Osteoarthritis/degenerative Joint Disease

Front 1

What is the most common form of arthritis?

Back 1

Osteoarthritis (also known as DJD)

Front 2

What is the definition of osteoarthritis (DJD)?

Back 2

"A progressive degeneration of articular cartilage

Front 3

There are two types of osteoarthritis, what are they?

Back 3

Primary - no direct attributable cause
Secondary - underlying/predisposing factors such as whiplash, trauma, etc.

Front 4

At what age in males does the incidence of DJD begin to increase?

Back 4

< age of 45

Front 5

At what age in females does the incidence of DJD begin to increase?

Back 5

> age of 45

Front 6

What races does DJD affect?

Back 6

All races

Front 7

What things cause (etiology) DJD?

Back 7

Excess or abnormal physical forces on cartilage (chondrocytes).

Front 8

With excess forces on cartilage, what occurs in the tissue on a cellular level?

Back 8

There is a loss of ground substance, exposing collagen fibrils, resulting in their destruction.

Front 9

With the destruction of cartilage in the joint space, what enzymes are released?

Back 9

The broken down cartilage stimulates the release of collagenase and other lytic enzymes.

Front 10

On an X-Ray, what would the doctor see in a patient with DJD?

Back 10

- Loss of cartilage, resulting in...
- decreased joint space
- lipping and spurring (osteophytes) at joint margines
- subchondral sclerosis/eburnation (eburnation is defined as; a change in exposed subchondral bone in degenerative joint disease in which it is converted into a dense substance with a smooth surface like ivory.)
- Radiolucent subchondral cysts

Front 11

If you were doing a physical evaluation (including x-rays) on someone with DJD, where would you see the DJD?

Back 11

- Skeletal wide
- Especially in weight bearing joints (hip, knee, spine)
- Also in DIPs

Front 12

Where is DJD typically seen in the cervical spine?

Back 12

C5 & C6 (the apex of the curve)

Front 13

What areas of the C5/C6 joints would you see arthritis?

Back 13

- Apophyseal joints (posterior IVF)
- Uncovertebral joints (anterior IVF)
- Discovertebral joints (canal stenosis)

Front 14

If a patient came in with DJD, what kind symptoms (if any) might the patient be experiencing?

Back 14

- asymptomatic
- sclerogenic ("discogenic") pain
- Cervical radiculopathy
- Cervical myelopathy

Front 15

If patient has DJD, but is asymptomatic, what might you see or realize?

Back 15

- X-ray findings may show no correlation between DJD and patient symptoms.

Front 16

If a patient has DJD and is experiencing sclerogenic pain, what would be the local symptoms?

Back 16

1. Chronic pain and stiffness
2. Pain increases with activity, cold, barometric pressure (pain is relieved by rest, heat, aspirin)
3. Stiffness is worse after rest (and relieved with activity)
4. Deep, aching pain
5. Local tenderness over spasmed muscle, spinouses, facets
6. pain is mild and moderate
7. Pain is continuous

Front 17

If a patient has DJD and is experiencing sclerogenic pain, what would be the referral symptoms?

Back 17

Note: Sclerogenic pain has embryologic connections to other areas, so:
1. Damaged discs
2. Damaged ligaments
3. Damaged joints

...will refer to other areas.

Front 18

Where does cervical pain typically refer to?

Back 18

The occiput, intrascapular region, shoulder and arm.

Front 19

A dermatomal pain referral pattern (cervical radiculopathy) might the result of what problem in the cervical region?

Back 19

- IVF encroachment, compromising the nerve root

Front 20

Why are most cervical radiculopathy's sensory related?

Back 20

Because the posterior nerve root is located more superior in the IVF, it is more exposed.

Front 21

A cervical myelopathy can cause what problems?

Back 21

- Spinal canal stenosis from disc protrusion or osteophytes
- Upper motor neuron involvement with a gradual onset of weakness and loss of motor control, including radiating pain and numbness.

Front 22

DJD in the hands causes what "nodes" in the DIPs?

Back 22

- Heberden's nodes (bony projection arising from any bone that develops from cartilage. The projections are about the size of a pea or smaller, found on the DIPs of the fingers in osteoarthritis, which are enlargements of the tubercles at the articular extremities of the distal phalanges.)

Front 23

DJD in the hands causes what "nodes" in the PIPs?

Back 23

- Bouchard's nodes (gelatinous cysts or bony outgrowths on the dorsal aspects of the proximal interphalangeal joints)

Front 24

DJD in the hands causes what symptoms in the carpometacarpal joints?

Back 24

pain, swelling, stiffness, tenderness

Front 25

DJD in the hip occurs more in males than females! True or False?

Back 25

True

Front 26

80% of the time DJD in the hip is related to what?

Back 26

- Underlying congenital or development abnormalities.

Front 27

If a patient has DJD in the hip, where might he/she feel the pain?

Back 27

- In the groin
- In the inguinal area
- May radiate to buttock, medial thigh, and distal thigh/knee

Front 28

If a patient has DJD in the knee, what part of the knee might the arthritic conditions develop?

Back 28

- In the medial knee, as it is the more weight bearing area

Front 29

If a patient has DJD in the knee, he she can develop chondromalacia patella. What is chondromalacia patella?

Back 29

It is damage to the posterior patellar cartilage.

Front 30

If a patient has DJD in the knee, would they experience S.H.A.R.P.? What is S.H.A.R.P.?

Back 30

Yes
S - Swelling
H - Heat
A - Altered function
R - Redness
P - Pain

Front 31

If you were going to diagnose someone with DJD, what would you look for?

Back 31

- Radiographic signs (osteophytes, decreased joint space, etc.)
- Pattern of involvement (trauma, excess use, etc.)
- Normal blood lab

Front 32

What would be your goal when treating a patient with DJD?

Back 32

Minimize pain and maximize function