What would you expect from an inflammatory joint problem?
• Pain - diurnal, precipitation.
• Stiffness - Early morning/inactivity, improves with activity.
• Response to steroids.
• Systemic symptoms?
What conditions may cause mono-arthritis?
• Septic arthritis • Crystal arthritis
What conditions may cause oligoarthritis (2-4 joints)?
• Osteoarthritis • Psoriatic arthritis • Ankylosing spondylitis
What are the risk factors of developing osteoarthritis?
• Smoking • Obesity • Hypermobility • Hereditary
What are four pathological changes associated with osteoarthritis?
1) Degeneration of cartilage 2) Sclerosis of subchondral bone 3) Subchondral cysts 4) Marginal osteophytes
Which compartment of the knee is most frequently susceptible to OA?
The medial compartment.
What is the most common presenting complaint of osteoarthritis?
What are 5 clinical features of OA?
1) Joint pain 2) Joint tenderness 3) Limited movement 4) Crepitus 5) Occasional effusion
What is the most likely cause of mono-osteoarthritis?
In nodal OA what is the name of the nodes located in the proximal-inter-phalangeal joint?
In nodal OA what is the name of the nodes located in the distal-inter-phalangeal joint?
What is the synovial fluid like in osteoarthritis?
Clear and colourless
What are the three things that contribute to a diagnosis of osteoarthritis?
Clinical history, examination and radiology.
What are the aims of management in osteoarthritis?
1) Treat symptoms 2) Minimise disability 3) Delay structural progression
What are the pharmacological treatments of osteoarthritis?
• Patient education • Weight loss • Identify and treat depression • Exercise • Adaptive devices • Support devices
What are the pharmacological treatments of OA?
• Analgesics - Paracetamol, NSAIDS • Intra-articular steroids
What are coxibs?
These are NSAIDS that selectively inhibit COX2.
What are the two main periods of the gait cycle?
• Stance phase (65%)
• Swing phase (35%)
What are the components of the stance phase of the gait cycle?
1) Initial contact - This is a period of double stance, usually starts with heel strike, heel rocker motion.
2) Loading response - Double stance, ankle becomes more dorsiflexed, knee begins to flex, hip begins extend, opposite leg is still in contact with floor.
3) Mid-stance - Single leg support, maximal weight bearing, toe rocker motion, starts from toe-off of opposite leg.
4) Terminal-stance - Begins with heel off, ends with toe-off/push-off, propulsion.
What are the components of the swing phase of the gait cycle?
1) Pre-swing - Moment at which the stance phase ends.
2) Mid-swing - The limb passes anteriorly to the supporting leg.
3) Terminal-swing - Ends with heel strike.