Painful Joint Flashcards
(42 cards)
What is osteoarthritis
The most common form of arthritis
- joint damage that results from a disparity between the stress applied to the articular cartilage and the ability of the cartilage to withstand stress
Commonly affects the hip, knee, DIP, PIP, thumb CMJ and hallux MTP joints
Usually spares the MCPJs
Clinical features of OA
Progressive pain
- initially activity related pain, progresses to a constant rest pain
- stiffness characteristically worse after periods of rest but lasts under 30min
Morning stiffness
Waxing and waning course
Muscle wasting
Loss of mobility
Deformity
Joint instability
OE of OA
Look: bone swelling, muscle wasting
Feel: joint line tenderness, possible effusions, crepitus
Move: limited range of movement
Red flags of OA
Age <45
Severe morning stiffness
Severe night pain
Fever / systemic symptoms
OA risk factors
Age
Obesity
FH
Female ( esp post menopausal)
Hypermobility
Previous trauma
Occupation
Protective factor for OA
Osteoporosis
What is the LOSS acronym for looking for OA in X-rays
Loss of joint space
Osteophytes
Sclerosis
Subchondral cysts
Causes of secondary OA
Pre existing joint damage: inflammatory, septic, crystal arthritis, AVN, trauma
Metabolic disease: acromegaly, chondrocalcinosis, haemochromatosis
Systemic disease: haemophilia, haemoglobinopathies, neuropathies
What is the difference between localised and generalised OA
Localised affects either hip, knee, shoulder
Generalised affects many joints and is classically worse in the hands
Clinical features of hip OA
Unilateral
Deep pain in the anterior groin initially on walking or climbing stairs
Pain may be referred to the buttock, thigh, knee or ankle. This can then progress to gait abnormalities
What is the trendelenburg gait
Lurch towards the affected hip with less time spent weight bearing on that side
Pelvis tilts towards unaffected side - due to wasting and weakness of the gluteal and anterior thigh muscles
OE of hip OA
Painful and decreased internal and external rotation of the hip
Positive trendelenburg test
Clinical features of knee OA
Bilateral and symmetrical at presentation
Strong relationship with obesity
What is unilateral knee OA likely to be indicative of
Previous trauma or soft tissue injuries
Pain usually localised to a specific compartment of the knee
What is seen in advanced knee OA
Varus (bow legged) deformity
Antalgic gait
Valgus deformity is less common
OE of knee OA
Moderate joint effusion, decreased range of movement, crepitus, quadriceps wasting
What does locking suggest in knee OA
Loose meniscal cartilage in the joint
What does giving way indicate in knee OA
Giving way may be due to weak quadriceps muscles, severe patellofemoral involvement or altered load bearing mechanisms
What is shoulder OA
Far less common than knee, hand or hip OA
Most commonly seen in women >70
Associated with increased BMI and previous shoulder injuries
What is nodal generalised OA
Joints of the hands are affected one by one over many years
- first presents with painful swelling and impairment of function
- typical in menopausal women
- familial tendency thought to have autoimmune aetiology
- DIPs affected more than PIPs
- heberden (DIP) and bouchard (PIP) nodes
OE of nodal generalised OA
Bony swelling and fixed adduction deformities - squared hand
Thenar muscle wasting will be seen
Other MCPJs generally spared
Once disease progresses, there may be ulnar or radial deviation at affected joints
What is erosive OA
Rare
Characteristic cysts seen on X-RAY
Poor prognosis
What is crystal associated OA
Calcium pyrophosphate deposition in the cartilage leads to chondrocalcinosis
This can be asymptomatic or lead to the signs / symptoms of OA
Knees and wrists affected
Pathophysiology of OA
In a normal synovial joint, the articular cartilage maintains the distance between the bone ends
In OA, wear and tear leads to erosion of this cartilage resulting in narrowing of joint space
There is inflammation and thickening of the joint capsule and synovium - capsular fibrosis
This causes progressive cartilage loss leading to eburnation
Small cysts develop beneath this abnormal bone surface and osteophytes form
