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Lucy Knox - Year 1 > 125 - Osteoarthritis > Flashcards

125 - Osteoarthritis Flashcards

1
Q

If someone has joint pain, how could you describe it in one word?

A

Arthralgia

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2
Q

Is someone has joint inflammation, how would you describe it in one word?

A

Arthritis

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3
Q

Is someone has a joint deformation, how could you describe it in one word?

A

Arthropathy

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4
Q

How could you determine between inflammatory joint pain and mechanical joint pain?

A 
Inflammatory: gets better with use. 
Has diurnal pattern. 
Early morning stiffness. 
Swelling
Red + Hot

Mechanical - worse after use
Most painful at end of day

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5
Q

What are the different dirstributions of inflammatory joint pain?

A

Monoarthritis - one joint
Olgioarthritis - a few joints
Polyarthritis - many joints

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6
Q

What is an example of monoarthritis?

A

Septic arthritis
Reactive arthritis
Gout
Isolated OA

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7
Q

What are examples of oligoarthritis?

A

Reactive arthritis
Psoriatic arthritis
OA
Ankylosing spondylitis

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8
Q

What can cause polyarthritis?

A

OA
RA
Gout

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9
Q

When considering joint pain, what must you be aware it could also be?

A

Periarticular joint pain - eg. in the close muscles, tendons, synovial fluid..

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10
Q

What non inflammatory joint disorders are there?

A

Metabolic - eg. osteromalacia, vit D deficiency, throid issues
Mechanical/degenerative
Fibromyalgia

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11
Q

What factors help maintain the stability of a joint?

A

Bones
Ligaments
Muscles

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12
Q

What is OA?

A

Osteoarthritis
Most common joint disorder
Degeneration of joint cartillage and the underlying bone - chronic degenerative process.

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13
Q

What increases the risk for OA?

A

Local biomechanical factors - joint weakness, joint congruency, high impact loading

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14
Q

What are OA risk factors?

A

Hereditary
Obestiy
Hypermobility
Smoking

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15
Q

Where is OA most common?

A

Hands - especially DIP and PIP joints
Knee - 75% medial sided
Feet
Hips

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16
Q

What clinical signs are expected in OA?

A 
Joint pain
Joint tenderness
Limited movement
Crepitus
Occasional effusion
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17
Q

What pathological changes are seen in OA?

A

focal destruction of cartilage
Sclerosis of subchondral bone
Subchondral cysts
Marginal ostephytes

  • due to a metabolically active repair process - triggered by a variety of joint insults
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18
Q

What investigations would you suggest for someone with suspected OA?

A

Bloods - CRP, ESR
Synovial fluid aspiration
X ray

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19
Q

What is synovial fluid normally like?

A

Clear, colourless, oil like

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20
Q

What might you see on a standing up knee X ray in someone with OA?

A

L oss of joint space
O steophytes
S ubchondral sclerosis
S ubchondral cysts

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21
Q

What is the non-pharmacological management of OA?

A

Info - use the joint
Weight loss
Exercise
Physio help - adaptive devices, supportive devices

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22
Q

What pharmacological management is seen in OA?

A

Topical - NSAIDS, capsaicin
Systemic - Paracetamol, NSAIDS, Opiods
Intra-articular - Corticosteroids, Hyaluronate (acts like fake synovial fluid)

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23
Q

If pharmacological methods fail in OA what is left for patients to try?

A

Surgery - Joint preserving, eg. arthroscopic debridement, osteotomy (realignment of the joint)
- Joint replacement - Arthroplasty

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24
Q

What is the future in terms of OA management?

A

Joitn modifying agents

  • Glucosamine was used, but limited evidence of repair benefit
  • Stem call transplants
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25
Q

What is Wolff’s law of biomechanics?

A

The shape and structure of a bone (and all MSK tissue) is a reflection of their mechanical loading history.

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26
Q

What are the 5 types of force a bone can be subjected to?

A 
Tension
Compression
Torsion
Sheer
Bending
27
Q

What fractures are seen after a tension force is exerted?

A

Avultion fractures - bits of bone pulled away where the tendon joins

28
Q

What fractures are seen after compressive forces are applied?

A

Vertebral fractures - particularly in osteoporosis

29
Q

What type of damage is caused by sheer forces?

A

Spondylolisthesis - 2 vertebrae are forced to slide over one another.

30
Q

What is the typical force caused by bending fractures?

A

Ski boot fractures

31
Q

What type of fracture is common from a torsion force?

A

Spiral fractures of the femur

32
Q

What are the bio-mechanical adaptations of cartilage?

A

Adapted to withhold compressive and sheer forces

33
Q

What are the bio-mechanical adaptations of tendons?

A

have high type 1 collage levels - so can resist tensile forces.
Act as springs in locomotion - store energy when stretched and released to complement muscle action

34
Q

What are the bio-mechanical adaptations of menisci?

A

Fibrocartillagenous - key to help load distribution.

50% of the compressive load of the knee is through the medial meniscus

35
Q

What are the bio-mechanical adaptations of ligaments?

A

Their stiffness can change - initially work in a low force range during normal movements, as force increases, ligaments become stiffer to protect the joint more

They link bones across joints, the guide joints and limit them.

They act as strain sensors.

36
Q

What are the 4 key biomechanical properties of muscle?

A

Irritability
Contractility
Extensibility
Elasticity

37
Q

What enables a muscle to have elasticity?

A

Titin

38
Q

What influences muscle movements?

A

Gravity

39
Q

What are the 4 classes of muscle actions?

A

Agonist
Antagonist
Fixator/stabiliser
synergist

40
Q

What does a fixator/stabiliser muscle do?

A

Provides an immobile base for a joint, on which an antagonist/prime mover can act.

41
Q

What does a synergist muscle do?

A

Prevents unwanted movements, which would be produced if the agonist acted solo.

42
Q

What are the 4 ways the skeletal movement is limited?

A

Passive insufficiency
Active insufficiency
Concurrent movement
Countercurrent movement

43
Q

Describe passive insufficincy

A

In bi-articular muscles, which cross 2 joints, you can’t move both joints simultaneously

44
Q

Describe active insuffieicney

A

There is a limit on hw much a muscle can contract - limiting the amount of movement possible

45
Q

Describe concurrent movement

A

When, for example, there is simultaneous flexion or extension of both the knee and the hip

46
Q

Describe countercurrent movement

A

When one muscle shortens at both joints, and its antagonist lengthens correspondingly, so tension is gained at both ends.

47
Q

What does the swing component of a muscle action do?

A

It moves or alters the angle of the mobile bone - eg. brachialis flexes the elbow

48
Q

What does the shunt component of a muscle action do?

A

It compresses bones together - eg. brachioradialis

49
Q

What does the spin component of a muscle action do?

A

It twists or rotates the bone along its long axis- eg. Supinator

50
Q

What is gait?

A

The manner and style of an individuals walk

51
Q

What occurs in stance phase?

A

65% of the gait cycle
From heel strike to toe off
Loading resposne, mid stance, terminal stance

52
Q

What occurs in swing phase?

A

From toe off to heel strike
Preswing - midswing - terminal swing
Single leg support
35% of cycle

53
Q

What is wolff’s law of bone?

A

The structure/shape of the bone changes depending on the mechanical loading of the bone. - all MSK tissue

54
Q

What forces is bone subjected to?

A

Tension - pullSheer - snappingCompression Bending Torsion - twisting/spiral

55
Q

Describe Menisci

A

fibrocartillagenousHelp load distribution - 50% of compressive load of knee through the medial meniscus.Increases joint contact area

56
Q

What helps tendons resist tensile forces?

A

Collagen I

57
Q

What are the 4 biomechanics properties of muscle?

A

Irritability - responds to nervesContractibilityExtensibilityElasticitiy

58
Q

What gives muscle it’s elastic properties?

A

Titin

59
Q

What are 4 types of muscle action?

A

Agonist - prime mover - main muscle of a jointAntagonist - Opposes the agonist - brings joint backFixator/stabiliser - provides immobile base so other rime movers can actSynergist - Prevents unwanted movements

60
Q

How do muscles help limit skeletal movement?

A

Passive insufficiency - biarticular muscles - can’t move both joints at once.Active insufficiency - Muscle can’t contract more than a fixed amountConcurrent movement - another muscle moves to aid the function of another. Countercurrent movement

61
Q

What is Osteroarthritis?

A

Joint failure - cartillage diseaseMost common joint disorderHeterogenous. Multiple interactions.Chronic degenerative condition - not just ageing

62
Q

What are the risk factors of OA?

A

HereditaryObesityHyper mobilitySmokingLocal biomechanics factors

63
Q

What clinical signs suggest OA?

A

Joint pain - mechanical - gets worse with useJoint tendernessLimited movementCrepitusOccasional effusion

64
Q

What investigations can you do for OA?

A

No set test - bloods will be normal (it doesn’t have much inflammation)- Xray- Synovial fluid usually clear

Lucy Knox - Year 1 (36 decks)

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