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PHCY220 Musculoskeletal Disorders Study Set Exam
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PHCY220 MusculoskeletalDisorders Study Set Exam
Osteoarthritis - Answer Osteo= bone
Arthritis = inflammation of the joint
A chronic joint disease that leads to the immobility and destruction of joints
2 types of OA - primary and secondary
Primary OA - Answer The most common form
No predisposing factor is apparent
Secondary OA - Answer Pathologically is not distinguishable from primary OA
Has a known underlying cause
- Obesity
- RA
- Diabetes
OA Epidemiology - Answer OA is the most common joint disease
The joint distribution in males and females in those less than 55 is similar
In patients > 55
- Hip OA is more common in males
- OA of hands, thumb base, and knee are more common in females
Distribution of joints and prevalence varies by various races
OA Risk Factors - Answer Age
Gender
Obesity
Heredity
Injury
Occupation
,Muscle Weakness
OA Joints affected - Answer OA usually affects joints in a non-symmetric manner
OA most frequently attacks fingers, toes, base of thumb, knee, hip, neck and low back
OA of the knee - Answer Most common in females
May affect one or both
OA of the hip - Answer Occurs in males and females
May affect one or both
OA of the hands - Answer Mainly affects females
Most often affects the base of the thumb and the joints at the end of fingers
Osteoarthritis of the neck/back - Answer Called 'spondylosis'
Often asymptomatic with no problems
OA of the foot - Answer Joint at the base of the big toe
Interphalangeal joints
Main findings in OA - Answer In OA patients
- surface of joint is damaged
- surrounding bone grows thicker
- joint damage/immobility
Main pathological feature is progressive loss of articular cartilage but also involves
other tissues including:
- subchondral bone
- synovium
- ligaments
- neuromuscular
The important articular changes in OA - Answer Early stage
- the cartilage is thicker than normal
Progression of OA
- Joint surface is breached and vertical clefts develop (fibrilation)
,- cartilage is metabolically active
- Chondrocytes replicate and form clusters
Late stage
- Cartilage becomes hypocellular
The important bone changes in OA - Answer Bone remodelling and hypertrophy
- Appositional bone growth occurs in subchondral region leading to bony 'sclerosis'
Pathogenesis of OA - Answer The extracellular matrix of normal cartilage contains
- Proteoglycans (PGs)
- Collagen
- Matrix metalloproteinases (MMPs)
Primary changes occur in the cartilage
Matrix metalloproteinases have an important role in the loss of cartilage matrix in OA
Synthesis and secretion of MMPs might be stimulated by IL-1 or other factors (i.e.
mechanical stimuli)
Symtpoms of OA - Answer Pain (worse with activity, improved with rest)
Stiffness after inactivity or in morning, usually less than 30 minutes
Swelling, usually mild
Reduced range of motion
Giving way or sensation of instability
Muscle spasm
Sleep disturbances
Fatigue
Signs of OA - Answer Gait abnormalities (painful gait)
Osteophytes (bony enlargements)
Crepitus
Tenderness on palpation
Ligamentous laxity
, Deformity e.g. varus, valgus, flexion deformity
Immobility and loss of joint motion
Muscle weakness
Decreased proprioception
Causes of joint pain in OA - Answer Synovium - inflammation
Subchondral bone - micro fractures
Osteophytes - stretching of periosteal nerve endings
Ligaments - stretching
Joint capsule - inflammation
Muscle - spasm
OA Diagnosis - Answer Based on clinical symptoms and radiographic features
Radiographic findings in OA - Answer Early stage is often normal
changes in radiographs become evident as articular cartilage is lost
- Joint space narrowing
- subchondral bone sclerosis
More radiographic findings
- subchondral cysts
- Osteophytosis
Lab tests for OA - Answer No specific lab test is available for diagnosis of OA
Lab findings may help to identify the underlying cause of secondary OA
OA is usually not systemic so the lab tests such as ESR, CBC, urine analysis are usually
normal
Synovial fluid reveals milk leukocytosis (mainly mononuclear cells)
Synovial fluid analysis is important in excluding other conditions (i.e. gout, septic
arthritis or RA)
Treatment goals for OA - Answer Reduce pain
Improve function/minimise disability
Improve quality of life
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