Osteoarthritis of peripheral joints and Erosive osteoarthritis Flashcards
What is osteoarthritis?
A non‐inflammatory joint disease characterised by degeneration of the articular cartilage, hypertrophy of bone at joint margins and changes in the synovial membrane
The most common form of arthritis
The leading cause of long-term disability among older adults
A slowly progressing disorder of unknown cause THOUGH often there is a progressive loss of articular cartilage and abnormal bone formation
Can affect any joints but m/c in hands, hips, knees and spine
What is osteoarthritis sub categorised as?
Primary generalised osteoarthritis
Chondromalacia patellae (knee)
Erosive osteoarthritis (Hand)
What are the clinical features of osteoarthritis?
Minimal morning stiffness or stiffness after inactivity
- Pain & Tenderness in and around the affected joints
- Crepitus with motion
- Limited ROM (active and passive ROM)
- No swelling in early OA
- Swelling with disease progression
- Deformities:
1. Herberden’s nodes (DIP joints of hand)
2. Bouchard’s nodes (PIP joints of hand)
3. Bow legs
What are the risk factors of osteoarthritis?
- Age (>50yoa)
- Obesity
- Muscle weakness
- Heredity
- Previous trauma to the joint
- Repeated stress on the joint, e.g., heavy physical activity
- Inactivity
What are the radiological findings of Degenerative Joint Disease (DJD)?
- One joint is typically affected (indicates focal biomechanical loading)
- Look for typical pattern of findings – (not all are present in every case)
1. Joint space reduction - non-uniform is typical (note direction if relevant)
2. Subchondral sclerosis
3. Osteophytes – bony outgrowths (osteophytosis)
4. Subchondral cysts (in marrow space – fluid squeezed through cartilage fissures)
5. Osteochondral bodies (“joint mice”) – bone-cartilage fragments in joint
6. Bony remodelling due to altered motion / loading (change in normal shapes)
7. Loss of joint congruity (joint surfaces no longer match normally) – luxation
What is the treatment of osteoarthritis?
Education and advice
E.g., literature, videos, self-learning programs, group therapy & other educational technology
Encouraged to take responsibility & control of their management
Footwear and walking aids (e.g., heal wedges, canes, arthoses)
Diet
Exercise therapy (low to moderate impact)
improves cardiovascular fitness and increases sense of well-being & happiness
improves mental function & reduces anxiety & depression
Hydrotherapy
helping pain relief and muscle relaxation, while reducing gravitational loading of joints
Drug therapy
Surgery
How does osteoarthritis of the hip display?
Narrowing - asymmetric and more prominent at the superior joint (weight-bearing) space
Axial or medial loss of joint space - a mechanical abnormality or process resulting in cartilage loss
Superomedial & superolateral joint spaces should normally be equal
Osteophytes form at femoral head and neck junction creating a ‘collar’ or bony rim (response to abnormal loads)
Subchondral cysts, especially in the acetabular roof, can be large and mimic an osteolytic (bone removing) lesion
How does osteoarthritis of the knee display?
Look for typical pattern of findings:
1. Medial femoro-tibial compartment involvement:
- most common
- may result in varus deformity
2. ‘Pan-compartmental’ or ‘tri-compartmental’ involvement – when all three compartments involved
Meniscectomy in any compartment after trauma:
- reduces pain and locking
- but does not prevent the development of OA
What is Knee: Chondromalacia Patellae?
Cartilage “softening” and or erosion
Clinical: Characterized by patellofemoral joint pain, accentuated during knee flexion, and associated crepitus. May mimic meniscal pathology.
Causes of acute chondromalacia:
instability, direct trauma, and fracture
Causes of chronic chondromalacia:
subluxation, an increased Q angle, quadriceps imbalance, post-traumatic malalignment, excessive lateral pressure syndrome, and PCL injuries.
How does osteoarthritis of the ankle display?
Severe osteoarthritis - usually due to intraarticular fracture or instability related to ligamentous damage
- Large spurs at the anterior ankle with eventual deep peroneal nerve impingement and limited dorsiflexion (‘anterior impingement syndrome’)
- Similar process can occur posterior (‘posterior impingement syndrome)
- Subtalar joint may degenerate especially with prior trauma
How does osteoarthritis of the foot display?
- The Lisfranc joint (tarsometatarsal joint) may degenerate if unstable
- usually due to Lisfranc type injury involving the Lisfranc ligament extending from medial cuneiform to 2nd MT base
- OA also common at 1st MTP joint especially if hallux valgus
What is a calcaneal spur?
A calcaneal spur is a form of osteophyte. Note that its location is deep to the inferior tubercle.
The plantar fascia arises from the calcaneal tubercles which is just superficial to this spur.
The plantar fascia is a more likely source of painful heel symptoms.
The spur indicates chronic biomechanical dysfunction
What is anterior impingement syndrome?
If there is osseous overgrowth at the margins of a joint, then there will likely result in limitation of joint motion at that location.
What is Hallux Rigidus or Hallux Limitus?
Developmentally squared shape morphology of 1st MT head predisposes to OA
Often with large dorsal osteophytes
Develop severe pain and limited ROM
Note the position of the extensive osteophytes. These will seriously reduce motion at the joint. Would need a lateral projection to identify dorsal osteophyte presence.
How does osteoarthritis of the AC joint display?
Very common
- Spurs at inferior distal clavicle or acromial spurs – possible cause of impingement syndrome
