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32 Cards in this Set

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What is the most common form of arthritis?
Osteoarthritis (also known as DJD)
What is the definition of osteoarthritis (DJD)?
"A progressive degeneration of articular cartilage
There are two types of osteoarthritis, what are they?
Primary - no direct attributable cause
Secondary - underlying/predisposing factors such as whiplash, trauma, etc.
At what age in males does the incidence of DJD begin to increase?
< age of 45
At what age in females does the incidence of DJD begin to increase?
> age of 45
What races does DJD affect?
All races
What things cause (etiology) DJD?
Excess or abnormal physical forces on cartilage (chondrocytes).
With excess forces on cartilage, what occurs in the tissue on a cellular level?
There is a loss of ground substance, exposing collagen fibrils, resulting in their destruction.
With the destruction of cartilage in the joint space, what enzymes are released?
The broken down cartilage stimulates the release of collagenase and other lytic enzymes.
On an X-Ray, what would the doctor see in a patient with DJD?
- 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
If you were doing a physical evaluation (including x-rays) on someone with DJD, where would you see the DJD?
- Skeletal wide
- Especially in weight bearing joints (hip, knee, spine)
- Also in DIPs
Where is DJD typically seen in the cervical spine?
C5 & C6 (the apex of the curve)
What areas of the C5/C6 joints would you see arthritis?
- Apophyseal joints (posterior IVF)
- Uncovertebral joints (anterior IVF)
- Discovertebral joints (canal stenosis)
If a patient came in with DJD, what kind symptoms (if any) might the patient be experiencing?
- asymptomatic
- sclerogenic ("discogenic") pain
- Cervical radiculopathy
- Cervical myelopathy
If patient has DJD, but is asymptomatic, what might you see or realize?
- X-ray findings may show no correlation between DJD and patient symptoms.
If a patient has DJD and is experiencing sclerogenic pain, what would be the local symptoms?
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
If a patient has DJD and is experiencing sclerogenic pain, what would be the referral symptoms?
Note: Sclerogenic pain has embryologic connections to other areas, so:
1. Damaged discs
2. Damaged ligaments
3. Damaged joints

...will refer to other areas.
Where does cervical pain typically refer to?
The occiput, intrascapular region, shoulder and arm.
A dermatomal pain referral pattern (cervical radiculopathy) might the result of what problem in the cervical region?
- IVF encroachment, compromising the nerve root
Why are most cervical radiculopathy's sensory related?
Because the posterior nerve root is located more superior in the IVF, it is more exposed.
A cervical myelopathy can cause what problems?
- 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.
DJD in the hands causes what "nodes" in the DIPs?
- 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.)
DJD in the hands causes what "nodes" in the PIPs?
- Bouchard's nodes (gelatinous cysts or bony outgrowths on the dorsal aspects of the proximal interphalangeal joints)
DJD in the hands causes what symptoms in the carpometacarpal joints?
pain, swelling, stiffness, tenderness
DJD in the hip occurs more in males than females! True or False?
True
80% of the time DJD in the hip is related to what?
- Underlying congenital or development abnormalities.
If a patient has DJD in the hip, where might he/she feel the pain?
- In the groin
- In the inguinal area
- May radiate to buttock, medial thigh, and distal thigh/knee
If a patient has DJD in the knee, what part of the knee might the arthritic conditions develop?
- In the medial knee, as it is the more weight bearing area
If a patient has DJD in the knee, he she can develop chondromalacia patella. What is chondromalacia patella?
It is damage to the posterior patellar cartilage.
If a patient has DJD in the knee, would they experience S.H.A.R.P.? What is S.H.A.R.P.?
Yes
S - Swelling
H - Heat
A - Altered function
R - Redness
P - Pain
If you were going to diagnose someone with DJD, what would you look for?
- Radiographic signs (osteophytes, decreased joint space, etc.)
- Pattern of involvement (trauma, excess use, etc.)
- Normal blood lab
What would be your goal when treating a patient with DJD?
Minimize pain and maximize function