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19 Cards in this Set

  • Front
  • Back
Osteoarthritis: epidemiology
75% of all arthritis
Huge cost on society
Prevalence increasing (increasing obesity/age, decreasing exercise)
OA: patterns of disease
Localized - hip, knee, hand
Generalized - 3+ joint groups
Spine - low back, neck
OA: definition
A progressive disease resulting from failed repair of joint damage due to stresses on the joint (NOT degenerative)
OA: Relationship between structural changes (diseas) and symptoms (illness)
Imperfect (unlike inflammatory arthritis)
OA: pathogenesis patterns
Abnormal stress with normal physiology/anatomy
Normal stress with abnormal physiology/anatomy
OA: structural changes
Subchondral sclerosis and cysts
Osteophytes
Joint space narrowing (assymetric)
OA: symptoms
Pain, fatigue, stiffness, functional limitations
Deceased sleep, mood, QOL
OA: signs
Jointline tenderness
Bony enlargement
Crepitus
Limited ROM (+/-)
Mild inflammation (+/-)
OA: Risk Factors
Old age
Women (hormones, body shape, genetics)
Genetics (50% hip, hand, generalized; <50% knee)
Joint load abnormality (malalignment, laxity in knee, nerve damage, joint injury, joint deformity)
Neuromuscular defects (proprioception, muscle and spinal reflex system)
Muscle weakness (Quads for knee OA in women)
Obesity (knee OA in women; mal-alignment, overloading, cytokines)
OA: management goals
Education
Control of symptoms
Maintain/improve functioning
Slow progression
OA: Pain management guidelines
1st line: Education/self management+physical activity+wt loss+ acetaminophen, clucosamine/chondroitin
2nd line: Joint injections
3rd line: NSAIDS +/- GI protection
4th line: opioids
5th line: surgery
OA: non-pharmacologic management
Self-management
OT and PT
Dietitian
Arthritis Society services: arthritis self-management program
Exercise
OA: pharmacologic management
Acetominphen: analgesic, not anti-inflammatory
Dietary supplements: chondroitin-no evidence of benefit, glucosamine sulphate-evidence inconsistant
Joint injections: cortisone, hyaluronic acid
NSAIDS:analgesic and anti-inflammatory, S/E, use with caution (kidney function, heart disease, history of GI bleed). Coxibs (cox-2 only)
Joint replacement surgery: hip and knee
Arthroscopic knee surgery: no evidence of benefit
Low Back Pain: spine OA vs. Degenerative Disc Disease
Spine OA = facet joint OA
DDD = deterioration of inter-vertebral disc with hypertrophic sponylosis
DDD can lead to spine OA
Acute regional LBP: symptoms
LBP:
1.Low back to buttocks/hip to laterl thigh to calf/foot
2.Hip OA to groin to medial thigh to knee
Relief when lying down
+/- radiation, neurological symptoms
Acute regional LBP: red flags
Pain worse at nigth
Systemic symptoms (wt loss, fever)
Significant neurological deficits (bowel/bladder dysfunction,etc)
Acute regional LBP: Diagnosis
Clinical - exclude other illnesses
Physical exam: back exam unreliable, neurologic status
Acute regional LBP: prognosis
Self-limited in 80%
Recurrance common
Educate to prevent
Acute regional LBP: management
If no red flags - don't investigate!
Exercise
Drugs: NSAIDS, opioid analgesics
Surgery: if severe sciatica >6wks