Osteoarthritis + Carpal tunnel syndrome Flashcards
(20 cards)
What is osteoarthritis?
Osteoarthritis is characterised by progressive loss of articular cartilage and remodelling of the underlying bone.
Osteoarthritis has a multifactorial aetiology and can be primary (with no obvious cause) or secondary (due to trauma, infiltrative disease or connective tissue diseases).
What are the risk factors for primary osteoarthritis?
- Obesity
- Increasing age
- Female gender
- Manual labour occupation
Which joints are most commonly affected by osteoarthritis?
- Small joints of the hands and feet
- Hips and knees
Symptoms of osteoarthritis
Patients typically present with symptoms that are insidious, chronic, and gradually worsening. Often asymmetrical.
- Pain and stiffness in joints
- worsened with activity, relieved by rest
- stiffness lasts for <30 minutes in morning
- Prolonged OA results in deformity and reduced range of movement
Osteoarthritis - on examination:
- Inspect for deformity
- Bouchard nodes (swelling of PIPJs) or Heberden nodes (swelling of DIPJs) in the hands
- Fixed flexion deformity or varus malalignment in the knees
- Feel for crepitus throughout the range of movement. Movement of the joint is generally reduced and painful.
General differential diagnosis for osteoarthritis
- Inflammatory arthropathies (e.g. rheumatoid arthritis)
- Crystal arthropathies (e.g. gout or pseudogout)
- Septic arthritis
- Fractures
- Bursitis
- Malignancy (primary or metastatic)
Differential diagnosis for osteoarthritis in the hand
- De Quervain’s tenosynovitis
- Rheumatoid arthritis
- Gout
Differential diagnosis for osteoarthritis in the hip
- Trochanteric bursitis
- Radiculopathy
- Spinal stenosis
- Iliotibial band syndrome
Differential diagnosis for osteoarthritis in the knee
- Referred hip pain
- Meniscal or ligament tears
- Chondromalacia patellae
The classical radiological features of osteoarthritis are:
Loss of joint space
Osteophytes
Subchondral cysts
Subchondral sclerosis
Conservative management of osteoarthritis
- Weight loss for patients who are overweight
- Strengthening and exercise
- Ice packs
- Joint support and physiotherapy
Medical management of osteoarthritis
- Simple analgesia
- Topical NSAIDs
- Intra-articular steroid injections
If conservative and medical interventions fail, then surgical intervention may be considered, especially if their joint symptoms have a substantial impact on their quality of life.
Surgical management choice will depend on the site affected. Options include:
- Osteotomy
- Arthrodesis (joint fusion)
- Arthroplasty
What is carpal tunnel syndrome?
Carpal tunnel syndrome is a condition involving a compression of the median nerve within the carpal tunnel of the wrist, due to a raised pressure within this compartment.
Risk factors for carpal tunnel syndrome
- Increasing age
- Female
- Pregnancy
- Obesity
- Previous injury to wrist
Symptoms of carpal tunnel syndrome
Throughout the median nerve sensory distribution (lateral three digits):
- Pain
- Numbness
- Parasthesia
Symptoms are worse a night and can be temporarily relieved by hanging the affected arm over the side of the bed or shaking it back and forth.
The palm is often spared in carpal tunnel syndrome, why is this?
The palmar cutaneous branch of the median nerve branches proximal to the flexor retinaculum and passes over the carpal tunnel.
Carpal tunnel syndrome - on examination:
- Sensory symptoms can be reproduced by:
- Percussing over the medical nerve (Tinel’s test)
- Holding the wrists in full flexion for one minute (Phalen’s test)
- In the later stages:
- Weakness of thumb abduction (due to denervation atrophy of the thenar muscles)
- Wasting of the thenar eminence
Conservative and medical management of carpal tunnel syndrome:
- Wrist splint (commonly worn at night, prevents wrist flexion)
- Physiotherapy
- Cortiocosteroid injections - administered directly into carpal tunnel to reduce swelling
Surgical treatment of carpal tunnel syndrome is only undertaken in severely limiting cases where previous treatments have failed.
What does carpal tunnel surgery involve?
Carpal tunnel release surgery decompressed the carpal tunnel, involving cutting through the flexor retinaculum, reducing pressure of the median nerve.
