Irritation of C2 nerve root supply to which tracts/nerves lead to facial & ear pain & occipital headaches?

A
  • Spinal trigeminal
  • Greater auricular
  • Greater occipital
56
Q

What happens with C1-C2 subluxation (usually anterior) in RA?

A
  • Compress SC –> lots of problems
  • Head fall forward with neck flexion
57
Q

What is the term for shocklike sensations of torso or extremities with neck flexion?

A

Positive Lhermitte sign

58
Q

RA causes cervical region to become (lordotic/kyphotic).

59
Q

Where do granulomatous lesions/rheumatoid nodules usually occur?

A
  • Extensor surface of elbow
  • Achilles
  • Extensor surface of fingers
  • Heart, lungs, GI tract
60
Q

Laxity of the __________ ligament for upper cervical spine & arthritic changes with erosive involvement of lower cervical spine facet joints cause neurologic manifestations in RA.

A

Transverse

61
Q

Rheumatoid __________ involving medium-sized arteries to muscles can lead to mononeuritis multiplex.

A

Vasculitis

62
Q

Small vessel vasculitis causes what type of peripheral neuropathy?

A

Stocking-glove

63
Q

What 3 things will be increased in a synovial fluid analysis?

A
  • WBC
  • Protein content
  • Protein antibodies
64
Q

What is the acute-phase reactant that is present in RA?

A

C-reactive protein

65
Q

True or False: MRI is more sensitive than conventional radiography for detecting early RA.

66
Q

What type of drugs are given for RA patients?

A
  • Analgesics
  • NSAIDs
  • Corticosteroids
  • DMARDs
  • Cytokine inhibitors
  • Lymphocyte inhibitors
67
Q

What procedure is the primary one done to reduce pain & joint damage in the wrist?

A

Synovectomy

68
Q

What procedure is the most common soft tissue procedure of the hand?

A

Tenosynovectomy

69
Q

The same factors that contribute to joint inflammation in RA also accelerate __________ & heart disease.

A

Atherosclerosis

70
Q

True or False: Joint pain & stiffness for RA is persistent & more bothersome at night.

A

False (morning)

71
Q

RA affects small joints of feet & hands (symmetrically/asymmetrically) & is not generalized all over the body.

A

Symmetrically

72
Q

Unexplained joint pain for ___ month(s) or more with systemic symptoms should raise concern for RA.

MSK (8 decks)

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