Lab: Joint Disease 1 Flashcards
(65 cards)
1
Q
non-inflammatory joint disease
Increased fibrillation and chondrocyte necrosis can be due to damage to the cartilage.
What is the general cause of this damage?
A
Excessive unit loads on articular cartilage
2
Q
Does an excessive unit load on articular cartilage lead to inflammatory or non-inflammatory joint changes?
A
Non-inflammatory
3
Q
Degenerative joint disease is also known as ___
A
osteoarthritis
4
Q
Degenerative joint disease/osteoarthritis is common in which joints?
A
Weight bearing/excessive unit loads
5
Q
DJD/osteoarthritis
What are four examples of the damage to articular cartilage with progressive deterioration?
A
- Narrowing of joint space
- Subchondral sclerosing (purple)
- Subchondral cysts (red)
- Osteophytes (blue)
6
Q
Is degenerative joint disease unilateral or bilateral?
A
Can be either
7
Q
Is degenerative joint disease symmetrical or asymmetrical?
A
Asymmetrical
8
Q
What are some clinical manifestations of degenerative joint disease?
A
- Unilateral or bilateral and asymmetrical
- Crepitus
- Heberden nodes
- Swelling, stiffness, pain
- Inflammation from cartilage damage
9
Q
What can predispose an individual to early or more severe degenerative joint disease?
A
- Excessive unit loads on articular cartilage
- Injury to supportive joint structures
- Altered gait
- Pathologic changes to biomechanical properties of bone at joint (e.g. acromegaly, Paget disease)
10
Q
What is the term for the softening and breakdown of knee cartilage found in younger adults?
A
Chondromalacia patellae
11
Q
A young adult patient reports anterior knee pain and stiffness. They have worse symptoms when going down stairs, running down a hill, squatting, or standing after sitting.
Which joint disease is this most consistent with?
A
Chondromalacia patellae
12
Q
What might aggravate symptoms of anterior knee pain and stiffness with chondromalacia patella?
A
- Going down stairs
- Running down hill
- Squatting
- Standing after sitting
13
Q
What are four pathologies associated with neuropathic arthropathy (Charcot joint)?
A
- Diabetes mellitis
- Neurosyphilis
- Syringomyelia
- Peripheral nerve trauma
14
Q
What is neuropathic arthropathy?
A
Severe and rapid degenerative joint disease secondary to a neurological issue
bone injury and eventually inflammation and destruction of joint
15
Q
If a patient has diabetes mellitus, where are they most likely to experience neuropathic arthropathy?
A
Feet and ankles
16
Q
If a patient has syringomyelia, where are they most likely to experience neuropathic arthropathy?
A
Shoulder and upper extremity
17
Q
If a patient has neurosyphilis, where are they most likely to experience neuropathic arthropathy?
A
Knee
18
Q
If a patient has a spinal cord injury, where are they most likely to experience neuropathic arthropathy?
A
Spine
19
Q
Is neuropathic arthropathy typically unilateral or bilateral?
A
Unilateral
20
Q
Progressive articular and subchondral bone destruction with neuropathic arthropathy are accelerated by ___
A
absence of pain and proprioception
21
Q
degenerative joint disease
What are the “6 D’s” describing degenerative changes?
A
- Destruction
- Density (subchondral sclerosing)
- Debris
- Dislocation
- Disorganization
- Distention
22
Q
What is tenosynovitis?
A
Inflammation of the tendon sheath
23
Q
What are the features of non-infectious tenosynovitis?
A
- Inflammation leads to increased fibrin thickening of synovial fluid
- Increase in friction between tendon sheath and tendon
24
Q
What are the features of infectious tenosynovitis?
A
- Bacterial infection affects sheath
- Purulent exudate present
- Necrosis of tendon sheath, tendon, and other structures
25
What is occurring at the arrow labeled 1?
What is occuring at the other label?
At label 1: **early cracking and fibrillation** of cartilage
At the other arrow: **synovial fluid is leaking into cracks**
| degenerative joint disease
26
What part of the pathogenesis of DJD is depicted in this image?
What factors contribute to the death of chondrocytes that initiate this event?
Early in pathogenesis:
* Decreased proteoglycans, decreased glycosaminoglycan chain length, increased fibrillin, increased H2O bonding, **collagenase** present
* **Fibrillation** in surface articular cartilage
* Fibrillation propagation (synovial fluid fills and increases fissures, pieces of cartilage break off)
27
The blood vessel shown penetrating into the damaged area here is an important part of the pathogenesis of DJD.
What is the process of new vessel formation called?
Angioneogenesis
28
Given that this is DJD what is displayed by label 2?
Label 3?
Label 2: deep crack **across tide mark** with underlying neovascularization
Label 3: **fibrocartilage plug**
29
# degenerative joint disease
What occurs as a consequence of this crack crossing the tide mark?
* Angioneogenesis
* Increased osteoclastic activity (subchondral resorption)
* Increased osteoblastic activity (subchondral sclerosis)
* Fibrocartilage forms (from fibroblasts)
30
# degenerative joint disease
Which tissue layers are damaged in this image?
* Articular (hyaline) cartilage (tangential, transitional, radial zones)
* Tide mark
* Calcified zone (cartilage)
* Subchondral bone plate
31
# degenerative joint disease
What is the reparative structure that fills the area of destroyed chondrocytes?
What tissue layer must be damaged before this structure is created?
**Fibrocartilage plug**: damage has passed tide mark into calcified cartilage
32
# degenerative joint disease
What terminology describes the thickened bone in the image on the right?
Subchondral sclerosis
33
# degenerative joint disease
What term is used to describe the necrosis of osteocytes and polished appearance of bone caused by the mechanical wear of bone-on-bone friction once articular cartilage is lost (label 4)?
Eburnation
34
# degenerative joint disease
What is the synovial fluid filled structure shown (label 5)?
Subchondral bone cyst
35
# degenerative joint disease
Label the following in this image:
1.
2.
3.
1: **Eburnation with subchondral sclerosis**
2: **Subchondral (synovial) bone cyst**
3: **Intact hyaline cartilage** (healthy)
36
Your new patient is a 55-year-old male factory worker. He reports pain in his left shoulder and low back. He broke his right radius playing baseball when he was 12 years old, but continued to play for decades. He had a heart attack recently and his left interventricular artery was stented. His heart attack inspired him to start trying to lose weight. His back pain has lasted for years, but eases when he comes home from work. His shoulder has been more concerning. It gives a little trouble all day, but is worse in the morning and after a long day at work.
What are some pathological features seen in this radiograph of his shoulder?
* Subchondral sclerosing (articular part of humeral head and glenoid fossa)
* Decreased joint space (articular cartilage reduced)
* Osteophytes
* Subchondral cyst
| degenerative joint disease
37
What cellular events could explain the radiolucent areas on the humeral head?
What is the term for these lesions?
* Fibrillation
* Synovial fluid fills cracks
* Increased osteoclastic activity (subchondral resorption)
* Decreased osteoblastic activity
Led to **subchondral bone cysts**
| degenerative joint disease
38
What is the term for the projections extending from the inferior portion of the humeral head?
What type of cells comprise these structures?
Where are they generally found in the joint?
**Osteophytes**: composed of osteoblasts, generally found at joint margins
| degenerative joint disease
39
What is subchondral sclerosing?
Does it appear radiopaque or radiolucent?
Thickening and hardening of subchondral bone in response to stress
Appears radiopaque
40
Your new patient is a 55-year-old male factory worker. He reports pain in his left shoulder and low back. He broke his right radius playing baseball when he was 12 years old, but continued to play for decades. He had a heart attack recently and his left interventricular artery was stented. His heart attack inspired him to start trying to lose weight. His back pain has lasted for years, but eases when he comes home from work. His shoulder has been more concerning. It gives a little trouble all day, but is worse in the morning and after a long day at work.
What is the term for the changes seen at the intervertebral joint margins of his cervical spine?
Spondylophytes
| degenerative joint disease
41
Is degenerative joint disease/osteoarthritis inflammatory?
Etiology is non-inflammatory, but pathogenesis includes inflammation
42
Your new patient is a 55-year-old male factory worker. He reports pain in his left shoulder and low back. He broke his right radius playing baseball when he was 12 years old, but continued to play for decades. He had a heart attack recently and his left interventricular artery was stented. His heart attack inspired him to start trying to lose weight. His back pain has lasted for years, but eases when he comes home from work. His shoulder has been more concerning. It gives a little trouble all day, but is worse in the morning and after a long day at work.
Would you expect to see the same level of degeneration in his right shoulder as is seen in his left shoulder radiograph here?
No, the left arm has been through more stress
43
The following are all changes featured in what joint pathology?
* Non-uniform decreased joint space
* Subchondral sclerosis
* Osteophytes and spondylophytes
* Subchondral cysts
* Chondral/subchondral loose bodies (joint mice)
Degenerative joint disease/osteoarthritis
44
The following are all changes seen in what joint pathology?
* Non-uniform decreased joint space
* Subchondral cysts
* Chondral/subchondral loose bodies (joint mice)
* Intra-articular loose bodies
* Subluxation
Degenerative joint disease/osteoarthritis
45
The following are all changes seen in what joint pathology?
* Non-uniform decreased joint space
* Subchondral/chondral loose bodies (joint mice)
* Subluxation
* Loss of congruity in joint space
* Muscle contractures or decreased muscle mass
Degenerative joint disease/osteoarthritis
46
Your new patient is a 55-year-old male factory worker. He reports pain in his left shoulder and low back. He broke his right radius playing baseball when he was 12 years old, but continued to play for decades. He had a heart attack recently and his left interventricular artery was stented. His heart attack inspired him to start trying to lose weight. His back pain has lasted for years, but eases when he comes home from work. His shoulder has been more concerning. It gives a little trouble all day, but is worse in the morning and after a long day at work.
What treatment should be recommended for this patient?
* Over the counter pain relievers
* Exercise, weight loss
* Support devices (ie. shoe inserts)
* Heat and cold therapy
* Complementary therapy
* Surgery
| degenerative joint disease
47
A 23-year-old female patient recently suffered a complete, non-comminuted fracture to her right tibia and was in a cast for several months with restricted activity. The cast was removed three months ago and she began jogging again. It was difficult at first, and recently, she has noticed her knee feel stiff and achy almost all the time. She stopped taking stairs because it makes it worse. Radiographs of both knees appear unremarkable.
Based on this case presentation what would the most likely differential diagnosis be?
Chondromalacia patellae (patellofemoral pain syndrome)
48
A 23-year-old female patient recently suffered a complete, non-comminuted fracture to her right tibia and was in a cast for several months with restricted activity. The cast was removed three months ago and she began jogging again. It was difficult at first, and recently, she has noticed her knee feel stiff and achy almost all the time. She stopped taking stairs because it makes it worse. Radiographs of both knees appear unremarkable.
What would your next step be to confirm a diagnosis?
Functional and orthopedic testing, eventually a referral
| chondromalacia patellae
49
A 23-year-old female patient recently suffered a complete, non-comminuted fracture to her right tibia and was in a cast for several months with restricted activity. The cast was removed three months ago and she began jogging again. It was difficult at first, and recently, she has noticed her knee feel stiff and achy almost all the time. She stopped taking stairs because it makes it worse. Radiographs of both knees appear unremarkable.
What cellular changes could you expect to see at her knee joints?
Which part of the joint will primarily be affected?
Cartilage softening, swelling, and edema
Primarily in anterior knee
| chondromalacia patellae
50
A 23-year-old female patient recently suffered a complete, non-comminuted fracture to her right tibia and was in a cast for several months with restricted activity. The cast was removed three months ago and she began jogging again. It was difficult at first, and recently, she has noticed her knee feel stiff and achy almost all the time. She stopped taking stairs because it makes it worse. Radiographs of both knees appear unremarkable.
Based on your differential diagnosis, what would your treatment recommendation be for this patient?
* Rest (take on exercise progressively)
* Alter exercise (adequate warmup and stretching)
* Weight loss
* Support devices
* NSAIDs
| chondromalacia patellae
51
A 60-year-old male comes to you for back pain. He has a pronounced slapping or stomping gait. He thinks he hurt his back lifting boxes. He was diagnosed with diabetes mellitus at the age of 16 years, broke three ribs in a car accident when he was 31, and has been suffering from depression, preventing him from much activity. He also admits he hasn't been eating as healthy or taking he diabetes medication as well as he should.
What is indicated by this patient's altered gait?
Some type of neuropathic condition
52
A 60-year-old male comes to you for back pain. He has a pronounced slapping or stomping gait. He thinks he hurt his back lifting boxes. He was diagnosed with diabetes mellitus at the age of 16 years, broke three ribs in a car accident when he was 31, and has been suffering from depression, preventing him from much activity. He also admits he hasn't been eating as healthy or taking he diabetes medication as well as he should.
He has reduced sensation in his foot. You order a radiograph.
What evidence is there for joint destruction in this radiograph?
All 6 D's:
* Distension
* Dislocation
* Disorganization
* Density (subchondral sclerosing)
* Debris
* Destruction
| hypertrophic neuropathic arthropathy (Charcot joint)
53
A 60-year-old male comes to you for back pain. He has a pronounced slapping or stomping gait. He thinks he hurt his back lifting boxes. He was diagnosed with diabetes mellitus at the age of 16 years, broke three ribs in a car accident when he was 31, and has been suffering from depression, preventing him from much activity. He also admits he hasn't been eating as healthy or taking he diabetes medication as well as he should.
He has reduced sensation in his foot. You order a radiograph.
What does the destruction of this joint indicate about his pain?
What does this mean for the surrounding soft tissues?
Absence of pain and proprioception leads to altered joint biomechanics and gait, as well as soft tissue swelling, enlarging the joint
| hypertrophic neuropathic arthropathy (Charcot joint)
54
A 60-year-old male comes to you for back pain. He has a pronounced slapping or stomping gait. He thinks he hurt his back lifting boxes. He was diagnosed with diabetes mellitus at the age of 16 years, broke three ribs in a car accident when he was 31, and has been suffering from depression, preventing him from much activity. He also admits he hasn't been eating as healthy or taking he diabetes medication as well as he should.
He has reduced sensation in his foot. You order a radiograph.
Is the etiology of this joint destruction inflammatory or non-inflammatory?
Non-inflammatory
| hypertrophic neuropathic arthropathy (Charcot joint)
55
What is the clinical presentation of neuropathic arthropathy?
* Non-inflammatory: due to underlying neurological condition
* Destruction is rapid and severe
* Painless instability
* Joint enlargement/swelling and warmth
* Abnormal joint mechanics
* "Bag of bones", surgically amputated appearance
56
A 36-year-old female presents with pain and stiffness in her right thumb. It's worse when she is working and causing her problems in her mail sorting job with the USPS. She has some swelling and tenderness in the area. Pain is reproducible when you ask her to abduct her right thumb. She has no other complaints or previous conditions.
What is the most likely cause/pathology?
De Quervain's tenosynovitis (subacute)
## Footnote
inflamed abductor pollicis longus tendon
57
A 36-year-old female presents with pain and stiffness in her right thumb. It's worse when she is working and causing her problems in her mail sorting job with the USPS. She has some swelling and tenderness in the area. Pain is reproducible when you ask her to abduct her right thumb. She has no other complaints or previous conditions.
What sort of treatment recommendations would you make?
Splint, NSAIDs, corticosteroids, surgery
| de Quervain's tenosynovitis
## Footnote
avoid anti-inflammatory drugs
58
A 70-year-old patient presents with pain, swelling, and obvious deformities of both hands. This is their radiograph.
Note the subluxation of the metacarpophalangeal joints.
What types of changes to the bone are indicated at the purple arrows?
Are these effects bilateral?
"Rat bite" lesions (marginal erosions), osteolytic lesions at the joint margins (juxta-articular)
Seen bilaterally and symmetrically
| rheumatoid arthritis
59
A 70-year-old patient presents with pain, swelling, and obvious deformities of both hands. This is their radiograph.
Note the subluxation of the metacarpophalangeal joints.
Is this pattern of injury consistent with a non-inflammatory condition?
What pathology is likely present?
No, this is **rheumatoid arthritis** which is **inflammatory**
60
What is generally the etiology of non-inflammatory joint pathology?
Etiology of inflammatory?
Non-inflammatory: **biomechanical wear and tear**
Inflammatory: **autoimmune**
61
What is the nature of primary bone changes in non-inflammatory joint pathology?
What bone changes in inflammatory?
Non-inflammatory: **mixed osteolytic and osteoblastic**
Inflammatory: **very osteolytic**
62
Are non-inflammatory joint pathologies typically bilateral/symmetrical?
Are inflammatory pathologies?
Non-inflammatory: **typically not symmetrical**
Inflammatory: **bilateral and symmetrical**
63
What are generally the symptoms of a non-inflammatory joint pathology?
* Stiffness with activity
* Dull pain
* Worse with long inactivity (morning, long standing)
* Worse over time
64
What are generally the symptoms of an inflammatory joint pathology?
* More constant pain
* Exacerbation remission pattern
* Cardinal signs of inflammation
65
What are the ESR/CRP lab results for non-inflammatory versus inflammatory joint pathologies?
Non-inflammatory: **normal** (may elevate later if inflammation results)
Inflammatory: **increased**
